CARE HOMES FOR OLDER PEOPLE
Heathfield Lodge 22/24 Melling Lane Maghull Liverpool Merseyside L31 3DG Lead Inspector
Mrs Janet Marshall Unannounced Inspection 10:00 4 & 7th May 2007
th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Heathfield Lodge Address 22/24 Melling Lane Maghull Liverpool Merseyside L31 3DG 0151 526 9463 0151 5261517 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Doris J Gidman Mr A J Gidman Mrs Doris J Gidman Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 26 OP. Date of last inspection 4th May 2006 Brief Description of the Service: Heathfield Lodge is a care home registered to provide personal residential care for a maximum of 26 older people. The home is privately owned by Mr and Mrs Gidman. Mrs Gidman has been the registered manager since it opened in 1988. Heathfield Lodge consists of two large semi-detached Victorian houses that have been amalgamated into one building. It is situated in the well established area of Maghull, and is close to all local amenities and transport links. A large enclosed garden and patio area at the back provides additional space that is well used by residents when weather permits. The space at the front of the home is mainly shrubs and car parking space. The home has a large lower ground floor that contains the kitchen, laundry and storage areas, a ground floor on which residents accommodation and the communal spaces are found, and a first and second floor that contain rooms and bathrooms and toilets. Twenty rooms are single; three are registered as double but each of these currently has one resident living in them. The communal space comprises a sitting room and large dining room that is divided into two smaller areas. The home has a lift to all floors. It cost between £266.00 - £375.00 each week to live at the home. Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection. The Commission considers 22 standards for Care Homes for Older People as Key Standards, which have to be inspected during a Key Inspection. The report has been put together using information gathered from a number of sources including information that the commission have received about the service since the last inspection, details provided in the pre-inspection questionnaire and results of surveys. A site visit to the home was also carried out as part of the inspection. Records examined, people’s comments and observations made during the visit have also been used as evidence for the report. People spoken with during the visit, included residents, staff, relatives, a GP, visiting hairdresser, a district nurse, and an NVQ assessor. Six residents were “case tracked”. Case tracking means that the Inspector concentrates on the care given and experiences of one or more residents to get an idea of what is like to live at the home and how that person’s needs are being met. What the service does well:
Prospective residents are given information about the home and their needs are properly assessed so that they can be sure that it is the right home for them. Available at the home was a care plan for each resident, which clearly set out how staff need to meet the persons health, personal, and social care needs. Care plans were signed to show that they were put together with the full involvement of the resident and or their representative. There was also evidence to show that care plans are being regularly reviewed and updated when a persons needs have changed. During the inspection visit staff were observed talking to residents in a polite manner. Residents spoken with said that staff are always polite and treat them well they made the following comments to support this: “All the staff are very polite” “The staff always show respect” “Most of the staff knock before coming into my room” “The staff speak to me very well” Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 6 The home has in place appropriate procedures for responding to concerns complaints and for ensuring that residents are safe from abuse, harm or neglect. The commission have not received any complaints about the home since the last inspection. Everybody spoken with during the inspection said that they had been given information about how to make a complaint if they needed to. People were confident that their complaints would be listened to and dealt with in the correct way. More than half of the staff team have achieved or are working towards a National Vocational Qualification in Care level 2 and above. What has improved since the last inspection? What they could do better:
Residents should be offered a wider range of opportunities for stimulation through leisure and recreational activities in and outside the home. Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 7 Recruitment and section records for a number of staff including two newly recruited persons were examined as part of the inspection, They showed that recruitment and selection procedures carried out by the home are not completely robust which compromises the protection of residents. Induction records for a number of staff were incomplete and there was only one reference for another new staff member. All the required records must be kept for each member of staff to show that they are fit to work at the home. Since the last inspection a number of staff have completed protection of vulnerable adults training, there are however a number of other staff still to complete the training. All staff need to complete Protection of vulnerable adults training so that they know how to respond to evidence or suspicion of abuse. A partial tour of the home, which was carried out as part of the inspection, this showed that parts of the home and items of furniture are in a poor state of repair. Improvements should be made to the environment to ensure the comfort and dignity of the residents. An open top trolley was used to transport medication from the office to the dining room. Blister packs are left unsupervised on the open trolley throughout the medication round has the potential to put residents at risk. A more suitable trolley should be provided at the home to ensure that medication is stored securely at all times. Arrangements should be made for all staff to undertake health and safety training so that they have the skills and knowledge to ensure residents and their own health and safety. On two separate occasions during the inspection visit staff were seen entering rooms occupied by a resident without knocking. All staff must respect residents dignity and their right to privacy by ensuring that they knock on doors before entering rooms, which are or may be occupied by residents. A wheelchair and a tabletop tray being used by a resident were dirty with what appeared to be dried food. This compromised the dignity of the service user and posed a risk to their health. Staff were advised to ensure that all equipment used by residents is kept clean. On separate occasions a number of staff were observed carrying out tasks wearing the same protective gloves and aprons, which they had put on and used to assist residents with personal care. This practice increases the risk of cross infection. Protective clothing must be used and disposed of appropriately to ensure peoples health and safety. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 does not apply, as the home does not provide intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. No resident moves into the home without having his/her needs assessed to ensure they would be met. EVIDENCE: A number of residents care files were looked at during the site visit as part of the case tracking process. Of those looked at two were for residents that have been admitted to the home since the last inspection. Each of the files contained assessments carried out by the home prior to the person moving in. The assessments, which were examined, were completed in good detail and covered the areas of need which are outlined in the National Minimum Standards for this type of service such as personal care, communication, mobility medication, religious and cultural needs. Where appropriate a needs assessment and care plan provided by other agencies such as health and social services were available.
Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 10 On the first day of the site visit the daughter of a new resident was spoken with. She confirmed that she received information about the home and that a full assessment of her fathers needs was carried out with her involvement before the home agreed to admit him. She also said that before moving in her father visited the home for a meal and to choose his bedroom. The deputy manager explained in good detail the process that is followed by the home for admitting new residents. She also explained that in the case of an emergency admission an assessment is carried out within twenty-four hours of the person arriving at the home. Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents receive a good level of healthcare support which ensures their physical and emotional well being, however some practices carried out by staff at the home compromises residents safety, privacy and dignity. EVIDENCE: During the visit, a care file was available for each resident, all stored in a locked cupboard ensuring confidentiality. As part of the case tracking process a number of residents care files were examined. Each file displayed a photograph of the person, personal details including their culture and religion, a pen picture, which is a short story about the persons life, and a care plan covering each area of need. Care plans set out in detail the action, which needs to be taken by care staff to ensure that the needs of the resident are met. Areas of daily living, which were covered within care plans included health and personal care, mobility, communication and diet. Risk assessments were part of each persons care plan. These provided information about tasks and activities, which are likely to pose a risk to the individual and the measures that staff, need to take to minimise the
Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 12 risk. Risk assessments covered things such as slips, trips and falls, moving and handling and mobility. All parts of the care plan including risk assessments evidenced that they have been reviewed and updated with the involvement of the service user and/or their representative. All surveys completed by residents indicated that they always receive the medical support that they need. Records of medical appointments were kept in good detail and showed that residents have regular access to specialist medical, nursing, dental, chiropody and GP services. During the visit discussion took place with a visiting GP. The GP said that staff at the home are responsive to the healthcare needs of the residents and call upon him to attend his patients when necessary. A district nurse also visiting the home said that the staff always follow her advice, communicate and provide residents with a good level of care. Both the GP and District nurse said they have no concerns about the care of the residents and felt that the residents are treated well at the home. The GP and District nurse attended to residents in the privacy of their own rooms. Residents spoken with confirmed that they could see their doctor when they choose. Comments made by residents to support this include: “Yes there is never a problem, if I want to see my GP the I tell the staff and they call him” “I can see my doctor at any time” “My doctor visits regularly” The pre-inspection questionnaire detailed the arrangements that are in place at the home to enable residents to access other specialist services such as speech therapists and dieticians. The pre-inspection questionnaire provides details of a number of policies and procedures, which relate to the health care of residents. They include control, administration, recording, safe keeping, handling and disposal of medication. When not in use medication was stored safely at the home. The blister pack system is used by the home. The local pharmacist that prepares the medication attended the home during the inspection visit. She confirmed that she carries out regular visits to the home to provide staff with support and advice and checks the keeping and storage of medication. Records of the pharmacists visits were seen at the home. The pharmacist also attends the home annually to provide staff with medication awareness training and guidance on the use of the blister pack system. A member of staff was observed administering residents with their lunch time medication. She administered medication and completed medication records sheets in the correct way. An open top trolley was used to transport medication from the office to the dining room. Blister packs were left unsupervised on the open trolley throughout the medication round which has the potential to put residents at risk. The deputy manager was advised to that
Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 13 a more suitable trolley is required to ensure that medication is stored securely at all times. Staff were seen knocking on bedroom and bathroom doors before entering rooms and assisting residents with personal care private. However on one occasion during the visit a member of staff was seen entering a bathroom occupied by a resident without knocking. On another occasion a member of staff was assisting a resident to dress in her bedroom whilst the door was open. Both members of staff were advised of best practice. All staff must respect residents dignity and their right to privacy by ensuring that they knock on doors before entering rooms, which are or may be occupied by residents. All staff were observed talking to residents in a polite manner. Residents spoken with said that staff always treat them well and respect their privacy and dignity. They made the following comments to support this: “All the staff are very polite” “The staff always show respect” “Most of the staff knock before coming into my room” “The staff speak to me very well” Discussion took place with an NVQ assessor who held meetings with a number of staff on the day of the inspection. She said that she had always observed staff treating residents in a polite and respectful was and had no concerns at all about the way residents are treated and spoken to. Residents are offered a key to their room and a lockable facility for the storage of personal items. There are a number of residents that do not have these facilities, however included in their care files was contract signed by the appropriate people agreeing to this. Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents preferred lifestyles and daily routines are supported and encouraged however the range of opportunities for recreation and leisure interests does not satisfy some people. EVIDENCE: The homes service user guide, which was available in residents bedrooms, provides information about the services and facilities, which are available at the home. Services listed in the guide include hairdressing, keep fit, the big picture show and church services. Care plans which were looked detail residents preferences and support needs in relation to social contact and activities. The pre - inspection questionnaire described the facilities/activities available for residents both inside the home and in the community. They include bingo, keep fit, film shows, hairdresser and sing a long. Residents spoken with confirmed that visits by the hairdresser, keep fit and bingo sessions take place once a week however other things such as films shows and sing-a-longs only take place occasionally. There was little evidence to show that residents are offered a wide range of appropriate leisure and recreational activities in and outside the home.
Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 15 During the inspection one resident was seen walking around the home and when asked what else they would like to do replied “there is nothing to do”. Another resident who was watching TV was asked what else they would like to do other than watch TV they replied “there is nothing else other than when an entertainer comes in or the lady that does keep fit”. Surveys completed by residents indicated that there are sometimes activities arranged by the home that they can take part in. A number of relatives and other visitors to the home also commented on the limited range of activities available at the home. An activities file was displayed at the entrance it contained brochures and leaflets advertising theatre shows, and coach trips most of the information was out of date. The deputy manager was advised that residents should be given more opportunities for stimulation through leisure and recreational activities in and outside the home. A visitor’s book was in place at the home. This showed that residents receive visitors at various times during the day and night. A number of residents received visitors on the day of the inspection visit. They were made welcome and offered refreshments. Residents and visitors spoken with said: “My family visit me every week” “There are no restrictions placed on visiting times, I can visit my mum at any time” “The staff are always very welcoming” “We can sit in the lounge or in my mums bedroom” During the inspection visit residents were offered choices and supported to make decisions about such things as were to sit, what to do and what to eat. Observation of a number of bedrooms showed that residents have brought personal possessions with them. Furniture, ornaments, pictures and plants were amongst some personal items that residents said they had brought with them to the home. On the day of the inspection the daughter of a new resident arrived at the home with some of her fathers personal possessions and took them to his room. Residents can have a key to their own room, during the visit a number of residents were seen using keys. For safety reasons there are certain restrictions placed on residents for example, use of keys, access without support to certain parts of the home and the community, management of money and medication. There are also instances when some decisions and choices have to be made for residents by others. Restrictions placed upon people and choices, which need to be made by others and the reasons why, were recorded in the person’s care file. Where possible residents are encouraged to manage their own finances. Management assist with financial arrangements when required. Financial records for a number of residents were examined these evidenced details of
Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 16 recent transactions. Records included receipts for purchases and two signatures were entered when transactions were recorded. The kitchen was clean and well organised. There was a good stock of fresh, frozen and tinned food. The chef said that he talks to residents on a daily basis The chef said that he has an NVQ level 1 & 2 in catering and has undertaken other training including Protection of vulnerable adults, fire awareness and food hygiene. A requirement was given as part of the last inspection for the residents to be offered a better choice of food. Since the last inspection the quality and choice of the food at the home has improved. This was supported by the following comments made by residents during the inspection visit: “The food is much better” “The food good” “I like the food” “The food is very good” “I am satisfied with the food” “I sometimes enjoy the meals. I must admit I am pretty fussy were food is concerned, but I haven’t lost any weight, so I must be getting my fill”. “My mother has never complained about the food” There are two dining areas is separated into two parts. It was decorated and furnished to a satisfactory standard. Some dining chairs and tables were showing signs of wear and tear and should be repaired or replaced to ensure the comfort and dignity of the residents. Tables were laid with table clothes, cutlery and crockery of a satisfactory standard. Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are satisfied that their complaints are listened to and acted upon. EVIDENCE: A complaints procedure was viewed in the policy and procedure file kept in the office. It described how the home responds to complaints and the timescales involved in the process. A copy of the homes complaints procedure was not on display in the home at the last inspection, a requirement was given as part of the last inspection because a copy of the complaints procedures was not on display at the home. A copy of the procedure was displayed near to the main entrance so that people can refer to it at any time. Surveys completed by residents indicated that they always know who to speak to if they were unhappy and that they know how to make a compalint. Comments made by residents and relatives during the inspection included: “I have nothing to complain about”. “I know who to complaint to”. “I am not worried about anything, if I was I would tell someone”. The pre inspection questionnaire showed that the home has received six complaints during the last year and that they were responded to within 28 days. Records of the complaints were available at the home. The Commission have not received any complaint about the home since the last inspection. Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 18 A copy of Seftons Local Authorities Protection of Vulnerable Adults procedure was viewed at the home. A requirement was given following the last inspection for arrangements to be made for all staff to complete Protection of vulnerable adults training. Records at this inspection showed that at least half of the staff team have completed the training. The deputy manager was advised that all staff should complete protection of vulnerable adults training. Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Parts of the environment, which are in need of repair and refurbishment, compromise the comfort and dignity of the residents EVIDENCE: A requirement was given as part of the last inspection report for parts of the environment to be improved. That was because communal areas of the home and a number of residents bedrooms showed signs of wear and tear. The pre-inspection questionnaire detailed a number of improvements made to the premises since the last inspection. They include the redecoration of two bathrooms, two toilets and four residents bedrooms. A tour of the premises was carried out as part of this inspection visit. The improvements made to the premises as detailed in the pre-inspection questionnaire were inspected. They have been redecorated to a satisfactory standard, however other parts of the home are still in need of improving.
Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 20 The following improvements which were detailed to the deputy manager are required to ensure the comfort and dignity of residents: Carpets throughout the ground floor, which are heavily stained and worn in parts, need replacing Doors leading into the dining areas, which were, damaged need repairing and repainting. The fabric and frames of a number of armchairs in communal areas were in a poor state of repair. One service user described a chair in the main lounge as being “sometimes uncomfortable”. The deputy manager was advised of this she reported that six new chairs are on order for the main lounge. Wardrobes bedside cabinets and chests of drawers in a number of residents bedrooms, which were, damaged need repairing or replacing. Front and back gardens were overgrown and in need of maintaining. The exterior window frames were showing signs of wood rot and should be repaired or replaced. A number of residents bedrooms and communal rooms which were viewed as part of the inspection were clean and tidy. Residents spoken with said that their rooms are cleaned each day. A Housekeeper employed at the home is responsible for cleaning most parts of the home. The housekeeper said she is provided with sufficient equipment and materials, which she keeps, locked up in a cupboard on the top floor of the home. During discussion the Housekeeper demonstrated high standards of cleanliness and hygiene. Surveys completed by residents showed that the home is always clean and tidy. On the day of the inspection a wheelchair and bedside table used by a resident was dirty with what appeared to be dried up food. This not only compromises the comfort and dignity of residents but also poses a risk to their health. A member of staff was advised of this. All equipment used by residents must be kept clean and in a good state of repair to ensure peoples comfort, dignity, health and safety. Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The way the home recruit, select and train staff does not fully ensure the protection of residents. EVIDENCE: The staffing rota, which was examined as part of the inspection and discussion with staff showed that there are sufficient staff on duty throughout the day and the night. Two members of staff were interviewed during the inspection. General discussion also took place with a number of other staff at intervals throughout the visit. Staff interviewed showed a good understanding of their roles and responsibilities and were knowledgeable about the needs of the residents. Residents spoken with said that staff are good at their jobs. They made the following comments, which supported this: “Don’t know what I would do without them, they are so good” “The staff are very good, they will do anything for me” “All the staff here are good at their jobs” “The staff are excellent, they are very caring” Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 22 Surveys completed by relatives, friends and advocates indicated that the care staff always have the right skills and experience to look after the residents properly. The pre inspection questionnaire detailed training undertaken by staff since the last inspection, which includes fire awareness, protection of vulnerable adults, health and hygiene and NVQ level 2 & 3 in care. Records examined showed that a number of staff have completed training in those areas detailed, however there are still a number of other staff that need to attend refresher courses in areas of mandatory training such as moving and handling, health and safety and first aid. The deputy manager was advised of this. The pre-inspection questionnaire and staff training records held at the home evidenced that at least half of the staff team have achieved or are currently undertaking a National Vocational Qualification (NVQ) in care level 2 or above. During the inspection an NVQ assessor met with a number of staff that are currently undertaking the award. The assessor said that there are currently six staff working towards NVQ Level 2. The pre-inspection questionnaire detailed future training planned which includes moving and handling, health and safety and further NVQs Level 2 & 3 in care. An equal opportunities policy and procedure was available at the home. There has been a low turn over of staff working at the home since the last inspection. Discussion with the deputy manager and details provided in the pre-inspection questionnaire showed two staff have left since the last inspection. Both staff have been replaced. Recruitment and section records for a selection of staff including two newly recruited persons were examined as part of the inspection, They showed that recruitment and selection procedures carried out by the home are not completely robust which compromises the protection of residents. Induction records for a number of staff were incomplete and there was only one reference for another new staff member. All information in respect of all staff must be maintained and kept at the home for inspection to show that staff are fit to work there. Personnel files for a number of other staff, which were examined, included all the required records. Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 23 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management procedures do not fully protect residents and staff. EVIDENCE: The manager who is also the owner of the home has not yet commenced a National Vocational Qualification level 4 in care & management. The manager has managed the home for approximately fifteen years. Records show that there have been no concerns or complaints made about her or the general management of the home. The manager has very good support from her deputy manager. People spoken with said that they are confident about approaching the managers about an issue if they needed to and know that they would be listened to.
Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 24 Quality assurance and quality monitoring questionnaires are in place and were available at the main entrance. There were four variations of questionnaires, for residents, resident’s family and friends, visiting service providers & Visiting GPs, district nurses, chiropodists, etc. Copies of completed questionnaires for all categories were viewed during the last inspection visit. They showed that people were mostly satisfied with all aspects of the home. The deputy manager said that no questionnaires have been completed since the last inspection. The deputy manager was advised that people should be encouraged to complete the questionnaires on a regular basis so that their views about the home can be obtained and were appropriate acted upon to ensure the quality of the service. Monthly visits to the home in accordance to Regulation 26 of the Care Homes Regulations are now being carried out. Reports produced following the visits were available at the home. A set of policies and procedures was viewed at the home. They are kept in a place that is easily accessed by staff and resident. Some of the policies and procedures showed that they have not been reviewed for some time. This was discussed with the deputy manager who said that she would ensure that this is done over a gradual period of time. All the homes policies and procedures should be reviewed and updated periodically to show that they are relevant and up to date in line with current legislation and good practice. The management of the home handle personal monies for some residents. Records examined at the last inspection showed only one signature against each transaction made on behalf of a resident. The manager was advised to obtain two signatures for all transactions made on behalf of residents. As part of this inspection visit the records and money for four residents were examined and checked. All transactions made were well recorded. Each transaction showed two signatures. Staff spoken with said that they have not yet received formal one to one supervision from management, however the deputy manager has carried out a number of observations and made records of her findings as part of intends to formally supervise staff. The manager was advised that staff must receive formal supervision with their senior/manager at least six times a year. Records show that the required health and safety checks are being carried out at the home. Discussion with staff and the management evidenced that some staff need to undertake refresher courses in mandatory health and safety areas described in the staffing section of this report. On separate occasions a number of staff were observed carrying out tasks wearing the same protective gloves and aprons, which they had put on and used to assist residents with personal care. This practice increases the risk of cross infection. The staff involved confirmed that they had not received up to Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 25 date infection control training or advice. They were advised of best practice in relation to the use of disposable clothing. All staff must be advised of the appropriate infection control policies and procedures to ensure that the risk of cross infection is minimised. An infection control policy was available at the home, the deputy manager was advised that all staff should refer to this. Some records required by regulation are not complete, they are detailed within the relevant sections of this report. Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP28 Regulation 19 Timescale for action Staff personnel files must include 07/07/07 all of the required information to show that people working at the home are fit to do so. (this is a previous inspection requirement) All staff must respect resident’s 07/06/07 dignity and their right to privacy by ensuring that they knock on doors before entering rooms, which are or may be occupied by residents. Protective clothing must be used 07/06/07 and disposed of by staff in the correct way to minimise the risk of cross infection. Requirement 2. OP10 12(4)(a) 3. OP38 13(4)(c) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP18 Good Practice Recommendations Arrangements should be made for all staff to undertake POVA training so that they know what to do if they
DS0000005374.V332868.R01.S.doc Version 5.2 Page 28 Heathfield Lodge evidence or suspect abuse of a service user is taking place. 2. OP38 Arrangements should be made for all staff to undertake health and safety training so that they have the skills and knowledge to ensure residents and their own health and safety. Arrangements should be made to carry out repairs and refurbishment of the home so that residents live in a homely and comfortable environment. A more suitable trolley should be used for transporting medication so that is kept securely at all times. 3. 4. OP19 OP9 Heathfield Lodge DS0000005374.V332868.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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