CARE HOMES FOR OLDER PEOPLE
Heathfield Lodge 22/24 Melling Lane Maghull Liverpool L31 3DG Lead Inspector
Janet Marshall Unannounced 5th July 2005 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 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 F53 F03 Heathfield Lodge S5374 V239530 05.07.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Heathfield Lodge Address 22/24 Melling Lane Maghull Liverpool L31 3DG 0151 526 9463 Telephone number Fax number Email 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 Mrs Doris J Gidman PC - Care Home Only 26 Category(ies) of OP - Old Age - 26 Places registration, with number of places Heathfield Lodge F53 F03 Heathfield Lodge S5374 V239530 05.07.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 26 OP. Date of last inspection 22nd February 2005 Brief Description of the Service: Heathfield Lodge is a care home registered to provide personal residential care for a maximum of 26 older people of either sex.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 village of Maghull, and is close to all local amenities and transport links. A large enclosed garden and patio area at the back provides an attractive space that is well used by residents when weather permits, and contains a large vegetable garden tended by one of the residents. 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 service user 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. Heathfield Lodge F53 F03 Heathfield Lodge S5374 V239530 05.07.05 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two inspection visits are required at the home each year, this was the first. There has been no cause for any visits to the home since the last routine inspection in November 2004. The inspection was unannounced and took place over seven hours. The requirements and recommendations from the last inspection report were discussed and checked with the manager. Some of these have been met. A partial tour of the home was conducted. Care records and other required records were inspected. Records that were examined included a selection of residents care plans, daily diaries, medical notes, medication sheets, staff rotas and certificates of health and safety checks. The manager, and 3 care staff were interviewed. 15 residents and 4 relatives were also spoken with and their views obtained. Two residents were ‘case tracked’. Case tracking means that the inspector concentrates on the care given and experiences of one or more residents to ensure that the persons needs are recorded in their care plan and are being met. The residents involved in this process were very helpful they talked about their care plans and confirmed information. What the service does well: What has improved since the last inspection?
Several of the requirements given at the last inspection have been addressed by the home.
Heathfield Lodge F53 F03 Heathfield Lodge S5374 V239530 05.07.05 Stage 4.doc Version 1.40 Page 6 A lockable cabinet has been purchased for storing controlled medication. The complaints procedure has been developed to include action and timescales involved in the process, and it also included details of the Commission for Social Care and Inspection (CSCI). A number of staff have completed NVQ L2 & 3 and several other staff have commenced it, this shows that 50 of staff currently working at the home have achieved NVQ Level 2 or above by the required timescale. What they could do better: 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.
Heathfield Lodge F53 F03 Heathfield Lodge S5374 V239530 05.07.05 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Heathfield Lodge F53 F03 Heathfield Lodge S5374 V239530 05.07.05 Stage 4.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 Assessments carried out by the home need to include more detailed information enabling the home to be sure of meeting residents care needs. EVIDENCE: Care records inspected contained assessment details completed by the manager or deputy manager of the home. The assessments contained information gained following admission. Care files also included further professional assessments carried out prior to admission by social workers and community care professionals such as district nurses. The homes assessments include information such as General health, continence, mental health, mobility, and safety of residents. Some areas of the assessment included little or no information about how to support an identified need. Assessments carried out by the home must include more detailed information about identified needs to ensure that the home is able to meet them. Heathfield Lodge F53 F03 Heathfield Lodge S5374 V239530 05.07.05 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 & 10 Personal support is carried out in a sensitive and flexible way to ensure the privacy and dignity of residents at all times. Information about residents health and personal care is not recorded as well as it needs to be to ensure that their care needs are understood and fully met. EVIDENCE: A selection of care files was examined. Details of residents health and personal care needs were not recorded as well as they could be. Care plans need to include more detailed information about the level and type of support that is required for each individual to ensure that their needs are fully met. Two residents care files were cased tracked, during this process it was noted that some of the residents needs which were identified by the care management team are not identified in the initial care plan formulated by the home. This means that there is a risk that care needs are not recognised and being met. Care files contain only occasional evidence that residents are routinely consulted when drawing up the care plans and those interviewed said that they had had little or no involvement. There is a risk here that not all individual needs will be identified and addressed consistently.
Heathfield Lodge F53 F03 Heathfield Lodge S5374 V239530 05.07.05 Stage 4.doc Version 1.40 Page 10 All residents interviewed felt that staff were very respectful of their right to privacy describing them as ‘very polite’ and ‘helpful’. Several residents spoken with were very complimentary of the way in which staff support them with personal care. They all said that they always treat them with respect and in a dignified way. Residents said that staff always knock and wait to be invited in before entering their room. Staff were observed treating residents with respect, they referred to residents by their chosen name. Some toilets did not have working locks, which compromises the privacy of residents. Several residents confirmed that they attend for regular health care checks to the dentist, chiropodist, opticians and Doctors. Medication and records were examined, they were all well kept. Heathfield Lodge F53 F03 Heathfield Lodge S5374 V239530 05.07.05 Stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 & 15 Meal times and social activities are both well managed and help create a varied and positive day for the residents in the home. Relationships are encouraged so that residents maintain contact with family and friends. EVIDENCE: All of the residents spoken to commented on the food and were appreciative of the quality of the meals provided. One resident reported a lack of variety stating that sandwiches were the only alternative to what was available on the day, although most residents stated that they were happy with the choice of food. Staff gave examples of residents who had not liked the main meal and the cook had supplied alternatives. Mealtime arrangements are flexible with residents eating in the dining room and also in their bedroom if they wished. There is a list of planned activities on display. Residents interviewed commented that they particularly enjoyed the quiz and video sessions as this gave opportunity to socialise. Outside entertainers and the frequent film shows were also commented on, as these were ‘relaxing and interesting ways to spend time’. Some residents missed being able to get out of the home on a regular basis although staff reported that they take residents out as often as they can. The manager has recently purchased a variety of age appropriate indoor games for the use of residents.
Heathfield Lodge F53 F03 Heathfield Lodge S5374 V239530 05.07.05 Stage 4.doc Version 1.40 Page 12 During interview the manager and staff demonstrated the importance of enabling service users to take part in valued and fulfilling activities. Staff were observed interacting well with residents and their wishes were respected and appropriately supported. Examination of records and discussion with residents, their relatives and showed that all residents are in regular contact with their family and friends. Relatives and friends stated that they are made welcome and can visit the home at any time, although most avoid visiting at mealtimes. Heathfield Lodge F53 F03 Heathfield Lodge S5374 V239530 05.07.05 Stage 4.doc Version 1.40 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 There were no recorded complaints since the last inspection. Residents were confident that their concerns or complaints would be listened to and acted upon. Staff have not undertaken recent training in Protection of Vulnerable Adults, this has the potential to put residents at risk EVIDENCE: A complaints procedure was viewed at the home. The Procedure has been developed since the last inspection it now includes details about the action and timescales involved in the process, and it also included details of the Commission for Social Care and Inspection (CSCI). The complaint record showed that no complaints had been made since the last inspection. Residents spoken with had no concerns about the service and said that if they did they would be confident in approaching the staff should any arise. A number of policies and procedures were in place to protect the safety, health and welfare of residents including a Protection of Vulnerable Adults Procedure (POVA), which clearly describes what action, must be taken in response to suspicion or evidence of abuse. During discussion staff stated that they have not recently undertaken Protection of Vulnerable Adults training. POVA training must be undertaken by all staff to ensure that they act appropriately in the event of suspicious or an allegation of abuse. Heathfield Lodge F53 F03 Heathfield Lodge S5374 V239530 05.07.05 Stage 4.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 25, 26 Since the last inspection there has been limited progress with the homes plans for upgrading some areas; this has a potential for compromising the comfort, privacy and dignity of some residents. A ramp has not yet been fitted to the front of the home making access difficult for residents, this also poses a risk to both residents and staff. EVIDENCE: The home was clean and tidy on the day of the inspection. Residents spoken to were generally pleased with the standard of the décor and fittings in the home. Residents were able to describe and display their own belongings and furnishings they had brought in which, as one resident commented ‘ helps me feel more at home’. A partial tour of the home took place. The furniture in some residents bedrooms are old and worn, some items are in need of repair and others should be replaced. For example, some of the Easy chairs in the communal lounge were heavily stained on the arms and cushions, these should be cleaned or replaced.
Heathfield Lodge F53 F03 Heathfield Lodge S5374 V239530 05.07.05 Stage 4.doc Version 1.40 Page 15 A requirement following previous inspections was for a ramp to be fitted at the front entrance of the home. A ramp has not yet been fitted making access in and out of the home for some residents very difficult. It was reported by some residents and staff that wheel chairs are being ‘Bumped up and down the steps’. This practice is putting both residents and staff at risk. The manager confirmed that arrangements have been made to install a ramp at the front of the home she stated that a ramp is expected to be in place within the next three months. A ramp must be fitted to the front entrance of the home so that all residents, staff and visitors can access the home safely and without difficulty. Heathfield Lodge F53 F03 Heathfield Lodge S5374 V239530 05.07.05 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, The deployment and numbers of staff available in the home meet the needs of the residents. The procedures for recruitment of staff need to be more robust to provide necessary safeguards and protection for people living in the home. EVIDENCE: There was the manager and 2 care staff care staff on duty at various times of the day for 27 residents at the time. The manager exercises some flexibility depending on care needs and staff interviewed felt that the home was sufficiently staffed at present. Resident’s interviewed where unanimous in their praise of the staff and said that they were very supportive and patient in their approach. The way that staff spoke to residents and assisted them supported this view. A relative commented that the staff are most welcoming and supportive of their mother. A selection of staff files was examined. Not all the required information was included in them, two written references for each member of staff are required one file included only one written reference. Staff files must include all the required information to demonstrate that they are of good character and have the competency, skills and qualifications to do their job. Heathfield Lodge F53 F03 Heathfield Lodge S5374 V239530 05.07.05 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 36 The home provides only informal support for the staff, which has the possibility of staff not fully understanding their role in caring for residents. EVIDENCE: Staff interviewed felt that the manager and senior staff were very approachable and would support them if needed, for example if they had a particular issue concerning the care of a resident. Although regular staff meeting and informal discussions take place there was no evidence that staff are formally supervised by management. Staff need to receive formal supervision at least six times a year. During 1:1 supervisions staff should be given the opportunity to discuss such things as care practices and career development needs. Written records of supervisions must be kept. Heathfield Lodge F53 F03 Heathfield Lodge S5374 V239530 05.07.05 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 2 2 x x x x 2 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x 2 3 x x x x x Heathfield Lodge F53 F03 Heathfield Lodge S5374 V239530 05.07.05 Stage 4.doc Version 1.40 Page 19 Are there any outstanding requirements from the last inspection? 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 OP 7 Regulation 15(1) Requirement The manager must ensure that care plans include more details about how residents needs are to be met. The manager must make arrangements for all staff to undertake POVA training The manager must ensure that a ramp is fitted to the front entrance of the home The manager must provide a maintenance plan for repairs and refurbishement of the home The manager must introduce a formal system for supervising staff The manager must ensure that care plans evidence the involvement of residents and/or their representatives. The manager must ensure that staff files include all of the required information. Timescale for action 31/09/05 2. 3. 4. 5. 6. OP18 OP22 OP19 OP36 OP7 13(6) 23(2)(n) 23(2)(b)( d) 18(2) 15(1) 31/09/05 31/10/05 31/09/05 31/10/05 31/09/05 7. OP28 OP33 Schedule 2 31/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Heathfield Lodge F53 F03 Heathfield Lodge S5374 V239530 05.07.05 Stage 4.doc Version 1.40 Page 20 No. 1. 2. Refer to Standard OP3 OP38 Good Practice Recommendations The manager should ensure that more detailed information about the support required for individuals is included in the homes assessment. The manager should seek advice from the Fire Authority regarding the practice of wwedging doors open Heathfield Lodge F53 F03 Heathfield Lodge S5374 V239530 05.07.05 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Burlington House, 2nd Floor, South Wing Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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