Inspection on 08/12/05 for Heathfield Lodge

This inspection was carried out on 8th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Heathfield Lodge 04/05/07

Heathfield Lodge 04/05/06

Heathfield Lodge 05/07/05

Heathfield Lodge 22/02/05

Heathfield Lodge 21/09/04

Similar services:

Thornton Lodge

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Heathfield Lodge 22/24 Melling Lane Maghull Liverpool Merseyside L31 3DG Lead Inspector Mrs Janet Marshall Unannounced Inspection 09:00 8 & 22nd December 2005 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.V279276.R01.S.doc Version 5.1 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.V279276.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Heathfield Lodge Address 22/24 Melling Lane Maghull Liverpool Merseyside L31 3DG 0151 526 9463 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.V279276.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 26 OP. Date of last inspection 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 an attractive 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. Heathfield Lodge DS0000005374.V279276.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second of two inspection visits that are required at the home each year. The inspection was unannounced and took place over two days. On the first day of the inspection the requirements and recommendations from the last inspection report were discussed and checked with the deputy manager. Two have been fully met. Those that have not been met have been raised again in addition to Statutory Requirements and Good Practice Recommendations given as part of this report. 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 and records, staff rotas and certificates of health and safety checks. The manager, and 2 care staff were interviewed. 12 residents and 2 relatives were also spoken with and their views obtained. What the service does well: What has improved since the last inspection? What they could do better: Care plans need to be developed to include more details about how resident’s needs are to be met ensuring that they are met consistently. All residents must be provided with a contract to show that they agree with the terms and conditions of their occupancy. Care plans must be signed by the resident and/or their representative to show that they agree with their plan of care. Further professional medical advice is needed for one resident who is experiencing an increasing number of falls. Heathfield Lodge DS0000005374.V279276.R01.S.doc Version 5.1 Page 6 A safer method for administering and recording medication must be introduced to the home to ensure complete safety of the residents. All staff must to undertake POVA training so that they know what to do in the event of suspicion or allegation of abuse. All staff must undertake mandatory training so that they are suitably competent and qualified to do their job. A maintenance plan for repairs and refurbishment of the home must be provided and the required work must be carried out to ensure that the residents live in a comfortable and safe environment. The management of the home must formally supervise staff so that they are clear about their roles and responsibilities. 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. An individual training and development plan must be provided for all staff so that are sure that they complete the required training. An effective quality assurance and monitoring system based on seeking the views of the residents must be introduced to the home, including monthly visits by the provider, to show that the home is run in the best interests of the residents. A review of the residents food likes and dislikes should be carried out to ensure that residents are given choices and offered food that they prefer. A new dishwasher should be provided at the home to ensure that dishes are appropriately disinfected. 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 DS0000005374.V279276.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Heathfield Lodge DS0000005374.V279276.R01.S.doc Version 5.1 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 the following standard(s): 3 & 2. Contracts were not available for all residents so they do not benefit from having a statement of terms and conditions of their occupancy. Assessments carried out by the home are more detailed so that the home can be better meet residents care needs. EVIDENCE: Not all residents have been provided with a contract/statement of terms and conditions. Contracts must be provided for all residents. They must set out the services and facilities offered by the home, terms and conditions of occupancy, fees, rights and responsibilities of parties and other issues as outlined in the National Minimum Standards. Contracts must be signed by the resident and/or their representative to show that they agree with the terms and conditions of the home. The manager confirmed that new contracts are currently being developed and on completion will be provided for all residents. A requirement was given as part of the last inspection to improve some areas of the homes assessments. This was because they included little or no information about how to support an identified need. Records for new residents who have been admitted to the home since the last inspection showed that the homes assessments have been improved and now include Heathfield Lodge DS0000005374.V279276.R01.S.doc Version 5.1 Page 9 more details about residents care and support needs. Records also show that assessments were carried out by the Care Management Team prior to the admission of new residents. Heathfield Lodge DS0000005374.V279276.R01.S.doc Version 5.1 Page 10 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 the following standard(s): 7, 8 & 9. Some individual plans of care do not fully set out the health personal and social care needs of residents, therefore there is a risk of those needs not being met. Residents are not fully protected by the homes procedure for administering medication. EVIDENCE: A requirement was given at the last inspection for care plans to be developed to provide more information about the health personal and social care needs of residents. Examination of a selection of care files showed that areas of the care plan have been improved and now include more detail to enable staff to provide appropriate care and support for individuals. Other care plans showed that further details are required to ensure that all needs are 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. This was raised as a requirement in the last inspection report. At this inspection the manager confirmed that she would ensure that all care plans show evidence that residents and/or their representatives are consulted when drawing up the plan of care. Heathfield Lodge DS0000005374.V279276.R01.S.doc Version 5.1 Page 11 At the last inspection some toilets did not have working locks, which compromised the privacy of residents. The locks have since been repaired and are in good working order so that people can use the toilets in complete privacy. Records showed that one resident has been experiencing a lot of falls, which are increasing. Discussion with the manager showed that the appropriate action has been taken to ensure the residents safety. Records show that the resident has been seen by their GP, however an increase in falls suggests that further medical advice is needed. A requirement has been given for the home to change its current method of administering medication. This is because at the moment medication is prepared the day before it is needed. It is dispensed daily from the manufacturers sealed packs into medication boxes which are individually labelled for each person. The boxes are divided into four parts and indicate when the medication is due. For example, Morning, Lunch, Tea and Supper. The boxes are then stored in a lockable cabinet. Medication is administered from the boxes at the required intervals and signed for by staff that give it out at that time. This is not a safe method because it means that medication is not given direct from the manufacturers packet or from a pack such as blisters packs, which are prepared by a pharmacist. Also the person who administers the medication from the original packet is not the person who signs the Medication Administration Record (MAR) sheet. More appropriate methods for administering medication were discussed with the manager. The deputy manager confirmed that the ‘Blister Pack’ system is going to be introduced into the home following a discussion with the pharmacist. Heathfield Lodge DS0000005374.V279276.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 14 Residents are not given maximum opportunity to exercise choice and control over their lives. EVIDENCE: Residents spoken with said that they could get up and go to bed when they chose. Those residents also confirmed that they receive visitors and that they can spend time with them in private if they wish. Relatives and friends of residents were seen visiting the home on the days of the inspection. The visitors book showed that residents receive visitors at various times of the day and night. One resident stated that her family are very important to her and that she looks forward to them visiting. Two residents stated that they were financial independent and that they had been able to bring personal possessions in to the home with them. Several residents commented that they are satisfied with the food at the home however other residents said that they were not so happy their comments included ‘the food could be better’, ‘there isn’t much choice’, we have the same thing 3 or 4 times a week’. Those residents said that nobody had asked them what they think about the food. These comments were discussed with the manager who confirmed that none of the residents had complained to her or the staff about the food. She was advised carry out a review of the likes and dislikes of residents with a view to change the menus to suit the wishes and Heathfield Lodge DS0000005374.V279276.R01.S.doc Version 5.1 Page 13 preferences of all residents. Two separate dining areas provide sufficient space for all residents. Residents can eat in the lounge or their bedrooms if they wish. Heathfield Lodge DS0000005374.V279276.R01.S.doc Version 5.1 Page 14 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 the following standard(s): 18. Staff have not undertaken recent training in Protection of Vulnerable Adults, which has the potential to put residents at risk. EVIDENCE: A requirement was given as part of the last inspection report for all staff to complete Protection of Vulnerable Adults training (POVA). During discussion the manager confirmed that since the last inspection POVA training has not been provided for any of the staff. However the manager did confirm that she has made contact with various training organisations to obtain information about suitable courses. Arrangements must be made for all staff to undertaken POVA training so that they know what to do in the event of suspicious or an allegation of abuse. Heathfield Lodge DS0000005374.V279276.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 19, 22, 24 & 26 Some areas of the home require upgrading as they have a potential for compromising the comfort, dignity and safety of some residents. EVIDENCE: A tour of the home was carried out. A portable ramp has been fitted to the front entrance of the home in response to a requirement raised at the last inspection. People who found it difficult to enter and exit the home using the steps said that they now find it easier since the ramp has been fitted. Signs of wear and tear were evident throughout the home. Skirting boards and architraves on the ground floor are damaged and in need of painting. Some carpets throughout the home including bedrooms are either stained or worn so need cleaning or replacing. Most of the bedroom furniture that is provided by the home is old. A number of wardrobes, bedside cabinets and drawer sets show signs of damage and/or are worn. The manager confirmed that improvements to the home are planned to take place in the near future. However there were no records to show this. The manager must develop a programme of routine maintenance and renewal of fabric and decoration for the home. Records of all work carried out must be kept. Heathfield Lodge DS0000005374.V279276.R01.S.doc Version 5.1 Page 16 The kitchen is in the basement a ‘Dumb Waiter’ is used to transport food and drinks up to the dining areas. The cook reported that the dishwasher is broken and that he has been washing dishes by hand at the required temperature using protective gloves. The manager confirmed that the machine has been repaired several times in the past and is now irreparable. It is recommended that a replacement dishwasher be provided to ensure that all dishes are appropriately disinfected. The home was clean and tidy throughout. Heathfield Lodge DS0000005374.V279276.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 & 30 The homes recruitment and staff training procedures are not as robust as they need to be to fully protect residents. EVIDENCE: A selection of staff files were examined. Some did not contain all the required information. 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. This was raised as a requirement in the last report but has not been fully met. The manager said that all staff files are being developed so that they include all the required information. Records and discussion with the manager showed that staff have not undertaken all the required training. Staff who work at the home must complete certain training to assist them in the work that they do. Training must be focused around such things as the needs of the residents, safe working practices and the principles of care. Staff files that were seen contained some certificates, which showed that some training has taken place. However, there were no structured training records for individual staff members. Each member of staff must have an individual training and development plan which shows a record of all training undertaken and future training that is required. Heathfield Lodge DS0000005374.V279276.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, & 38 The manager needs to make improvements to show that the home is being managed effectively. EVIDENCE: Mrs Gidman is the Owner and Registered Manager of the home. The manager has been in post since the home opened, but she does not have level 4 NVQ in management and care, and says she is unlikely to obtain this. There are clear lines of accountability within the home, from the manager to the deputy and the senior carer. Discussion with residents, relatives and staff showed that they have a good relationship with the manager. They described her as approachable and caring. There was evidence that regular staff meeting and informal discussions take place but there was no evidence that staff are formally supervised by management. Staff need to receive formal supervision at least six times a year. This gives staff the opportunity to discuss such things as care practices Heathfield Lodge DS0000005374.V279276.R01.S.doc Version 5.1 Page 19 and career development needs. Written records of supervisions must be kept. This was raised as a requirement as part of the last inspection report and has not been met. The manager said that she plans to make arrangements in the near future for staff to be formally supervised. There was no evidence of any quality monitoring systems at the home. This involves residents and/or their relatives/representatives being consulted on their views about the home. This can be done through discussion, which is recorded and/or written questionnaires. This is important to show so that the home is run in the best interests of the residents. Also as part of a quality assurance process a representative for the home, someone who is not involved in the day to day management must visit the premises monthly, to interview residents and staff and inspect the environment. It is important that this is done to check records and form an opinion of the standard of care in the home. Following the visit the representative must write a report a copy of which must be sent to the Commission. These visits are not taking place therefore the Commission are not receiving the reports in accordance with Regulation 26 of the Care Homes Regulations 2001 Amended (2004). Health and Safety records that were examined showed that checks on the environment are being carried out and recorded. The manager must implement systems and make the improvements as described within this report, so that the home fully complies with the requirements of the Care Homes Regulations 2000. Heathfield Lodge DS0000005374.V279276.R01.S.doc Version 5.1 Page 20 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 2 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 2 X X 3 2 2 X 3 STAFFING Standard No Score 27 X 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 3 Heathfield Lodge DS0000005374.V279276.R01.S.doc Version 5.1 Page 21 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 2 3 4 5 6 7 Standard OP2 OP7 OP9 OP18 30 OP19 OP24 Regulation 5 15(1) 13(2) 13(6) 18(1)©(i) 23(2)(b)( d) 23(2)(b) Requirement All residents must be provided with a contract/Terms and Conditions of the home. Care plans must include more details about how resident’s needs are to be met. A safer method for administering and recording medication must be introduced to the home. Arrangements must be made for all staff to undertake POVA training Arrangements must be made for all staff to undertake all other required training. A maintenance plan for repairs and refurbishment of the home must be provided. Arrangements must be made for the required repairs and refurbishment of the home to be carried out. A formal system for supervising staff must be introduced to the home. All care plans must evidence the involvement of residents and/or their representatives. Staff files must include all of the DS0000005374.V279276.R01.S.doc Timescale for action 28/02/06 28/02/06 31/01/06 31/01/06 31/01/06 28/02/06 31/03/06 8 9 10 OP36 OP7 OP28 18(2) 15(1) OP33 Sch 31/01/06 28/02/06 31/01/06 Page 22 Heathfield Lodge Version 5.1 11 12 13 14 OP30 OP33 OP33 OP8 2 18(1)(i) 24(3) 26 12(1)(b) 13(1)(b) required information. All staff must have an individual training and development plan. A system for obtaining residents views about the home must be introduced. Quality audit reports must be forwarded onto the commission each month. Arrangements must be made for a resident to receive further professional advice regarding an increasing number of falls. 28/02/06 31/03/06 31/03/06 31/03/06 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 2 3 Refer to Standard OP3 OP14 OP26 Good Practice Recommendations More detailed information about the support required for individuals should be included in the homes assessment. Residents food likes and dislikes should be reviewed. A new dishwasher should be provided at the home. Heathfield Lodge DS0000005374.V279276.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Heathfield Lodge DS0000005374.V279276.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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