Inspection on 24/11/08 for Heathfield Residential Home

This inspection was carried out on 24th November 2008.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heathfield Residential Home 31/01/07

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Heathfield Residential Home 20/22 Alexandra Road Grappenhall Warrington Cheshire WA4 2EL     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Paul Ramsden     Date: 2 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Heathfield Residential Home 20/22 Alexandra Road Grappenhall Warrington Cheshire WA4 2EL 01925602195 01925611248 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Heathfield Residential Home Limited Name of registered manager (if applicable) Vanessa Laurelle Johnson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of services users who can be accommodated is: 25. Date of last inspection Brief description of the care home Heathfield is a large Victorian three-storey privately owned care home. Access between floors is via a shaft lift or the stairs. Residents are accommodated on all floors. The home is located in the Warrington suburb of Grappenhall and is close to a variety of shops, churches and other community facilities. Heathfield is registered to provide personal care for up to twenty-five older people. It is the homes policy to only provide accommodation to female residents. Residents accommodation consists of fifteen Care Homes for Older People Page 4 of 26 care home 25 Over 65 25 0 Brief description of the care home single and five double rooms. All of the bedrooms, with the exception of one double and two single bedrooms that have an en-suite facility, are fitted with wash hand basins. There are three separate day lounges and a separate dining room available for residents use. Heathfield has an adequate number of toilets and a variety of bathrooms available. Aids to facilitate independence are in evidence throughout the home; these include bath hoists, grab rails and an emergency call bell system. The current fee range for the home is 347 - 500 pounds per week. A copy of this inspection report can be made available to anyone who may be thinking of choosing this service. Existing residents can also have a copy if requested. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced visit took place on the 24 November 2008 and lasted for a total of eight hours. Paul Ramsden and Wendy Smith, Inspectors, undertook the visit on behalf of the Commission for Social Care Inspection. Any references to we or us in the report refer to the Commission. Feedback on the findings of the inspection was given to the home owner at the end of the visit. This visit was just one part of the inspection. Prior to the visit the home manager was asked to complete an Annual Quality Assurance Assessment [AQAA] to provide up to date information about the service provided in the home. This is a very detailed questionnaire that provides us with a lot of information about the service before the visit. Questionnaires were also sent out to a random sample of residents and the home Care Homes for Older People Page 6 of 26 for staff members to complete in order to find out their views about the service. Four resident and two staff forms have been returned to us. We looked at the Annual Service Review [ASR] that was carried out 9 months ago [This is a review of good and excellent services that takes place between key inspections, good services only have an inspection every two years and excellent services every three years]. At the time we found no evidence to suggest that our quality rating had changed or that we needed to bring the inspection forward. During the visit various records and the premises were looked at. When looking at the documents relating to the type of care each person needs [assessments and care plans]we use a system called case tracking. This is a method that allows us to follow or track a particular situation in order to ensure it was dealt with appropriately. A number of residents, visitors to the home and staff were spoken with; they gave their views about the home and the service provided. Due to personal reasons the manager has not worked in the home since January 2008; details of how this was to be managed within the home were provided at the time. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are not always fully assessed before they move into the home and as a result they may be at risk of harm. Evidence: The home provides a range of information for prospective residents. This is presented in a statement of purpose and a service user guide, which contain all of the information required. We have been informed previously that people are encouraged to visit the home prior to making any decision to move in permanently. Pre-admission assessments had been carried out prior to new residents moving into the home, but the information gathered did not always reflect the care needs of the individual resident concerned. One resident was assessed as being at risk of choking but did not have an accompanying care plan for this need. This could put the health of the individual concerned at risk, particularly at mealtimes. We found that assessments Care Homes for Older People Page 10 of 26 Evidence: generally were of a very poor standard and were not being signed, dated, reviewed or acted upon. (Please see the notes made regarding care plans for more details.) Where somebody has been placed in the home by the Local Authority we saw assessment documentation that they had provided to the home. In the absence of the home manager, the assessments are being carried out by the proprietor and one of the senior carers, neither of whom have sufficient experience to carry out assessments thoroughly and safely. During our visit, two officers from a nearby Local Authoritys Social Services department visited to carry out an assessment of a resident. They considered that the homes assessment and care plans for this person did not fully identify their needs. They also told us that they had been given conflicting information about the persons likes and dislikes. They raised a number of other issues that have been detailed in other areas of this report. Intermediate care is not provided at Heathfield. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans seen were poorly written and maintained. This means that staff may not have sufficient information about peoples needs and what actions they should be taking to meet them; as a consequence residents may be at risk of harm. Evidence: It was clear from looking at a selection of care plans that they did not provide staff with the necessary information for them to look after each persons needs. Areas of need and how they were to be managed were not always clearly identified, for example, the continence products used by some people had changed; the reasons were not recorded and the care plans were not amended although they were using different pads from what had been recommended by the continence adviser. With regard to continence, the documentation we looked at did not provide enough evidence to explain why 14 of the 16 residents needed to use continence aids. We found that some issues were not being addressed appropriately, for example we Care Homes for Older People Page 12 of 26 Evidence: found clear documentation showing that a weight loss of nearly a stone had occurred since the beginning of the year, there was however no indication as to how this had been addressed. We also found that a clearly identified need for one person did not have an accompanying care plan. Care plans were not being reviewed appropriately and although there were references to changes in needs in the daily notes we found very little evidence to show that the relevant care plan had been updated. Risk assessments were also poorly completed or, in some cases, had not been completed at all even although a clearly identified risk was apparent. For example, one person had recently had a hip replacement but the risk assessment about mobility had not been changed. In addition we saw some risk assessments that were unsigned, undated and had not been reviewed regularly. In the absence of the registered manager, the proprietors have delegated responsibility for care plans to one of the senior carers. She told us that she had received no training in this area, did not know how to complete care plans and had been given no extra time in order to do this. (Please see the management and summary sections of this report.) Although the staff members we spoke with appeared to have a good understanding of the people they were supporting we cannot say with any certainty whether or not they are fully aware of all of the residents needs . The changing needs of individuals are discussed between staff and we saw this in practice during the visit, however we are unable to say whether this fully reflects the needs of the residents when the documentation maintained is so poor. There was evidence to show that people receive support from district nurses, GPs etc, but this is recorded on a separate system and the information was not always transferred to the care plans so that all staff can know about it. Medicines are administered using a blister pack system provided by a local pharmacist. The arrangements for the administration of medicines were looked at during this visit; no major issues were identified and the residents were being given their medication as prescribed. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are able to maintain contact with family and friends and were positive about the home and the support they receive. Evidence: Residents are able to move freely around the home and a choice of sitting areas is available. Residents confirmed they could make choices in many areas of daily living; for example, whether or not to join in with planned activities and where to spend time and with whom. The residents and visitor who we spoke with made a number of positive comments during the inspection. The visitor said; The staff are very caring and my friends personal standards are being maintained. Various religious denominations conduct services in the home and residents are free to attend if they wish to do so. A hairdresser also visits the home on a regular basis. Links with the local community are maintained and people are able to go out with their families whenever they like. Care Homes for Older People Page 14 of 26 Evidence: People have their meals in the dining room. We were told that people can have an alternative meal if they wish to do so, but at lunchtime everyone had the same meal (cottage pie) and the menus we saw did not indicate that any choice was available. We did not receive any negative comments regarding the food provided, but recommend that the menus are changed to show that a choice is available. Special diets can be provided if needed. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints and adult protection procedures are in place in order to ensure that residents are fully protected from harm. Evidence: There is a written complaints procedure for the home and this is included in the Service User Guide. We looked at the complaints file; although we did not see any record on the day of the visit as to how the five complaints received [since September 2007] had been addressed we have since seen the responses to the complaints made. People who completed CSCI comments cards told us that they would inform the owner or a senior staff member of any issues. The home has an adult protection procedure that complies with all of the relevant legislation and good practice guidelines. Safeguarding training has been provided to staff members. We have received one safeguarding referral in the previous 12 months. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the facilities and accommodation in the lounges and in a few of the bedrooms are of a good standard some bedrooms are poorly furnished and do not provide a comfortable and homely environment for residents. Evidence: We looked around all parts of the building including communal areas and all of the bedrooms. The lounges and dining room are comfortable and homely. The quality of the furniture in the bedrooms varied. Two bedrooms had been refurbished and had new carpets and furniture, while others, currently unoccupied, had a complete mismatch of poor quality cabinets and wardrobes, and some carpets were in poor condition. The majority of the bedrooms we saw had been personalised and contained items belonging to the resident. Four bedrooms that did not have a window [they received ventilation and natural light from the adjoining bedroom via a glass partition at the top of the dividing wall] have now had either windows or velux roof lights fitted. Although this is an improvement we did find a large piece of unpainted hardboard screwed to the wall in one of these rooms; this had not been cut to size and only partially covered the glass partition. This did not look homely and had not fully addressed the problem of light disturbing residents in adjoining bedrooms at night. The home owner has told us since the visit Care Homes for Older People Page 17 of 26 Evidence: that this was only a short term measure that has now been permanently addressed. A new lift has just been fitted; this replaces the old lift which was unreliable and had generated a number of complaints. All bedrooms are fitted with a call system. Aids to help maintain independence, for example bathing aids are provided. There are fully accessible gardens at the front of the home for residents to use. The laundry is appropriately equipped and good systems are in place for the care of peoples clothes. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust recruitment procedures need to be followed for all new staff in order to be sure that residents are protected from possible harm. Evidence: We looked at the staff rotas and the number of staff on duty on the day we visited. We were satisfied that enough staff are provided to meet the day to day needs of the people living at the home. The staff were cheerful and friendly and the residents and visitor we spoke with were complimentary about the attitude and competence of the staff. The AQAA told us that eight of the eighteen care staff employed have an National Vocational Qualification [NVQ] and that another four are undertaking this. This is a nationally recognised qualification for staff members working in care settings. The files for four recently appointed members of staff were looked at. Two of the files contained all of the information required but the other two did not have a completed application form. There was no check of the applicants previous employment history and it was unclear who had provided the references for them. All of the files had a CRB disclosure. Care Homes for Older People Page 19 of 26 Evidence: New staff have an induction from the home and this was confirmed by a new staff member during the visit. While looking at staff files we saw that one of the staff had undertaken some of the induction training provided by Warrington Borough Council. From the evidence available it was not clear whether all staff members participate in this. The training matrix provided showed that mandatory training such as moving and handling, first aid, health and safety etc are being provided and are up to date. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of an experienced manager and the poor standard of record keeping within the home suggests that it is not being managed in the best interests of the people who live there and as a consequence residents may be at risk of harm. Evidence: The manager has been on long term absence due to personal reasons since January 2008. We were sent a plan of how this was to be managed. This was acceptable to us as it delegated her responsibilities to the owners and the senior staff members within the home. Unfortunately this has not been successful and care plans, risk assessments etc that were up to date when the previous inspection took place are now extremely poor. No one has taken overall responsibility for addressing this and as a consequence residents may be at risk. One of the staff members has written on a survey form; At the moment, due to the absence of the manager we lack the important support from the main person. We were also told that none of the newly appointed staff members had any care experience and that this caused problems for existing staff who were Care Homes for Older People Page 21 of 26 Evidence: spending additional time showing the new staff what to do. We were informed by the owner during the visit that the manager had been suspended in October 2008. We asked for a reason but were told that it was not possible at this stage to give any further information. We should have been informed of this at the time and been provided with the arrangements made to ensure the home was being run in the best interests of the people living there. The owner explained that they have employed consultants to assist them in improving the care plans and they have since written to us with further information regarding the running of the home in the immediate future. The CSCI are considering these proposals. Heathfield has a quality assurance system in place to ascertain whether residents and their families are happy with the standards of care being provided. The home keeps some personal spending money in safekeeping for some residents. A random sample of these monies were checked and although they had a correct balance there were no signatures on the record sheets; this is a potential risk as there is no record of who is either putting in or taking money out. Sixteen staff members received formal supervision from one of the seniors in November 2008, prior to this all staff members had received an annual performance review in September, this does not fully meet the standard. Any accidents are recorded; however there was no record of any audit in order to ensure that any trends, for example, a resident having a number of falls would be identified and addressed. The maintenance records seen demonstrated that the appropriate service contracts were in place. These included, the bathing aids, the fire alarm system and the gas and electrical installations. The fire safety log book showed that the tests on the system and emergency lighting were being carried out at the recommended intervals and that drills and training were also up to date. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Residents must not be admitted into the home unless an appropriate assessment has been undertaken by a person qualified to do so. This will ensure that the needs of the individual concerned can be safely met. 12/12/2008 2 7 15 A care plan that fully details 23/12/2008 how an individuals needs are to be identified and met must be completed. So that staff members are able to fully meet the assessed needs of the residents they are caring for. 3 8 12 Proper provision for the health and welfare of residents must be made. This will ensure they receive any medical or other attention they need. 23/12/2008 Care Homes for Older People Page 24 of 26 4 29 19 A robust recruitment procedure needs to be implemented. This will ensure residents are protected from possible harm. 23/12/2008 5 31 12 In the absence of the registered manager proper arrangements the day to day running of the home must be in place. In order to ensure the home is run in the best interests of the people living there. 23/12/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 a Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!