CARE HOMES FOR OLDER PEOPLE
Heathlands Constitution Hill Road Parkstone Poole Dorset BH14 0PZ Lead Inspector
Amanda Porter Key Unannounced Inspection 13th July 2006 05:50 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 Heathlands DS0000004047.V304314.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. Heathlands DS0000004047.V304314.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Heathlands Address Constitution Hill Road Parkstone Poole Dorset BH14 0PZ 01202 676858 01202 684643 heathlands@care-south.co.uk www.care-south.co.uk Care South 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) Mr Nicholas Robin Holman Care Home 51 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (6), Old age, not falling within any other category (45) Heathlands DS0000004047.V304314.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One named person (as known to CSCI) who is under the age of 65 and whose primary care needs are due to a physical disability may be accommodated for periods of respite care. 5th February 2006 Date of last inspection Brief Description of the Service: Situated at the bottom of Constitution Hill Road the home has pleasant gardens and some off road parking. The land is leased by the Borough of Poole and is shared between Heathlands and other day services run by the borough. Heathlands was built as a care home approximately 40 years ago. It is registered with the Commission for Social Care Inspection to provide care for 51 service users, 45 in the category of old age and 6 in the category of either dementia or mental disorder. The care home is registered for service users over the age of 65. Bedrooms are on 3 levels. Care South is a not for profit company who operate the home, it is managed by Mr N Holman. Along with service user bedrooms, the home provides sufficient communal space by means of a large lounge and dining room, smaller lounge areas, staff office space and utility services from the main kitchen and laundry. There are shops within half a mile. The main town centre of Poole is one and a half miles away. Bus and train routes serve the main shopping areas of Poole and Bournemouth. A short drive to the top of Constitution Hill Road reaches the view-point from which there are views over Poole Harbour and the Purbeck Hills. Weekly fees range from £425 - £515. Heathlands DS0000004047.V304314.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 13th July 2006 and took two inspectors approximately five and a half hours each. The purpose of the inspection was to review the requirement and recommendations made in the last report, to assess all the key standards and to look into a concern raised with the Commission for Social Care Inspection. The concern was about some residents getting up very early in the morning and at the start of the inspection, 5.50am, six residents were up and dressed. They appeared happy to be up and generally their care documentation confirmed their wish to rise early. Information gathered for this report came from several sources including: • Reports made to the Commission for Social Care Inspection by the home. • A pre-inspection questionnaire completed by the registered manager. • 61 comment cards completed by residents; relatives/visitors; GPs; health and social care professionals and care managers. • Tour of the premises. • Review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. • Discussion with residents and staff. Eight residents, two relatives and thirteen members of staff were spoken with and asked their views on the service provided at Heathlands. Comments received included: “It’s very good here apart from the fact it’s not your own home.” “We cannot fault the care.” “Very happy with the care and attention provided.” “My wife and I have been very pleased with the care that my relative receives. The manager and staff are always extremely helpful and ready to assist.” “The staff have become much more relaxed and look as if they enjoy their job. I have always been able to express my concerns and observations.” “The home is always clean and fresh. The care my mother receives is good and I am happy she is a resident at Heathlands.” “This is a good home to work in.” All the staff and residents were welcoming and helpful. Heathlands DS0000004047.V304314.R01.S.doc Version 5.2 Page 6 What the service does well:
The home carries out thorough assessments prior to residents moving in and assurances are given that individual needs can be met. The activities arranged within the home meet the expectations of the residents living there. Residents are encouraged to maintain their links with friends and family and all visitors are made welcome. Residents are helped to exercise choice and control over their lives as far as possible. Meals are wholesome and nutritious and planned around the likes and dislikes of residents. The complaints and quality assurance procedures reassure residents that their views are important to the home and that any complaints they raise will be properly investigated. The house and gardens are generally well maintained which provides residents with a comfortable place to live. Residents are encouraged to personalise their rooms with small items of furniture, pictures and a variety of mementos. The home protects the residents from abuse by ensuring robust policies and procedures are in place, which staff find easy to follow. Sufficient numbers of staff are on duty throughout the day and night to be able to meet the needs of the residents. A thorough recruitment process is followed when employing staff, which ensures that residents are protected from risk. Heathlands has an ongoing training programme for staff, which means that generally residents will be cared for by skilled staff. A suitably qualified and experienced manager, who is well supported by the registered provider and the staff within Heathlands, runs the home in the best interests of the residents. Financial procedures within the home also ensure that residents’ interests are protected. The health and safety of the residents and staff are protected by the policies and procedures that the staff follow at Heathlands. Heathlands DS0000004047.V304314.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? 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. Heathlands DS0000004047.V304314.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 Heathlands DS0000004047.V304314.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New residents move into the home having had their needs assessed and been assured that these needs will be met. EVIDENCE: Care files for three residents were seen and each contained a pre-admission assessment, which provided sufficient information so that a plan of care could be drawn up. The manager confirmed in writing to each resident that their needs could be met. Residents and relatives confirmed that they were invited to view the home before making a decision about admission and given information about the home. Twenty-one residents responded to the question “Did you receive enough information about this home before you moved in so you could decide if it was the right place for you?” Seventeen said, “Yes” and four said “No”.
Heathlands DS0000004047.V304314.R01.S.doc Version 5.2 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 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident had a care plan giving details of how needs were to be met, but it did not include preferred times of getting up or going to bed. Generally health needs were met through support from the home’s staff and the community health teams. However the home needed to ensure that the needs of residents with continence problems were fully met. Residents receive their medicines as prescribed but the home needs to improve procedures for dispensing liquid medicines to properly protect residents. The staff treat people with dignity and ensure their basic individual rights are respected. Heathlands DS0000004047.V304314.R01.S.doc Version 5.2 Page 11 EVIDENCE: The care documentation for six residents was reviewed. Files contained a variety of assessments including: • Moving and handling • Falls • Environmental risks • The risk of pressure sores. Information from the assessments was used to formulate plans of care. Residents and/or their chosen representatives were invited to be involved in drawing up care plans. Care plans were generally very informative but not all included the resident’s preferred time of getting up in the morning and going to bed at night. Staff needed this information to ensure that the resident’s wishes were respected. It was evident during the inspection that a large amount of soiled laundry was collected during the night due to urinary incontinence problems and that incontinence pads for residents with this problem were not always available during the nighttime. It is suggested that the manager reviews the home’s policies and procedures for caring for people with continence problems. The home has a well-written and informative medicines policy and procedure including reference to self-administration and associated risk assessment and arrangements for ordering, administration and disposal. Medicines were stored securely. Records were kept of the receipt, administration and disposal of medicines. Examination of records indicated that medicines are properly administered in accordance with the prescriber’s instructions. However some liquid medicines were seen to be dispensed during the early hours of the morning and then administered at various times of the day by another member of staff. A recommendation has been made that this practise stops and that medicines are only dispensed at the time they are going to be administered. Comments received from residents and their relatives/visitors confirmed generally that staff treated them with respect and were supportive and kind. 21 residents responded to the question “Do you receive the care and support you need?” and 13 said “Always”, 7 said “Usually” and 1 said “Sometimes”. In response to the question “Do the staff listen and act on what you say?” the answers were 15 said “Yes”, 1 said “No” and 5 said “it depended on which staff were on duty”. Heathlands DS0000004047.V304314.R01.S.doc Version 5.2 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): 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. There is an adequate range of social opportunities available in the home, which reflects residents’ interests and preferences. There is a strong sense of homeliness and inclusion of family and friends in life at Heathlands. Residents are helped to exercise choice and control in their daily lives within their capabilities and desire to do so. The dietary needs of residents are well catered for with a balanced and varied selection of food available that meets their tastes and choices. EVIDENCE: Most residents spoken with said that they were “free to make decisions about how they spent their days” and they were happy with the lifestyle that living at Heathlands afforded them. Some chose to spend time on their own but knew they could join in with any organised activities. There was a programme of activities drawn up by the activities organiser these included included: • Arts and crafts. • Quizzes.
Heathlands DS0000004047.V304314.R01.S.doc Version 5.2 Page 13 • Reminiscence. These activities are based on the assessed needs of the residents. The activities coordinator has a written record of each residents preferred activities. 21 residents responded to the question “Are there activities arranged by the home that you can take part in?” all of them said “Always”. Residents confirmed that their visitors were always made welcome at the home and they could have visits in private. Residents spoken with at the time of inspection said that they enjoyed the food provided. The menu offered choice. 21 residents responded to the question “Do you like the meals at the home?” 10 said “Always”, 4 said “Usually”, 6 said “Sometimes”, and 1 said “Never”. Heathlands DS0000004047.V304314.R01.S.doc Version 5.2 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): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A written complaints procedure leaves residents in no doubt that steps will be taken to deal with any complaint or concern they may have. Staff’s knowledge and understanding of Adult Protection issues provides a safe environment to protect service users from abuse. EVIDENCE: The home has a clear complaints procedure available to everyone. In the last twelve months the home had received three complaints, all of which were responded to promptly. One complaint was partially upheld. The Commission for Social Care Inspection had received a concern that some residents were made to get up earlier than they wished. At the beginning of the inspection at 5:50am were up in the lounge and foyer and all appeared to be quite content. Heathlands has a robust policy and procedure to respond to suspicion or evidence of abuse or neglect. Several of the staff had received training on abuse. Through discussion staff demonstrated knowledge of the Department of Health guidance “No Secrets” and local protection of vulnerable adults procedures. Heathlands DS0000004047.V304314.R01.S.doc Version 5.2 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 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment at Heathlands is good providing residents with an attractive, homely and safe place to live. The home provides a clean, pleasant and hygienic environment for the residents, staff and visitors. EVIDENCE: The home has a programme of routine maintenance and a member of staff is employed to attend to any running repairs and redecorating that needs to be done. Records show that a variety of outside agencies have attended the home to undertake the routine maintenance of: • Fire safety equipment. • Gas installation. • Lift. • Hoists.
Heathlands DS0000004047.V304314.R01.S.doc Version 5.2 Page 16 The grounds are safe and attractive and accessible by residents. A call bell system is available in every room. The home was clean and free from any unpleasant odours. Residents and visitors confirmed that it was kept very clean and tidy. Twenty one residents responded to the question “Is the home fresh and clean?” Nineteen said “Always” and two said “Usually”. The laundry was well managed. However the current bags used to collect foul laundry were faulty and did not allow effective sluicing of these items to take place. Heathlands DS0000004047.V304314.R01.S.doc Version 5.2 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): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient staff are employed and deployed to meet the care needs of residents. Residents would benefit from more staff having NVQ level 2 in care. However staff are generally well trained. Robust recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. EVIDENCE: Staff rosters demonstrated that there are sufficient staff on duty at all times. Twenty-one residents responded to the question “Are staff available when you need them?” Nine said “Always”; eleven said “Usually” and one said “Sometimes”. The home has an ongoing training programme, which includes NVQ level 2 and 3 in care. At the time of inspection approximately 30 of care staff held this award, which is below the 50 recommended. Heathlands DS0000004047.V304314.R01.S.doc Version 5.2 Page 18 Staff • • • • • • • recruitment files were reviewed and they contained: Completed application forms Two written references Enhanced CRB checks Terms and conditions of employments Documentary evidence of any relevant qualifications Proof of identity A record of the interview Training files demonstrated that healthcare assistants were receiving induction training. Records showed that staff had received mandatory training such as manual handling, food safety, first aid, dementia care, health and safety and fire safety training. Heathlands DS0000004047.V304314.R01.S.doc Version 5.2 Page 19 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, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run by a committed and competent manager, who creates an open and positive atmosphere, which supports good care practices for residents. The home regularly reviews aspects of its performance through a programme of self-review and consultations, which include seeking the views of residents and relatives. Residents are assured of sound management of their financial interests. The health and safety of the service users and staff are protected by the policies and procedures followed at Heathlands. Heathlands DS0000004047.V304314.R01.S.doc Version 5.2 Page 20 EVIDENCE: Mr N Holman is registered with the Commission for Social Care Inspection as manager of Heathlands and has several years experience of senior management. There is a good rapport between the staff, who appear to work well together as a team. Most residents choose not to deal with their own finances but they all had someone to act on their behalf. The home does hold a small amount of money for some residents at their request. All monetary transactions were recorded and seen to be accurate. The home regularly reviews the quality of facilities and service it provides. Since the last inspection satisfaction questionnaires had been sent out to residents, relatives, staff and stakeholders in the community, eg GPs. Topics covered in the survey included: • Catering and food. • Personal care and support. • Daily living. • Premises and facilities. • Staff. The results had been analysed by an independent consultant and a report was available at the home. It showed a high degree of satisfaction from residents and staff and stated, “The most striking feature is the appreciation felt for the warmth and friendliness of the staff and their ability to create a warm and welcoming atmosphere in the home.” Heathlands currently meets the requirements of the Dorset Fire and Rescue Service and the environmental health standards. Records relating to the maintenance and servicing of equipment, including fire safety equipment were seen to be up to date. Generally staff follow sound procedures to reduce the risk of cross infection and there is a plentiful supply of gloves and aprons. Training records showed that staff were receiving fire safety and moving and handling training at appropriate intervals. Heathlands DS0000004047.V304314.R01.S.doc Version 5.2 Page 21 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Heathlands DS0000004047.V304314.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation Requirement Timescale for action 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 4 Refer to Standard OP7 OP8 OP9 OP28 Good Practice Recommendations Care plans should include the preferred time of getting up in the morning and going to bed at night. Policies and procedures for continence care at night should be reviewed to ensure that residents with continence problems are comfortable at all times. Liquid medications should only be dispensed at the time of administration. A minimum ratio of 50 of care staff should be trained to the NVQ level 2 or equivalent. Heathlands DS0000004047.V304314.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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