CARE HOMES FOR OLDER PEOPLE
Heathlands Constitution Hill Road Parkstone Poole BH14 0PZ Lead Inspector
Trevor Julian Unannounced 19 July 2005 09:30
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Heathlands D55 S4047 Heathlands V233457 190705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Heathlands Address Constitution Hill Road Parkstone Poole Dorset BH14 0PZ 01202 676858 01202 684643 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care South Mr Nicholas Robin Holman Care Home only 51 Category(ies) of OP - 45 registration, with number DE(E) - 6 of places MD(E) - 6 Heathlands D55 S4047 Heathlands V233457 190705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: 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. Date of last inspection 08 February 2005 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. Heathlands D55 S4047 Heathlands V233457 190705 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Tuesday 19th July 2005 09:4516:00. The total inspection time was 18 hours including preparation, inspection, travelling and report writing. This was the first of two statutory visits to be completed during the year. Information was gathered through discussion with residents, visitors, staff and the manager. Further information was gained through examination of records and a tour of the premises. For the purpose of this report the terms resident and service user are interchangeable. What the service does well:
Prospective residents and their carers were given information about the services provided and the home. Information was displayed about the inspection process and report. New residents were only offered placement once their needs had been assessed and the management had ensured that those needs could be met. Residents and visitors confirmed the assessments had been completed before admission and they had been able to visit the home before deciding. There were two people in the home on respite care, they both said they looked forward to returning home but would come back for another break if the opportunity arose. Care plans were in place giving the staff information on how care needs were to be met. Staff were told of changes to care needs during shift changeover. Residents and visitors said the staff arrange GP appointments and organise transport for hospital appointments. Residents and visitors said that people were treated with dignity and respect. During the visit staff were seen knocking doors before entering. Visitors said they were always made welcome. The home did not manage the finances for residents but they did look after personal allowances for most residents. Residents said the food provided was varied and of good quality. served during the inspection was not rushed. The meal The home has an accessible complaints procedure with compliments also recorded and shared with the staff. Staff were aware of their responsibilities in responding to adult protection issues.
Heathlands D55 S4047 Heathlands V233457 190705 Stage 4.doc Version 1.30 Page 6 Residents and visitors praised the laundry service in the home with items normally returned correctly. When items were mislaid staff were normally able to sort the problem. During the visit staff responded promptly to call bells, residents commented that there were only short delays in staff answering call alarms. Safety systems were in place to provide a safe environment for residents and staff. This included training in fire safety, safe moving and handling, infection control and food hygiene. Accident reports were monitored for trends and the electrical and gas installations were serviced and tested by approved contractors. 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 D55 S4047 Heathlands V233457 190705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Heathlands D55 S4047 Heathlands V233457 190705 Stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 & 3. Intermediate care (Standard 6) was not provided at Heathlands so therefore it was not assessed. Residents were admitted once an assessment had been completed to confirm that identified needs could be met within the home. EVIDENCE: The manager carried out the initial assessment. These were generally carried out with the prospective resident and their carers. A check of records of recent admissions showed they were carried out before admission and the assessment included the recommended topics. The files seen did not hold confirmation of resident or their representatives involvement in the process. During the inspection the relatives of two recent admissions were visiting the home. They both confirmed the manager had made visits to their relatives before admission. They had been able to visit the home to satisfy them of the home’s suitability. Both felt the information provided by the home had helped them with selecting the placement. One visitor said they had looked at several places and concluded that Heathlands offered the best overall services and added that he had not been disappointed.
Heathlands D55 S4047 Heathlands V233457 190705 Stage 4.doc Version 1.30 Page 9 A copy of the service users guide and the last inspection report was available on a notice board opposite the dining room on the ground floor. Heathlands D55 S4047 Heathlands V233457 190705 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9, and 10 Care plans were in place to inform staff how assessed needs were to be met. The staff worked with community health services to maintain the health of residents’. For the safety of residents and staff medication was safely stored and administered. The residents were treated with dignity and respect in order to maintain their basic rights. EVIDENCE: Care plans were in place and had been developed from the pre-admission assessment and subsequent reviews. Staff said they were told of changes in care needs at shift handover and that they had access to the records. In order to respond to short term changes to the care provided a document was completed to address the changed need without carrying out a full review. The files contained manual handling assessment and risk assessments. The risk assessments seen identified areas of risk but did not fully inform staff of how to manage those risks.
Heathlands D55 S4047 Heathlands V233457 190705 Stage 4.doc Version 1.30 Page 11 The records showed that appropriate healthcare referrals were made and the outcome. Residents and visitors confirmed that the staff arrange GP and community nurse appointments for the residents. They also assist in organising transport if hospital consultation is needed. A brief audit of the medication system showed the items were securely held. Temperature sensitive items were held in a fridge and a max/min thermometer was in place, however only the operating temperature was recorded. It is good practice to record the maximum and minimum temperatures and then reset the thermometer. A sample of the administration records was up to date. There were photographs of the residents to assist staff. Where manual additions or alterations had been made a second person should countersign the entry to reduce the risk of transcription errors. During the visit there was a relaxed and peaceful atmosphere in the home. Several residents said that the staff were kind and helpful and always knocked on their doors before entering. The staff said the preferred term of address was discussed during the pre – admission assessment and currently all residents were known by their preferred first name. Heathlands D55 S4047 Heathlands V233457 190705 Stage 4.doc Version 1.30 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 standard(s) 12, 13,14, and 15 Social activities were organised to provide stimulation and interest for the residents. The home encouraged contact with the community, family and friends to help the individuals not to feel isolated. Residents were encouraged to exercise as much choice as their circumstances allow to help them feel valued. Meals were provided in suitable surroundings, the menu offered good levels of choice and the food was appetising to encourage a healthy nutritional intake. EVIDENCE: Since the last inspection an activity organiser had been appointed. During the visit a small group of residents were playing dominoes. Residents said the activities were available to all people but there was no compulsion to attend. They said they welcomed the appointment of the organiser and that she was enthusiastic. One to one sessions also took place to involve people in their preferred pastime. Residents said library books were also available. Religious and spiritual needs were considered during the admission process but the activity organiser had not had chance to review those needs. The home had arranged excursions previously but these were not well attended but they
Heathlands D55 S4047 Heathlands V233457 190705 Stage 4.doc Version 1.30 Page 13 were hoping to try again and have better support. Several people did have trips out with their family or friends. There had been a successful barbeque and that was being repeated shortly after visit. During the visit there were several visitors in the home they said they visited at various times of the day and the staff were always welcoming and if refreshments were being served they were always offered. There was a small lounge on the ground floor which was equipped with a fridge and tea / coffee making facilities which was freely available to residents and their guests. The visitors said they helped their relatives with financial matters and most deposited an allowance with the home for personal expenditure such as hairdressing and toiletries. These records were not checked on this occasion. The home had two dining areas the main dining room and small lounge dining room opposite. Residents normally take their main meals in these rooms but meals can be taken in the bedrooms on request. Staff were seen discreetly helping some people. Residents said the meals were not rushed and they could have breakfast between 08:30 and 10:00 most added that they were offered a cup of tea before going to breakfast. Records showed that nutritional monitoring was carried out as needed. The chef took the menu around the home each day to find out preferences. Residents said there was always a good range of foods and a choice of main dishes and sweets. Heathlands D55 S4047 Heathlands V233457 190705 Stage 4.doc Version 1.30 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 standard(s) 16 and 18. The organisation’s complaint procedure allows people to raise concerns and have those concerns investigated. Adult protection procedures assist in protecting residents from abuse. EVIDENCE: The complaints procedure was displayed on the notice board in the hallway. Visitors confirmed that they had been given a copy in the information provided during the admission process. The records in the home showed that the manager responded to issues raised and carried out investigations into the points raised. Compliments were also recorded. Residents and visitors said they were able to discuss any concerns with the manager and staff who were always approachable. Adult protection procedures were discussed with the staff, the topic was always covered during induction and reviewed in supervision and staff meetings. All those asked were aware of their responsibilities. Heathlands D55 S4047 Heathlands V233457 190705 Stage 4.doc Version 1.30 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 standard(s) 19, 26 The home provided a clean and comfortable environment for the safety of the residents. EVIDENCE: Since the last visit the hallways and stairwells had been redecorated and recarpeted as part of the ongoing maintenance plans. This had improved the overall impression given when entering the building. One visitor commented that the external decoration of the building was neglected and this had initially put them off the placement however the standard of internal decoration was very good. At the time of the visit contractors were tidying the garden, which had seating areas available to residents and visitors. The laundry area was located away from the food preparation and storage areas. The laundry assistant said all the equipment was working correctly, items of clothing were well labelled and aided the return to the rightful owner. Residents and visitors confirmed that the laundry was good with only
Heathlands D55 S4047 Heathlands V233457 190705 Stage 4.doc Version 1.30 Page 16 occasional errors in return of correct items; when the errors occur they are able to ask the staff locate the missing items. Heathlands D55 S4047 Heathlands V233457 190705 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The home was appropriately staffed to meet the needs of the residents. EVIDENCE: The home had continued to recruit new care staff further reducing reliance on agency staff to cover vacant shifts. On the day of the visit there was just one agency carer covering an afternoon shift. Staff said the levels of care were manageable. Residents said that the staff attended call bells promptly, this was also observed during the visit. One person added that the new staff were very nice and learning the ropes. Heathlands D55 S4047 Heathlands V233457 190705 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The organisation provides a safe environment for residents and staff. EVIDENCE: The fire alarm system is regularly tested by staff and serviced by approved contractors. Records showed that all staff received regular fire safety training. Agency staff were given basic instruction before their first shift. Accident reports were analysed by the deputy manager to monitor for trends. Staff were trained in safe moving and handling techniques, basic food hygiene and infection control. Heathlands D55 S4047 Heathlands V233457 190705 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 3 Heathlands D55 S4047 Heathlands V233457 190705 Stage 4.doc Version 1.30 Page 20 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 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. Refer to Standard OP 7 OP 9 Good Practice Recommendations The registered person should ensure that the risk assessments provide information on how the risk is addressed. Where manuscript amendments are made to the medication administration record the alteration should be checked and countersigned. Heathlands D55 S4047 Heathlands V233457 190705 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection 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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