CARE HOMES FOR OLDER PEOPLE
Heathlands Constitution Hill Road Parkstone Poole Dorset BH14 0PZ Lead Inspector
Trevor Julian Unannounced Inspection 5th & 6th February 2006 09:45 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.V276499.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. Heathlands DS0000004047.V276499.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Heathlands Address Constitution Hill Road Parkstone Poole Dorset BH14 0PZ 01202 676858 01202 684643 heathlands@dorsettrust.co.uk 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) Care South 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.V276499.R01.S.doc Version 5.1 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. 19th July 2005 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. Heathlands DS0000004047.V276499.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Sunday 5th February and was concluded on the 6th February 2006. This was the second of two statutory visits to take place during the inspection year. The purpose of the visit was to follow up on a complaint investigation and to review key standards not covered on the previous visit. The complaint related to care planning and staffing levels. Information was gathered through discussion with residents, staff and visitors, inspection of the premises and reviewing records and procedures. Comment cards were received from GP’s, Community Nurses and Care managers none expressed any concerns about the care of the residents. The time spent on the premises was 5 hours the total time taken including preparation, inspection and report writing amounted to 14 hours. What the service does well:
Each person had an individual care plan including risk assessments these provided the staff with information about how care needs were to be met. Medication records were up to date. The home was warm clean and odour free; cleaners said the staffing roster ensured that two cleaners covered the weekends. They were provided with specialist carpet cleaning machines and as a result there were no unpleasant odours. The home had continued to recruit permanent care staff which improved continuity of care. Where agency staff were used to cover vacant shifts they tried to ensure the workers knew the home and were aware of the routines. Staffing levels were appropriate for the needs at the time of the visit. The organisation’s training programme was accessible and provided a good standard of core and specialist training for the staff. Residents were enjoying a relaxed breakfast and said the meal was always unrushed, starting at 08:30 until 10:45. Residents and visitors said the staff were kind and caring. The home was well managed by an experienced and qualified person. The organisation carry out monthly monitoring visits to ensure that standards were correctly maintained. Heathlands DS0000004047.V276499.R01.S.doc Version 5.1 Page 6 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.V276499.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 Heathlands DS0000004047.V276499.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): Not assessed during this inspection. Please refer to the previous inspection report. EVIDENCE: Heathlands DS0000004047.V276499.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 Each resident had a care plan giving details of how needs were to be met, however the planning did not show the involvement of the resident or their representative. Medication was generally managed safely for the residents however some improvements were identified. EVIDENCE: The care plans for three residents were examined, each contained risk assessment covering a variety of subjects. The care plans or the risk assessments did not show the involvement of the resident or their representatives. This can result in action being taken without the residents’ consent or agreement. On one care plan there was no mention of specialist equipment in use. The manager said the organisation had a new training course on risk assessment and he was due to attend the course later in the week. Heathlands DS0000004047.V276499.R01.S.doc Version 5.1 Page 10 A sample of medication records were checked and were found to be up to date. It was noted that some of the records did not have details of allergies recorded and another had handwritten amendments these had not been checked by a second person, which could lead to transcription errors. Heathlands DS0000004047.V276499.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 Activities for the residents are organised based on the preferences of the individuals. EVIDENCE: Not fully considered during this inspection. Since the last inspection, the home’s activity organiser had settled into her role. Two of the residents said that the new activity organiser was “the best they had ever had … she helps us all”. Others said they felt they were treated as individuals they said the chef made birthday cakes. Heathlands DS0000004047.V276499.R01.S.doc Version 5.1 Page 12 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): Not assessed during this inspection. EVIDENCE: Heathlands DS0000004047.V276499.R01.S.doc Version 5.1 Page 13 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): Not fully assessed during this inspection. EVIDENCE: During the visit the home was clean, warm and there were no unpleasant odours. During the Sunday morning the cleaner explained that the shift ensured that two cleaners were on duty over the weekend. The home had infection control procedures in place to reduce the chance of cross-infection. Heathlands DS0000004047.V276499.R01.S.doc Version 5.1 Page 14 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, 30. The home was adequately staffed to meet the current care needs of the residents. Training programmes for new and existing staff helps to ensure that the staff are competent to carry out their caring role. EVIDENCE: On the Sunday morning the home was staffed by seven carers including the shift leader, two cleaners, a laundry assistant, the chef and a kitchen assistant. One person was from an agency but she said she was a regular at the home and was fully aware of the routines of the home. Some residents were still enjoying breakfast at 10:45 and several commented that they appreciated the unrushed atmosphere at breakfast time. The home had recruited new staff this had meant that many of the staff were not trained to NVQ level 2 at the time of the visit 5 carers had the award and another 15 had started the course; at current levels that would equate to 66 of the care staff with the award. All the staff spoken to said the training was of a good standard there were core specialist topics covered including a Dementia awareness course. The training programme is developed through staff supervision meetings where training needs are discussed.
Heathlands DS0000004047.V276499.R01.S.doc Version 5.1 Page 15 Residents and visitors were very complimentary about the staff in the home and they were described as kind and caring on resident said her daughter was a carer in the home. Heathlands DS0000004047.V276499.R01.S.doc Version 5.1 Page 16 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. The home is managed by an experienced and qualified manager. EVIDENCE: The manger has managed the home since 2004. He has previous care home management experience and the required qualifications. The organisation carries out monthly visits to the home and a copy of their reports are given to the manager and copied to the Commission. The residents and staff said the manager was very approachable and often joined the early morning handover meeting to keep abreast of changes in care needs. Heathlands DS0000004047.V276499.R01.S.doc Version 5.1 Page 17 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X X STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X X Heathlands DS0000004047.V276499.R01.S.doc Version 5.1 Page 18 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. 1 Standard OP7 Regulation 15(2) Requirement The risk assessments and care planning must involve the resident or their representatives and appropriate healthcare professionals. Timescale for action 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 OP7 OP9 OP9 Good Practice Recommendations Any specialist equipment provided for the care of residents should be included in the care plan. Where manuscript amendments are made to the medication administration record the alteration should be checked and countersigned. Any known allergies should be recorded on the medication records. Heathlands DS0000004047.V276499.R01.S.doc Version 5.1 Page 19 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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