Inspection on 20/06/07 for Heathlands Residential Home

This inspection was carried out on 20th June 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Heathlands Residential Home 07/02/06

Heathlands Residential Home 13/09/05

Heathlands Residential Home 27/07/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Heathlands Residential Home Crossfell Wildridings Bracknell Berks RG12 7RY Lead Inspector Steve Webb Unannounced Inspection 20th June 2007 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 Residential Home DS0000031025.V330656.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 Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heathlands Residential Home Address Crossfell Wildridings Bracknell Berks RG12 7RY 01344 425650 01344 302427 linda.parsons@bracknell-forest.gov.uk www.bracknell-forest.gov.uk Bracknell Forest Borough Council Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Linda Frances Parsons Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Heathlands is a purpose-built registered residential home accommodating older people. The home accommodates up to thirty-six long stay residents and provides an additional two short-stay beds for respite care. There are bedrooms on both ground and first floors and all rooms are single occupancy. The home is operated by Bracknell Forest Borough Council and is located in a residential area in Bracknell, with local shops available nearby. The home provides a choice of three main lounge areas with smaller seating areas available separate from these. Residents also have the choice of two dining rooms. The home has two main encloses garden areas with keypads on exit gates, to enable residents to move freely and safely within the gardens, which provide areas of lawn, paved paths and patios, and seating in various areas, with shade available, as well some sensory planting. There is also a first floor terrace where residents may sit outside. The current fees at the time of inspection were £510 per week, with additional charges for hairdressing, chiropody, toiletries, papers and some day centre provision. Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit from 09.45 until 18.45 on 20th of June 2007. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from brief conversations with staff members on duty, and discussions with the manager. The inspector spoke to a number of the residents during the inspection, and some time was also spent observing the interactions between residents and staff at various points during the inspection and over lunch with the residents. Written feedback was obtained from five residents and the relatives of two of the residents, who were broadly happy with the service provided. Two GP’s and a district nurse also completed inspection comment cards. The inspector also toured the premises, and ate lunch with the residents. What the service does well: The needs of prospective residents are effectively assessed by the home prior to admission, to try to ensure that the home can meet their needs effectively. The needs of each resident are identified within their individual care plans, and appropriate risk assessments are undertaken, and these documents are kept under regular review. Staff work diligently to meet the identified needs of residents, and engage with them individually in the course of their work to maintain their wellbeing and involvement. Residents’ healthcare needs are effectively met with support from external healthcare agencies where necessary. The home has an appropriate system to manage the medication on behalf of residents, but would enable self-management of medication if requested, subject to risk assessment. The home addresses the privacy and dignity of residents effectively, and residents feel their needs are generally well met by the staff. Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 6 The social, cultural and spiritual needs of residents are provided for within the home, with a range of activities, outings and opportunities for worship being made available, though take-up of the activities provided can be limited. The home supports the ongoing contact between residents and their families and friends, and staff support residents to take day-to-day decisions and to take part in domestic tasks if they wish and are able to do so. Residents receive a varied menu and feedback suggests that the food is more than satisfactory for most residents. Residents and relatives were confident the home would respond to any concerns raised and were aware of the procedure. The home has systems in place to protect residents from harm, including regular staff training and appropriate recruitment and vetting procedures. Residents are provided with a well-maintained, homely environment, within which hygiene standards are good. Residents needs are met effectively, by the numbers and skill-mix of staff within the team. Recruitment and vetting practice protects the residents. Residents live in a well run home with sound management, and the manager is personally accessible to the residents in whose interests, the home is run. The financial interests of residents are appropriately safeguarded by the home’s financial management systems, and their health, safety and welfare are promoted effectively by the home, though some minor issues still need to be addressed. What has improved since the last inspection? The majority of the home has been redecorated since the last inspection. Recruitment has been successful since the last inspection, with four new care staff having been appointed, reducing the home’s reliance on agency staff. Four additional permanent staff have recently been recruited. Good progress is being made on the level of NVQ attainment and other training input to ensure that residents are in safe hands. Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Heathlands Residential Home DS0000031025.V330656.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 Residential Home DS0000031025.V330656.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3 and 6: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective residents are assessed by the home prior to admission, as well as the home receiving any available care management assessment, to try to ensure that the home can meet their needs effectively. Standard 6 is not applicable as the home does not provide an intermediate care service. EVIDENCE: Copies of pre-admission assessments were in place in two of the three files examined as part of case tracking. The service now has a detailed needs assessment of its own rather than relying solely on the information provided by the referrer. The assessment is undertaken where the resident is living at the time, usually by the manager, along with a second staff member. Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 10 The referral and admission procedure includes a pre-admission visit, and this was confirmed by two of the residents in discussion. Four of the five residents who completed inspection questionnaires also indicated they had received some information about the home prior to coming. The home does not provide an intermediate care service but does have two designated short-stay beds, which are used for emergencies and respite care. Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, and 10: Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The personal, social and healthcare needs of each resident are identified within their individual care plans, and appropriate risk assessments are undertaken, and these are kept under regular review. However, some aspects of recording could be improved in these areas. Staff work diligently to meet the identified needs of residents, and engage with them individually in the course of their work to maintain their wellbeing and involvement. Healthcare needs are effectively met with support from external healthcare agencies where necessary. The home has an appropriate system in place to manage the medication on behalf of residents, but would enable selfmanagement of medication if requested, subject to risk assessment. The home addresses the privacy and dignity of residents effectively, and residents feel their needs are generally well met by the staff. Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 12 EVIDENCE: The residents’ files contain a standard care plan format, together with a record sheet indicating monthly review of the plan, and noting any changes necessary. The care plan addresses the necessary areas including physical, social and emotional needs as well as diet, communication, mobility, and level of self-care ability, and includes some evidence of the preferences of residents around their care, where known. Each file also contains a risk assessment summary format, which supports residents in taking some appropriate risks, identifying where support is necessary to enable this. This, like the care plan is regularly reviewed and dated. A manual handling assessment is also present, and there were copies of recent annual reviews in each of the three files examined. Each resident also has a second, (archive) file, containing old Medication record (MAR) sheets, expenditure receipts and daily notes. Current copies of care plans, MAR sheets, etc. are held collectively per floor for ready access by staff for reference and record-keeping purposes. There were references to residents’ choices, rights and preferences within the case files and plans, but these aspects could perhaps be further developed to evidence the consultation with residents, which was evident from discussion with staff and residents. Copies of accident forms were also usually present, but not in one case. (See discussion re accident recording in Management section of report). The healthcare needs of individuals are being recorded within the daily contact sheets and unit diary systems. It is suggested that these be recorded individually to better reflect confidentiality issues, within a standard format to include the dates and brief summary of all healthcare contacts and support. Significant details of individual appointments should continue to be recorded within daily notes and, where relevant, within the care plan, if changes in the care needed, have arisen. Similarly records of the personal care support given, where these are recorded, are held on collective record sheets containing the details of various residents, which prevents them being filed on individual files. It is recommended that a format for individual records of personal care given, is created, which provides confidentiality and enables filing on the relevant resident’s file once completed. Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 13 The home maintains good relationships with external healthcare professionals, from whom advice and equipment can be obtained. Feedback from two GP’s and a district nurse was very positive regarding the care provided, and the staff’s awareness of the healthcare needs of residents. It was reported that a staff member always accompanies a resident where they need to go to hospital, unless a family member is escorting, to ensure that their basic needs are met promptly whilst at the hospital. Examination of a sample of medication records indicated an appropriate system to manage medication on behalf of residents, which included individual MAR sheets, medication stock sheets and a returns log, which together provide the required audit trail for the medication. However, a couple of gaps were noted and the unit convention of entering a cross to clearly indicate that a PRN (as required) medication had not been given, was not always followed. Staff should be reminded of the importance of following the correct recording procedure. Observation of administration practice indicated this to be appropriate. None of the current residents is able to manage their own medication, but this is enabled where possible and desired, subject to risk assessment. Medication is then stored within a lockable area within the resident’s bedroom if required, and varying degrees of staff support would be offered according to need. At present the senior staff have been trained and administer the medication, but care staff are also being trained and will commence this role once assessed as competent. Residents confirmed that their privacy and dignity were respected by the staff, and that staff always knocked on their bedroom door before coming in. Each resident has a single bedroom unless two individuals have specifically asked to share. The wishes of residents, upon their death are obtained wherever possible and recorded to ensure that their dignity and wishes continue to be respected at the end of their life. It was also commented that the staff usually respond promptly to the call bell, and the residents who completed the inspection survey felt that their care and medical needs were usually well met, and staff were observed to engage residents in conversation when interacting with them, to provide emotional as well as physical support. The home has the necessary adapted bathing equipment to meet the needs of the current residents and there are plans for the conversion of an old hoist Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 14 bath into a level-entry shower facility. Any required aids to reduce the risk of pressure area development are obtained on an individual basis when required, from the health authority, thought the home does own some adjustable beds to meet individual needs. Two of the residents have reverted to speaking languages other than English as they have become older, but in each case there is a staff member who can converse in their mother tongue, which helps to reduce isolation and ensure that some communication can be maintained. The manager indicated they would seek external support within the locality to address any unmet cultural or language needs. Though a number of residents use wheelchairs, all but one of them are able to move around without using one when within the home, and they tend only to be used when supporting these residents out in the community. The doorways in the home are sufficiently wide to accommodate wheelchairs and there is a lift between floors. Ramps have been provided at any changes of level to enable residents to circulate freely, and one of the two vehicles used by the home is a ramp ambulance. Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15: Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The social, cultural and spiritual needs of residents are provided for within the home, with a range of activities, outings and opportunities for worship being made available, though take-up of the activities provided can be limited. The home supports the ongoing contact between residents and their families and friends, and staff support residents to take day-to-day decisions and to take part in domestic tasks if they wish and are able to do so. Residents receive a varied menu and feedback suggests that the food is more than satisfactory for most residents. EVIDENCE: The manager described a number of activities made available to residents, both within the unit and in the local community, including bingo, bead making, basketwork, quizzes, reminiscence sessions, drives out in the bus, visits to local garden centres, trips to a farm shop, shopping outings, and feeding the ducks. Trips to a local fish and chip shop were also said to be very popular. Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 16 There had been a previous visit by a travelling farm, who were due to visit again in the near future, and a steel band had also visited as part of a Caribbean day, which some of the residents also remembered favourably. A dance therapy session had been booked, and some volunteers were due to come to undertake a container planting session in the garden with residents. One resident suggested they grow some strawberries in a planter. The home has two vehicles available, a ramp-ambulance and an un-adapted minibus, which are used for outings and transport to hospital etc. Some of the residents access day centres in the community and occasionally places on outings are offered to residents, by the on-site day centre, which provides a service to others in the community, when there are spaces. Some of the residents felt that there could be a greater variety of activities provided for them to choose from, but one acknowledged that a lot of people didn’t really want to take part when they were provided. One resident summed up their view by saying “ I couldn’t fault this place”, and others said “the staff are very kind and helpful”, and “It’s nice and quiet here”. The home has a cat, chosen by some of the residents from a cat rescue organisation, who was popular with the residents spoken with. Residents’ spiritual needs where identified, are either met through visiting clergy or they can be taken to appropriate places of worship. At present, clergy from the Baptists and Church of England faiths visit the home, and a local Catholic priest will visit on request. Residents described going on visits to family, and receiving visits from them at the home, and confirmed that their visitors were made welcome. The staff have provided an escort and transport to enable residents to visit family on occasions. Visitors to two of the residents, were met by the inspector in the course of the inspection, and confirmed that they were made welcome by the staff who would answer any concerns they might have. They described the home as clean and pleasant, and felt that the manager was also accessible should they feel the need to talk to her. The visitors also felt that residents were given choices, though again there was a perception of a lack of available activities. Perhaps the manager should consider advertising the available activities more prominently via notice board displays, or a monthly newsletter to raise their profile. Questionnaires to residents at admission and resident surveys regarding potential activities and trips could also help identify new ideas. Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 17 Four of the staff had previously attended training on engaging residents in activities and a further course was planned. A document on the principles of involving residents and carers, was available in the unit, and the manager said that resident were encourage to take on small domestic tasks if they were able to manage these and wished to be involved, and residents confirmed that they were asked to make day-to-day choices. The manager is considering the appointment of a dedicated activities coordinator, alongside other development plans for the service. Residents who smoke are able to do so on the patio outside the dining room. Residents confirmed that there had been some recent resident meetings, (initiated by a student on placement at the home), and one felt this was a good idea to discuss planned activities and menus. The manager is seeking to continue them, which would be a positive development. Residents were generally pleased with the meals, and the lunch on the day, consisting of ham, chipped potatoes and cauliflower cheese, followed by trifle, was well presented and tasty. Residents ate lunch in a quiet and unhurried atmosphere, in one of two dining rooms, which were pleasantly decorated. Food is transferred to the upstairs dining room directly via a dumb-waiter system. Staff were attentive and support was offered discretely, where necessary, for example by cutting up the meat for one individual, and in one case helping to feed a resident. One resident commented that there were always lots of fresh vegetables. The feedback obtained from inspection surveys was also positive with regard to the menus. A resident said that one of the staff gets her some fresh fruit on her behalf, when she can’t go out, and also described having purchased some fresh produce once during an outing, which the chef later cooked for her as part of her teatime meal. There was a choice of water or squash at lunch and one resident had her preferred glass of sherry. The manager indicated that they monitored and encouraged levels of food and fluid intake carefully, and offered ice-lollies in hot weather to assist with this, and fruit smoothies to increase vitamin intake. The menus were posted on the dining room wall and indicated a varied diet, and choices of main meal on most days. One resident receives a special diet to manage their diabetes, and the home has previously provided a gluten-free diet to a resident. Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives were confident the home would respond to any concerns raised and were aware of the procedure. The home has systems in place to protect residents from harm, including regular staff training and appropriate recruitment and vetting procedures, though complete records should be available within the unit. EVIDENCE: The home has an appropriate complaints procedure in place, which was posted on the notice board. The complaints log indicated that the last recorded complaint was dated 29/5/06, and this had been resolved appropriately. No complaints about this service have been received since the previous inspection. In discussion with the manager it seemed that most issues that were raised, were dealt with then and there, and not felt to need logging as complaints. A small number of these other issues could have been logged as complaints, since the positive management attitude expressed towards the lessons that the service could learn from complaints, could not currently be demonstrated via the log, in the absence of any recent entries. Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 19 Residents the inspector spoke with were clear they would be happy to raise any concerns with senior staff or the manager, and expressed confidence that the matter would be addressed. Six residents and two relatives who completed inspection questionnaires also confirmed they were aware of the complaints process. The recent residents meetings appear to have been a success and the manager is seeking to continue these. This would be a positive development as it provides a forum for any concerns to be raised as well as demonstrating that residents have a say in aspects of how the home is run. The home has systems and procedures in place to protect residents from abuse and staff receive POVA training on a two-year cycle and receive an induction in accordance with the Common Induction Standards. Appropriate systems are in place to protect residents’ funds, where the home manages these on behalf of residents. There have been no POVA incidents since the last inspection in February 2006. Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 19 and 26: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a well-maintained, homely environment, within which hygiene standards are good. EVIDENCE: The home was in good decorative order, having been redecorated throughout in the recent past. Communal rooms were light and airy and corridors well lit. There are two main lounges and additional small seating areas are available. The bedrooms seen were pleasantly decorated and individualised to varying degrees, with one or two standing out in particular. Two of the residents confirmed that they very much liked their bedrooms. Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 21 As noted earlier, the home has two main dining rooms, which enables the residents to be divided into two smaller groups. Both rooms are pleasantly decorated and homely, and provide a pleasant dining environment. The home has appropriately adapted bathing facilities to meet the needs of residents, with two parker bath-equipped bathrooms and a further bathroom which is due to be converted into a level-entry shower room. There are two main areas of garden, which are fairly secluded and enclosed to enable residents to move about freely. Exterior gates are secured with keypad locks to prevent unauthorised access, or residents getting onto the road without staff being aware, and external doors are alarmed. There is also an enclosed terrace area accessible from the first floor. The gardens offer paved and lawned areas, some sensory planting and some raised planters to try to encourage and enable resident involvement. Ramps are provided where necessary at exits to the garden. There is a range of seating available and shade is provided for residents, by trees, umbrellas and an awning over the first floor terrace. Observed standards of hygiene were good, and were confirmed by residents to be so, with no evidence of unpleasant odours, and the home has an appropriately equipped laundry. Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents needs are met effectively, by the numbers and skill-mix of staff within the team, and additional permanent staff have recently been recruited. Good progress is being made on the level of NVQ attainment and other training input to ensure that residents are in safe hands. Recruitment and vetting practice protects the residents, but is not fully evidenced within the unit. EVIDENCE: The staff team has an appropriate skill mix and there is a core of long-term staff. Retention is good with only three staff having left since the last inspection. Feedback from residents regarding the staff was generally very positive, individual comments included “the staff respond quickly to the bell”, “the staff are kind and helpful”, and “the chef is very kind”. One relative confirmed that the staff provided appropriate information openly, when asked. It was commented that the home appeared short of staff on occasions. The home had been using quite high levels of agency staff, but this was being Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 23 reduced since the appointment of four new staff who were undergoing their induction. The manager indicated that where they had to use agency staff, these were individuals who had previously worked in the unit and were familiar with the residents, wherever possible. Regular staffing is four carers throughout the day, divided into early and late shifts, with, at times, an additional person in the busy periods, plus a duty officer and manager 9am-5pm Monday to Friday (mostly), though the manager said she undertook occasional shifts to monitor and observe issues for herself. On weekdays there is also admin. Support and two domestics 9am-4pm, and the home has a gardener/handyman who also drives the unit vehicles at times. In the kitchen there are two cooks and a kitchen domestic daily. At nights there are two waking night staff and a staff member sleeping in nightly. Around 36 of the staff had attained their NVQ, but in September, one staff member is starting their NVQ level 4 in management, one, the registered manager’s award and three staff are due to start their NVQ level 3. These are to be fast-tracked. A sample of recruitment records for two recent recruits, indicated that the thorough process described, could not be fully evidenced in both cases, as copies of ID and references were not on file in one case. The manager confirmed that she saw the references for all staff and that copies of ID were held at head office. Copies of these items should however, be available for inspection within the home. The human resources department provide written confirmation of a satisfactory enhanced CRB check having been returned. Staff training was generally good, though at the time of inspection only 20 of them had a first aid qualification. The manager indicated that a further six staff were booked on an upcoming course and said that the one-day first aid course was now included within staff induction. Written induction records were in place in accordance with the Common Induction Standards and staff receive a copy of the code of conduct. It was positive that four staff had attended training on providing activities for older people and the manager plans for others to attend this training. Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a well run home with sound management, and the manager is personally accessible to the residents. The home is run in the best interests of residents though the quality assurance system and reporting could be developed further to provide feedback to participants. The financial interests of residents are appropriately safeguarded by the home’s financial management systems, and their health, safety and welfare are promoted effectively by the home, though some minor issues still need to be addressed. Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 25 EVIDENCE: The home’s manager is appropriately qualified and experienced, having attained her NVQ level 4 in care and management, and the Registered Manager’s Award. She has managed the unit for twelve years, having worked there for 26 years. Residents commented that the manager was available and accessible to them, and also noted that they enjoyed being consulted via the recent house meetings and hoped they would continue. A series of quality assurance questionnaires are provided annually, for residents, relatives and visiting professionals, and are returned to head office, who produce an internal summary report to the manager, which is not currently shared with participants in the survey. It would be best practice to provide a summary report to the participants, including details of any proposed action in response to matters raised, as this validates their contributions and demonstrates that appropriate action is taken in response to any concerns. An annual business plan is prepared for the unit, which addresses the majority of relevant areas to fulfil the need for an annual development plan. The manager should ensure that the full range of developmental issues and priorities are addressed within this document. The provider does undertake Regulation 26 monitoring visits though there were significant gaps in the resulting reports available on file in the home. The manager confirmed that the visits took place monthly and undertook to ensure that copies of all visit reports were available in the file. It is also suggested that the full date and times of the visit, should be recorded on these reports, not just the month and year. Examination of a sample of the home’s records of the management of residents’ finances indicated appropriate individual running balance sheets, and receipts are retained of any expenditure. Indications from the receipts were that money was spent on the expected range of items, mainly hairdressing, toiletries and other individual items. These records are included in the home’s biannual external audit. Examination of the accident records indicated appropriate levels of recording for the most part, though the completed accident forms were being retained Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 26 within the book, despite being in tear-off format. The accident book was being kept secured, confidentially. Staff also have to complete a separate local authority accident form, which is copied to head office and the resident’s file, and in relevant cases, also a RIDDOR form. In one case this second format had yet to be completed, though the accident book did contain a completed form. Also there were three forms in the accident book that had not been fully completed, all of which had been started by the same ex-staff member. Staff should be reminded of the need to fully complete the accident record as soon as possible after the event. It is suggested that consideration be given to having only the tear-off accident format (plus RIDDOR form, where necessary), to reduce duplication. The completed forms should, in any event, be removed from the accident book and stored collectively as the unit’s record of accidents. It is also suggested that this completed form could be photocopied and a copy placed on the relevant resident’s file as the individual record. Examination of a sample of health and safety-related service records indicated that all had been carried out with the required frequency. However, it appeared from the electrical appliance testing record, that items in a number of the bedrooms may not have been tested. The manager agreed to arrange a re-test to cover these items. A fire drill had been held in February and previously in July of 2006, and records included a detailed analysis of any issues that arose. The unit had a fire risk assessment in place, which had been reviewed in April, and the manager confirmed that all of the matters raised in a fire authority deficiency notice just after the last inspection had been addressed. Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 27 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 4 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 28 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 OP29 Regulation 17(2) & Schedule 4.6 Requirement The provider must ensure that appropriate evidence of the recruitment and vetting process is available within the unit, to confirm that the system protects residents, appropriately. Timescale for action 20/07/07 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 Refer to Standard OP8 Good Practice Recommendations The manager should consider the separation of personal care records within an individualised format, to enable these records to be filed on completion as part of the care history of each resident. The manager should consider the creation of an individual record of healthcare appointments to enable these records to be filed on completion within the individual resident’s case record. The manager should remind staff of the importance of adherence to the proper recording system for medication to provide evidence that the needs of residents, with respect to medication, have been met. DS0000031025.V330656.R01.S.doc Version 5.2 Page 29 2 OP8 3 OP9 Heathlands Residential Home 4 OP33 5 OP38 The manager/provider should consider further development of the quality assurance system as detailed, in order to provide feedback to the participants in the process. The manager/provider should consider the recommendations regarding the accident recording system, to ensure that required records are present to provide evidence that appropriate action was taken in the event of an accident to a resident. Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: 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 © 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 Heathlands Residential Home DS0000031025.V330656.R01.S.doc Version 5.2 Page 31 - 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. 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