Inspection on 12/08/08 for Heathside House

This inspection was carried out on 12th August 2008.

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

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

Heathside House 17/02/09

Heathside House 25/06/07

Heathside House 01/02/07

Heathside House 21/06/06

Heathside House 09/01/06

Heathside House 16/08/05

Heathside House 30/03/05

Heathside House 30/09/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

CARE HOMES FOR OLDER PEOPLE Heathside House Heathside Lane Goldenhill Stoke On Trent Staffordshire ST6 5QS Lead Inspector Linda Clowes Key Unannounced Inspection 08:30 12th August 2008 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 Heathside House DS0000030493.V364340.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. Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heathside House Address Heathside Lane Goldenhill Stoke On Trent Staffordshire ST6 5QS 01782 234551 01782 234553 karl.shepherd@stoke.gov.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) Stoke on Trent City Council Mr Karl Shepherd Care Home 44 Category(ies) of Dementia - over 65 years of age (44), Learning registration, with number disability over 65 years of age (2), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (5), Old age, not falling within any other category (44), Physical disability over 65 years of age (44) Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 2 Learning Disability over 65 years pf age (LD(E)) - Places for existing residents only To include 1 male service user under the age of 65 years. Date of last inspection 25th June 2007 Brief Description of the Service: Heathside House is a care home registered to provide personal care and accommodation for up to 44 older people. It provides long term and respite care and includes an eight-bed Elderly Mentally Ill (EMI) unit. The home is situated in Goldenhill, on the outskirts of Stoke-on-Trent and was purpose-built approximately 25 years ago. It is managed by Stoke-on-Trent City Council. Heathside is located in a residential area and is close to a wide range of community amenities and well served by public transport. There are good local community links including churches, pubs, shops and community centres. The home is situated in its own grounds surrounded by lawns and shrubs. It has a patio area with seating surrounded by secure fencing. Limited on site car parking is provided although parking is available on the surrounding side roads. The home is purpose built with accommodation provided on two floors. There is a passenger lift and stairs access between floors. All bedrooms are single occupancy with a wash hand basin and, although the rooms are quite small, there is compensatory communal space to enable the service to meet the minimum standards. Bedrooms seen were comfortable and homely and had been personalised by service users with their own possessions. Although there are no en-suite facilities there was a range of bathrooms with assisted bathing facilities and toilets and separate toilets all conveniently situated throughout the home. There was also a walk-in shower facility. The home is divided into four areas (Wedgwood, Leadale, Newhaven and Goldenview) all of which have their own sitting rooms and dining areas. In addition, there is a dedicated smokers lounge situated off the entrance hall. Three of the lounges offer a domestic style of environment with a kitchenette area for preparing breakfasts, snacks and drinks. Information about fees were not included in the Statement of Purpose or Service Users Guide. Prospective service users and their relatives would need to apply directly to the home to establish current fees. Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 5 Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The overall quality rating for this service is zero star. This means that the people who use this service experience poor quality outcomes. The Lead Inspector for the home was accompanied by Mr Ian Henderson, Pharmacist Inspector, during this unannounced inspection. We inspected against the National Minimum Standards for Care Homes for Older People and the Care Homes Regulations 2001. This was a key inspection and covered all of the core standards. This inspection took place over a period of eleven hours and included an examination of records, service user care plans, personnel files and associated recruitment procedures, complaints files, health and safety records and a feedback session. Various methods were used to obtain information regarding the services provided by the care home. We spoke with a high number of people who use the service on the day. Questionnaires were forwarded to fifteen people who use the service and four responded. We also received a survey from a health care professional Prior to the inspection visit the Providers had completed a self-assessment tool, which is known as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to undertake a self-assessment, which focuses on how well outcomes are met for people using the service. Information from this AQAA was used to plan the inspection visit and references to it have been included in this report. The AQAA was returned on time and gave a reasonable picture of the current situation within the service. Indeed, the AQAA tells us that in the Local Authority’s ten-year plan this home is targeted to become a Centre of Excellence. Discussions with the Registered Manager identified that this would probably take place in the next two years. We had received information about the service that had prompted us to arrange for the Pharmacist Inspector to accompany us to monitor the medication arrangements. Unfortunately, the concerns raised have been upheld and there are a number of requirements relating to medication as part of this report. We discuss this in more detail under the section for Health and Personal Care. Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 7 We were also concerned that in some cases good quality, explicit information was not recorded in the plans of care of individuals. Without detailed recorded information care staff would be unable to provide a ‘tailored’ person centred service to meet individual needs; particularly in a home that has 50 bank and agency staff on each shift. Of the 37 people who were resident in the home on the day of this inspection, (including one short stay) twenty-five had dementia care needs. What the service does well: What has improved since the last inspection? What they could do better: Medication was an issue during this inspection visit. There must be an immediate improvement to ensure that people who use the service are not placed at risk of harm. Information contained in the plans of care must be up to date and in sufficient detail to inform care staff what they must do to meet people’s individual needs. It was considered that there were insufficient care assistants on duty to cover the needs of the people who used the service. 50 of the care staff on duty were bank or agency care assistants. A move to more permanent staff would assist in improving the quality of the service. Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 8 A review of the timing of meals should be carried out to ensure that meals are served at times to suit the people who use the service 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. Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 9 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 Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 10 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): 1, 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service provides information in order that prospective service users are able to make an informed choice about whether the home is suitable for them. EVIDENCE: No requirements were made in this outcome group in the last inspection report. The home understands the importance of having sufficient information when choosing a care home and those people spoken with on the day confirmed that they had chosen to move to Heathside. Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 11 The home had a current Statement of Purpose and Service User Guide. All corporate literature was available in different formats and languages on request. We received four surveys from relatives in relation to this service and all considered they had been provided with sufficient information about the care home. A high number of people who use the service have dementia care needs that have an affect on the dynamics of the home and the interactions between people who use the service. This is a consideration for some people who may be looking for care home accommodation. In order to address this issue, the home is divided into four separate units, although people are able to access all areas, to more readily accommodate more dependent residents as well as those who benefit from more social interaction. Each service user has a contract outlining the terms and conditions of residency. We spoke with one relative on the day who said “My mum is so settled here. It was the right choice for her as well as our family. Staff are very supportive of all of us”. Heathside does not provide intermediate care; therefore, this standard was not inspected. Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 12 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): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Not all of the plans of care provide enough detail and instructions to staff about how they should manage the current health care needs of the people using the service. The current medication arrangements place the people using the service at risk of harm. EVIDENCE: Two requirements were made in this outcome area in the last inspection report, for the home to rationalise care planning to offer more comprehensive records and for dates to be noted on packets when creams were opened. These issues had not been fully addressed. We monitored the plans of care for five people. Each contained a full assessment of need completed by the social worker. Two had a complete plan Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 13 of care completed by the home, two were partially completed and one was not started even though the person had been in the home since 15/05/08. Without person centred plans of care, clearly specifying how the person’s needs must be met, it is difficult for care staff to provide an individual service as outlined in the care needs assessment. An immediate requirement was made in relation to this issue on the day of our visit. We will continue to monitor this situation. Prior to this inspection we had received information from a health care professional regarding concerns with medication procedures. In view of this, we had asked our Pharmacist Inspector, Ian Henderson, to accompany us to monitor medication arrangements. His report is outlined as follows: In summary the medicines management systems within the home were poor and as a result seven urgent action conditions were left on the day of the inspection in order to ensure that the poor medication practices are eradicated. We found that the medication records were poor and could not be used to evidence that medicines were being administered as prescribed. The quantity of medication received into the home is not always being recorded. Any medication carried over from the previous month is not being taken into account and added to the new quantities at the start of the next month. We found gaps in the administration record and therefore it could not be confirmed whether the resident concerned had received their medication. We also found that the treatment sheets, which care staff used to record the administration of creams and ointments were not being always being completed after the application of the creams and ointments. We also found that where variable doses had been prescribed the records did not show what quantity had been given. We found that the home was administering some “when required” medication on a regular basis but there was no evidence that the medication was required. We found overall that the care plans were poor for containing information about the administration of medicines. In particular we found little or no information about: (i) the administration of when required medication, (ii) the administration of as directed medication, (iii) the changes made to the doctors original directions and (iv) the reason for the administration of the medication and where appropriate the length of treatment, in particular the administration of creams and ointments. A number of concerns were highlighted with the administration of the peoples’ medication. One of these concerns was the insufficient time period between the morning and lunchtime medication rounds. Normally the morning medication round Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 14 would start at 9:00am and finish at around 10:00am. With the lunchtime round starting at 12:15pm the administration process, as it stands, does not guarantee that there is an adequate gap between doses to ensure the safety of the people using the service, particularly with the administration of Paracetamol containing products. We also found that the home had been administering an out of date medicine for a period of 14 days. We were informed that all assistant managers who administered the medication had received training on the safe handling of medicines. We found no evidence that the assistant managers had undergone any assessments to check that they were competent to handle and administer medication safely and correctly. We found that the care staff were administering medicated external products such as creams and ointments and eye drops but none had undergone any formal medication training. We also found that the assistant managers were taking small blood samples for the purpose of assessing the blood sugar levels of some of the people using the service. We found that none of the assistant managers had received any training or been assessed as competent to carry out the process safely by any healthcare professionals. We found that not all prescribed medication is being kept secure. We found numerous medicated creams/ointments located in the residents bedrooms. As a consequence all occupants and visitors have access to this medication, which could, if used inappropriately, affect the health and welfare of those concerned. We also found that all grades of staff within the home have access to the treatment room thus creating a greater security risk for the medicines held within the room. Medicines are not being stored at the correct temperatures. Medicines should not be stored above 25°C yet on the day of the inspection the temperature of the treatment room was recorded at 26°C. The home is not recording the temperature of the treatment room. The maximum and minimum temperatures of the fridge are not being recorded on a daily basis instead the ambient temperature was being recorded. On closer examination of the records we found that the ambient temperatures recorded were not a true representation of the actual temperature of the fridge. There were a number of medicines found in the fridge that did not need to be stored under cold storage conditions. We found that the home had failed to store a particular medicine in the fridge and as a consequence this medicine had to be discarded. There are a number of people who have been prescribed Controlled Drugs, which require a stricter storage environment. Unfortunately the home does not have a cabinet to store these Controlled Drugs that complies with the Misuse of Drugs (Safe Custody) Regulations. We found that the home is using a Controlled Drugs register to record the receipt, administration and disposal of Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 15 Controlled Drugs prescribed to the people using the service. On examination of the Controlled Drugs register we found that some improvements in the recording are needed and these improvements were discussed during the inspection. The pharmacist inspector has made five requirements and three recommendations as part of this report. Following the inspection we sent an urgent action letter to the Responsible Individual for the service to ask what action they are going to undertake to address the issues highlighted. We have received a satisfactory response to this letter but will continue to monitor the situation in further unannounced inspections. Feedback from surveys showed that relatives were satisfied with the personal care service provided. Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 16 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): 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. The home endeavours to promote the individual lifestyles of people who use the service and community links are encouraged. There is a choice of a wholesome balanced diet available. EVIDENCE: The last report required the service to provide a programme of activities suitable for all users of the service. The manager has arranged for an Activities Programme each day, mainly carried out by a bank staff care assistant. People using the service were seen watching television, listening and singing to songs of their youth. In recent months 6 people have been on a trip to Llandudno accompanied by 4 staff and a relative. Three people were case tracked as part of this inspection. This means that we checked their records against the care and actual lifestyles actually provided to them. It was found that their different choices of lifestyle were respected by the home in all respects. Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 17 One spends most of their time in the communal areas of the home, one spends the majority of their time in their own room and the third spends most of their time in the smokers lounge. Two of the people are permanent residents of the home whilst the other was on a short-stay. Even though all three have dementia care needs, they said they are happy in the home and that care staff are kind to them. Other people we spoke with on the day expressed satisfaction with their lives in the home. The AQAA shows that the home has flexible visiting times and ensures that people have a choice whether to see visitors or not. People spoken with confirmed that they enjoy the food served and that they have a choice. People were observed having cooked breakfast or cereals for breakfast – some in the dining room, others in their own rooms. It was noticed at lunchtime that a number of people did not eat all their lunch. Discussions with the cook identified that this was a problem. There is a concern that there may not be enough time between meals. This may result in people becoming malnourished. The service has been asked to undertake a review of mealtimes to ensure that people receive meals at times that are suitable to them, particularly bearing in mind the high numbers with dementia care needs. The provider has agreed to undertake a review. A recommendation has, therefore, been made as part of this report. People who use the service have the opportunity to develop and maintain important personal and family relationships. Staff practices promote individual rights and choice. One person who responded to the survey stated, “We could do with more activities – only possible if more staff was available”. Heathside House DS0000030493.V364340.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): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service and their relatives are confident that their complaints are listed to and appropriately handled. The service has policies and procedures in place to ensure that people are protected from abuse. EVIDENCE: No requirements were made in this outcome area in the last report. Details regarding Heathside’s complaints procedure are contained in the Service User Guide. The complaints procedure is also displayed in the home. We have received no complaints about the service since the last inspection visit. The service has received one complaint that has been investigated locally and upheld. The manager is aware of the protocols and procedures in respect of Safeguarding Adults from Abuse. The manager has made three safeguarding referrals since the last inspection and these were investigated by the Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 19 Safeguarding Team. The registered manager is reminded of the need to notify us of any safeguarding issues. The AQAA states that staff are aware of the vulnerable adults policy and that they are informed about the whistle blowing policy. A member of staff spoken with on the day confirmed that these issues were part of their induction training. The home is able to arrange advocacy services where appropriate. All four people who responded to surveys confirmed that they were aware of the home’s Complaints Procedure. Heathside House DS0000030493.V364340.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): 19, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is clean and hygienic, but would benefit from being upgraded to better assist people with dementia care needs. EVIDENCE: No requirements were made in this outcome area in the last report. The service provided adequate facilities for people. It is understood from the AQAA that architects of Stirling University have recently visited and given advice about how the home can be improved to better assist people who have dementia care needs. This issue was also acknowledged in the AQAA, which states, “the environment would benefit from alterations that further support the daily function of disorientated service users….”. This issue will be Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 21 monitored at the next inspection visit to identify progress and a recommendation has been made as part of this report. The home is clean, pleasant and hygienic. No unpleasant odours were detected during this visit. It is of concern, bearing in mind the care needs of the majority of people in the home, that fire doors in the laundry area were propped open for most of the afternoon. This area was unmanned and easily accessible by people who use the service. A requirement has been made as part of this report for this matter to be reviewed as it may cause a risk to people who use the service. The AQAA states that there is a rolling programme of decoration of the home. However, they have been without a handy person for some months. We were assured that this post will shortly be advertised and filled. There is a pleasant patio area where people can sit and enjoy the warm weather should they choose to do so. It was noted that the area would benefit from weeding. Heathside House DS0000030493.V364340.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): 27, 28, 29, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are not enough care staff on duty to meet the needs of people who use the service. Particularly, bearing in mind the physical layout of the home and the division of people who use the service into four lounges according to dependency levels. EVIDENCE: This inspection identified that in view of the geography of the home and the complex needs of people who use the service there were insufficient care staff on duty. It was also identified that on most of the shifts for the past three months 50 of the care staff were either bank or agency staff. It is understood that there are vacancies for 2 care assistants, 1 night care assistant and 1 handy person. The AQAA shows that twenty-seven people need help with dressing/undressing and with assistance to the toilet and all needed a degree of assistance with washing and bathing. The current people who use the service are very dependent on the staff supporting them. Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 23 We asked that an urgent review of staffing requirements be undertaken and left an immediate requirement form on the day. Subsequently, we have been advised that the home has allocated an extra 70 care staff hours per week with immediate effect, we will continue to monitor this. From information provided we identified that three Assistant Managers have attained National Vocational Qualification (NVQ) level 3 in care and one has NVQ level 2. Of the 20 permanent care staff 11 have attained NVQ level 2 in care. It was also identified that none of the bank or agency staff have an NVQ qualification. The AQAA shows that no care staff are working towards NVQ Awards. We would expect the service to be actively promoting and supporting staff to take up a relevant qualification. We were not able to confirm on the day how many care staff have received dementia care training and we asked that this information be obtained and forwarded to us. We have since been advised that 17 of the 20 permanent care staff have attended dementia care training. The remaining three have now been nominated to dementia care courses. Four of the casual staff require dementia care training and these have also been nominated to dementia care training courses. It is recommended that information regarding qualifications of staff working in the home, including care staff is readily available. The Registered Manager is a trained trainer for the Management of Actual or Potential Aggression (MAPA) and a high number of staff have attended this training. The Assistant Managers are responsible for administration of medication. We were able to identify that three have received medication training but there was no record on file to show that the fourth has received such training. One member of care staff was also administering mediation but we were unable to confirm that she has attended medication training. The Pharmacist Inspector has made a requirement as part of this report for the service to ensure that only competent staff are involved in the administration of medication. A random sample of care staff files was inspected. It was identified that robust recruitment procedures had been undertaken with the taking up of Criminal Record Bureau Enhanced Disclosures (police checks) and two references for each person. We interviewed one care staff on the day. She was able to confirm that she had received thorough induction training. Her moving and handling training was up to date. She has attended on-going training. She confirmed that she is well supported by managers in the home to enable her to do a good job. She also confirmed that she attends regular supervision sessions with her line manager. Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 24 Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 25 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): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing issues and poor medication practices in the home have a negative impact on the quality of the service for the people using the service. The service must be continually monitored to ensure that it meets the needs of the people using the service. EVIDENCE: No requirements were made in this outcome area in the last inspection report. The Registered Manager has relevant qualifications for his role and he has worked in the home for many years. Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 26 It was disappointing, however, to identify concerns with medication procedures and the competency of staff administering medication. Since our visit procedures have been put in place for the manager to regularly monitor all aspects of medication to ensure that the people who use the service are in safe hands. The manager understands person centred planning and the principles behind this and since our visit has tightened up procedures to ensure that accurate individual information is included in the plans of care for each person who receives a service in the care home. Records show that regular staff meetings are taking place at all levels. Regular staff supervision is also taking place, however observation of practice should be included in this process in order to determine that staff at all levels continue to carry out their roles to an acceptable standard. The AQAA shows that there are equality and diversity policies and procedures in place. The service seeks the views of people by issuing regular service users questionnaires as an audit tool for improving the quality of the service. The manager has identified in the AQAA document that the questionnaire would benefit from being updated. One relative spoken with on the day of this visit spoke highly of staff and management at the home. She stated that she was always made to feel welcome and found managers very approachable. The service has a Business Support Assistant who deals with most financial issues for people who use the service. The City Council Auditors regularly monitor/inspect financial records at the care home. The manager is aware of his responsibility to ensure that fire, lifts, hoists and other equipment must be regularly serviced. These records were not inspected at this visit. There is current insurance in place. The Certificate of Registration was displayed as required. Heathside House DS0000030493.V364340.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 3 X 3 X X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 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 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Heathside House DS0000030493.V364340.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 OP7 Regulation 15(1) Requirement The service must ensure that a plan of care is in place for each person accommodated in the home outlining how the individual’s needs in respect of his health and welfare are to be met. This will ensure that care staff know how to provide a person centred service for every person in the home. The records of the receipt, administration and disposal of all medicines for the people who use the service must be robust and accurate to demonstrate that all medication is administered as prescribed. Appropriate information relating to medication must be kept, for example, in risk assessments and care plans to ensure that staff know how to use and monitor all medication including “when required” and “as directed” to ensure that all medication is administered safely, correctly and as intended by the prescriber to meet individual health needs. DS0000030493.V364340.R01.S.doc Timescale for action 15/08/08 2. OP9 13(2) 17/08/08 3. OP9 13(2) 17/08/08 Heathside House Version 5.2 Page 29 4. OP9 13(2) Staff who administer medication must be competent and their practice must ensure that the people using the service receive their medication safely and correctly. Medication must be stored within the temperature range recommended by the manufacturer to ensure that medication does not loose potency or become contaminated. Controlled Drugs must be stored in a cabinet that complies with the Misuse of Drugs (Safe Custody) Regulations. It is essential, bearing in mind the needs of people who use the service, that fire doors are not propped open in the home, unless it is assessed as being safe and complys with fire safety regulations. It is essential bearing in mind the needs of the people who use the service and the geography of the building that there are sufficient experienced and competent care staff deployed to provide an adequate and appropriate service. This will ensure that the people who use the service receive the care they need. 19/08/08 5. OP9 13(2) 26/08/08 6. OP9 13(2) 12/11/08 7. OP19 12(1)(a) 12/08/08 8. OP27 18(1)(a) 31/08/08 Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 30 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. Refer to Standard OP9 OP9 Good Practice Recommendations All staff administering medication should undergo regular assessments to ensure their ongoing competency to follow the home’s procedures correctly. The fridge temperatures are monitored on a daily basis using a maximum and minimum thermometer to ensure that the fridge temperature is maintained at between 2 and 8°C. The receipt of all medication is recorded and the total quantity for each medicine present within the home at the beginning of the month is also recorded prior to the start of the new month. It is recommended that a review of the timing of meals be undertaken to ensure that people who use the service receive meals at times that are suitable to them. It is recommended that the service notify us regarding any safeguarding issues that affect people who use the service. The commission is to be advised of the initiation and outcome of all safeguarding referrals. It is recommended that a review of the signage/facilities of the home be undertaken to ensure that it is better suited to the needs of those people who have dementia care needs. It is recommended that a training matrix be introduced that identifies staff training ‘at a glance’. The manager should also have a record of training (with dates) of bank and agency care staff. It is recommended that the supervision process include direct observation of the worker’s practice to ensure that this is of a satisfactory standard. 3. OP9 4. 5. OP15 OP16 6. OP19 7. OP30 8. OP36 Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Heathside House DS0000030493.V364340.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!