Inspection on 17/02/09 for Heathside House

This inspection was carried out on 17th February 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Heathside House 12/08/08

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 19/06/2009.

CARE HOMES FOR OLDER PEOPLE Heathside House Heathside Lane Goldenhill Stoke on Trent Staffordshire ST6 5QS Lead Inspector Linda Clowes Unannounced Inspection 17th February 2009 09:00 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 DS0000030493.V374194.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. DS0000030493.V374194.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 Care Home 44 Category(ies) of Dementia (44), Old age, not falling within any registration, with number other category (44), Physical disability (44) of places DS0000030493.V374194.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within other category (OP) 44 Physical disability (PD) 44 Dementia (DE) 44 The maximum number of service users who can be accommodated is: 44 20th November 2008 2. Date of last inspection 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 are comfortable and homely and have been personalised by people who use the service with their own possessions. DS0000030493.V374194.R01.S.doc Version 5.2 Page 5 Although there are no en-suite facilities there is a range of bathrooms with assisted bathing facilities and toilets and separate toilets all conveniently situated throughout the home. There is 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 is not included in the Statement of Purpose or Service Users Guide. Prospective people who wish to use the service and their relatives will need to apply directly to the home to establish current fees. DS0000030493.V374194.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 one star. This means that the people who use this service experience adequate 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. The objective of the inspection is to evaluate whether people who use the service and their family carers experience services of good quality that offer and promote independence. On the day of this inspection the Manager was on holiday and the Deputy Manager was off sick. Two Assistant Managers were on duty and took the lead. Another Assistant Manager was ‘on loan’ from another City Council care home. We identified concerns, mainly with medication, at the last Key Inspection on 12th August 2008 following which we carried out a random inspection on 3rd October 2008. We considered at this stage that the home was providing poor services. As there were still issues with medication on 3rd October 2008 we issued a Statutory Requirement Notice to the service requiring them to improve medication practices within a specified timescale and we carried out a further Random Inspection on 20th November 2008 to monitor compliance. It is our policy to carry out a Key Inspection within six months where a service is rated as poor. This is to determine how the service is progressing and whether there is a sustained improvement in the quality of the service. This inspection took place over a period of ten hours. We looked at people’s assessments and care plans, personnel files, complaints files, medication records, health and safety records and gave a feedback session. 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 is used to plan the inspection visit and references to it have been included in this report. The AQAA was returned on time and gave us a reasonable picture of the current situation within the service. DS0000030493.V374194.R01.S.doc Version 5.2 Page 7 We are trying to improve the way we engage with people who use services so we can gain a real understanding of their views and experiences of social care services. We are using a method of working where ‘experts by experience’ are an important part of the inspection team and help inspectors to get a picture of what it is like to live in or use a social care service. The term ‘experts by experience’ used in this report describes people whose knowledge about social care services comes directly from using them. We used an ‘expert by experience’ to aid us in this inspection. The ‘expert’ spoke to as many people as possible who use the service and who were able and willing to express their views, and two sets of relatives during this inspection. The impression gained from these discussions is positive in relation to the care staff team and their commitment. There are issues highlighted in relation to the lack of meaningful activities provided by the home. People told the ‘expert’ that they are “comfortable” in the home and the food is “good”. Several said that there is “not a lot to do”. The ‘expert’ commented that people are well dressed and well groomed We have made 5 Requirements and 5 Recommendations as a result of this visit. What the service does well: What has improved since the last inspection? The four requirements made in the last Random Inspection have been met The management team has been strengthened and includes a new manager. A new post of Deputy Manager (37 hours per week) has been implemented. There has been an increase in staffing of 110 care hours per week. DS0000030493.V374194.R01.S.doc Version 5.2 Page 8 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. DS0000030493.V374194.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 DS0000030493.V374194.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): 1,3,5. 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 so that people are able to make an informed choice about whether the home is suitable for them. No person moves into the home without having their needs assessed. EVIDENCE: No requirements were made in this outcome group in the last inspection report. Thirty-eight people were accommodated in the home on the day of this inspection. A high number of people who use the service have dementia care needs that make it difficult for them to relay some aspects of their lives in the home. DS0000030493.V374194.R01.S.doc Version 5.2 Page 11 The home has a current ‘Service User Guide’ and Statement of Purpose to assist people to decide whether the home will be able to meet their needs. People we spoke with on the day could not recall whether they received a Service User Guide but tell us that relatives visited to ‘check everything was alright’ before they moved in. Seven out of eight people who returned surveys as part of this inspection tell us that they received information about the home before deciding about whether to live at Heathside. One said they did not receive any information as ‘the social worker had decided’ they should stay at Heathside. Where possible, people are invited to ‘sample’ by visiting the home prior to admission. Decisions about permanent admission to the home are not made until the person has been in residence for some six weeks to enable everyone to consider whether Heathside is suitable for their needs. A key worker (care assistant) is allocated to each person in the home. The Statement of Purpose tells us, “Each resident is appointed a member of staff as a keyworker who has special responsibilities towards that resident”. The AQAA also tells us, “Key workers are allocated on admission to provide a personal service and to promote individual rights and wishes”. The Statement of Purpose for the home tells us that, “All prospective residents should be subject to a detailed assessment…. by an appropriately trained member of staff”. We looked at the files of four people who recently moved into the home and found current care plans completed by a social worker prior to admission. Heathside does not provide intermediate care and so Standard 6 (Intermediate Care) was not assessed. DS0000030493.V374194.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 adequate. This judgement has been made using available evidence including a visit to this service. Not all of the plans of care (support plans) that are completed by the service provide enough detail and instructions to staff about how they should manage the current health and social care needs of people who use the service. EVIDENCE: We issued a Statutory Requirement Notice to Stoke-on-Trent City Council on 23rd October 2008, as we were concerned about medication procedures in the home. We also made three requirements regarding medication issues in the Random Inspection Report of 20th November 2008 as follows: DS0000030493.V374194.R01.S.doc Version 5.2 Page 13 1. The current medication regime for people who are admitted for respite care must be confirmed with the person’s doctor so that people entering the home receive their medication as prescribed. 2. Systems must be in place to ensure that people receive their medication as prescribed, in particular there must be adequate supplies of medicines for each person in the home and the morning medication round must be flexible enough to accommodate those people who are late risers. 3. Liquid medication must be administered appropriately and hygienically using disposable syringes. This will promote the health and welfare of people who use the service and reduce risk of cross-contamination. The AQAA we received prior to this inspection tells us, “All managers are fully aware of the medication policy and the documentation that we must retain in regards to administration storage and disposal of medication both general medication and controlled drugs”. We have received a satisfactory response from the home regarding use of syringes for the administration of liquid medication. The issuing pharmacist has been consulted by the home and has provided good practice advice and appropriate syringes. We looked at the procedures on the day of this inspection and are now satisfied with the process. We observed staff administering medication by syringe and discussed this with them. They were knowledgeable about the procedure. This requirement (3) is, therefore, met. We found during the key inspection that the new MAR (medication administration record) chart had only started in the last couple of days but we could still see that medication received into the home was being recorded upon receipt. We also found, with one or two exceptions that the medication being carried over from the previous month was being accounted for on the new MAR charts. Looking at the previous months MAR charts, we found that they were being completed well. We also found that the disposal of medication was being recorded accurately. We still have concerns about the use of the treatment sheets, which are used to record the administration of the prescribed external products, (creams and ointments). We found that these sheets are not being filled in accurately and therefore indicated that some external products are not being administered as prescribed by the person’s doctor. They also did not adequately display the amount of times that these creams and ointments needed to be applied to the person that they had been prescribed for. Advise was given by the pharmacist inspector on how this issue could be addressed. We also still have concerns about the time period between medication rounds and in particular the time period between Paracetamol doses. We found that this issue has not been resolved by the home, as they are not able to show what time periods have elapsed between the doses of Paracetamol for DS0000030493.V374194.R01.S.doc Version 5.2 Page 14 individuals prescribed Paracetamol on a regular basis. Advise was given by the pharmacist inspector on how this issue could be addressed. At the last inspection we raised concerns about the handling of medicines for people who are entering the service for respite care. At this inspection we found there have been some improvements but not enough to safeguard the people concerned. We examined the admission of one person into the service and found that there were some anomalies between the information which had been produced by the person’s doctor and the medication brought into the service. We found that there had been no attempt to resolve the differences with the person’s doctor. We also found that the staff had found an old gel in the person’s handbag and started applying it without any knowledge of the administration directions because the label stated, “As directed”. A relative a few days later told staff that the person concerned did not use the gel anymore. As a result of this information the staff immediately stopped the gel and discarded it. At no point, following the discovery of the gel and the discovery of the person not requiring it did the home contact the person’s doctor to clarify the situation. We found that the fridge temperatures have intermittently over the past couple of months been maintained outside the accepted temperature range. As a consequence of this we found some insulin in the fridge that had been subjected to near freezing conditions, which would affect the viability of that insulin. We made an immediate requirement for the insulin concerned to be discarded and a new supply obtained, which would be kept within the accepted temperature range upon arrival. We rang the home and spoke with the manager on 23/02/09 to discuss the situation with the medication fridge. The manager told us that as requested by our Pharmacist Inspector, she had obtained new supplies of insulin to replace that affected by being stored at too low a temperature. She confirmed that she had already ordered a new medication fridge but in the interim has asked the fridge manufacturer to make an urgent visit to carry out maintenance on the fridge. She had also ordered a new temperature probe. She confirmed that the fridge temperature is now more stable and that the insulin and other medicines stored in the fridge did not need to be moved to another fridge. We looked at the home’s Care Plans for four people who use the service and who were in the home on short-stay/respite/assessment arrangements. Two care plans are satisfactory with sufficient information, generated from the social work care plan, to inform care staff how to provide for the person’s care needs. One person has dementia and has stayed in the home previously. They were last admitted on 07/02/09 (ten days previously). There was a great deal of old paperwork dating back to 2004 in the file much of which was not in date order. DS0000030493.V374194.R01.S.doc Version 5.2 Page 15 The file showed that the person ‘self-medicates’. We visited this person in their room to monitor storage arrangements for medication. It was apparent that they are no longer able to self-medicate. We checked the medication trolley and medication administration record (MAR) and found that the home is administering medication. We discussed this with the assistant managers in the home and it was identified that the person no longer self-medicates but the file has not been updated. We have, therefore, made a recommendation about this issue. For another person admitted on 07/02/09 (ten days previously) there was a current social work care plan in the file dated 07/01/09 but the home’s plan of care (support plan) and risk assessment was not completed. We asked the assistant manager if the support plan might be stored elsewhere but were told that it should be in the file. We did however check the medication trolley and MAR chart and found that medication was being administered and recorded correctly. The AQAA tells us, “We develop a full Alzheimer’s society ‘building on strengths’ care plan that outlines service users individual needs and the level of support that they require”. This clearly has not happed in this case. It is vital that the home’s plans of care for people who are scheduled to be accommodated in the home for short periods are completed promptly in order to inform staff how they are to meet the person’s individual care needs. This will be imperative for people who have not been accommodated in the home previously and also when there are temporary staff on duty to cover regular staff holidays or sickness. We have made a requirement regarding this issue. At the previous inspection we recommended that the home make a record of people’s weight upon admission in order to have a baseline measurement. We notice from this sample of files that this is now being carried out. We also made a recommendation in the last report that where there are concerns regarding a person’s diet that a record of nutritional and fluid intake should be introduced. We found that this was being satisfactorily carried out for one person on the day of this visit. We checked the files of one person in the home on a permanent basis to monitor how often it is reviewed. The plan of care has been reviewed on a monthly basis. There is also a comprehensive record to identify when the person has received visits/intervention from healthcare and other professionals. There is evidence that individuals are involved in some decision making about the home such as day to day living and social activities but this tends to be the people using the service whose communication styles/skills are more easily understood by staff. We observed staff encouraging individuals to be DS0000030493.V374194.R01.S.doc Version 5.2 Page 16 independent. There are, however, a high number of people who need individual staff attention. All need assistance with washing and bathing, thirtyfour need assistance with dressing/undressing, twenty-one need help to toilet, with twenty-one having continence issues, ten have a physical disability, five have mental health needs, thirty have dementia care needs and five need the assistance of two staff at all times with their care. The home has recognised that it has some limitations in identifying what people want. The AQAA tells us that the service has plans for improvement in the next twelve months following liaison “with the Combined Health Trust and will be utilising a new service for older people with mental health needs (the community outreach practitioner service) which will work closely with the home offering advice, guidance and staff training”. The home endeavours to provide a service that is as individual as possible using the staff and resources at its disposal effectively, bearing in mind the high dependency levels of people who use the service. Feedback from the eight surveys tells us people who use the service consider that staff listen and act on what they say. The following comments were added to surveys: “The staff are very good at listening”. “Staff are very helpful. Go out of their way to help. Recently I was ill and had to go to hospital. Due to their caring I have now fully recovered”. “They always give a very good response. Even if busy they make time”. “Staff are friendly and helpful”. I could not expect any more care and attention… carers are excellent….” “Staff are really caring, most pleasant and very understanding”. The Expert by Experience who accompanied us on this inspection spoke to two sets of visitors who each told him that it has taken a while for the person who uses the service to settle but with staff understanding and patience they have now settled. In one case the person had failed to settle in two previous care homes. He spoke with a number of people who use the service and those who are able to express an opinion confirmed they are well looked after. He commented that everyone was well dressed and well groomed. DS0000030493.V374194.R01.S.doc Version 5.2 Page 17 After observing interaction between staff and people who use the service he has also commented, “Staff do not have time to do other than see to the basic needs of people who use the service. This they do in a remarkably cheerful and efficient manner considering the pressure they are under… I saw nothing but kindness and consideration from all members of staff”. DS0000030493.V374194.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. Lack of meaningful activities limits the ways that recreational, spiritual and social needs of people who use the service can be met. There is choice of a wholesome balanced diet available. EVIDENCE: No requirements were made in this outcome area in the last inspection report. Generally staff are aware of the need to support people who use the service, to develop their skills including social, emotional, communication and independent living skills but this process could be improved with greater stimulation. We observed a high number watching large screen televisions throughout the day that are tuned in to their favourite ‘chat shows’ or showing selected DVD’s - Daniel O’Donnell being high on the list. DS0000030493.V374194.R01.S.doc Version 5.2 Page 19 We looked at the Activities Record and found that four people who use the service and four staff visited Blackpool in October 2008. The activities for February showed that people had watched DVDs, including a sing along with various artists, seven spent one session on an electronic keyboard, some reminiscence discussions, four people played dominoes/darts on one day and nail care for ladies. People who use the service have opportunities to develop and maintain important personal and family relationships. We observed staff practices which promoted individual rights and choices, e.g. asking permission before moving people, giving people choice of meals and drinks, knocking on doors, etc. The Expert by Experience observed activities that take place in the home. He reports, “Nowhere in the home did I see any publicity for forthcoming activities. There is no regular act of worship organised within the home. There is a Prayer Card from the local Methodist Church on the mantelpiece close to the entrance”. He concludes, “Sadly, I have to conclude that this home sees the provision of large screen televisions and comfortable chairs as being sufficient to occupy people’s attention….the staff do not have time to do other than see to the basic needs of people” We understand that there is currently no Activity Co-ordinator which has an affect on the home’s ability to organise a regular programme of activities. The AQAA tells us, “We strive to offer activities that are tailored to the individual, e.g. reminiscence, sing along, gentle exercise, garden workshop”. It also tells us that improvements could be made by, “further develop(ing) an activities programme and recording system, so as to ensure that we capture and evidence all service users participation”. (We could) “encourage a wider range of activities outside the home”. In surveys two people tell us they ‘always’ take part in activities, with six saying they ‘sometimes’ do – two qualified this by saying that they were no longer able to take part. The following comments were added: “Unfortunately (name) is unable to take part in some activities due to their lack of sight”. “This is a weakness. Residents are left to watch television or sleep on their beds. Activities are needed. I take (name) out in their wheelchair when I visit. It’s the only time that they go out”. “More activities are needed but more staff would be needed too, especially for residents with no visitors”. DS0000030493.V374194.R01.S.doc Version 5.2 Page 20 “(There are) magnetic darts, skittles, dominoes. Most don’t seem to bother”. This situation results in people not being able to achieve their full potential as routines and activities are not individualised or person centred. We have made a requirement as part of this report regarding this issue. People tell us that they enjoy the meals served in the home. The following comments are added to surveys: “I am a good eater and like most of the varied menus”. “All meals are varied and nutritious”. “Someone sits and feeds (name) to ensure she is getting enough nourishment”. “Maybe a little more variety (needed) at tea time”. “(name) always talks about their meals. They say how good they are. They like the hot meal at lunch time best”. The Expert by Experience observed lunches in three of the four lounges and comments: “The food was well presented and looked appetising. Requests for extra were met and those not eating too well were encouraged”. We discussed menus with the cook on the day. There was a wide variety of choice and special diets can be catered for. Records for fridges and freezers were up to date and satisfactory. The cleaning rota for the day was not carried out as a kitchen assistant had been off sick and a replacement from the ‘bank’ had arrived late and left early. We observe that the kitchen is clean and tidy when we visited at the end of the day. The Expert by Experience made the following suggestions that may improve the quality of life for people using the service: *A quiet area away from the televisions, *Attention to spiritual needs, *Talking Books, *Talking Newspapers, *Large print books, *Introduction of Activities Co-ordinator(s). DS0000030493.V374194.R01.S.doc Version 5.2 Page 21 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 listened 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 inspection report. Details about the home’s complaints procedure are contained in the Service User Guide. The complaints procedure is also displayed in the home. Seven out of eight people who responded to surveys tell us that they know how to make a complaint. The eighth tells us that she leaves it up to her family. The AQAA tells us that one complaint has been received by the home since the last inspection. This is still under investigation. We, the commission, have received no complaints about the home since the last inspection. The manager is aware of the protocols and procedures in respect of Safeguarding Adults from Abuse. There have been no safeguarding referrals/investigations since the last inspection. We have received no safeguarding alerts about the home since the last inspection. DS0000030493.V374194.R01.S.doc Version 5.2 Page 22 The AQAA states that, “All staff are aware of the vulnerable adults policy. There is a robust safeguarding procedure and all staff receive updated training in how to recognise and report any signs of abuse”. All staff have received training in restraint. The home has an open culture that allows people using the service and their advocates to express their views and concerns in a safe and understanding environment. We observed one relative discussing issues with the Assistant Manager and receiving a positive and pleasant response. People tell us that they are happy with the service provided and feel safe and well supported. There is a clear system for staff to report concerns about colleagues and managers. Staff have access to “Whistle Blowing” policies and procedures at the start of their employment. DS0000030493.V374194.R01.S.doc Version 5.2 Page 23 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 home is comfortable and clean but would benefit from being upgraded to better assist the high number of people who have dementia care needs. EVIDENCE: No requirements were made in this outcome area in the last inspection report. We recommended that the home provide appropriate signage to assist people who have dementia care needs. The AQAA tells us that this is “on order”. The AQAA tells us that the City Council’s 10-year plan for older people’s services includes the provision of, “A full refurbishment programme for the home”. It is apparent that the home will benefit from upgrading and redecoration. The AQAA tells us there is a rolling programme of decoration. DS0000030493.V374194.R01.S.doc Version 5.2 Page 24 When we arrived at 9.00am an offensive odour was detected as we walked through the door. There should be two domestic staff on duty but one was off sick and there was one bank domestic on duty whom, we understand, had not worked in the home before and was ‘finding her way around’. Once she started, the cleanliness and freshness in the home improved markedly. The surveys tell us that the home is ‘always’ or ‘usually’ fresh and clean. A laundry assistant is on duty from 9am – 4.30. The laundry area was secure, clean and tidy when we checked it late in the day. All bedrooms are single occupancy. They are limited in space but people had personalised them to individual taste. Bathrooms and toilets are conveniently located around the home, are accessible and sufficient in numbers. Small group living has been encouraged in this large home with the four separate lounge areas (Wedgwood, Goldenview, Leadale, Newhaven) three of which have kitchenette facilities. At the last inspection we noticed that the ambient temperature in some areas was rather low. We recommended that the home monitor this situation and we saw that they have located thermometers around the home in order to do so. Large face clocks have also been provided throughout the home as recommended in our last report. DS0000030493.V374194.R01.S.doc Version 5.2 Page 25 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service does not always provide sufficient staff with the skills mix to meet the needs of people who use the service. This will adversely affect the quality of the service they receive. EVIDENCE: No requirements were made in this outcome area in the last inspection report. A new Manager has been in post since December 2009. A new Deputy Manager has been in post since January 2009. The service has increased staffing since our last key inspection visit on 12th August 2008. On 20th November 2008 we carried out a Random Inspection and observational exercise to monitor the effect of the increased care hours. At that time, we observed good interaction between care staff and people who use the service. Care staff have a good approach and are sensitive to individual needs. Bearing in mind the dependency needs of people using the service, we considered the increase in care staff hours had improved the quality of care provided, although it is considered that staffing was only just sufficient in Wedgwood Unit. DS0000030493.V374194.R01.S.doc Version 5.2 Page 26 At this visit we found that there were only five instead of six care assistants on the 8am – 3pm shift, one of whom was a bank staff who had not worked in the home since before Christmas. The Assistant Manager tried to obtain another care staff from the bank but one was not available. There were two experienced Assistant Managers on duty, one of whom has only worked in the home since December 2008 the second is ‘on loan’ from another home to cover absences at Heathside and is not fully conversant with all the people who use the service. The morning medication round takes one Assistant Manager over two hours to complete. We observed one Assistant Manager doing the lunch time medication round, monitoring people in Wedgwood Unit as the staff had to leave people in the lounge to attend to the personal care needs of a person being cared for in their bedroom. At the time of this visit, the Manager and two Assistant Managers were on annual leave. The Deputy Manager was off sick. The AQAA tells us that in the past three months 396 shifts have been covered with bank staff or staff from an agency. Everyone who responded to surveys indicated that staff are ‘always’ or ‘usually’ available when they need them, one adding “even if busy, they make time”. The Expert by Experience noticed on the day that staff, “Are obviously under severe pressure due to absences and the need to cover more than their normal tasks”. The AQAA tells us that care hours have increased by 110 hours per week over the past year, plus 37 for the new Deputy. We have outlined the high dependency needs of the present group of people accommodated in the home under the Health and Personal Care Section of this report. High dependency levels and the geography of the building need consideration when calculating numbers of staff needed in this home. It is apparent that staff shortages on the day had a detrimental impact on the quality of care provided and that the staff team were very busy. The fact that two people also need to be cared for in their rooms throughout the day is a further consideration. All these issues need to be considered and managed to provide an effective service at all times. Although additional staffing hours have been provided, the management of sickness and/or annual leave does not seem to have been taken into account and there needs to be a contingency plan. We have made a requirement regarding this issue. DS0000030493.V374194.R01.S.doc Version 5.2 Page 27 From information provided we identified that of the care staff team of twenty, twelve have NVQ level 2 in care or above. There is a stable, well-trained and experienced staff team. The four Assistant Managers have NVQ level 3. We did not look at the staff training matrix on this visit as this was satisfactory on our last visit and the service has provided us with training information as part of the Improvement Plan. We also clarified at that time that staff from the bank and agencies were checked to see that they have received mandatory training and dementia care training. The AQAA tells us that in the last twelve months the following training has been provided: Infection Control Health and Safety/COSHH Equal Opportunities and Diversity Dementia Awareness We saw that fifteen care staff have attended ‘Applying Ointment and Creams’ training on 26/08/08 and that six are due to attend at the end of February/beginning March 2009. At the last inspection recruitment procedures were considered to be safe and in the best interests of the people using the service. We have not looked at recruitment practices at this inspection as we are told that no new staff have been recruited. Staff tell us that they get regular supervision and are well supported. They also confirm that they attend staff meetings. This area will be monitored in detail at the next inspection. We received the following responses in surveys: “Heathside is run very well. The managers and staff are very caring and friendly. They make sure a happy atmosphere is always there”. “Thanks to the excellent care staff (name) is happy. They do a good job and work very hard”. “Everyone always gives my mother the best care and attention possible”. “I have nothing but praise for this home and the staff”. DS0000030493.V374194.R01.S.doc Version 5.2 Page 28 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some areas need to be managed more effectively in order that the health and welfare of people who use the service are promoted and protected. EVIDENCE: No requirements were made in this outcome area in the last inspection report. The manager has the required qualifications and experience to run the home. She has extensive experience working for Stoke-on-Trent City Council in the DS0000030493.V374194.R01.S.doc Version 5.2 Page 29 Residential Care sector. She took over responsibility for the management of Heathside in December 2008. A new post of Deputy Manager has been introduced which is also occupied by an experienced and qualified manager who has worked for Stoke-on-Trent City Council for some considerable time. The manager completed the AQAA, which is a legal document, and returned it to us within the specified timescale. The document tells us that it is proposed that Heathside House will be developed into a Centre of Excellence for Older People with Mental Health problems. It will be a base for community mental health teams and in time there will be a total refurbishment of the home. The service has sound policies and procedures. There are systems to monitor staff adherence to policies and procedures during their practice. The AQAA tells us that the manager works in accordance with Health and Safety legislation and all records are kept accurately. We looked at the home’s maintenance and fire records and found these to be up to date. On the day we saw that the Maintenance Room door was unlocked and the light on at 9.10am. The area holds COSHH chemicals, cleaning and maintenance equipment that could be a hazard for people who use the service. The door was still unlocked at 9.20am but was locked when we checked again at 9.45am. We identified that due to staff sickness, the home had a ‘bank domestic’ on duty who was unfamiliar with the home and who had left the door unlocked. We have made a recommendation regarding this matter as part of this report. On this occasion we did not monitor the finances of people who use the service. Finances have been inspected on previous inspections and found to be satisfactory. There is a designated business support assistant who deals with the home’s financial matters and monitors the finances of people who use the service. Financial care plans are in place for all people who use the service. The City Council Auditors regularly monitor/inspect financial records at the home. Heathside seeks the views of people who use the service by asking them and their relatives to complete satisfaction questionnaires. “Service User” meetings are held. We have considered the issues that have been highlighted in earlier outcome groups in this report, e.g. care plans not in place or up to date for two people in the home on respite care arrangements; medication issues have improved but there are still issues to be tackled; lack of meaningful activities and the need to strengthen arrangements for the management of annual leave and DS0000030493.V374194.R01.S.doc Version 5.2 Page 30 sickness. We acknowledge that the new manager has been in post for a very short time. There is current insurance in place. The Certificate of Registration is displayed in the home as required by our regulations. DS0000030493.V374194.R01.S.doc Version 5.2 Page 31 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 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 3 DS0000030493.V374194.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 13(2) Requirement The current medication regime for people who are admitted for respite care must be confirmed with the person’s doctor so that people entering the home receive their medication as prescribed. Timescale of 31/12/09 not met 2 OP9 13(2) All insulin stored in the 17/02/09 medication fridge must be discarded and a new supply must be obtained, which is stored within the correct temperature range. Immediate Requirement 3 OP7 15(1), 15(2) & 12(1)(a) The service shall, in consultation with the person who uses the services or a representative, prepare a written plan as to how the service will meet the person’s needs in respect of his health and welfare. This will assure people that their health and welfare is being promoted. 31/03/09 Timescale for action 31/03/09 DS0000030493.V374194.R01.S.doc Version 5.2 Page 33 4 OP12 16(n) The service must make provision 30/04/09 to actively promote activities and routines that are individualised and person centred. A programme of activities must provide for recreation, fitness and training. This will improve the quality of life and promote positive attitudes, enjoyment and opportunities to develop and maintain skills for people who use the service. The service must ensure that at all times there are suitably qualified, competent and experienced persons working in the care home in such numbers as are appropriate for the health and welfare of people who use the service 30/04/09 5 OP27 12(a),(b) & 18(1)(a) 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 OP9 Good Practice Recommendations The when required protocols should be improved to include further information that will ensure appropriate and safe administration. Medicine Administration Record (MAR) charts should be used to record the administration of external products (creams and ointments). The administration times of Paracetamol should be recorded so that it can be guaranteed that there are fourhour intervals between each dose. 2 OP9 3 OP9 DS0000030493.V374194.R01.S.doc Version 5.2 Page 34 4 OP7 Plans of Care (Support Plans) must be kept up to date to reflect the current care needs of people who use the service. This will ensure that care staff have the information they need, including any risks to be taken into account, to deliver appropriate care and protect the health and welfare of people who use the service. The service must ensure that the Maintenance Room is locked at all times. This will promote the health and safety of people who use the service. 5 OP38 DS0000030493.V374194.R01.S.doc Version 5.2 Page 35 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 DS0000030493.V374194.R01.S.doc Version 5.2 Page 36 - 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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