Inspection on 25/06/07 for Heathside House

This inspection was carried out on 25th June 2007.

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

The inspector 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 17/02/09

Heathside House 12/08/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Heathside House Heathside Lane Goldenhill Stoke On Trent Staffordshire ST6 5QS Lead Inspector Mr Berwyn Babb Unannounced Inspection 25th June 2007 11:30 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.V343005.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.V343005.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 F/P 01782 234552 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.V343005.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 1st February 2007 Brief Description of the Service: Heathside House is registered to care for 44 older people. It provides long term and respite care and includes an eight-bed EMI unit. The home is situated in Goldenhill, on the outskirts of Stoke-on-Trent. The home was purpose-built approx 25 years ago and is managed by Stoke-on-Trent City Council. It is registered under the Care Standards Act 2000. The home is well placed for public transport, which gives frequent access to the main centres of Kidsgrove, Tunstall and Hanley that provide a wide range of facilities. There are good local community links including churches, pubs, shops and community centre. The home is situated in its own grounds 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 shaft lift and stairs access between floors. All bedrooms are single occupancy with a wash hand basin although none provide en-suite facilities. There is a range of assisted bathing facilities, including one providing a Parker bath and another a walk-in shower room. There are adequate assisted toilet facilities throughout the home. The home is divided into four areas, all of which have their own sitting rooms and dining areas. In addition, there is a small 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. Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out on Monday that 25th of June 2007 during the late morning, afternoon, and early evening of an unseasonably wet summer day, by one inspector working alone. He was furnished with assistance and hospitality by the Registered Care Manager, and spoke to people who use the service and members of staff (including a formal interview), toured the majority of the environment excluding only the kitchen and some bedrooms, and looked at care plans, records, and facilities for the storage of medication. The home was warm, clean, tidy, without odour, and generally acceptably decorated, and he observed and was told of good interaction between people who live there, and the staff who look after them. The fees currently charged for accommodation ranged from £338 per week in the elderly category, through £534 per week for those with Mental Health needs, rising to £731 per week for persons with a Learning Disability. What the service does well: What has improved since the last inspection? The majority of those things commented on unfavourably on the last report have now been addressed. Letters were being sent to prospective users of the service to confirm the ability of the home to meet their assessed needs and personal choices. The problem with the lift had been addressed within 48 hours of the last inspection. Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 6 Much remedial work had been undertaken to improve the décor of the home. Safety guards had been fitted to radiators in the lounge commented upon in the last report. Bathrooms and toilets had been cleared of items that posed a threat of cross infection, and of the personal belongings of people who use the service. Photographs had been added to care plans to help identify (especially to agency staff) which person theyre referred to. Better evidence was available that appropriate recruitment procedures had been followed, and that CRB checks and references had been taken before a member of staff commenced work. New furniture had been purchased for the patio, where people with confusion who use this service, are able to enjoy being outside in the safety of a secure area. All fire safety checks have been recorded more robustly than previously. A special fridge for the storage of medication, with an integral visual display unit to show the temperature, and Yale type lock had been purchased and installed in the medication room. Business support assistants have been added to the staff team. What they could do better: Further work would be done to streamline the care planning documentation so that staff unused to the home can simply, safely, and quickly, access the information they need to provide appropriate care to the people who use this service in the way that suits them best. Signatures on medication records could be made more legible. People could be protected from the use of medications being exposed to the environment for longer than advised, by ensuring the date they were first opened was clearly written on the container. Arrangements could be put in hand for an activities person within the staff group, both as a resource for general activities, and to spend time in 1to 1 engagement with people who have Dementia. Steps could be taken to alleviate the problems caused by the aluminiumframed windows. Remedial work to the windowsills and surrounding wallpaper is urgently recommended, and if this type of window is retained, secondary double-glazing is suggested as a possible way of eliminating the problem of excessive condensation. Consideration of what a true quality assurance system is, needs to become part of the ethos of the providers. Having an audit trail that leads from steps Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 7 taken to obtain peoples views, right through to changes or improvements made as a result of these views, needs to be much more substantial and transparent. The provision of lines indicating where cars can and can not be parked in the enclosed yard would benefit both the delivery of goods, and the safety and welfare of the people who use this service should they need to evacuate the homes through the fire door that opens onto this area. 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.V343005.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, and 6. The Quality outcome in this area, for the group of residents who use this service, was good. This judgment was made using all available evidence including a visit to the service. Prospective users of this service had sufficient and accurate information made available to them in order to make an informed choice about whether they should live there or not. A full assessment of their needs to determine the ability of the home to meet these was carried out, and if successful, they were informed in writing of the homes commitment to provide care and individual choices that they need. Intermediate care was not provided. Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 10 EVIDENCE: Information provided by the home in the Annual Quality Assurance Assessment confirmed that since the last inspection was made, they have increased the number of visits carried out to prospective people using their service to clarify that the home is able to meet their needs, and that now there are sending out written confirmation to each prospective user or their representatives, that their needs and personal choices will be met in the home. A statement of purpose was available near to the front entrance of the home and the care manager stated that this had recently been revised to incorporate the latest information about the facilities on offer. Discussion with the care manager and staff confirmed that people were able to enter the home for respite care, but that Intermediate Care as defined in National Minimum Standards Six is not provided. Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. 6, 7, and 9. Quality outcome in this area for this group of people using the service is adequate. This judgment has been made using all the available evidence including a visit to the service. Substantial improvements had been made in the field of medication, and some parts of the care plans were easier to follow than others. There was evidence of engagement with a wide range of health care professionals, and prompt and sensitive attention to intimate needs by the care staff of the home. However, part of a previous requirement needs to be repeated concerning safe recording of dates medication were opened. EVIDENCE: Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 12 A thorough examination was made of the Medication Administration Record, and there were no errors or omissions. (The Care Manager was advised that the signature of one senior member of care staff could be mistaken for a deletion symbol, and that the safety of people who use the service might be improved if she used a clearer and more defined mark.) Storage arrangements were in line with current recommended best practice, in that the fixed cabinets was secured to the wall with rag bolts, was made of metal, and contained a separate locked inner cabinet, for the storage of controlled medication. This was checked, against the stock list, and was found to be accurate. The mobile medication trolley was secured to a hasp in the wall by a substantial chain and padlock, and a sample of the N. O. M. A. D. cassettes matched the recording on the M. A. R. sheet. There was a risk assessment for the person who administers his own medication, and his ability to do this responsibly was confirmed in writing by the GP. Concern had been expressed in the previous report that out of date medication was being used, so a detailed check was made on this, and unfortunately it was not possible to confirm that the medication was still safe in current use, because no date of opening had been recorded on either the container itself or the box it was stored. This error applies to all medication and topical cream stored in the medication fridge, and is made harder to understand by the fact that medications in liquid or gel form stored in the trolley did have the date first open recorded on them. The previous requirement covering this matter will remain. The individual plans of care for people using this service were sampled, as they too had been commented on unfavourably on the previous report. It was found that in daily use there was a folder for each of the four units of the home, and these had a section for each of the people using a particular part of the service. A photograph of them appeared at the front of their personal information, and the most important thing anyone caring for them would need to know was highlighted on the front sheet. In those care plans sampled this ranged from a food allergy, through an intensely held personal dislike, to a chronic health condition. The information in this part of the care plans was handwritten, relevant, informative, and gave a detailed account of the care received and the choices made by that person throughout the whole of the 24hour period of the day and night. The second element of the care plans were folders individual to each person who uses the service, containing an exhaustive and cumbersome printed template of all possible eventualities related to the care of somebody in a residential home. Individual information that was relevant to the care of the person using the service could be extracted from this document, but not without dedicated searching, through the many pages where there was nothing to record about or helpful to the care of that individual, to find those pages on which essential, and possibly urgently needed, information was recorded. Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 13 The Registered Care Manager produced some examples of a type of care plan previously used, with columns for the individual recording of a need, risk, or individual choice, for recording the effect on the individual of either meeting or not meeting them, for what action needed to be taken to stabilise, maintain, or improve the situation, and for the benefit that this would bring to the person who uses the service. These had the benefit of being concise, pertinent, and individualised, and would have resulted in a person with say, seven needs and all individual choices having seven current pages in their care plan, rather than seven current pages and 32 unused pages whose existence could challenge the ability of staff, especially agency or bank staff, on whom this home is overwhelmingly dependent, to quickly, appropriately, and safely give care to those people for whom they are responsible. A suggestion was made to the Registered Care Manager that what was needed was a single sheet giving a word picture of the needs and choices of the person on a normal day (which would be reflected by the record already been made of what had been done for that person over a 24-hour period) so that anybody not in regular contact with her could quickly and safely determine what it was they needed to meet that persons needs and individual choices in the most expedient way possible. This will be reflected in a requirement at the end of this report. Fortunately the home has retained the record sheets for visiting health professionals, so it was possible to determine that people using this service had seen their GP, had been for hospital appointments, had been seen by the chiropodist and the dentist, had benefited from the advice of the continence nurse and the diabetic nurse, as well as having their hearing checked, and regular testing of their eyesight. One resident told the inspector: Oh yes my dear, they are always most particular about our dignity. They always knock on the door or call to us before coming into our rooms, and are sensitive about any, you know, private matters. During the course of the inspection observation confirmed the automatic response of staff when approaching the room to ensuring that they announced themselves before entering. They were also observed to be discreet when prompting people over issues of personal hygiene. In the privacy of his own room one gentleman said: Theyre all right here, they look after you very well and if you dont want to do something they dont make you . Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 14 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, and 15. The Quality outcome in this area for this group of people using the service is adequate. This judgment has been made using all available evidence including a visit to the service. Work had been done to focus on activities, but insufficient resources have been devoted to this by the providers. People are assisted to maintain family and friendship links, and to retain the greatest possible measure of independence. People spoke highly of the meals. EVIDENCE: One of the more able people who use this service commented: The more confused ones sometimes come down when we are doing things (activities), but they dont seem to want to join in, they just sit . It had been recorded in the last report of evidence of specialised activities for this group of residents have been hard to find, and discussion took place with the Registered Care Manager about the benefits of sufficient staff to undertake one-to-one activities with this group of people who use the service, as would be more appropriate to their concentration and attention span, and understanding of complex or group situations. Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 15 A recommendation will be made at the end of this report are about specialist advice and training in this field. During the visit to the service family and friends were present in the home, and discussion took place after things had been observed in a couple of care plans, about the complex knowledge that staff have to build up, regarding the dynamics of families, to help some people maintain links with their relatives. In one care plan a hierarchy of contacts had been established by the family themselves, and in response to an observation made after reading another care plan, the inspector was told of the work being done by staff to help that person come to terms with the lack of contact with her family . Records were available of daily activities in the home but it again became apparent that the people who use this service would experience a positive benefit from having somebody in post whose dedicated role it was to organise and enable a varied programme of activities to take place. There will be a recommendation to this effect at the end of this report. Two of the people spoken to confirmed that they were able to exercise control over the majority of aspects of their daily existence. In a formal interview with a member of staff, she was asked to talk about the intimate care task of giving somebody a bath. The response not only showed great sensitivity and respect for the persons dignity, but also the lengths to which she went, to ensure that person exercised control over their lives and maintained the highest level of independence that was consummate with their ability. The minutes of resident meetings recorded requests being made for the addition of a local delicacy to the monthly rotation of menus. It was also stated by the Registered Care Manager that finger foods such as fruit or sandwiches, were provided as an alternative for those people who have Dementia. One person who uses the service particularly commented favourably on the food, saying: I always get up in the morning so that I can enjoy a proper sit down breakfast. They do that very well here . Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 16 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 and 18. The quality outcome for this group of people who use the service in this area is good. This judgment has been made using all the available evidence including a visit to the service. People who use this service are in the care of a group of staff who have the policies, procedures, training, and empathy, to support them in expressing any concern that they have, and to do all possible to protect them from abuse EVIDENCE: No complaints have been received about this service in the period since the last inspection report. The home records that they have links in place to access local advocacy services should anybody need this to help them expressed a concern. During a formal interview with a member of the care staff the issue of abuse was discussed, and the person being questioned was correctly able to identify that the vulnerable people in the home are potentially at risk of abuse by anybody who has any type of contact with them, or access to them. In addition to the more publicised major aspects of abuse, she also had the sensitivity to consider that anything that did not respect a persons wishes, or compromised their dignity, was in fact abusive. She knew of the locally agreed Vulnerable Adults Policy which had been adopted by the providers, and was correctly able to identify the course of action that she was required to take should she ever suspect that anybody in her care had been, or was being, abused. Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 17 The provider has confirmed in writing that during the last 12 months all members of staff have received Vulnerable Adults awareness training. Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 18 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, 20, 21, 22, 24, and 26. The quality outcome for this group of people using the service in this area is good. This judgment has been made using all the available evidence including that gathered during a visit to the service. People who use this service have a comfortable home that has benefited from much attention to the environmental decor, and improvement in care practices, and attention to impending legislation. EVIDENCE: This home was purpose-built and currently accommodates 44 older people, on two floors, in single rooms all of which have their own washbasin, and are served by communal bathrooms and toilets that are conveniently located, but none have ensuite facilities. Some rooms that had previously been shared were designated for people with greater mobility problems, as they allowed more space for the use of such things as wheelchairs and hoists. Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 19 In addition to stairs, the second floor could be accessed by a vertical shaft lift. At the previous inspection there had been a fault with this, but this has been rectified, and the engineers worksheet/invoice showed that the work had been carried out within 48-hours of the last inspection. The last report had also criticised the home for failing to protect people who use the service from the danger of accidental burns presented by radiators and hot water pipes, and since that time much work has been done to cover these, and make them safer for a group of people some of whom are confused, and some of whom have impaired mobility. A full tour of the internal environment was made without uncovering the wholesale need for remedial work on the decor commented on in the last report. The Registered Care Manager stated that in addition to the rolling programme of redecoration and repair, the handyman and a member of care staff had undertaken an extra program of spot redecoration to both bedrooms, and corridor areas, so that at this inspection the general effect for people who use the service was good. However, there were some areas identified that still needed attention, and in corridors three areas where noted where wallpaper had been torn off or scuffed, and two areas where the recent work undertaken to comply with the advice of the fire officer had resulted in trunking or appliances such as fire bells and alarms being removed, leaving gaps in the wallpaper. In bedrooms, a problem was identified in relation to those areas still glazed with aluminium-framed windows. Here there was discoloration to the wallpaper and rotting woodwork on the windowsills, both thought to be as a result of excessive condensation. Additionally, The Care Manager volunteered the information that in relationship to those rooms where replacement UPVC double glazed units had been fitted, these rooms were much harder to keep warm in winter. All toilets and waiting areas in the home were examined, and these were pleasantly decorated with pastel shaded ceramic tiles on the walls and appropriate impervious flooring, and were free from anything that might compromise infection control, and were adequately provided with the usual mobility aids, and appropriate emergency call systems, including rubberised activators that could be left floating in the bath of someone who wanted to have a soak in privacy. A variety of bathing facilities were offered, including A Parker bath, domestic style bath with integral Arjo chair hoist, and a walk-in shower room. The only areas noted needing attention were in the long bathroom on the 2nd floor, where a small patch of rubberised sealant at the foot of the bath was in need of a good scrub, and the frames surrounding the skylight showed evidence of substantial deterioration. The care manager was informed that these areas needed to be attended to without delay. Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 20 Each of the bedrooms visited were appropriately and comfortably furnished (something confirmed by people who use the service, one of whom said its just the job, everything I need , and a lady who said It can never be home, but its the next best thing, and Im very comfortable here, I have ever think I want .) Rooms reflected the individual interests and histories of the occupants, with lots of family photographs, ornaments, small items of furniture, and expressions of religious belief. Mention must be made of the Sun Lounge. This appeared to protrude from the main building in the manner of a garden room and with five large windows arranged in a semicircle gave pleasant views of the garden and surrounding areas. The decision has been taken to dedicate this as the smoking room for the home. A substantial extractor fan is provided with comfortable seating, good quality curtains and appropriate ceramic tiled floor, together with robust freestanding ashtrays and all necessary signs and notices. Before July the first the television and book shelving will be removed in line with policy adopted by the providers for smoking areas. The home was free from the offensive odours, and procedures were observed in place to minimise the possibilities of the spread of infection, including systems for the disposal of soiled and medical waste. Directions to staff to ensure compliance with the policies and best practice were on display, and supplies of personal protective equipment, both aprons and gloves, were available. Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 21 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. The quality outcome in this area, for the group of people who use this service, was adequate. This judgment was made using all the available evidence including that gathered on a visit to the service. The physical layout of the home and the division of the people who use the service into lounges identified by levels of dependency, suggests that their health and welfare would be improved by the provision of more staff hours, particularly some dedicated to planning and facilitating a wider range of activities. EVIDENCE: The statistics returned by the provider in their dataset show 387 care staff hours provided in a typical week. The minimum number of care hours recommended for a home with 44 people would be 704. From observation of staff on duty at the home, and the rota of weekly hours provided, it has been concluded that the actual number of hours being worked is nearer 600, excluding any management hours used for on the floor actual care, but including the hours of the person asleep on call in the home during the night. Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 22 During the week chosen for the statistics six beds were vacant which would reduce the number of hours required by a maximum of 96, still leaving the home marginally under the minimum hours indicated, even without taking into account such factors as the layout of the home, which was the major reason for the requirement in the last report. Whilst it is acknowledged that the welfare and safety of the people in Wedgwood Lounge has been improved by the introduction of new working practices, the requirement to review staffing deployments to ensure appropriate levels and stimulate interaction (especially considering the lack of a dedicated activities person) will be repeated in this report. In a formal interview, a member of staff confirmed that the procedures in place during her recruitment, and induction both met equal opportunities legislation, and protected people who use the service and by requiring her to have a clear police check, and provide two written references, and access to her doctor to ensure she was fit for care work. She went on to confirm that she had received mandatory training during her two weeks of induction, as well as when working on the floor of the home, and that she had received refresher training whenever any of her certificates were up for renewal, and had now started on NVQ level 2. Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 23 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, and 38. The quality outcome in this area for the group of people who use the service is adequate. This judgment has been made using all available evidence including that gathered during a visit to the service. Procedures to demonstrate that the views of people who use the service and their supporters were being used to measure and inform success in meeting the aims, objectives, and statement of purpose of the home, were not available. Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 24 EVIDENCE: The registered manager for this home is trained to NVQ level 4 and receives updates in training periodically according to the dataset provided. He has substantial experience in running a home for the elderly, and was accorded positive regard by a member of staff interviewed, who said: He is always ready to support you, or listen to anything you say or ask, and he tells us about any plans for the home as soon as he knows about them. In this time of uncertainty, this is very important to us . In the Annual Quality Assurance Assessment return by the providers, the manager acknowledges the need to implement an annual development plan based on evidence from quality assurance systems. In discussion he confirmed that questionnaires had been sent out and completed by people who live in the home and their relatives, but that this information had not yet been worked out into a proper database to evidence the work done in this area. The requirement of the previous report will therefore be commuted to a recommendation to ensure that the positive response of the providers to comments received about quality can be evident both on paper, and in changes and improvements to the lives of people using the service. No review of the financial matters of people who use this service was undertaken at this inspection, but the providers have confirmed in writing that during the last 12 months they have initiated the use of Business Support Assistants to deal with most of the financial issues they experience. Evidence was seen during a visit to the service and taken from the Annual Quality Assurance Assessment to protect the health safety and welfare of the people who use this service. This included the regular servicing of equipment within the home by both the city council Works Department and outside contractors, the undertaking of regular fire safety checks such as weekly fire alarm testing, monthly emergency lighting testing, regular equipment testing, and staff training including mock evacuations/fire drills, regular testing of water temperatures and Legionella safety, risk assessments of both the environment and the individual (including risks posed by peoples health conditions as well as their choices), and adherence to the policies and procedures of the home, especially those concerned with the containment of substances hazardous to health, and to prevent the spread of infection. A cursory visual examination of the exterior of the premises had not identified any causes for concern, and the interior examination found nothing that posed an immediate or dangerous threat to the safety and welfare of the people who use this service, or to their enjoyment of it. Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 25 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 N/a 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 X 3 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 2 X 3 X X 3 Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15(2) Requirement The registered person shall rationalise care planning to offer a meaningful assessment, plan, risk assessment and review of care. This is outstanding from the previous inspection reports. 01/08/06 and 01/03/07 The registered person shall ensure that the home is conducted so as to promote and make proper provision for the health and welfare of the residents. The registered person shall make arrangements for the recording, handling, safekeeping and safe administration and disposal of medicines received into the care home. The registered person should provide a programme of activities suitable for all users of this service, including the people who have dementia in the Wedgwood Unit. Timescale for action 25/07/07 2. OP9 12 (a)13(2) 25/07/07 3. OP12 16(n) 25/08/07 Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 27 4. OP27 18(10(a) The registered person shall 25/07/07 ensure, that having regard to the size of the home, the statement of purpose, number and needs of the residents, ensure that there are sufficient staff on duty at all times for the health & welfare of the residents. and 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 OP19 Good Practice Recommendations The registered person should review their policy concerning signatures to be entered into the medication record, to ensure that all are clearly identifiable. The registered person should take appropriate action to remedy the damage to wallpaper and woodwork surrounding those windows that have aluminium frames. Remedial work to repair the décor shall be addressed more effectively to ensure the safety of the residents. The registered person should ensure that evidence is made available to identify any effective quality assurance process from relatives, residents or stakeholders, and how that is being used in planning and improving services. The home should have a minimum of 50 of staff with the appropriate National Vocational Qualification in Care. The registered person should consider that the provision of lines indicating where cars can and cannot be parked in the enclosed yard would benefit both the delivery of goods, and the safety and welfare of people who use this service, should they need to evacuate the home through the fire door that opens onto that area. 3 OP33 4 5 OP27 OP19 Heathside House DS0000030493.V343005.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Stafford Local Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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. 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