Inspection on 13/08/07 for Heathside Rest Home

This inspection was carried out on 13th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 Rest Home 24/05/06

Heathside Rest Home 21/12/05

Heathside Rest Home 29/06/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Heathside Rest Home 74 Barrington Road Altrincham Cheshire WA14 1JB Lead Inspector Sylvia Brown Unannounced Inspection 9:00 13 August 2007 th 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 Rest Home DS0000063746.V343058.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 Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heathside Rest Home Address 74 Barrington Road Altrincham Cheshire WA14 1JB 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) 0161 941 3622 Miss Alicia McDonnell Miss Frances Anne McDonell Miss Alicia McDonnell Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users requiring personal care shall be sixteen (16) over the age of 65. Care staffing levels will not fall below the minimum levels set out in the Residential Forum Guidance `Care Staffing in Care Homes for Older People`. The registered persons must undertake training in the protection of vulnerable adults from abuse by 31 July 2005. 24th May 2006 Date of last inspection Brief Description of the Service: Heathside is a residential home that provides personal care and support for up to 16 residents within the category of old age. However, any of the residents could additionally have a physical disability. Heathside is a family run home. The property is large and situated on Barrington Road in Altrincham, close to the town centre. A small car parking area is available at the front of the building. There are gardens to the rear of the property. This area includes a patio/barbecue area, with garden furniture, where residents can sit in the summer months. Internally, there are two lounge/dining areas for communal use. Bathing and toileting facilities are also provided on both the ground and first floors. One bathroom is equipped with a specialised ‘Parker’ bath that supports those who have difficulty with movement. There are 15 bedrooms, some of which are ensuite. One bedroom on the first floor is for double occupation. The home does not have a passenger lift, however there is a suitable stair lift, which supports residents to reach all floors, as they require. The current fee structure ranges from £346.42 to £405. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key unannounced inspection site visit of Heathside was completed in one day, commencing at 9am. The site visit is part of the key inspection process. A key inspection looks specifically at the entire key National Minimum Standards and sees what the home is doing to meet them. Other standards were also looked at. Prior to the site visit, and as part of the overall key inspection process, the home completed an Annual Quality Assurance Assessment (AQAA) which is a self assessment and dataset that is filled in once a year by all providers, whatever their quality rating. It is one of the main ways that the Commission for Social Care (CSCI) will get information from providers about how they are meeting outcomes for people using their service. The AQAA also provides the CSCI with statistical information about the individual service and trends and patterns in social care. The AQAA document was completed in fairly good detail and indicated what the home did well, what had improved in the last 12 months and what future developments were planned for. During the site visit two people were case tracked, this means the care of two people were looked at in depth. Time was spent talking to the registered manager and manager, both of whom are the registered providers. The registered manager and manager are related and, in essence, manage the home jointly. For reporting purposes, the term used when referring to either of the managers will be managers. The term preferred by people consulted during the site visit was residents. This term is, therefore, used throughout the report when referring to those living at the home. Service user surveys were provided to residents, their families and professional visitors. Information received will be included within the report where appropriate and applicable. Comments received after the report is completed will be included within the next inspection process. Since the last inspection, which took place on the24th May 2006, the CSCI has not received any complaints about this home. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The AQAA stated that all privately funded residents now receive a written contract, which they are able to read and sign to say they agree with the services to be provided for the required fee. Since the last inspection, the home has been equipped with a dumb waiter, new stair-lift and new specialised bathing facility. The main kitchen has been updated and residents’ bedrooms continue to be upgraded, with new beds, furniture, decoration and fixtures and fittings. The upgrading of the home is improving the everyday living conditions of residents. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 7 Residents have been consulted regarding the standard of food served and the menu. Although general feedback was positive, a new menu has been put in place and a wider choice of meals and food options have been made available to those on a diabetic diet. As a consequence, all residents at the home are able to receive an equal menu, which offers the same amount of choice regardless of the diet required. One relative stated, “They are kept comfortable and well fed.” Residents’ surveys indicated that they were satisfied with the meals served. The home has improved arrangements to ensure support or services are available to those who wish to continue with their spiritual beliefs and practices and other various activities important to them, like attendance at the blind and stroke club. This enables residents to have contact with people within the community and benefit from mixing with people who have the same beliefs and/or conditions. Staff training has commenced and continues regarding the protection of vulnerable adults. This is to ensure that all staff are aware of their responsibility to protect residents and report any suspicions or allegations of abuse. Systems have been put into place to provide staff with formal supervision, and although still in the early stages, staff meetings have increased and staff appraisals have been started. Such practices now provide managers with formal systems for meeting with staff in private to discuss any issues arising, evaluate practice and plan for staff’s future development and training. All of which should provide residents with a consistent level of support being provided by trained competent, knowledgeable staff. What they could do better: Medication administration records were poorly maintained. Medication administered was not always signed for; crossing out and unclear coding was evident. Medication administration procedures were interrupted, medication administration records were left on view, medication was left unattended, secondary dispensing was evident and tampering of secure medication prepared by the pharmacist was undertaken. Furthermore, medication stocks did not balance with administration records. Such errors place residents at an increased risk of not receiving their medication as prescribed. Recruitment and selection procedures were not clear. There was poor record keeping, with essential information being brief and or absent. References and POVA Checks did not appear to have been received prior to the person being offered a position or commencing duty. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 8 Whilst there was thorough assessment documentation, residents did not have a concise written care plan, which they had seen and agreed to. Residents were observed to receive support from at least one staff member who spoke in a disrespectful manner; they were also insensitive when offering support. The home did not operate a formal staff code of conduct and it was unclear how staff’s practice was being monitored. A number of health and safety matters need addressing to ensure the safety of residents. In order to comply with fire safety regulations, the managers should ensure that all people entering and leaving the building sign a record of their arrival and departure. Some staff require training in moving and handling. They also require monitoring to ensure they are competent at such procedures and carry out support safely. All staff require training in infection control. Staff were observed carrying out procedures which increase the risk of spread of infection, rather than minimising the risk. The rotas of hours worked by staff need to be more detailed. It is important that such records accurately reflect the required information, such as staff’s full name and staffing position. Where a person has two roles, be it care and domestic support or cooking, hours should clearly be identified for each position. The rota should also identify who is in charge of the home in the absence of the managers. This enables an accurate assessment to be undertaken to see if there are enough care hours’ support provided, staff know who is in charge and clarifies what hours are allocated for ancillary support. A record of complaints needs to be maintained in order to verify how complaints and/or dissatisfactions are received and dealt with. 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 Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heathside Rest Home DS0000063746.V343058.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. Standard 6 is not applicable to the home. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Prospective residents have their needs assessed and are able to visit the home prior to making any decisions about their future. The statement of purpose contained misleading and out of date information and needs reviewing in order that prospective residents have up to date information about the home. EVIDENCE: The home has a statement of purpose in place, which is provided to prospective residents and their representatives. Whilst the statement of purpose contains appropriate information, its structure is not easy to follow; it is in small print and not service user friendly. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 11 Some information could be misleading to the public, in that, the managers state their qualifications in nursing without clearly detailing they are not currently practicing, which may lead people to assume they will provide nursing support. Some information is out of date and still refers to the National Care Standards Commission, that has not been in operation for a number of years. It is recommended that the statement of purpose is fully reviewed and developed to be user friendly, free from jargon, up to date and relevant. Advice has been provided where developments are required. Once completed, the statement of purpose will support those prospective residents considering a placement to make informed choices. Two residents’ files were looked at. Both had thorough and complete assessments of needs in place. Action had been taken to ensure care needs were kept under review and assessments updated as required. The managers explained that once an enquiry has been made for accommodation, the prospective person is invited to look round the home. The managers then visits the person in their own home to complete the initial assessment of needs. Consideration is then given by the managers as to their ability to meet identified needs and the person’s suitability to join the resident group. The prospective resident is then invited to visit the home and meet with other residents, observe practices and day-to-day routines and sample a meal. The managers stated that they always ensure that one of them is on duty on the day of such visits and at time of admission, so someone welcomes the resident who they have already met. A recommendation has been made to record the pre-admission process of residents in order to evidence the good practice undertaken. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Whilst residents received sufficient support to maintain their health and well being, poor medication administration and management systems increased the risk of medication being administered incorrectly. Residents cannot be confident they will be treated with respect, as some staff were seen to be disrespectful and unsympathetic. Care plans need to be developed more; but contained sufficient detailed to ensure that residents received the care and support they individually required and desired. EVIDENCE: Throughout the inspection residents were observed to be clean and wearing clothes that were pressed and well maintained. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 13 Care plans looked at had good assessments in place that identified all the care needs of the residents, however there was no comprehensive care plan in place. Notwithstanding that, there was sufficient information recorded to evidence that residents received support to maintain their health. Staff were observed contacting a doctor for a resident. Records of visits recorded district nurse support and the action taken to ensure residents received the correct aids and adaptations, as they required. One person had received a specialised bed, which assisted in supporting her safety. Residents are able to receive visits from a dentist or are supported to visit dentists within the community. At least one resident is deaf. Comments received indicate that this has caused some impact, with the resident becoming isolated and not having sufficient occupation provided to them. Whilst the home provides support for the resident to attend the deaf club, it is unclear if the staff had the skills or expertise to support the resident. Staff do not have skills in sign language or communication techniques for communicating with deaf people. The premises are not equipped with flashing lights or vibrating pillows to indicate and inform deaf residents of a fire emergency. Daytime occupation is limited and arrangements are not in place for the resident to receive visits or be taken to outside places of interest by people who can communicate with them. The AQAA identified that a number of residents have hearing difficulty and may or may not wear hearing aids. It is advised that where residents wear hearing aids, care plans should detail the action required to support them and practice required to maintain the device. Furthermore, as part of the home’s upgrading programme, consideration should be given to having a loop system installed in the areas used by residents. This would improve the sound quality for those with a hearing aid. During the inspection medication administration practices were observed and an audit of medication was partially undertaken. Records of administered medication were also looked at. The staff member was observed getting three blister packs, containing prescribed medication, from the medication storage area in the basement. On reaching the ground floor the medication packs were left unattended on a table whilst the staff member proceeded to serve tea and coffee to residents. Medication was administered after the drinks were provided. Medication records were signed collectively after administration had been completed for all three residents. At the start of the inspection and during the morning medication records were observed left on view in a dining area on a windowsill. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 14 Inspection of medication stocks identified that practices were not correct. One supposedly sealed medication pack prepared by the pharmacist, had lots of holes in the seals, medication was still present and cellotape had been applied to prevent medication falling out. When asked, the managers stated this is done after additional medication received had been added to the dispensed medication, confirming that they puncture the sealed packs to add the medication. The manager stated this practice was done on the advice of the home’s pharmacist. An audit of some medication confirmed that some medication left in packs did not correspond with the administration records. Of the 16 residents at the home, medication administration records for six were look at covering a 28 day period. A total of 75 signature omissions were evident. In addition, the administration for one handwritten medication for antibiotics was unclear. Crossings out over signatures were evident and it was not clear that medication which should have been given before food was administered as prescribed. The AQAA stated that managers regularly assess staff who administer medication. Managers stated that they checked the records two weeks prior to the inspection to ensure administration was correct. There was no indication of this practice, or evidence to support that errors had been noted and action taken to investigate. Errors are made undetected, which indicates there are no formal routines systems to effectively oversee the safe management and administration of medication. This places residents at significant risk of not receiving medication as prescribed. The previous inspection also identified that medication administration practices fell below the required standard. The inspector observed at least one staff member to be abrupt with residents, she was uncaring and unsympathetic. One resident was observed repeatedly calling for staff. As staff did not attend, the inspector summoned assistance. The call system was disconnected before the staff found who the resident was or what had occurred. The staff member approached the resident and spoke in a less than friendly voice. On a second occasion, one resident was observed having extreme difficulty rising up from a dining chair. As staff did not response to calls by the resident, the inspector went into the next room and asked staff if they could assist a resident. The tone and approach of the staff member in speaking to the residents were inappropriate. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 15 After obtaining support from a second member of staff, incorrect moving and handling techniques were used. Staff should not assist residents to stand by hooking under the arm. These practices place both the residents and staff at risk of injury. The technique used is, under health and safety and moving procedures, classed as an illegal lift. A further incident occurred when a gentleman had fallen upstairs, again this went undetected and the inspector had to call for assistance. Staff’s approach when initially attending was less than sympathetic. The approach and attitude of staff was disrespectful. Staff did not appear to be appropriately deployed around the home to ensure they responded to calls for assistance from residents in a timely manner. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents are able to develop their own day-to-day routines; they receive a varied nutritional diet and have the opportunity for social activity and interaction. EVIDENCE: On the day of the inspection some residents were up and about as the inspector arrived at 9am. The managers stated that most residents had breakfast in their rooms and that they chose when they wish to rise. Observations were that the two lounge areas are divided into groupings of residents, with the more mentally frail sitting in the front lounge. Residents in both areas seemed contented with their living arrangements and had a say in how they wished to live. Residents were not restricted from moving around the home and were able to go into any lounge if they wished. From general observations, it was evident that some residents received morning papers and magazines. At the time, residents were sat in one of the two lounges and were in conversation with each other. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 17 The home provides the services of outside entertainers who visit the home at least monthly. In addition, the home employs the services of one person to visit the home to provide structured exercise classes with the residents. The AQAA stated that staff sickness has hampered the amount of activities undertaken outside of the home and that staff being away on training has also impacted on this area. However, there continue to be some planned activities provided within the home. The managers stated that they are intending to significantly improve how activities are structured and ensure that residents will have some opportunity to join in an activity each day. There was evidence to support the managers’ statements and information to confirm they had been researching appropriate activities and consulting with residents on what they would like. Visitors were observed in the home and are made to feel welcome; however, it was evident that staff are not routinely ensuring visitors sign the visitor’s book when entering and leaving the premises. This is required to ensure it is known who is in the building in the event of a fire. Residents have recently been consulted about the menu and have been able to influence what meals are served. Residents receive meals that are freshly prepared. Fresh vegetables and fruit are always provided and available. Consideration should be given to the development of individual nutritional assessments being undertaken. The initial assessment regarding likes and dislikes of food is adequate as an initial assessment but does not meet the criteria as a nutritional assessment. Both files looked at stated ‘likes most things’. Nutritional assessments should be in place, which identify risk relating to poor nutrition. Where information cannot be obtained, staff should be able to contribute and update records as they make their day to day observations. This would promote the individuality of residents and ensure that their individual favoured food is provided either at mealtimes and/or as a treat during snack times. Furthermore, their nutritional intake could be monitored. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents are aware of the home’s complaints procedure and are protected from abuse by staff who are trained in safeguarding vulnerable adults procedures. EVIDENCE: The managers confirmed that they had not received any complaints in the last 12 months. Previous inspections identified that there was a clear complaints procedure in place. There is a complaints procedure in every bedroom and staff have been made aware of updated procedures in a staff meeting in June 2007. The AQAA stated that consultation with residents had been undertaken regarding how complaints were dealt with. The outcome of which was ‘our service users and visitors’ satisfaction questionnaires have rated our response to comments/complaints as good’. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 19 The inspector observed that at the inspection in May 2006 the home stated it had had no complaints for the previous 12 months. It would be unusual that, over a two-year period, no dissatisfactions about service provision had been made. The inspector concludes that there is possibly a training issue regarding how to recognise complaints and record them. Such records should include the complaint and the action taken to resolve them and of the complainant’s satisfaction or dissatisfaction with the outcome. The managers said that in order to ensure confidentiality for those who may not like to complain and to make raising comments about the service is easier, a comment, compliments and complaints box is to be placed in the public area which will enable people living and visiting the home to make comments at any time. The home has written policies and procedures for the safeguarding of vulnerable adults in place. It was confirmed that all staff have received training by Trafford Social Services in safeguarding vulnerable adults. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents live in a clean, well maintained home which is being upgraded to ensure their comfort, safety and enjoyment. EVIDENCE: It is acknowledged that since taking ownership two years ago, the current owners have and continue to, invest considerably in the upgrading of the home. Although not completed, many areas have improved. A new dumb waiter has been purchased and fitted to ensure food transferring from the kitchen in the basement to dining rooms is done so hygienically and in a timely manner. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 21 A Parker bath has been fitted in one bathroom. This is a specialised bathing facility that fully supports residents to bathe safely and comfortably, no matter what their mobility condition is. A new stair-lift has replaced the old one. The present one has comfortable seating that supports and promotes residents’ safety and offers residents security when in use. The home has improved the safety of residents by replacing the front door mortice lock to one that is activated to the fire alarm system, this means in the event of a fire emergency the door lock automatically releases. The are future plans in place which include a full upgrade of the hall, stairs and landing, lounges and dining facilities; this includes redecoration, curtaining, lighting, fixtures and fittings, and carpeting. The inspector observed that the layout of the back lounge/dining area could be improved. Should residents use some of the lounge chairs, staff would constantly disturb them as they walked by. Consideration should be given to a better layout or changing staff practice from going from one lounge to another through the joining walkway, as opposed to the main lounge doors. Observations of bedrooms were that they were clean and pleasantly decorated. The mangers confirmed that once a resident leaves the home, rooms are fully evaluated before the next admission. Redecoration takes place and, where required, new carpeting is provided. Beds are being replaced, as is bedroom furniture. Bedrooms looked comfortable, private places. Personal possessions were evident and rooms were personalised by the residents. The home was free from odours and clean. The home has a maintenance routine in place, which ensures that, as far as possible, residents live in a safe environment. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 28 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Residents receive support from staff who are not always properly recruited and supervised. Records could not demonstrate that robust recruitment procedures were in place or that staff were in sufficient numbers and/or deployed appropriately. EVIDENCE: Currently there are three staff awaiting a place on an National Vocational Training (NVQ) course at level 2. The managers stated that it is their intention to have 75 of staff trained at NVQ level 2 or above in the near future. Once this has been achieved, the training target expected will exceed the required standard. The managers have developed a training programme for all staff, which follows Trafford’s training consortium plan. A full audit of training is being undertaken to ensure that all staff have received the individual training they require for their role and responsibility within the home, as well as general mandatory training. Discussions were held regarding the provision of timely training and how that may have to be provided outside of Trafford’s own training programmes. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 23 The rota of hours worked by staff did not detail the required information. Full names were not in place, staffing positions were not recorded. It was unclear who was in control of the home in the absence of managers, and agency staff and/or additional hours worked were not identifiable. There was also some confusion as to the hours worked by some staff, as they were recorded as a carer and a cook on the same day. The home does not employ domestic staff, therefore the hours used to maintain the hygiene of the home should be deducted from care hours when carers are providing that support. As a consequence, domestic hours should be identified on the rota in order to enable a full analysis of care hours provided at the home can be made. The managers stated that induction procedures are completed for all new staff, commencing with the home’s own induction/orientation, and then skills for care induction procedures are followed. It is advised that initial induction procedures are recorded; to ensure that staff’s induction processes and initial training can be confirmed. Two staff files were looked at regarding their recruitment and selection. One application form was very basic and the other did not appear to be an application form, rather, information was added to another form. References were in place, however two were received after employment commenced and another was not signed or dated. There was no indication of the interview process, no contracts issued or letters of appointment evident. There was no current photo for one staff. The managers gave assurances that they had recruited appropriately, however they had not recorded all the required information, nor were they able to produce it at the time of the inspection. As stated earlier in the report, there were issues regarding staff’s conduct when talking and attending to residents. When asked about a code of conduct, the managers stated they did not have one, rather they trained staff to be respectful themselves. They had applied for and were awaiting the General Social Care Council’s codes of practice information packs. A recommendation has been made to ensure staff receive information, instruction and guidance regarding their conduct. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The registered providers of Heathside need to develop effective management routines and procedures that ensure that the safety and security of residents are paramount and that standards are maintained appropriately. EVIDENCE: The registered manager has returned from maternity leave and has commenced completing the registered manager’s award. The management structure at the home has not ensured that standards have been maintained. Currently, both managers are registered providers, however only one is registered with the CSCI. Both managers manage the service, however roles Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 25 are not defined nor have there been formal systems in place to appropriately monitor staff’s practice and procedures. The absence of the registered manager, and unclear defined roles and responsibilities of the managers has been a contributing factor for errors to go undetected and standards being reduced at the home. The managers appeared committed to improving standards and ensuring the safety of residents. Since taking ownership, the managers have understood the needs to develop all areas of the home, including its recording and administration systems. As a consequence, this year, considerable investment has been made to secure a company who will assist in the development of this area of work. The home has consulted with residents regarding service provision. Advice has been given regarding best practice for quality assurance procedures. It is recommended that such procedures be completed in accordance with Regulation 24 and standard 33. This includes the production of a public report of the outcome, a copy of which should be supplied to the CSCI. Routine formal supervision for all staff has not fully commenced, however staff meetings are now in place and managers ensure all staff receive up to date information on practice, policies and procedures. Health and safety procedures are undertaken. Certificates of service confirmed that electrical and gas supplies and equipment are fit for purpose and use. The AQAA stated that 100 of staff have received up to date food hygiene training. Infection control was poorly managed during the inspection. On one occasion, in order to answer the front door, one staff placed bedding, a nightgown and a used incontinence aids in the hallway. They answered the door with their gloves on, which increases the risk of spreading infection, rather than decreasing the risk. In addition, walking around the home with protective gloves on indicates that personal care is being completed. This does not promote privacy, dignity or respect and is institutionalised practice. Furthermore, the risk of spread of infection is again increased. The items were later observed to be left at the top of the basement steps. The items were not in a container with a lid or sealed to prevent the spread of infection. Records could not confirm that staff had received infection control or that practice was monitored regarding the removal of clothing from bedrooms to basement laundry areas. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 26 Accident records were completed correctly and identified consultation with GP and next of kin each time an accident had occurred. Records were collectively stored for safekeeping. In order to ensure confidentiality, such records should be stored in a resident’s individual file. The home keeps the CSCI informed appropriately of all significant issues as required under Regulation 37. The home does not manage residents’ finances. Support from relatives, advocacy services and/or legal services are in place for those who require assistance in managing their finances. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 X 3 3 X 3 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 1 X 2 Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 28 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 Timescale for action 14/08/07 2 OP9 13(2) 3 OP10 13(4) In order to protect residents from maladministration of medication, the registered manager and/or provider must ensure that safe systems are introduced for the safe management, storage and administration of medication. In order to ensure residents 14/08/07 receive medication in doses that have been prescribed by a GP, staff must cease adding medication to sealed containers where a pharmacist has already prepared the dose. In order to ensure residents are 14/08/07 safe when being moved/ handled, managers must ensure that all staff employ correct moving and handling procedures at all times. All staff with responsibility for supporting residents must have up to date moving and handling training and be assessed as competent to undertake such support. Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 29 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. 4 Standard OP16 Regulation 17 (2) Schedule 4 11 Requirement To demonstrate that residents’ concerns are dealt with, a record of all complaints and/or dissatisfactions reported to, or dealt with by the managers and staff must be recorded. Staff must be recruited through robust recruitment and selection procedures, which are designed to safeguard residents. Formal supervision must be undertaken with all care staff for the benefit of residents and to ensure that staff practices are overseen and monitored with staff training needs identified. The home’s managers must ensure the home is run in a manner which respects the privacy and dignity of residents. In order to protect residents from the risks of cross-infection in the home, all staff must be trained in infection control procedures. Such procedures must be followed at all times and monitored by the home’s managers. Timescale for action 01/09/07 5 OP29 19 14/08/07 6 OP36 18 (2) 01/09/07 7 OP38 12 (4) (a) 14/08/07 8 OP38 13 (3) 15/09/07 Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP1 OP5 OP7 Good Practice Recommendations The statement of purpose should contain accurate up to date information, be jargon free and produced in a service user friendly format. The registered manager should record the good practice pre-admission process undertaken with prospective residents. Each resident should have a concise care plan in place that sets out their individual needs and preferences for care support. They should also direct staff on how those needs should be met. Care plans should detail the specific support required to support residents with hearing difficulty and, where applicable, the practice required to maintain hearing aids. Formal systems should be introduced to monitor staff’s practice and competency in administration of medication. Formal systems should be introduced to monitor medication administration records to ensure that errors are noticed and dealt with in a timely manner. Staff practices should be monitored and overseen to ensure all staff treat residents with dignity and respect at all times. Activities and daytime occupation should be in place to support all residents as they desire and require, including those who are deaf. An accurate record of all people entering and leaving the building, including residents and staff, should be maintained. Nutritional screen should be in place and reflect the residents’ likes and dislikes in food sources and identify any areas where deficits in nutrition may occur. 4 5 6 7 8 9 10 OP7 OP9 OP9 OP10 OP12 OP13 OP15 Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 11 Refer to Standard OP22 Good Practice Recommendations If the home is to accommodate people who are deaf, appropriate aids and adaptations should be in place to support their comfort, safety and independence. Consultation with specialised services should be undertaken regarding best practice and equipment provided such as flashing lights to indicate a fire emergency and vibrating pillows that identify a fire emergency at night when sleeping or when someone wishes to gain entry to their room when they are asleep and flashing doorbells to indicate someone is at their bedroom door. The record of hours worked by staff should be maintained appropriately. Staff names, actual hours worked, staffing position and additional responsibilities should be recorded. Staff should be trained in communication techniques, including various methods for communicating with people who are deaf. Records should be maintained to validate the practice undertaken to introduce new staff into the home. Details should include supernumerary hours worked, training and guidance, etc. A code of conduct procedure should be implemented. Staff should be trained in such procedures and monitored to ensure their conduct is correct at all times. Quality assurance procedures should be completed in accordance with Regulation 24 and standards 33. Once completed and analysed, individual accident reports should be filed within the individual records. 12 13 14 OP27 OP27 OP28 15 16 17 OP30 OP33 OP38 Heathside Rest Home DS0000063746.V343058.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Old Trafford, Manchester M16 9HU 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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