CARE HOMES FOR OLDER PEOPLE
Heathside Rest Home 74 Barrington Road Altrincham Cheshire WA14 1JB Lead Inspector
Val Bell Key Unannounced Inspection 11:00 24th May 2006 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.V292405.R01.S.doc Version 5.1 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.V292405.R01.S.doc Version 5.1 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.V292405.R01.S.doc Version 5.1 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. 21st December 2005 Date of last inspection Brief Description of the Service: Heathside provides residential accommodation and personal care for up to sixteen residents within the category of old age. However, any of the residents could additionally have a physical disability. Heathside is a large property, which is set in pleasant grounds. The home is situated on Barrington Road in Altrincham, close to the town centre. Resident’s bedrooms were personalised with furniture, photographs and possessions from home. Fourteen single bedrooms and one double bedroom are located on two floors. All rooms are fitted with washbasins and vanity mirrors. 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. Heathside Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place during daytime hours on 24th May 2006. During the inspection conversations were held with seven residents staff on duty and the provider. A variety of records were examined and the care plans for five residents were case-tracked. The relatives of these residents were contacted by telephone for their views on the quality of the care provided by the home. Additionally, satisfaction surveys were sent to the relatives of six residents. There were no outstanding requirements from the previous inspection. At the time of this inspection the fees for this service ranged from £333.10 to £390.00 according to the size and facilities offered in the bedrooms. There were no additional charges made. What the service does well:
The home promotes issues of diversity and equality by treating people as individuals and by providing the facilities and equipment for people to maintain their independence and enhance their quality of life. A robust system of needs assessment and care planning had been put into place and the home was commended for the quality of information contained in residents care plans. The seven residents and five relatives spoken to confirmed that people were treated with dignity and respect and that their right to privacy was maintained. One relative said, ‘Sometimes my husband needs help with feeding. Staff always help him in an unobtrusive way. My husband trusts the staff and I have never felt the need to be concerned about the way he is treated.’ The new owners have invested considerable capital in making improvements to the environment in the previous twelve months and work is ongoing. One of the relatives acknowledged this by commenting, ‘the environment still needs some upgrading but it is very comfortable and homely. I think the staff do a marvellous job as the home always smells clean and fresh.’ Staff take time to listen to resident’s views and always act on any concerns expressed. A relative said, ‘Staff always keep me informed of my fathers progress and will ring me if they have any concerns. I’ve never had to make a complaint as it doesn’t get that far; staff sort things out.’ Heathside Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 Page 6 The homes catering was tailored to meet the individual needs of people living in the home with an emphasis on providing seasonal produce, such as fresh salmon. During the lunch time meal residents agreed that the food provided was ‘good home cooking’ which was varied, wholesome and appetising. What has improved since the last inspection? What they could do better:
Five requirements and four good practice recommendations were made during this site visit. It was noted that self-funding residents were not being offered a contract for the services and facilities provided by the home. Resident’s rights must be protected by written contracts that specify exactly what is included in the weekly fee charged. A safe system of medication was in place. However, one member of staff had signed for medication in pencil and a gap in the records where medication appeared to have been administered but not signed for. Two good practice recommendations were made in this area. Written guidance on the circumstances in which staff can administer ‘as required’ medication should be available and a list of those staff authorised to administer medication should be included in the medication records. Two issues relating to health and safety were noted. Radiators in resident’s bedrooms posed a risk to burning from prolonged contact with hot surfaces. The radiators must be individually risk assessed and where the risk cannot be effectively managed radiators must be fitted with protective covers. Secondly, The kitchen window needed to be fitted with a suitable screen to guard against food being contaminated by flies. In relation to the recruitment of staff a new member of staff had been appointed with a three-month old Criminal Record Bureau certificate. Legislation requires that POVA (Protection of Vulnerable Adults) First checks be
Heathside Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 Page 7 undertaken on all staff prior to their appointment. This had not been addressed on this occasion. Two further good practice recommendations were made to consider displaying a sample menu to inform residents and visitors of the type of diet provided by the home and to develop a good practice model of recording the quality of outcomes experienced by residents on a daily basis. 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. Heathside Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 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 Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. A robust system of needs assessment ensures that the individual needs of residents are identified. The home needs to provide self-funding residents with a standard form of contract to ensure that their rights to accommodation and personal care are protected. EVIDENCE: The inspector was told that while local authority funded residents were issued with contracts, the home did not provide contracts to privately funded residents. The home must provide a standard form of contract to residents for the provision of services and facilities. This should include the information listed under 2.2 of the National Minimum Standards for Older People. Heathside Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 Page 10 Care manager assessments of need had been obtained for the five residents that were case-tracked during this inspection. Additionally, skilled and experienced staff had undertaken comprehensive in-house assessments of need. A recently admitted resident said that she had been consulted about her particular needs and that sufficient information had been provided in order for her to make an informed choice on whether the home could meet her needs. She also remarked that staff had provided reassurance to her following admission and this helped her to settle in. The home does not offer an intermediate care service. Heathside Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home had a strong ethos and focus on respecting people’s individuality. The quality of care planning was commended as the system in place ensured that residents had their needs met in a sensitive and caring way. EVIDENCE: Care plans had been developed from assessments of need and the five examined contained comprehensive and clear information that considered all areas of resident’s lives. Particular attention had been paid to the regular monitoring of resident’s health needs through timely referrals to relevant health professionals. There was also evidence to demonstrate that staff work closely with health and social care professionals for advice and support. The use of social histories and attention paid to recording preferences and dislikes meant that people were being treated as individuals and that their diverse needs were respected. Outcomes of the care being delivered had been recorded on a daily basis and this provided valuable information when the care plans were reviewed every month. Of particular note were the daily recordings
Heathside Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 Page 12 of one of the senior care staff. These records were very detailed and included the emotional support and reassurance that had been offered to people living in the home. A good practice recommendation was made for this style of recording to be used as a model of best practice in development of the care teams recording skills. The home received a commendation for the quality of the care planning in place. The local pharmacist had regularly monitored the system of medication and staff had received training in the administration of medication. However, some minor shortfalls were identified. These included a carer signing for medication administered in pencil and a gap in the records where it appeared that medication had been administered but not signed for. This can be improved by the implementation of regular management checks to monitor compliance. It was also recommended that a list of signatures for those staff authorised to administer medication should be included in the medication folder. Additionally, if residents are prescribed ‘as required’ medication guidelines, on when this can be administered should be included in the medication folder. The seven residents spoken to confirmed that staff always respected their dignity and privacy and treated them as individuals. The atmosphere in the home was very relaxed and staff were observed to have developed good relationships with residents. Requests for information and/or advice were dealt with efficiently and promptly. Heathside Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home places importance on listening to the views of individual residents and encourages and supports people to exercise control over their own lives. EVIDENCE: From examination of care plans and conversations with residents it was evident that a variety of interesting and stimulating activities are provided. These included health and beauty days, a visiting entertainer, library services, special celebrations and TV and radio. A newly admitted resident commented that she hoped that trips out would be arranged in the summer months. The provider confirmed that trips out would be provided in the warmer weather. The home was proactive in seeking the views of residents so that a continual system of quality monitoring, review and updating of service quality could be made. A person-centred approach was in evidence as the homes routines were flexible and planned around the resident’s needs and wishes. This had resulted in residents being confident in expressing their views and maximising their independence. From conversations with staff it was evident that input from relatives was valued and encouraged.
Heathside Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 Page 14 Prior to the site visit the provider had sent copies of the homes menus to the Commission. These provided evidence that residents were offered a healthy and balanced diet. Menus were being done in retrospect as the provider shopped for food on a daily basis, buying food items that were in season, such as fresh salmon. A good practice recommendation was made to display a sample menu on the notice board to inform residents and visitors to the home of the type of diet provided. The inspector joined resident’s for their midday meal. The two-course meal was freshly cooked, attractively presented and appetising. Residents said that the quality of catering was always good and that their preferences were respected. The cook was experienced and knowledgeable about the individual dietary needs of residents and special diets were catered for. Fresh fruit and vegetables were used and cakes, pastries and desserts were homemade. The kitchen had been maintained regularly, food was stored appropriately and the required health and safety checks were up to date. A requirement was made for a fly screen to be fitted to the kitchen window. Heathside Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents could be confident that the home valued their views and that systems were in place for their protection and safety. EVIDENCE: The homes complaints procedure was clear, had recently been updated and was prominently displayed. Residents were clear on who they could complain to and were confident that their concerns would be addressed effectively. A complaints recording system was in place although no complaints had been received in the previous twelve months. Robust policies and procedures for the protection of vulnerable adults were in place and staff had been trained in how to recognise and deal with issues of abuse. In conversation with the inspector a care assistant was able to explain the correct action to take if she suspected that a resident was suffering abuse. Residents said they felt safe and that their rights were being protected. Heathside Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents were provided with a clean and comfortable living environment and specialised equipment to meet their care needs. However, the absence of radiator guards in bedrooms potentially placed residents at risk. EVIDENCE: On a tour of the home the premises were found to be well maintained and the appropriate aids and equipment had been provided to meet the care needs of residents. The owners had made considerable improvements in the previous twelve months and planned to invest further capital on improvements by installing en-suite toilets in eight bedrooms and the provision of a Parker bath. Residents bedrooms were personalised with ornaments and family photographs. Residents said they were comfortable and that the home was adequately heated and clean. Two communal lounges were provided and residents could receive visitors in these lounges or their bedrooms.
Heathside Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 Page 17 It was noted that radiators in resident’s bedrooms had not been fitted with guards to prevent the risk of burning from contact with a hot surface. A requirement was made for bedroom radiators to be risk assessed. Where the risk of burning cannot be managed, radiator guards must be fitted. The inspector was told that this would be addressed. Residents were looking forward to the warmer weather so that they could take advantage of attractive and private garden at the rear of the home. The steps down to the garden had been widened to make it safer for mobile residents and wheelchair access was also available. Heathside Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home recognised the importance of ensuring that staff had opportunities for training and development so that they would have the knowledge and skills to meet the assessed needs of residents. EVIDENCE: Staff rotas provided evidence that sufficient care staff were being deployed to meet the assessed needs of residents. Management hours were also included on the rotas. The home had not employed agency staff. Four care assistants had begun a course of study towards NVQ level 2 and the senior carer on duty was due to start a level 3 NVQ in September 2006. Staff were asked if they had received mandatory update training in health and safety. The inspector was told that this had been discussed with the manager and would be arranged when she returned to work from maternity leave. Progress on this will be assessed at the next inspection. It was encouraging to note that the home had joined the Trafford Training Consortium, as this would provide a variety of training and development opportunities for staff. Four personnel files were examined and found to contain most of the required information relating to pre-employment checks. However, a recently recruited member of staff did not have a current Criminal Record Bureau (CRB) or
Heathside Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 Page 19 Protection of Vulnerable Adults from Abuse check. The registered person mistakenly believed that CRB certificates under six months old were acceptable. Providers of care have a statutory obligation to obtain POVA First checks prior to confirming new staff in post and these checks can only be obtained by applying for Criminal Record Bureau disclosures. Heathside Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents were involved in the homes quality assurance system and their views and suggestions were listened to and acted upon to make improvements according to their needs and preferences. EVIDENCE: The registered manager was on maternity leave at the time of inspection. Her progress on undertaking a course of study to achieve NVQ level 4 in management will be assessed at the next inspection. The registered provider was managing the home in the manager’s absence and a senior care assistant was on duty throughout the inspection. Staff said that they received the support and guidance that they needed to do their jobs effectively and a system of regular supervision was in place.
Heathside Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 Page 21 Satisfaction surveys had been undertaken in January 2006 and the views of residents had been taken on board by making improvements to the service provided. The home did not manage resident’s personal finances. Their relatives or legal advisors undertook this. As mentioned previously in this report, a requirement was made for care staff to receive annual updates in mandatory health and safety training. There were no further health and safety issues identified during this inspection. The home had received an environmental health inspection in March 2006 although the report was not available at the time of this inspection. Heathside Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Heathside Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5 (1) (c) Requirement Self-funding residents must be offered a contract for the provision of services and facilities within the home. Staff must complete medication records in permanent ink and all medication administered to residents must be signed for. A fly screen must be fitted to the kitchen window. Radiators in resident’s bedrooms must be risk assessed. Where the risk of burning from prolonged contact with a hot surface cannot be managed, radiator guards must be fitted. The registered person must ensure that POVA First checks are undertaken prior to confirming new staff in post. Timescale for action 24/08/06 2. OP9 13 (2) 24/06/06 3. 4. OP15 OP19 13 (4) 13 (4) 24/06/06 24/08/06 5. OP29 19 24/06/06 Heathside Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 Page 24 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. 4. Refer to Standard OP7 OP9 OP9 OP15 Good Practice Recommendations The registered person should consider developing a model of best practice for the quality of information recorded to demonstrate positive outcomes for residents. The registered person should include in the medication folder a list of signatures for those staff that are authorised to administer medication. The registered person should provide written guidance for staff on the circumstances when ‘as required’ medication can be administered. The registered person should consider displaying a sample menu to inform residents and visitors to the home of the type of diet provided for residents. Heathside Rest Home DS0000063746.V292405.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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