Inspection on 05/06/07 for Heeley Bank

This inspection was carried out on 5th June 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Heeley Bank 08/01/09

Heeley Bank 30/11/07

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Heeley Bank Heeley Bank Road Sheffield S2 3GL Lead Inspector Marina Warwicker Key Unannounced Inspection 5th June 2007 07:50 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 DS0000068866.V334852.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. DS0000068866.V334852.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heeley Bank Address Heeley Bank Road Sheffield S2 3GL 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) 0114 255 7567 0114 255 5803 heeleybank@schealthcare.co.uk CC Care Ltd Pam Brooks Care Home 64 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (46) of places DS0000068866.V334852.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The first floor is registered for nursing and personal care and has 2 wings. One is registered for 18 people in the category DE/E, Dementia for people 65 and over, nursing and personal care and the other is registered for nursing care 18 people in the category OP, Old Age not falling within any other category and will provide intermediate care. Bedrooms 10 and 40 must not be used to accommodate wheelchair users (whether self propelling or not) or anyone who needs a walking frame to mobilize. New Service 2. Date of last inspection Brief Description of the Service: Heeley Bank is a purpose built two storey building in the Heeley area of Sheffield. It had sixty four bedrooms, all en-suite consisting of toilet and wash basin. The home was divided into three units. Each unit had facilities for a designated category of people. The ground floor unit had twenty eight bedrooms and it was registered to care for people requiring personal care only. On the first floor there were two units. One was designated to give nursing care for eighteen people with dementia and the other unit had four bedrooms for nursing care and the rest of the fourteen beds for intermediate care. There was a large car park to one side of the building and there was a large garden area. The weekly charges ranged between £310.00 and £494.00. There were additional charges for hairdressing, newspapers and chiropody. There were copies of the statement of purpose and service user guide available on request from the manager. DS0000068866.V334852.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was carried out on Tuesday 5th June 2007 between 7.50 am and 3:20 pm and the following day between 7.00 am and 8:45 am. Twelve people who use the service, visiting professionals, two relatives were consulted and fifteen staff were spoken to. A further fifteen service users/ relatives, fifteen staff and five visiting professionals were contacted by post to obtain feedback about the service. Comments received from the surveys have been included in the body of the report. Time was spent observing and interacting with staff and the service users. The manager was present during some parts of the inspection. The premise was inspected which included bedrooms of service users and the communal areas inside and the outdoors. Samples of records such as the care plans, medication records, some service reports and staff recruitment and training files were checked. I would like to thank the service users, the relatives, the staff and the managers for their contribution towards this process. What the service does well: Prospective people and their representatives who wish to use the service were given information to make an informed choice. The information ensured that the home would meet their needs. The intermediate care unit provided support to those who need rehabilitation facilities. The health and personal care of those who live at Heeley Bank were on the whole based on their individual needs. The principles of respect, dignity and privacy were put into practice by the staff working at the home in order for the people to feel comfortable and part of the community. Some people who live in Heeley Bank were able to make choices and influence the decisions made for them by the staff. The staff on the whole try to offer support to the residents so that they were able to maintain their life skills and thereby sustain independence as long as they were able to. Most of the time the meals were served and presented in a manner, which was attractive and appealing to the residents. The people who use the service were able to express their concerns and have access to a complaints procedure. The people who live and the staff who work DS0000068866.V334852.R01.S.doc Version 5.2 Page 6 at the home were on the whole protected from abuse, and generally able to exercise their rights. The physical design and layout of the home enabled people who use the service to live in a safe and comfortable environment, which encourages independence. Generally the home was kept clean. Some of the staff were trained and skilled to support the people who use the service with their specific needs. What has improved since the last inspection? What they could do better: The statement of purpose must be accurate as to the facilities and services, which are provided by the home. For example, It must be clear where nursing care is to be provided and the facilities made available in each unit for the specific category of people. The people must be assessed as to whether they are able to self medicate to promote independence instead of staff taking on the administration of medication from the day of admission to the home. The people must not be provided accommodation unless the home is able to meet the person’s needs. The registered manager must ensure that the assessment of the peoples’ needs are kept under review and revised. If it is necessary the management must take action to address the changed circumstances by relocating the person or appointing extra resources to provide the service. The care plans must be regularly reviewed and the staff must ensure supporting evidence such as the food, turns, elimination charts are recorded accurately and at the appropriate intervals. The manager must ensure that the staff are competent in managing incontinence. The care staff must be encouraged to follow the guidance given to them by the visiting health care professionals; the manager must monitor how familiar the staff are with the guidance and encourage them to use it. The designated staff must ensure that the medications are ordered on time to prevent any omissions. The care staff must observe the people to ensure that the medication they are taking for pain, discomfort or depression are having the desired effects and need to keep records of daily progress. The management must make every effort to train front line staff in end of life care so that staff are competent and able to give the person and the family support and comfort. The people living at the home and their representatives must be consulted about the programme of activities. DS0000068866.V334852.R01.S.doc Version 5.2 Page 7 The activities in relation to recreation, health and fitness must be part of every person’s daily life and the staff working at the home must promote this. Hot and cold drinks and snacks must be made available for the people at all times. The manager must ensure that there are sufficient numbers of care staff available at meal times so that people are given enough attention and help. The timing of the main meals must be reviewed so that the people don’t receive the three main meals of the day within 8 hours and then rely on snacks being offered over the next 16 hours. The manager must keep a record of all complaints made and including details of investigations and any action taken. The present recording system did not give adequate information about complaints handling. The people living and working at Heeley Bank must be able to contact the Commission for Social Care Inspection if they so wish. The management must not deter them. The programme of routine maintenance must be monitored to prevent the problems with faulty doorbells and unlocked doors. The garden area surrounding the home is not fit for its purpose since the people are unable to use it. Due to the large staff turnover in the past 12 months the staff working at the home are fairly new therefore require extra support and effective supervision. Additional staff must be on duty at peak times. Domestic and laundry staff must be employed in sufficient numbers so that care staff are not instructed to complete the tasks of the ancillary staff by the management. The registered manager must ensure that suitable staff are employed and must introduce systems to retain staff. The management style must reflect the purpose, the aims and the objectives of Heeley Bank and the people who live there. The management approach must be open, transparent, and receptive to the suggestions of others involved in the service. The manager must introduce strategies for enabling staff, people living at the home and other stakeholders to affect the way in which the service is delivered. The home’s quality assurance and quality monitoring system must measure the success in meeting the aims, objectives and the statement of purpose of the home. The outcome of the survey and the action taken by the home must be published. 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. DS0000068866.V334852.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 DS0000068866.V334852.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 People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Prospective people and their representatives who wish to use the service are given information to make an informed choice. The information ensures that the home will meet their needs. The people have their needs assessed by the placing authorities and the management of the home allocates the appropriate unit following consideration of their needs. However, the present system for allocation does not always reflect the actual needs of the people. Therefore people are inappropriately placed. The intermediate care unit provides support for those who need rehabilitation facilities with the help of the community physio and occupational therapists. DS0000068866.V334852.R01.S.doc Version 5.2 Page 10 EVIDENCE: The manager made available copies of the statement of purpose and the service user guide. The documents were easy to read and gave a variety of information. However, the information with regards to the registration was not accurate. The home was divided into three units. The ground floor unit had 28 bedrooms for people needing personal care only and on the top floor there were two units, one unit had 18 bedrooms for people with dementia needing care and the other unit had four nursing beds and 14 Intermediate care beds. This was not explained clearly in the statement of purpose. During the tour of the premise health professionals and care staff were consulted; it was evident that the allocation of individuals did not comply with the agreed registration. There were several people requiring nursing care cared for in the personal care unit on the first floor. This issue was discussed with the manager and the operations manager. They said that the placement was dependent on the fees the placing authorities were prepared to be pay and their assessment deemed the level of care the individuals needed. The surveys also confirmed that the management had accepted people into units without proper assessment and then had to move them on to other units. On the days of the site visits this was witnessed. The manager said that there were four people receiving intermediate care. The inspector was unable to speak to the therapy staff. DS0000068866.V334852.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, 10 and 11 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. In general the health and personal care of those who live at Heeley Bank are based on their individual needs. However, the systems to monitor the standard of care delivered are not effective and therefore need to be improved so that the care reflects each individual’s needs. Those people who are able to self medicate need to be given the opportunity. The principles of respect, dignity and privacy are put into practice by the staff working at the home in order for the people to feel comfortable and part of the community. EVIDENCE: Three care plans were checked, people receiving the care were consulted and relative and staff comments from the surveys were considered. The care plan had been generated from the assessments by the placing authority and the senior staff at the home. There was insufficient evidence that the care plans had been drawn up and reviewed with the help of the person receiving the care and/or their representatives. DS0000068866.V334852.R01.S.doc Version 5.2 Page 12 There was a lack of indication that the staff at the home maintains and promotes health and personal care so that individuals’ needs were met. Problems had been highlighted and interventions had also been set out but there was no follow up monitoring of outcomes for the people. The care audit tools such as the tissue viability/position change, continence/elimination, food and fluid intake are some examples. These charts were not filled in accurately and therefore prompted further questioning of staff and the manager. Or example according to a food chart the person had not had anything to eat after the evening meal at 5.00 pm until the following morning 9.30 am. This was not just one omission but was the norm. The same person’s weight has been fluctuating and requires close monitoring. Elimination chart had not been filled in for four consecutive days and there were several gaps in the previous week too. The daily progress report had not been completed for four days by staff. The reason for people being kept in bed was not always documented. The care plan indicated that the person was immobile but this person was seen walking with the aid of a Zimmer frame. Another person was said to be immobile but was at risk of falling. The information did not explain that the person was able to sit out in a chair and at that point s/he was at risk. Often the risk assessment had been copied down each month by the staff without giving due consideration to the present status of risk to that individual. The statement of purpose indicated that the medication would be managed by the staff at the home hence the individuals were not assessed and given the opportunity for them to self medicate. The supplying pharmacist had carried out an audit and recommendation had been made. The staff said that the manager carried out monthly audits. Medication Administration Sheets and medication storage were checked. These were in the main satisfactory. The designated person was seen administering medication to individuals. People were prescribed pain relief and antidepressant medication. However, the daily or weekly progress record did not give any account of the effectiveness of the treatment. A person was not given a prescribed medication for three days since they were out of stock. The staff said that it was the pharmacy that was out of stock hence the omission. The manager was made aware of the above on the day. The visiting professionals and five people occupying the home were consulted. They all confirmed that the care staff always respected the privacy and dignity of the people living at the home. One person said, “I can assure you that the staff will never knowingly neglect the residents living here. If they did do anything which can be seen as unacceptable I can say it is due to lack of supervision and lack of understanding.” DS0000068866.V334852.R01.S.doc Version 5.2 Page 13 Four staff were interviewed with regards to the way they respect people, they said, “Attend to their personal needs in their rooms. I always explain and talk to them.” “Keep the doors closed when helping with personal hygiene.” “ Know their likes and dislikes and when helping them change, offer them their favourite clothes. Style their hair the way they like.” “ Always speak to them respectfully even if they have dementia and forgetfulness. They have the same feelings as us”. Staff said that the office staff delivered the mail to the person in charge of the unit. They either leave it for the family to read the mail if the person was unable to read it themselves or read it to them. The staff were seen addressing the people living at the home kindly and courteously. The staff had made attempts to consult the residents with regards to death and dying wishes. The care plan did have documentation with regards to this. None of the staff interviewed have had formal training on End of Life care. However, during the staff training record checks some staff have had the above training. DS0000068866.V334852.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 People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. Some people who live in Heeley Bank are able to make choices and influence the decisions made for them by the staff. However, those who lack capacity and therefore require support and guidance do not always have the opportunity to do so therefore this group of peoples’ expectations and preferences are not taken into account. The staff on the whole try to offer support to the residents so that they are able to maintain their life skills and thereby sustain independence as long as they are able to. Social, cultural and recreational activities most of the time do not meet individuals’ expectations. The people and their representatives are not consulted when activities are organised. As part of the daily routine the care staff are not encouraged to participate in the activities with the people. DS0000068866.V334852.R01.S.doc Version 5.2 Page 15 Most of the time the meals are served and presented in a manner, which is attractive and appealing to the residents. The transportation of cooked meals from the kitchen to the serveries is not satisfactory. The mealtime is disorganised therefore the people do not get the meals at the right temperature. This practice prevents people enjoying the meals. The time between the last meal of the day and the breakfast is too long and this leaves the people hungry. EVIDENCE: The manager said that the activities co-ordinator was to take some of the people out to lunch to the nearby public house. There were lists of activities displayed at the reception areas. However there was no indication of any other activities for the people at the home. These were some of the comments received through our surveys. “There is not enough distraction for the residents. They look bored.” “Every day there could be different activities and the staff could include those in the EMI unit.” “ My Y would like someone to read for a short while each day and discuss what is going on around.” “On the EMI corridor little stimulation is provided, although the appointment of the activities person is beginning to have an effect.” During the site visit it was noted that the staff did not know how to interact with the people. The care staff were around the units assisting people if they wanted help. But they did not take the opportunities to chat with the people and intermingle. The staff need to be trained and given the opportunities to develop skills and be confident when interacting with people. Some staff were willing but did not know how to go about engaging with the people. The people living in the home and the staff said that visitors were encouraged and community contacts were encouraged. The families of most people managed the finances for them and the manager was appointee for seven people and she stated that she handled the financial affairs for them. People were allowed to bring their own possessions with them and details of the items brought in by them were documented in the care plans. The cook and the kitchen assistant were interviewed. The feedback from the surveys was shared with them and the manager. These are some of the comments. “Very unhappy with the meals. Not a lot of nutritional value. Have complained about meals to no avail.” “ Meals questionable at the moment”. “Menus are asked to be filled in and it is not stuck to.” “Everyone is given the same meals, diabetics may have a different desert.” “ Some request a certain meal but it is not granted.” “The carers work 12 hour shifts sometimes without a break. If they forget to bring food with them there is nowhere for them to get anything. This alone can make staff tired with working 12 hours. This in my mind puts people at risk by the management. Surely something should be provided for these carers.” “Provide biscuits for a night cup of tea.” DS0000068866.V334852.R01.S.doc Version 5.2 Page 16 “At times residents have to ask their family to bring in snacks to have with the cup of tea.” “ Some nights people are hungry because the tea served is too early.” The cook explained that she was managing with one kitchen assistant on the days of the site visit. Therefore they were unable to serve out the meals in the serveries to the people. She evidenced that she had the information on special diets and the peoples’ likes and dislikes. It was agreed that the transportation of cooked meals would benefit from a hot trolley. The cook said that on some occasions she had changed the menu purely to please the people. Recently they had requested cheese on toast so that evening menu was not adhered to. The cook assured the inspector that each evening she left a tray of sandwiches, cakes and home made biscuits for supper time and she said that the night staff had access to bread and snacks if the people wanted. This seemed to be yet another example of care staff and the kitchen staff not communicating and the management not being aware of this or not taking action to improve team working. DS0000068866.V334852.R01.S.doc Version 5.2 Page 17 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 People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. People who use the service are able to express their concerns and have access to a complaints procedure. Those who have made complaints have called the effectiveness of the procedure into question. The people living and working at the home are on the whole protected from abuse, and generally able to exercise their rights whilst living at the home. EVIDENCE: The manager said that there was a complaints procedure, which included the time scales and stages for the process. A summary was found in the statement of purpose. The manager and the operations manager said that all complaints were dealt with promptly and effectively. A copy of the complaints register was obtained during the second day of the site visit. On examining the records the topics of complaints were not clearly documented. Often documented as ‘various issues’ and there was a lack of information as to whether the complaints were upheld or not and what corrective action was taken and how the progress has been monitored by the management of the home. DS0000068866.V334852.R01.S.doc Version 5.2 Page 18 The relatives and the staff had voiced concern about this practice or the lack of it during their feedback. The following are some of the comments received. “The manager does not take complaints seriously. The changes due to complaints are short lived.” “The manager does not appreciate why the staff complain. She needs to work on the floors and watch the goings on. She has been in post long enough now to find out what happens during 24 hours.” “I have raised concerns about the care and the lack of staffing. Also questioned the reason for the tremendous staff turnover. But no one has got back to me to tell me what they are doing about it.” The staff said that they had received training on Protection Of Vulnerable Adults. They knew what action to take if they were to witness any abuse neglect or inhuman treatment of people. Four staff files were checked and all four had evidence of satisfactory CRB checks and records of POVA training. DS0000068866.V334852.R01.S.doc Version 5.2 Page 19 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, 23, 24, 25 and 26 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The physical design and layout of the home enables people who use the service to live in a safe and comfortable environment, which encourages independence. The lack of doorbells and the unsecured outer doors put the people at risk at nightime. The specialist equipment for the use of the people is provided so that the peoples’ independence could be maximised. Generally the home is kept clean but some areas have offensive odour due to the inappropriate management of continence. DS0000068866.V334852.R01.S.doc Version 5.2 Page 20 EVIDENCE: The location and the layout of the home were suitable for its stated purpose. It was accessible for wheelchair users. On the first day of the site visit the inspector was unable to enter the home due to all the doorbells being faulty and had to make a telephone call to gain access. The same morning it was noted that one of the outer doors to the home was left unlocked due the lock being broken. This led to the inspector questioning the security arrangements for the people and the staff at nightime. The management were instructed to rectify these issues immediately before the end of the day and it was complied with. The grounds outside the home need attention and one of the comments received describes the outside garden area as a disgrace to the company, which own the home. This area was overgrown and the manager said that they had obtained estimates to hire a gardener to maintain the outdoor area. The statement of purpose indicated that there was a designated lounge for the residents to smoke. During the site visit this was not evident and the manager said that they had one resident who smoked and that person was happy to go outside and have a cigarette. The staff said that they had an adequate number of aids and hoists. During this site visit the inspector was unable to meet the community therapists to gain their opinion of the running of the intermediate care unit. The individual accommodations were personalised and looked comfortable. The bedrooms were centrally heated and well ventilated. Some parts of the unit with 28 Personal care beds were emitting unpleasant odour, which could only be described as incontinence. In one of the lounges some of the chairs too smelt unpleasantly. The manager was informed of this. She said that they had cleaned the chairs the previous week. The laundry was sited in the basement and discussion took place with regards to the laundry staff completing the service by taking the clean laundry back to the peoples’ rooms each day. It was then identified that this would release care staff who were currently expected to complete laundry duties during their night shifts. The manager was present and agreed to look into this arrangement. DS0000068866.V334852.R01.S.doc Version 5.2 Page 21 There were notices on doors instructing people and their visitors that they had no access to the areas. This gave the feeling of an institution. If people need to keep away from parts of the home alternative arrangements must be made. During the tour of the premise there were some rooms with the persons name and some without. On questioning the staff they said that the names were displayed on the bedroom doors with the agreement of the people and those who had not had their names displayed were due to omission by the staff. DS0000068866.V334852.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. On the whole the staff are trained and skilled to support the people who use the service with specific needs. However, staffing levels and skill mix are not satisfactory to meet the needs of the people. The management have taken measures to train care staff to NVQ level 2. The recruitment procedure was in line with the different legislations. However, the retention of staff is a major problem at Heeley Bank. The management need to devise a staff training and development programme to value the staff and offer them opportunities for development. EVIDENCE: The staffing numbers and skill mix of qualified staff were not appropriate to the assessed needs of the people living at the home; especially on the Ground floor i.e. Personal care unit. The ratio of care staff to the residents was not determined by the assessed need of the people but it was based on management decision. DS0000068866.V334852.R01.S.doc Version 5.2 Page 23 The number of ancillary staff employed and when on duty needs to be reviewed. During meal times the food was served by the care staff who then had to give people assistance and then go on to feeding those who needed help. The number of staff available during lunchtime was inadequate and as mentioned before the mealtime was disorganised. The laundry staff were employed between 8.00 am and 3.00 pm. Therefore the rest of the laundry duties were completed by the care staff under the instruction of the manager. These activities took away the care workers from the people who deserve care. The manager explained that due to staff leaving those who had completed NVQ level 2 in care was not up to 50 , however staff had been signed up to commence training soon to comply with the requirement. Four recruitment files were randomly selected and checked with the help of the manager. They had all of the information required by the Care Homes Regulations 2002. DS0000068866.V334852.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, 32, 33, 36 and 38 People who use this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The management and administration of the home is seen as not an integral part of the care service and there are divisions between the staff and the management and this is causing the people who live at the home and their representatives to be anxious and unsure. There is a quality assurance system used by the manager and her staff. The effectiveness of this exercise is questionable. Better communication is needed to inform the people at the home, their relatives and the staff of the improvements, which had been made as a result of quality assurance for the best interest of the people who live and work there. DS0000068866.V334852.R01.S.doc Version 5.2 Page 25 EVIDENCE: The registered manager was responsible for the day-to-day running of the home. The administration staff and the operations manager supported her. There was a clear line of accountability and the staff interviewed knew their responsibilities. It was verified by the comments received during and before the site visit that the home’s management do not communicate a clear sense of direction and leadership, which the people living at the home and the staff understand and are able to relate to the aims and purpose of Heeley Bank. There were no effective strategies for enabling the people, the stakeholders and the staff to influence the way in which the service is delivered. The process of managing and running the home was seen as by those who were involved as oppressive. The following comments would help ascertain the above. “Good staff leave. If staff don’t agree with the management they are out.” “Unacceptable levels of staff turnover and the management don’t seem to worry about it. But its our families who need to get use to the new staff all of the time.” “They say that they have relatives meetings but how come we only get to know after the event. The last time the admin staff had forgotten to send out the invitation and then the manager made out that we were not bothered to turn up.” “Whenever the manager is approached about a concern all she says is leave it with me and that is the last we hear.” “The staff under the present regime look frightened to say anything and their attitude has changed and they come over as uncertain.” The staff had also been instructed by the management of the home that they must not go to Commission for Social Care Inspection telling tales and if they found out they would be out on the street. If this is factually correct the management will be liable for obstruction and the fitness of the manager and the organisation could be called into question. The quality assurance and the quality monitoring systems need to be effective. Not only the views of the people who use the service need to be sought the results of the surveys need to be analysed, appropriate action taken and the outcomes need to be published so that those who gave their time by getting involved in the home’s surveys find out the results. The manager and the staff demonstrated that they were committed to life long learning by attending training and development days. All the care staff interviewed said that they had received formal supervision and this was verified during checking of the staff files. Due to the comments received by the Commission for Social Care Inspection it was difficult to ascertain whether the supervision covered all aspects of care practice and the philosophy of care in Heeley Bank. Whether the manager had acquired an overall feedback from the supervisions from the staff of the issues raised by the individuals. DS0000068866.V334852.R01.S.doc Version 5.2 Page 26 The manager had tried to ensure the health, safety and welfare of those who live and work at the home. But due to the lack of two way communication between the management and the others working at the home the people were put at risk. The manager said that all new staff received induction and the unit manager who was responsible for induction training explained how the process worked. The staff interviewed too supported that they had received induction. DS0000068866.V334852.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 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 3 4 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X X 3 X 3 DS0000068866.V334852.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NA 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 OP1 Regulation 4 Requirement The statement of purpose must be accurate as to the facilities and services, which are provided by the home. For example It must be clear where nursing care is to be provided within the home and the facilities made available in each unit for the specific category of people. The people must be assessed as to whether they are able to self medicate to promote independence instead of the staff taking on the task. The registered manager must not provide accommodation unless the home is able to meet the person needs. The registered manager must ensure that the assessment of the peoples’ needs are kept under review and revised at any time. If it is necessary the management must take action to address the changed circumstances. Timescale for action 25/07/07 2. OP3 14, 15 25/07/07 3. OP7 12, 13, 15 The care plans must be regularly reviewed and the staff must DS0000068866.V334852.R01.S.doc 25/07/07 Page 29 Version 5.2 ensure supporting evidences such as the charts are recorded accurately and at the appropriate intervals. 4. OP8 18 The manager must ensure that the staff are competent in managing incontinence. The care staff must be encouraged to follow the guidance given by the visiting health care professionals; the manager must monitor this. The designated staff must ensure the medications are ordered on time to prevent omissions. The care staff must observe the people to ensure that the medication they are taking for pain/discomfort and/or depression are having the desired effect and document on the daily progress records. The management must make every effort to train front line staff on end of life care so that staff are competent and able give the person and the family support and comfort. The people and their representatives must be consulted about the programme of activities. The activities in relation to recreation, health and fitness must be part of every person’s daily life and the staff working at the home must be involved. Hot and cold drinks and snacks must be made available for the people at all times. The timing of the main meals must be reviewed so that the DS0000068866.V334852.R01.S.doc 25/07/07 5. OP9 12, 13 25/07/07 6. OP11 12 24/10/07 7. OP12 16, 14 30/08/07 8. OP15 12, 16 06/06/07 Version 5.2 Page 30 people don’t receive the three main meals of the day within 8 hours and then rely on snacks being offered over the next 16 hours. 9. OP15 12, 16 The manager must ensure that there are sufficient numbers of care staff available at meal times so that people are given enough attention and help. The people living or working at Heeley Bank must be able to contact the Commission for Social Care Inspection if they so wish. The management must not deter them. 25/07/07 10. OP16 21 06/06/07 11. OP16 17, 22 The manager must keep a record 25/07/07 of all complaints made and including details of investigations and any action taken. The programme of routine maintenance must be monitored to prevent the problems with faulty doorbells and unlocked doors. Due to the large staff turn over in the past 12 months the staff working at the home require extra support and effective supervision. Additional staff must be on duty at peak times. Domestic and laundry staff must be employed in sufficient numbers so that care staff are not required to complete the ancillary workers jobs during care hours. The registered manager must ensure that suitable staff are employed and introduce systems DS0000068866.V334852.R01.S.doc 12. OP19 13, 23 25/07/07 13. OP27 17, 18 24/10/07 14. OP27 17, 18 25/07/07 15. OP29 12,19 24/10/07 Version 5.2 Page 31 to retain staff. 16. OP31 7, 8 The management style must 25/07/07 reflect the purpose, the aims and the objectives of Heeley Bank and the people who live there. The management approach must be open, transparent, and give an inclusive atmosphere to people. The manager must introduce strategies for enabling staff, people living at the home and other stakeholders to affect the way in which the service delivered. 25/07/07 17. OP32 7, 9, 10 18. OP33 24, 15, 12 The home’s quality assurance 25/07/07 and quality monitoring system must measure the success in meeting the aims, objectives and the statement of purpose of the home. 24, 15, 12 The outcome of the survey and the action taken by the home must be published. 30/08/07 19. OP33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000068866.V334852.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000068866.V334852.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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