Inspection on 03/03/06 for Heffle Court

This inspection was carried out on 3rd March 2006.

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

Heffle Court 30/07/08

Heffle Court 03/09/07

Heffle Court 26/06/06

Heffle Court 03/01/06

Heffle Court 07/12/04

Heffle Court 29/06/04

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

CARE HOMES FOR OLDER PEOPLE Heffle Court Station Road Heathfield East Sussex TN21 8DR Lead Inspector Melanie Freeman Unannounced Inspection 3rd March 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Heffle Court DS0000021402.V284752.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. Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Heffle Court Address Station Road Heathfield East Sussex TN21 8DR 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) 01435 864101 01435 868046 The Harebeating Care Company Mr James Sales Care Home 32 Category(ies) of Dementia (32) registration, with number of places Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is thirty two (32). Service users must be aged sixty five (65) years or over on admission. Only older people with dementia type illness are to be accommodated. Date of last inspection 3 January 2006 Brief Description of the Service: Heffle Court is a large, purpose built home providing residential care and support for 32 older people with a dementia type illness. The manager and dedicated staff team have created a relaxed, welcoming and homely environment. The registered owners are the Harebeating Care Company. The premises are well maintained, safe and accessible and comprise of service user accommodation on two floors, in single rooms. All rooms are fitted with an alarm call system and all but four have en-suite facilities. The rooms have been individually decorated and furnished to a high specification. Many have been personalised with the service user’s own furniture and other possessions. Communal areas on both floors include comfortable lounges, spacious dining areas, bathrooms and toilets. Outside, there are safe and secluded courtyard gardens where service users may sit and relax. The home is located close to the centre of town and is close to local shops and a public house. Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Heffle Court will be referred to as ‘residents’. This report should be read in conjunction with the report of the inspection that took place on 3 January 2006 for an overview of the core standards inspected over the year. This was an unannounced inspection carried out on a weekday between the hours of 10.00 and 16.45 by two inspectors with a follow up meeting held with the registered manager a week later. The inspectors spent time with residents and one visitor and were able to have a mid-day meal with residents in the communal dining room. Staff were spoken to and observed whilst working. The care documentation for 4 residents was reviewed in depth. Other records reviewed included the homes statement of purpose, service users guide, contract arrangements, some of the homes policies and procedures and the health and safety documentation. What the service does well: What has improved since the last inspection? The home has responded to the requirements and recommendations made at the last inspection. Improvements made included improved information availability to all interested parties about the home and its facilities, improved care documentation and use of risk assessment. Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 6 The storage of residents care documentation has been improved. New adult protection procedures have been developed and the registered provider is completing regular visits to the home in accordance with regulation 26. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 7 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 Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 8 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): 2,4 and 5 The inspector found that the home provides prospective residents with a good level of information on the services and facilities provided and the costs involved. Care staff are not fully trained to meet all the care need of residents living in the home. EVIDENCE: The statement of purpose and service users guide has been updated since the last inspection and a copy of this is available in the office. During the inspection the contractual arrangements for 2 recently admitted residents were checked, contracts were in place however these need to be fully completed as identified to the deputy manager at the time of the inspection. Clearly the residents admitted to Heffle Court have specific care needs related to their dementia, and although staff were responding to the care needs of Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 9 residents the amount of training provided to ensure the staff have the competency and skills to look after these residents was not evidenced. Discussion with the home manager confirmed that prospective residents/representatives are not advised in writing that the home is able to meet their needs and ways to advise the appropriate people was discussed. While the inspection was being completed the inspectors were pleased to note that relatives of a prospective resident were being given full information on the home and its facilities. Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 10 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): 7,9 and 10 The arrangements for meeting resident’s needs and dealing with identified risks is good, however the care documentation does not fully reflect this and does not provide a record of care provided or give clear guidance to staff or promote residents dignity. Although the administration of medicines in the home was seen to be safe systems for the safe storage were not satisfactory. EVIDENCE: Since the last inspection the plans of care and risk assessments have been reviewed and updated and the care documentation has been improved and is far more structured. Further improvement is however needed to provide a clear record of the care provided and clear guidance to all staff on how to provide that care. Risk assessments completed must be followed up with documented evidence of the control measures implemented to promote residents and staff safety. Nutritional screening is not completed and the need for these was discussed with the home manager. Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 11 During the inspection staff were observed to be following a safe procedure for medicine administration and record keeping. It was however noted that medicines were being stored in an unlocked fridge in a communal lounge area. The residents appeared to be relaxed and staff addressed them appropriately throughout the inspection. However the inspectors were concerned to note that some language used within the care documentation was not respectful and one staff member referred to ‘potting residents’ and routines followed. It was also noted that some residents were wearing plastic aprons at the mealtime to protect their clothing. Later discussion with the manager confirmed relatives had requested the use of these although it was agreed that the use of large napkins might have been more appropriate. Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 12 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): 13 and 15 Although contact with visitors and the community is a priority these links are not evidenced within the care documentation. The provision of meals is managed to ensure residents have meals that they enjoy and like. EVIDENCE: Discussion with the home manager confirmed that links with the community are very important to the home with the home encouraging links through regular contact with local facilities and the home facilitating 2 day care services. These links are not demonstrated within the records held in the home and this was raised with the manager. The inspectors ate a midday meal with the residents in the communal dining room. There was a main meal with an alternative for those who did not like the main meal. The meal was served by the cook from a heated trolley and was satisfactory. Residents spoken to said they found the meals to be good, as did a regular visitor. Following the inspection the manager said that he had met with the cook and has reviewed the menus in consultation with the residents to Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 13 ensure a good quality and choice of food. Staff were seen to be supporting residents and encouraging them to eat as independently as possible. Although an attractive dining room is provided the inspectors noted that some residents were wearing plastic aprons, which was felt not to be necessary in all cases and could be replaced with cloth napkins providing a less institutional environment. Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 14 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 Procedures in the home ensure that complaints if received would be responded to appropriately. Systems for reporting under adult protection procedures need further clarity along with improved staff training to ensure all staff are aware of action to be taken following an allegation or suspicion of abuse. EVIDENCE: The home has a written complaints procedure in place, which is included within the home’s statement of purpose; this has recently been amended and updated. The home manager said that any concerns raised are dealt with immediately to promote early resolution formal complaints are therefore very rare. The home’s adult protection policy has been updated since the last inspection and this can be improved further with a clear flowchart to give clear guidance to staff with relevant contact numbers. At the time of the inspection it was noted that staff needed to receive further training in respect of adult protection issues. At the follow up visit it was noted that training on adult protection for staff is being provided. Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 15 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): 25 and 26 Physical standards in the home are good ensuring that residents live in a well maintained, hygienic and generally safe environment. EVIDENCE: Areas of the home visited by the inspectors were found to have a good standard of cleanliness however one area of the home was noted to have an unpleasant smell. The deputy manager advised the inspectors that this was related to an individual continence problem and that this was being responded to. Regular shampooing of carpets is completed. A selection of residents rooms were viewed and were found to be individualised and created a pleasant environment that each resident could identify with. The laundry was seen to be suitably equipped. It was noted that some building work was being completed and the home manager confirmed that internal alterations to provide an extra bedroom are in progress. This room is to replace one double room and therefore the home is Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 16 not going to increase the homes registration. The registered manager confirmed that he would ensure that the CSCI was kept fully informed of any building works. Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 17 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): 29 and 30 The homes recruitment procedures were found to be poor and did not ensure resident’s safety. Co-ordinated staff training to ensure staff competencies needs to be established. EVIDENCE: The recruitment records for 4 care staff were reviewed in depth and these were found to be incomplete. The records were poorly maintained and the inspectors found it difficult to confirm the records held in respect of each individual employee. The follow up visit carried out a week later enabled the home manager to produce some of the required documentation. The records available to the inspectors confirmed that required identification documents were not always retained by the home and that one newly appointed carer was working in the home without evidence of a CRB/POVA check being completed. This was a serious shortfall and an immediate requirement form was left with the deputy manager at the end of the inspection which required this shortfall to be addressed, she confirmed that the carer concerned would not work in the home again until the necessary checks are completed. New staff are not currently provided with a copy of GSCC code of council. Records of staff training were again poorly maintained and did not demonstrate that the staff had completed the required training in respect of health and safety or to meet the care needs of the residents. The inspector Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 18 was advised that a new staff-training manager has been appointed to address the training issues in the home. There was no evidence that training development plans had been developed for staff. Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 19 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): 33,35,36,37 and 38 Although the management of the home is well established and systems to monitor quality and ensure residents monies are safeguarded are in place staff are not receiving regular supervision and health and safety issues have not been fully addressed satisfactorily. EVIDENCE: Systems to monitor the quality of the care and services have been established and include the use of resident and representative questionnaires. The home manager confirmed that these are audited and responded to. Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 20 The home manager said that no personal monies are held on behalf of service users; any purchases are made from the home’s petty cash and service users or their representatives are billed on a monthly basis. Staff records indicated that staff supervision is not provided regularly. A review of the homes policies and procedures identified that they are not dated and evidence to confirm that they are reviewed regularly was not available. It was also noted that some were in need of an update and a procedure on legionnaires disease and safe bathing was not available. During the inspection the records and certificates relating to Health and Safety were reviewed. A number of certificates were not available and those not available at the follow up meeting with the home manager included, the safety certificate for the electrical installation and the mobile hoists. The environmental and fire risk assessments have not been updated recently and this was discussed with the home manager who confirmed that these would be undertaken. During this inspection it was noted that some doors were being held open and this practice needs to be reviewed in line with a fire risk assessment to ensure fire prevention measures and procedures ensure resident and staff safety. Hot water checks are completed and the home manager advised the inspector that he felt that the checks completed are adequate and ensure the hot water supplied to all areas accessible to residents is supplied at a safe temperature. Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 21 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 3 X 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X X X X X X 3 3 STAFFING Standard No Score 27 X 28 X 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 1 2 1 Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 22 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 OP4 Regulation 18(1)a Requirement All staff receive appropriate training to meet the specialist dementia care needs of residents. That the plans of care provided give clear guidance to care staff on how to meet the needs of residents with reference to individual risk assessments. That nutritional screening is completed on all residents and responded to as necessary. That all medicines are stored appropriately and safely at all times. That resident’s dignity is further promoted through individualised care. That the registered person operates a thorough recruitment procedure that ensures the safety of residents. That staff are provided with appropriate training to equip them fully to care for residents and to work safely. That a formal process of DS0000021402.V284752.R01.S.doc Timescale for action 01/05/06 2. OP7 15 01/05/06 3. 4. 5. OP9 OP10 OP29 13(2) 12(4) 19 01/04/06 01/05/06 03/03/06 6 OP30 18(2) 01/06/06 7 OP36 18(2) 01/06/06 Page 23 Heffle Court Version 5.1 8 9 OP37 OP38 24 23 10 OP38 23 documented supervision is implemented, and provided to care staff at least six times a year. That all the homes policies and procedures are updated and reviewed regularly. That appropriate risk assessments are completed in relation of health and safety issues and responded to as necessary. That all the necessary maintenance checks are maintained. 01/06/06 01/05/06 01/05/06 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 OP18 OP29 OP33 Good Practice Recommendations That the adult protection procedure is improved with a clear flowchart with relevant contact numbers. That all staff are provided with a copy of the GSCC of conduct. That the CSCI is provided with a report in respect of quality monitoring review. Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 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 Heffle Court DS0000021402.V284752.R01.S.doc Version 5.1 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!