CARE HOMES FOR OLDER PEOPLE
Heffle Court Station Road Heathfield East Sussex TN21 8DR Lead Inspector
Alexis Reilly Unannounced Inspection 10:30 30th July 2008 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.V367496.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. Heffle Court DS0000021402.V367496.R01.S.doc Version 5.2 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 Heffle@Caringhomes.org Harebeating Care Company (Holdings) Ltd Manager post vacant Care Home 34 Category(ies) of Dementia (0) registration, with number of places Heffle Court DS0000021402.V367496.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Dementia (DE). The maximum number of service users to be accommodated is 34. Date of last inspection 3rd September 2007 Brief Description of the Service: Heffle Court is a large, purpose built home providing residential care and support for 34 older people with a dementia type illness. 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. 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. The Regional Manager stated that the current fees range from £475.00 £700.00 per week. A change in registration has now allowed the home to provide nursing care for 17 residents. Heffle Court DS0000021402.V367496.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes.
This was an Unannounced key Inspection, which included a visit to the home which took place between 10.30 and 5pm on the 1st August 2008. This inspection focused on assessing whether the home was building upon adequate outcomes, in order to improve quality of life for the residents placed in the home and meet their individual needs. During this inspection the inspectors examined care records for three residents on the residential side of the home and three care records of residents on the nursing side of the home. The following documents were also examined; the homes statement of purpose, Adult Protection guidelines, the staffing rotas, staff recruitment files for two new staff members, risk assessments, the activities schedule, menus, training books, the accident book and medication records. A full environmental tour was also carried out. The inspectors spoke with four residents individually, and one resident and family member, other residents were observed in the home. The inspector spoke with the Acting Manager, the staff member in charge of the care plans, the RGN in charge of the nursing wing on duty that day, the person in charge of maintenance and the Chef Manager. The inspector has also include comments taken from a thank you letter seen in the home, and comments made by relatives and residents. The home sent back to the CSCI a completed Annual Quality Assurance Assessment before the visit which informed this inspection, this document was comprehensively filled in. Of eight-outcome areas four are judged to be good and three are judged to be adequate. What the service does well:
The Acting Manager has worked hard to bring changes into the home since the last inspection. Residents are now able to help make drinks and are more active and involved in the home.
Heffle Court DS0000021402.V367496.R01.S.doc Version 5.2 Page 6 Some comments received from relatives were ‘Very pleased with changes at the home, feel they have always looked after my relative very well, came to live there just as home was undergoing changes and new manager was appointed’. Also a letter of thanks was seen during the inspection dated 25th June 2008, ‘a huge thank you’, ‘a very special thank you’,’ they looked after my relative as if she were their own mum’. The Chef Manager spoke to the inspector and showed a great understanding of the dietary needs of the residents in the home, and spends time each morning discussing the menu on offer with the residents. He also discussed how to make the food attractive and interesting for those who need a softer diet. The inspector saw a large range of fresh produce in the kitchen. All rooms are fitted with an alarm call system and all but four have en-suite facilities. 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. What has improved since the last inspection?
The service has new signs at the front of the building and has made the entrance more welcoming. Within the building new signage has been put up, with pictures for bathrooms and toilets, all bathroom and toilet doors are to be painted the same colour. The kitchenette area is now open so residents and staff can make drinks together, allowing residents to take supervised risks. The home has three different garden areas, one with raised beds which the residents have planted and this is used as a tranquil area, one area for a sensory garden which the residents have also planted and one area with three sheds which will be painted into beach huts each having a different theme; one will be a 1940s parlour, one will have a singer sewing machine, and one will have a train, car and plane theme. The home has various animals and a mini farm in the grounds these include pigs, chicken, goats, and rabbits, all are rescue animals. The Acting Manager has ensured the relationships with the external district nurses are promoted and has arranged for them to come into Heffle court to do training sessions for staff. The home now has fully changed to a monitored dosage system for administering medication in addition the service has stated that a full audit and
Heffle Court DS0000021402.V367496.R01.S.doc Version 5.2 Page 7 competency assessment of all staff currently administering medication has been carried out. The complaints procedure is clear and the Acting Manager informed the Inspector that complaints are dealt with promptly and effectively Records for checking the water temperature are in place and these are checked monthly. In addition the service has informed the inspector that a survey has been arranged via the property services team to identify any anomalies to supply and temperature of water. Clinical waster containers have been purchased and soap and paper towel dispensers have been fitted throughout the home Regulation 26 reports were available to view on the day of the inspection Staff have commenced training in Dementia Awareness. 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. The summary of this inspection report can be made available in other formats on request. Heffle Court DS0000021402.V367496.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 Heffle Court DS0000021402.V367496.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): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service experience good outcomes in this area. Prospective residents are appropriately admitted to the home and are provided with information they need in order for them to make an informed decision about whether to reside there. The homes’ statement of purpose is now complete and regularly reviewed. All residents have a signed contract in place. The service does not offer intermediate care facilities. EVIDENCE: The service users guide, and statement of purpose is in place. The service users guide reflects the acting managers experience and qualifications and includes a clear complaints procedure with the contact details of the CSCI.
Heffle Court DS0000021402.V367496.R01.S.doc Version 5.2 Page 10 Prospective residents are given the opportunity to spend time in the home, and staff make sure residents have the information available to allow them to make an informed choice about living in the home. Residents are provided with a contract. This sets out in detail what is included in the fee, the role of the home and the rights of the individual. This is clear, jargon free, easy to understand and gives a very clear understanding of what residents can expect. The manager actively promotes opportunity for discussion and regular residents meetings are held as well as residents’ views being sought individually. The Acting Manager is also starting a relatives’ support group which will consist of regular meetings. Heffle Court DS0000021402.V367496.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service experience adequate outcomes in this area. The Acting Manger has made positive changes to the running of the home, and these are positive and inclusive towards the residents which reside there. However at the time of the inspections the care plans and risk assessments did not reflect and were not based around all the new activities in the home. The service will benefit greatly from the introduction of the new dementia type care plans which are focused and have a comprehensive risk assessment at their base. EVIDENCE: All care plans are in the process of being changed, new dementia care plans are being issued by the company and the Acting Manager will ensure that all
Heffle Court DS0000021402.V367496.R01.S.doc Version 5.2 Page 12 residents have care plans based on the dementia style format which include comprehensive risk assessments. However until this is completed the full care packages for residents can not be easily seen and this in turn can impact on their daily lives in the service. The kitchenette area is now open so residents and staff can make drinks together, allowing residents to take supervised risks. The Acting Manager has changed policies around staffing and staff no longer wear uniforms, or have their own staff toilet or cups, this is to try and break down the barriers between staff and residents. Residents also prepare the vegetables for lunch and dinner with staff. The Acting Manager was currently researching buying flowery aprons as some of the residents have mentioned that they always put their apron on when they used to prepare the lunch. The Acting Manger must ensure risk assessments are available to cover these activities. The nursing staff at the home are able and have been trained to take bloods and change dressings. The nursing staff have a good relationship with the district nurses who come in and do training sessions at the home, two have been arranged for incontinence and palliative care. The home has three different garden areas, one with raised beds which the residents have planted and this is used as a tranquil area, one area for a sensory garden which the residents have also planted and one area with three sheds which will be painted into beach huts each having a different theme; one will be a 1940s parlour, one will have a singer sewing machine, and one will have a train, car and plane theme. The home has various animals and a mini farm in the grounds these include pigs, chicken, goats, and rabbits, all are rescue animals. This followed comments from the residents about watching TV and wishing they could have animals, in the home. The Acting Manager brings her dog in to the home daily which the residents appeared to enjoy. Heffle Court DS0000021402.V367496.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service experience good outcomes in this area. The home provides suitable entertainment and activities. The food provided is of good quality, varied and wholesome, the chef ensures fresh produce is used and should be commended with regard to the effort and thought of producing dishes for the menus. EVIDENCE: The home has the following activities on offer; reminiscence bingo, memory quiz, hand massage, manicures, pedicures, short walks, reading news & magazines, books, crosswords, dominoes, draughts. Residents also participate in washing & drying up the tea cups, polishing silver, cake baking, cross stitch, button sewing, flower arranging, dough modelling, letter writing poetry, fabric printing, stencil painting, wooden picture making, glass
Heffle Court DS0000021402.V367496.R01.S.doc Version 5.2 Page 14 painting, watercolour painting, cushion making, scented drawer parcels, mosaic work, ports, mirrors, tables, picture frame decorating, pressed flower picture, vase decorating, old time music hall, videos. Discussing personal photos, personal history questionnaire, jigsaws, flower arranging, skittles darts and bingo, cake decorating, cheese and wine afternoons, cake afternoons, leisurely strolls around Heathfield, cream teas at the trough, outings to garden centres, pampering days, music afternoons and tea dances. Also residents can access the garden and there are things to do in the home, they are also involved in helping making drinks. Heffle Court DS0000021402.V367496.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service experience good outcomes in this area. The home records and responds to complaints appropriately. The homes policies and procedures protect the residents from potential abuse. Concerns with regard to staffing and cleanliness in the home have been addressed. EVIDENCE: A relatives support group is being started next week, and the complaints procedure is on the notice board in the home and relatives are made aware of this and it will be discussed again at the relatives support group next week. The service has a policy in place on Management of service users money, valuables and financial affairs. The service has one complaint with regard to laundry and one Adult protection alert since the last inspection these have been resolved. Heffle Court DS0000021402.V367496.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service experience adequate outcomes in this area. The home has made progress in redecorating and adding new signage to the building. However the carpet downstairs is stained and in need of replacement and there are issues around the safe storage of incontinence products and wheelchairs. EVIDENCE: Heffle Court DS0000021402.V367496.R01.S.doc Version 5.2 Page 17 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. 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. The service has new signs at the front of the building and has made the entrance more welcoming. Within the building new signage has been put up, with pictures for bathrooms and toilets, all bathroom and toilet doors will be painted the same colour. New name plates have been put on the doors of each residents’ room with a photographs of the residents 40 – 50 years ago to enable them to recognize more easily their own room. The kitchenette area is now open so residents and staff can make drinks together, allowing residents to take supervised risks. The home has three different garden areas, one with raised beds which the residents have planted and this is used as a tranquil area, one area for a sensory garden which the residents have also planted and one area with three sheds which will be painted into beach huts each having a different theme; one will be a 1940s parlour, one will have a singer sewing machine, and one will have a train, car and plane theme. The home has various animals and a mini farm in the grounds these include pigs, chicken, goats, and rabbits, all are rescue animals. Water temperatures are checked regularly and water pressures have been corrected. The service has clinical waste bins, paper hand towels, liquid soap and gel. |The service is in the process of finishing the painting of corridors and also replacing the carpets downstairs as they are very marked and stained. The inspector found unsafe storage of incontinence pads under the open stair well in the ground floor and also wheelchairs were stored upstairs in one of the main bathrooms. The service must ensure it addresses this as unsafe storage can impact on the safety of the residents. Heffle Court DS0000021402.V367496.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service experience good outcomes in this area. Staff are receiving appropriate training and meet the needs of the residents residing in the home. Recruitment policies and procedures protect the residents. However the home is in the process of recruiting one more trained nurse. EVIDENCE: Currently the home employees two Registered General Nurses and one Registered Mental Nurse, they are currently in the process or recruiting one more registered Nurse. The head of care is qualified to NVQ3 and has achieved the Registered Managers Award. The home has three senior care assistants and eleven care assistants 50 of these have NVQ level 2. Additionally the home has One Chef Manager, one kitchen assistant, one cleaner, two laundry assistants, a maintenance man, and gardener. The Acting Manager is a RMN and she has the Registered Managers Award also. In the nursing unit, they have one registered nurse on each shift, plus three carers depending on level of needs of the residents, and on the downstairs floor one senior carer plus two carers are on duty. The Registered Managers hours are additional to this at all times. They also employ a administrator 20 hours a week.
Heffle Court DS0000021402.V367496.R01.S.doc Version 5.2 Page 19 Staff have completed the mandatory training and specific dementia training is taking place. The service is in the process of recruiting an additional nursing team member to ensure the residents benefit from staff in the appropriate number on duty at all times in the home. Heffle Court DS0000021402.V367496.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service experience good outcomes in this area. The Acting Manger has made a lot of positive changes to the service and brought it forward a great deal in a short space of time, it now presents as a well run and home, staff are motivated and were seen interacting in a positive and caring manner to the residents placed in the service. However the Acting Manager must register with CSCI and must also ensure that the good progress made to date is reflected in the care plans and risk assessments and documented evidence of the service. The Acting Manager must ensure they contact the fire department with regard to the storage of continence products. Heffle Court DS0000021402.V367496.R01.S.doc Version 5.2 Page 21 EVIDENCE: The manager is not yet registered with the CSCI although she has been in post since September 2007. She is an RMN with experience in the management (deputy and manager) of care homes with and without nursing for people with a dementia type illness. The manager has achieved the RMA and has plans to complete a Diploma in Dementia Care. The inspector evidenced records of staff meetings in the home and policies were signed and evidenced that these are worked through with staff on a monthly basis. Supervision is carried out for staff every bi monthly and in some cases monthly depending on staffing needs. The Acting Manager has made improvements to the home but must ensure that care plans and risk assessments are up to date and comprehensive. The Acting Manger must also ensure improvement with regard to environmental factors continues within the home especially in relation to the storage issues at Heffle Court. Heffle Court DS0000021402.V367496.R01.S.doc Version 5.2 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 3 X X X X X 2 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Heffle Court DS0000021402.V367496.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1)(2)( a)(b)(c)(d ) 23(2)(l) Requirement Care plans must be comprehensive and informative and include comprehensive and detailed risk assessments Suitable storage must be put in place for incontinence products and wheelchairs. The downstairs carpet must be cleaned or replaced The Acting Manager must ensure that they continue to process their application for registration with the CSCI Advise should be taken from the Fire department with regard to the risk associated with the current storage of continence pads. Timescale for action 01/11/08 2 OP25 01/10/08 3 4 OP26 OP31 23(2)(d) 8(1)(a) 01/11/08 01/11/08 5 OP38 23(4)(a) 05/09/08 Heffle Court DS0000021402.V367496.R01.S.doc Version 5.2 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 Refer to Standard OP27 Good Practice Recommendations The Acting Manager must ensure they have sufficient staffing levels to support the needs of the residents placed within the home. Heffle Court DS0000021402.V367496.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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
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