Inspection on 27/06/07 for The Heights Care Centre

This inspection was carried out on 27th 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

The Heights Care Centre 25/06/08

The Heights Care Centre 19/05/06

The Heights Care Centre 23/06/05

The Heights Care Centre 28/02/05

The Heights Care Centre 17/11/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Heights, The Care Centre Ankerbold Road Tupton Chesterfield Derbyshire S42 6BX Lead Inspector Susan Richards Unannounced Inspection 27th June 2007 09:30 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 Heights, The Care Centre DS0000002085.V337646.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. Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heights, The Care Centre Address Ankerbold Road Tupton Chesterfield Derbyshire S42 6BX 01246 250345 01246 250520 theheights@schealthcare.co.uk 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) Southern Cross Care Homes Limited Mrs Sharon Rogers Care Home 36 Category(ies) of Dementia (6), Old age, not falling within any registration, with number other category (30) of places Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. That The Home Accommodates One Named Individual For Nursing Care Who Is 41 Years Old. The registered person will only admit service users, into the home who have Dementia, Alzheirmer`s Disease, Picks Disease, Huntington`s Chorea, Creutzfeldt Jakob Disease, Korsakoff`s Psychosis, Artereo-Sclerotic Dementia conditions, who are in the latter stages of the illness, and present with similar clinical features, as Dementia. 3. The unit must have at least one member of staff trained in Demential care on each shift. 4. A Registered Mental Nurse must be available for advice and support for the service users, staff and the unit, 24 hours a day. 5. 6 DE service users can only be accommodated in the specialist unit, which has keypad locks and is located to the left of the main entrance. To add a one-off variation for a named individual (CW), under the category of PD. 19th May 2006 3. Date of last inspection Brief Description of the Service: The Heights Care Centre is a purpose built care home within the village of Tupton, approximately 5 miles to the south east of Chesterfield town centre. The home provides nursing and personal care and support for up to 36 older persons, including up to six older persons with dementia, who are accommodated within a dedicated ground floor area of the home. This area consists of six bedrooms, a lounge/dining room and a bathroom and toilet facilities, although people accommodated there mix freely with others who live at the home. The home also provides one bed for the purposes of rolling respite care and accommodates day care, although at the time of this inspection there were no persons receiving day care. The main home is purpose built over two floors. There is a choice of lounge and dining space on each floor and all bedrooms are currently used a single occupancy, some having en suite facilities. There are a range of aids and equipment and also environmental adaptations to assist those with disabilities, including level access, suitable bathing and toilet facilities, a shaft lift, emergency call system, handrails and grab rails and moving and handling equipment/hoists. The front door of the home is secured by way of a key-pad type lock. Kitchen and laundry facilities are centralised. Heights, The Care Centre There is level access to outside Version 5.2 Page 5 DS0000002085.V337646.R01.S.doc garden areas to the rear of the home, which provide seating and are well maintained with lawn and patio areas and planting. People are provided with twenty-four hour care and support from a team of nursing, care and hotel services staff, currently led by an acting manager. An activities co-ordinator is also employed. The most recent inspection report is not displayed openly in the home. The manager advised that people should request to see this. The range of fees per week as at 09 April 2007 is as follows: £333.85 to £450.75. Fees are dependant upon individual’s assessed needs and their individually agreed terms and conditions, as agreed via local authority or primary care team contracting arrangements; or written contracts as agreed between the home and individual for those who are privately funded. All are also dependent as to whether people receive nursing care or personal care only. Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. For the purposes of this inspection we have taken into account the relevant information the Commission holds about the service over the previous 12 months, including the previous key inspection report of 19 May 2006, a preinspection questionnaire (AQAA) completed by the registered persons for the purposes of this inspection. During our visit to the home, case tracking was used as part of our methodology. This included three people whose care and service provision was more closely examined. Discussions were held with them and with staff about their care and the services they receive and their care plans and associated care records were examined. Their private and communal accommodation was also inspected. Discussions were also held with the relatives/representatives of some people accommodated. At this inspection there were thirty-three people accommodated, including eight under the category of dementia and one under the category physically disabled. Of the total people accommodated, sixteen receive nursing care and seventeen receive personal care only. What the service does well: What has improved since the last inspection? Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 7 Floor coverings have been replaced to those areas identified at that inspection. Cleaning substances are safely stored and not left out around the home. What they could do better: Promote open access to key information about the home (guide, complaints procedure etc), including equal opportunity of access for people with sight difficulties, by providing alternative/suitable formats. Ensure that medicines recording and storage practises are always consistently and safely maintained in accordance with recognised guidance/practise. Ensure that where necessary, specialist advice is pursued and obtained from outside (health) care professionals in order to promote evidenced based care planning and practise. Develop care-planning interventions, which promote individuals’ inclusion with regard to their social care and daily living activities for those with more diverse specialist needs in order to better promote their individual expectations and known lifestyle preferences and capacities. Promote people’s opportunity to be involved in the drawing up of their care plans, which should be signed by them wherever possible. Provide a written programme for the repair and renewal of the fabric of the home, which is regularly reviewed to ensure more prompt attention to the maintenance, renewal and repair of the home and seek advice from external authorities concerned with the environment as and when necessary. Implement an evidenced based approach to determining staffing levels/staff deployment, which accounts for people’s dependency care needs in order to promote the best interests of people who live at the home and the staff employed there. Develop consistent management arrangements, which are based on seeking people’s views in order to better measure the home’s own success in meeting it aims and objectives and statement of purpose and to ensure that the home is always run in the best interests of people who live there. Provide an annual development plan for the home, which reflects aims and outcomes for people who live there. Ensure that timely action is taken with regard to the use of bedrails, in accordance with nationally recognised guidance in order to ensure that as far as in reasonably possible, people’s health and safety is best promoted. Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 8 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. Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1, 3 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s needs are effectively assessed, in consultation with them, although a more person centred approach to recording these may benefit them. The providers stated intent regarding the review of information provided for people about the home, may better inform the majority, although its availability in standard format only may not best promote equal opportunity for access for those with sight difficulties. EVIDENCE: Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 11 At our last key inspection of this service in May 2006, we judged that accurate assessments ensure that the home has sufficient information to be aware of service user’s needs prior to admission. In the pre-inspection questionnaire completed by the manager, they said that they provided good information and documentation with regard to the standards in this section. The development of trial visits to the home for people before they are admitted is an area they identified, that they would like to improve. At this inspection there were 33 people accommodated. All are British white with Christian beliefs or non-religious. Sixteen people receive nursing care and there are also a number of people with dementia and one person under the category of PD. Information is provided for people about the home in print standard format by way of a written guide. This was not seen. The manager advised that this was currently under review, with the aim of providing more accurate and key information, including, the range of needs the home intends to provide for and the change of manager details. Case tracking was undertaken in respect of 3 people, two admitted under the category DE (dementia), and one person admitted under the category PD (physical disability). Individual’s written needs assessment information, including that relating to risk was fairly comprehensive and detailed in accordance with recognised professional guidance Records of reviews of these were also properly maintained. However, individual’s lifestyle preferences and wishes with regard to their daily living routines were not particularly well recorded. Pre-admission assessment records and placement review records were provided for each person case tracked, including for those whose placement and funding arrangements are either by way of care management and/or local health primary care teams. For the latter, copies of the single assessment and care plan and where relevant, their health/nursing assessments and reviews were in place. People said that staff regularly consulted them about their needs (or their representatives where necessary). The home does not provide for intermediate care. Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 12 Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 13 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): NMS 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. Overall people’s healthcare needs are reasonably well met and their rights to dignity and privacy are suitably promoted, although some aspects of medicines storage and recording may not best promote people’s safety. EVIDENCE: At our last key inspection of this service, we judged that accurate care plans did contribute to the delivery of care, which people are satisfied with. In the pre-inspection questionnaire completed by the home, they said that they felt that people’s written care plans and care delivery were things that they did well. They said that they needed to improve people’s involvement in their care planning and develop a more person centred approach. Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 14 At this inspection, the written care plans and associated health care records of those people case tracked were examined. The inspector was unable to hold any meaningful discussions with those people about their care due to their illnesses and individual capacities. Discussions were held where possible with their representatives, including staff about the arrangements for their care delivery. Care plans were formulated in accordance with individual’s risk assessed needs and had regularly recorded reviews. In terms of individual’s physical care and support, they were reflective of recognised clinical guidance, including that relating to the care of older persons, as relevant for two of them. However, care planning interventions and care approaches focus in the main on people’s physical care and do not best reflect specialist care advice, concerned with their known medical conditions. We agree with the home’s identified development aims with regard to individual care planning. Overall, inputs from and access to outside healthcare professionals were well accounted for, including that related to routine health care screening. However, for one person, case tracked, whose care plan is referred to above, access to specialist advice was not followed through with regard to their medical condition and nursing care (detailed as an available support on their admission information). This was discussed with the manager and staff, who felt that pursuance of this may benefit that person and also themselves with regard their care plans and care delivery. Representatives said that that staff worked hard and provided a reasonable standard of care for people and treated them with dignity and respect. During the inspection staff were observed to approach people in a kind and courteous manner and staff spoken with demonstrated awareness and understanding of people’s rights to be treated with respect. Discussions held with a relative, said that they are regularly consulted and involved in care reviews in accordance with their role as representative, although had not signed care plans on behalf of the person receiving care. Other care plans sampled were not routinely signed as agreed with people (or their representatives on their behalf where not possible). Systems for the management and administration of medicines were examined via case tracking. This involved observation of the administration of the prescribed medicines for some people, inspection of medicines records and the arrangements for their storage and also discussions with people responsible for the administering of medicines on behalf of people accommodated. Key information was accessible to staff in respect of medicines, including relevant policy and procedural guidance, nursing practise standards guidance and specific medicines information. However, during discussions with the person administering medicines they were not clear regarding the correct Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 15 action to take with regard to the home’s policy and procedural guidance in event of a verbal instruction for the administration of medicine. The staff member was observed to administer medicines to people in a sensitive manner. Overall medicines administration records were safely recorded, including controlled drugs, although for one persons medicines, there were three recent omissions of recording, where medicines prescribed were not signed as given on the dates and times specified on their medicines administration record (MAR) sheet, and had no recorded reason as to why these were not signed as given. Medicines were reasonably safely stored, although one person’s eye drops prescribed were opened for use with no date of opening recorded on the label, as necessary for short life preparations. The temperature of the room where medicines are stored was warm, although a fan was in situ. Daily recording of room temperatures detailed that these sometimes rise to 31 degrees centigrade, which lies above recommended temperatures for some medicines storage. Registered nurses are responsible for the administration of medicines in the home. The arrangements for refresher/update training were discussed with staff and it was confirmed that medicines training updates were arranged for the future. All bedrooms have lockable storage provided in the event of any person wishing to manage their own medicines. Although at the time of the inspection there was no person who did so, relevant policy and procedural guidance including a recorded risk assessment were in place in event of this. Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although people are provided with some choice from a range of activities, the use of a more person centred and validated approaches to the planning and delivery of social care and daily living activities may better promote inclusion, particularly for those with more diverse specialist needs. People are provided with a good standard of food, which accords with their preferences and risk assessed needs. EVIDENCE: At our last key inspection of this service we judged that activities organised within the home, which may potentially stimulate people and enhance their quality of life and that opportunities to exercise their right of choice regarding the provision of meals were given. Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 17 In the pre-inspection questionnaire completed by the home, they said they felt that they provided a variety of social activities, promoted good contacts with family and friends and that the standard of food provided was good. They said they would like to improve activities provision for people by providing more diverse, individual activities and outings and by developing a sensory garden and securing access to alternative therapies, including aromatherapy and reflexology. At this inspection we spoke with people in the home (residents, staff and visitors) about the arrangements for social activities, including contacts with friend and relatives and access to the local community. Feedback from people was fairly indicative of that which the home stated within its pre-inspection questionnaire. Although, the activities co-ordinator was unfortunately absent from work at the time of this inspection. Care staff expressed frustration that they did not often have sufficient time to support people to engage in activities given their physical care needs and dependencies. During this inspection, singing and music was organised during the morning for people in the first floor lounge, which they appeared to enjoy. Although there is a standardised recording format, which prompts staff to assess and document individual’s social profiles, hobbies and interests and also their preferred diet and daily living routines, these were not always consistently or comprehensively recorded or detailed. Also, individual’s written care plans provided little in the way of person centred care practises and interventions with regard to these areas, particularly for people, who may have communication difficulties and confusion. (Care plans were mainly orientated towards physical interventions and support). We therefore agree with the areas of improvement, which the home has identified within the pre-inspection questionnaire. Staff was able to provide some clear examples about ways in which choice is promoted for people in terms of their daily lives, including choosing clothing, food and drinks and bringing personal possessions into the home. Lunches were organised and served during the inspection. These were well organised and tables were attractively set. Staff assisted people in accordance with their needs in a calm and sensitive manner and people were provided with aids and equipment to assist them to eat and drink independently as required. People said they enjoyed the meals and all spoken with said that food was to a good quality and in usually in accordance with their tastes. Food served to people case tracked was prepared in accordance with their risk-assessed needs. Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 18 Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 19 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): NMS 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People know how to complain. Concerns and complaints are taken seriously and acted upon in people’s best interests and they are protected from abuse. EVIDENCE: At our last key inspection of this service, we judged that there is a complaints procedure, which operates according to company policy and that people are protected from abuse. In the pre-inspection questionnaire completed by the home, they said that they provide good information about how to complain, regularly review complaints, action and outcomes and ensure that staff received adequate training in terms of adult protection. They said they wanted to continue to improve staffs’ awareness in the recognition of abuse and to be involved in the world abuse awareness campaign. They also identified the need to review the manager’s open ‘surgery’ times (for open consultation with people and their representatives) to better suit and accommodate relatives by providing weekend and evening availability. Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 20 At this inspection we asked to see the complaints procedure for the home. There is a written procedure, available in standard type format, although it is not openly displayed in the home. This was discussed with the manager, who agreed to display this in suitable location. Information is also provided about how to complain in the home’s guide/brochure. There was one complaint recorded in the complaints record kept by the home. This was a recent complaint made regarding the attitude of a staff member towards a relative. Details of the investigation of this complaint are recorded by the home and included together the outcome and further action taken, indicating that this was dealt with in a satisfactory manner. People spoken with, and who were able to express a view, said that they knew who to complain to, although could not recall seeing a copy of the home’s complaints procedure. They said that any concerns they raised were usually dealt with without cause to make a formal complaint. Staff spoken with was conversant with their responsibilities with regard to dealing with complaints. And also with those responsibilities in recognising and reporting any suspicion or witnessing of the abuse of any person accommodated as per the home’s own written procedures. Discussions were held with staff about the home’s policies and practises for dealing with and managing violence and aggression. This included care approaches with one-person case tracked. The approaches they described were appropriate, although based on common sense rather than a clear knowledge and understanding about recognised care interventions or the home’s policy guidance. This was discussed with the manager as staff felt they may benefit from additional training and/or instruction in respect of known best practise strategies concerned with dealing with people who have dementia and who may become frustrated and aggressive in conjunction with the home’s policy guidance. Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 21 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): NMS 19, 24 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall, people live in a safe, clean and comfortable environment, which suits their needs, although more prompt attention to the maintenance, renewal and repair of the home would be to their benefit and in some instances the benefit of staff who work there. EVIDENCE: At our previous inspection of this service we judged the environment was not always maintained to ensure the safety of people who live at the home. We made a requirement that the rooms identified within the body of the report have adequate floor covering. These have been replaced with new. Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 22 In the pre-inspection questionnaire completed by the home they said that they provide an environment for people that is clean and odour free, warm and friendly and that people’s own rooms are personalised and reasonably well decorated. They said they wanted to improve the environment by providing quiet and private areas for people to use, by continuing with a programme of redecoration and renewal, which will include the companys dementia strategy in respect of the environment. At this inspection we inspected the private and communal areas of those people case tracked and also randomly sampled a small number of additional bedrooms/facilities and inspected these. The manager, who had very recently come into post, confirmed that she was in the process of conducting an environmental audit, which would inform a written plan for the repair and renewal if the home. She advised that this would include further work to either reseal or replace floor coverings in a number of people’s bedrooms, review beds, mattresses and equipment and develop the environment with regard to dementia care, including further signing and aids to orientation. All areas seen were clean, comfortable and reasonably well decorated and equipped, personalised and for the most part free from hazards, although the first floor corridor carpet, was heavily stained and worn despite frequent cleaning and was in need of replacement. (See also management section of this report with regard to the use of bedrails). The ground floor area accommodating the majority of people with dementia was better developed in terms of its environment to assist those with confusion. Staff said that they have no separate staff facilities, as they were observed to staff take their meal break in the residents’ dining room/lounge area. (See also staffing section of this report). The laundry was not inspected on this occasion. Staff confirmed that they were provided with sufficient and necessary equipment in terms of hand washing facilities, handling and dealing with waste (both clinical and household). Clinical waste container bins are stored at the side of the property free standing. The heat/temperature of the kitchen was very warm. Kitchen staff said that the air-cooling system was broken for some two years. Daily monitoring of temperatures were sometimes recorded at 35 and 38 degrees centigrade, which staff found difficult to work in. We recommended that she consult with the relevant environmental health agency/authority with regard to this. Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 23 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): NMS 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s needs are met from a staff team who are recruited, inducted and trained effectively. However, the implementation of an evidenced based approach to determining staffing levels, which accounts for people’s dependency care needs may better promote the interests of people who live at the home and the staff employed there. EVIDENCE: At our previous inspection of this service we judged that there were effective staff recruitment procedures to promote people’s protection from abuse and that staff had received training relevant to the care of people who use the service. In the pre-inspection questionnaire completed by the home they said that staff are properly recruited and trained and deployed, but said that they would like to improve by ensuring that all staff undertake specifically identified training with regard to caring for people with dementia and to increase the number of care staff who have achieved at least NVQ level 2. Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 24 At this inspection we discussed the arrangements for staffs’ recruitment, induction, training and deployment with them, and with the manager and examined related records, including the personal files for four staff, including the most recent staff starters. Staff turnover was also discussed, which was high with some thirty-three staff having left over the previous 12 months. There was no record of the reasons for this, although the manager advised that leavers forms are completed and held centrally. Staff felt there had been a period of management uncertainty and unsettlement prior to the recruitment of the new manager. Overall, staff files examined, contained satisfactory records and information regarding their recruitment, employment and training, although there was no formal record of their induction. We spoke with staff about the arrangements for staff induction, which indicated that this process was being undertaken. The manager advised that she intended to complete and register with Skills for Care with regard to their national minimum data set information collection. A total of 75 of staff have achieved at least NVQ level 2 with two more due to complete and four recently signed to do these. The manager had completed a staff training needs analysis and formulated a training matrix and plan. Staff felt that the support and access to training was relatively good including that relating to ensuring safe staff practises/health and safety, which is delivered by way of a rolling programme and also training related to the conditions and care needs of people living at the home. Staff felt that staffing levels could be improved and that these were not always sufficient. This was discussed further with them. All said that residents were safe and felt they received good basic personal and health care. However, all felt that given the numbers and dependencies of people accommodated and the arrangements for staff deployment, this impacted on their ability to promote person centred care, including stimulation and activities (see also social care section of this report). Staffing levels were confirmed with them as per the home’s duty rotas. People said that staff worked very hard to meet their personal and healthcare needs and felt that their basic care needs were being met. At the time of this inspection there were thirty-three people accommodated, including eight under the category of dementia. Sixteen of the total accommodated receive nursing care, including one person with physical disabilities and seventeen receive personal care and support. Staff on duty, were as follows: Acting manager (who is also a registered nurse) – 9 am to 5 pm. Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 25 X 1 Registered Nurse on duty 8am – 8pm. X 3 care staff on the ground floor from 8am – 2pm reducing to 2 from 2pm – 8pm. X 2 care staff on the first floor from 8am – 8pm. Night duty – x1 registered nurse and x2 care (with some nights increased to 3 for additional cover). The activities co-ordinator was absent at the time of the inspection. Staff working a long day on the ground floor did not take their lunch break until well after 2.30 pm. This was taken in the dining room/lounge area as they provided monitoring and support for residents at the same time. Discussions were held with the manager about the arrangements for staff deployment and residents’ dependencies. Although all residents dependencies are individually assessed using a recorded assessment tool – as kept in their care files and reviewed monthly, this information is not used to inform staffing levels/deployment. The application of the residential forum tool was also discussed. The manager was aware of this staffing tool but had not accessed it. She also advised as indicated in the pre-inspection questionnaire that staffing levels had recently been increased to assist in meeting people’s needs. Some information was provided in the AQAA as completed by the manager about people’s overall dependency needs, which were discussed with the manger and staff at the inspection. Based on an assumption that there are no people accommodated with high dependency needs, 16 with medium dependency (as per 16 nursing accommodated) and 17 with low dependency (personal care only). The residential staffing forum tool indicates that there should be a total of 560.00 care staff hours plus 20.60 activities hours and 12.30 hours for staff training per week totalling 592.00 total care hours (ie not including registered nurses or hotel services staff) with 161.35 overhead hrs (sickness and holidays) which totals 754.24 hrs planned for per week. Information given on the AQAA re care staff hours (not including registered nurse hours) actually provided per week totals 546.00. Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 26 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 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is reasonably managed and overall, there are suitable arrangements in place to promote people’s health, safety and welfare. However, development of consistent management arrangements, which are based on seeking people’s views, will better enable the home’s measurement of its own success in meeting its aims and objectives and statement of purpose. EVIDENCE: At our last inspection of this service, we judged that the management of the home complied with requirements and that there was effective team working, together with quality assurance systems, although one identified area of Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 27 unsafe practise may have placed people at potential risk to their health and safety. A requirement was made with regard to the latter. This is complied with. In the pre-inspection questionnaire completed by the home they said that that they have good quality assurance and monitoring systems in place and that record keeping with regard to staff employed is also done well. They said they would like to improve their storage arrangements for records and documents. At this inspection discussions were held about the management arrangements for the home, including that relating to quality assurance and monitoring systems. The current manager had been in post for approximately seven weeks and has not yet submitted an application to the Commission as registered manager for the home, although she advised that she was in process of formulating her application. Satisfaction surveys were not being carried out, although leaflet type questionnaires were available. The manager had conducted various service audits since coming into post and ‘Consultation Surgeries’ were advertised, which aim to provide a forum for people and their representatives to meet with the manager to discuss anything they wish to raise regarding the home. The manager also advised that she intended to organise resident and relative meetings. The arrangements for ensuring safe working practises in the home, were discussed with the manager and staff, including the arrangements for staff training which were satisfactory, although a number of beds have bed rails provided, which may pose potential risks to people of becoming trapped and/or injured. The manager advised that she was reviewing these by way of risk assessment, with a view to replacement. Details of the arrangements for the maintenance of equipment were provided in the pre-inspection questionnaire completed by the home and are satisfactory. Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X 2 Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? 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, 5 Requirement Timescale for action 31/08/07 2. OP9 13(2) 4. OP9 13(2) 5. OP9 13(2) The revised statement of purpose and service user guide must be available for people as soon as possible to ensure that they have accurate key and accurate information about the home. Medicines must always be signed 31/07/07 as given on the medicines administration record (MAR) sheet or if they have not been given, the coded reason be recorded there. This is to ensure that people received their medicines as prescribed or that where for any reason these are not given, there is a clear record as to why. The date and time of the opening 31/07/07 of eye drops for administration to any person must be recorded on the outer label to ensure that these are safely administered to people – i.e. within the specified time of four weeks from opening as failure to do so may place their optical health at risk. Medicines must be correctly 31/08/07 stored – in this instance DS0000002085.V337646.R01.S.doc Version 5.2 Heights, The Care Centre Page 30 6. OP27 18 1 (a) 7. OP38 13(4)(c) appropriate action must be taken to ensure the consistent and safe room temperature for the storage of medicines. Staffing levels and skill mix must 20/08/07 be appropriate to the assessed needs of people accommodated in order to ensure that the arrangements for staff deployment are based on good evidence and are in people’s best interests (both residents and staff). Unnecessary risks to people’s 31/07/07 health and safety must be identified and as far as possible eliminated. In this instance, it must be ensured that all bed rails used in respect of any person are correctly fitted and are safe and fit for use in accordance with recognised practise guidance. 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 OP1 Good Practice Recommendations Key information provided for people about the home should be available in alternative formats to promote equal opportunity of access for those people who may have sight difficulties. The written care plans for people with dementia should be developed to best reflect specialist and recognised good practise concerned with dementia care. Particular reference here is made to wandering behaviours and social, emotional and cognitive care planning interventions. Where possible, care plans should be drawn up with the involvement of people receiving care and agreed and signed by them whenever capable (or their DS0000002085.V337646.R01.S.doc Version 5.2 Page 31 2. OP7 3. OP7 Heights, The Care Centre 4. 5. OP9 OP12 6. 7. OP16 OP18 8. 9. 10. OP19 OP19 OP33 representative). Staff should be conversant with the home’s medicines policy and procedure regarding the event of any verbal instruction for the administration of medicines. OP13 also applies here. The home should further develop people’s opportunities and choice in relation to leisure and social activities with particular consideration to people with dementia and other cognitive impairments, sensory impairments and physical disabilities. This is to best promote their individual expectations and known lifestyle preferences and capacities. The complaints procedure should be openly displayed in the home and be available in alternative format(s) to assist those who may have sight difficulties. The manager should review staff’s understanding and knowledge regarding dealing with violence and aggression in conjunction with the home’s policy and procedural guidance. The registered person should provide a written programme for the repair and renewal of the fabric of the home. OP27 also applies here. Consideration should be given to attempting to the provision of separate staff facilities and suitable arrangement for their breaks. The views of people who use the service, including families and friends and stakeholders in the community as to how the home is achieving its goals for people, should be formally and regularly sought in order to ensure that the home is run in the best interests of people who live there. Heights, The Care Centre DS0000002085.V337646.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Heights, The Care Centre DS0000002085.V337646.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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