Key inspection report
Care homes for adults (18-65 years)
Name: Address: Heightside House Nursing Home Newchurch Road Rawtenstall Rossendale Lancashire BB4 9HG The quality rating for this care home is:
one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marie Dickinson
Date: 1 9 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area.
Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection.
This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years)
Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home
Name of care home: Address: Heightside House Nursing Home Newchurch Road Rawtenstall Rossendale Lancashire BB4 9HG 01706830570 01706220206 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Randomlight Limited care home 78 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 78 Date of last inspection Brief description of the care home Heightside House is registered to provide nursing care for up to 78 people who have mental health care needs. The home comprises three separate units; The House, The Mews and Close Care. The House is an extended detached property. Bedroom accommodation is provided on 4 floors and consists of some single and some shared bedrooms. None have en-suite facilities although there are ample bathrooms and toilets. Communal space comprises reception/lounge area, a separate lounge and a dining room. A new lounge has been created on the first floor of The House. The Mews comprises 10 units. These vary from single apartments with a bedroom, kitchen and Care Homes for Adults (18-65 years)
Page 4 of 35 Over 65 0 78 Brief description of the care home bathroom, to larger buildings, with shared rooms, accommodating up to 6 residents. Communal space in The Mews is provided in a reception/lounge area and a dining/lounge area. Some of the shared apartments also have lounge areas. Accommodation in the Close Care unit consists of 1 separate bungalow for 4 residents and 6 single rooms in the main building. There are shared toilets and bathrooms. Communal space comprises a reception/lounge area, a second lounge and a dining room. Each of the areas has their own staff team. Meals are prepared in the main kitchen, attached to The House, and transported to The Mews and Close Care. At the time of the key inspection part of The Mews was temporarily closed for refurbishment. Information about the home is sent out to anyone making enquiries about admission. Copies of Commission for Social Care Inspection reports are available from the home manager on request. Weekly fees are dependent on the assessment of the individual. Additional charges are made for hairdressing, transport (not included in a residents care plan) and some activities or trips outside the home. Care Homes for Adults (18-65 years) Page 5 of 35 Summary
This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home
peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A key unannounced inspection was carried out in respect of Heightside House Nursing Home on the 11th, 12th, and 19th July 2009. An annual quality assurance assessment (AQAA) was sent to us by the manager prior to this inspection. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service, such as number of staff trained, and of essential maintenance to keep the home safe being carried out. There were written comments from residents and staff who gave their views as to how well they considered the service met their needs. Care Homes for Adults (18-65 years)
Page 6 of 35 Discussion took place with the manager, staff, and residents during inspection. Documents including policies, procedures, and staff and residents records were looked at. The premises were inspected as part of the process. Areas that had been required to improve at the last key inspection were looked at for progress made. The home was assessed against the National Minimum Standards for Younger Adults. Care Homes for Adults (18-65 years) Page 7 of 35 What the care home does well: Before people are admitted to the home their needs such as personal care, mental health care needs, family, communication, diet, and medication are assessed. Planned admissions supported people who were detained under the Mental Health Act to stay at the home on leave. This meant there was a period of time to carry out a more thorough assessment to make sure the placement was suitable and needs could be met as required. People admitted were given a placement contract and a resident handbook. There was evidence that the service did understand the right of some residents to take control over their own life and make their own decisions and choices. Care plans belonging to some residents had good information recorded and linked very well to residents needs. Specialist help required for residents was identified, and details of specialist support were recorded. Staff interviewed and those who provided written comments considered the service did well as they Care for people with mental health problems, and I am proud to say we have an excellent reputation for dealing with the more challenging and complex mentally ill individuals. To ensure Equality and Diversity is considered, information for staff , and policies and procedures are available on each unit identifying how staff and residents should deal with and expect issues related to race, gender, disability and sexual orientation to be dealt with. This includes clear guidelines for staff ensuring zero tolerance of any discrimination. Where residents lacked capacity to make informed choices they have access to an advocate at Heightside House, and through the East Lancashire advocacy service for independent Mental Capacity Advocate representation. Those medication records checked were found to be in good order. The storage and administration of medication was good. Meals provided generally met with residents tastes, needs, and choice. Those residents spoken to during inspection said the food was good. They said they could have what they wanted. One resident who provided written comments said, The kitchen staff do really nice meals which is heaven. Group activities were provided for residents. They were varied to suit all tastes such as bingo, karaoke, in house entertainment, community outings, home baking and cheese and wine tasting. Staff helped residents keep in touch with their family and friends. Residents health care was being monitored with routine check ups and specialist support. One resident who provided written comments stated, Its a pleasure to know when youre really ill, they get you a doctor or ambulance. Residents who were consulted, generally knew who to talk to if they were not happy. Staff working at the home had been trained in adult protection and those spoken to during inspection knew their responsibility in this area. The home was maintained, clean, and tidy, and provided a homely and pleasant environment for residents, visitors, and staff. Residents were satisfied with their Care Homes for Adults (18-65 years)
Page 8 of 35 bedrooms and living arrangements. Staff interviewed said they enjoyed their work. Learning opportunities were relevant to the homes purpose. The home was managed and run in the interests of the people living and working there. What has improved since the last inspection? What they could do better: Residents care plans must include all identified needs and provide clear detailed instructions for staff on how to meet these needs. This would provide residents with a more person centred approach to their care and personal development. To manage risk effectively, guidance should be clear for staff to know what to do and keep safe. All residents should have a daily living plan linked to their assessed needs to ensure they are cared as they wish and require. Short term goal planning should be managed to provide some structure for residents rather than an ad hoc arrangement. This will ensure any barrier to support residents achieve maximum independence during difficult times is identified, recorded, and planned for. Daily routines should not be institutionalised and should allow for a more person centred approach to meeting needs. Residents living long term in the home should have as part of the basic contract price the option of a minimum seven day holiday they help to choose and plan. Care Homes for Adults (18-65 years)
Page 9 of 35 How meals are provided for residents living in Close care and the Mews should be reviewed and delivery improved to ensure meals are hot and appetising when they arrive. Residents should be given the opportunity to have a flexible and consistent support programme for personal care, by staff who are respectful and knowledgeable about their individual needs. Health risk such as weight loss should have a clear action plan written to deal with problems identified in monitoring this. Contractual arrangements for staff should be made to ensure they comply with the homes ruling regarding no acceptance of gifts, or be beneficiary in any will or bequest. Proper arrangements must be in place to monitor staff working in the home and ensure they are confident they can raise any issue of concern regarding the care and welfare of residents to senior management. This will ensure any unacceptable practice is dealt with promptly. An emergency call system must be provided for residents living in the Mews. This will enable them to summon help in an emergency. The reason for the low water temperature in some rooms should be investigated and a measure taken to ensure the temperature is around 43 degrees Celsius plus or minus 2. Attention to minor repairs for example tiling in bathrooms and the floor leading to the kitchen to prevent further deterioration. The recruitment process must include obtaining full employment history. More care should be taken when accepting an application form to ensure it is complete and satisfactory in providing this. Gaps in employment should be explored during interview and a record made of any explanation given. It is essential that information disclosed as a result of any checks carried out is fully considered with a written account made of the circumstances to support a decision to employ. This will ensure the right people are employed to care for residents. The use of agency staff should be reduced by recruiting sufficient staff to work permanently in the home. This will provide stability for residents and consistence when receiving personal care. Staff meetings should be at least six times a year and a written record kept. This will help staff to know their views are valued and they can help to improve practice. Staff training records should be kept up to date. Staff must be given regular formal supervision that provides them with support to do their work professionally. This will help to ensure only qualified and competent staff care for residents. Staff must receive the terms and conditions of their employment. This is to make sure residents staff and employer are protected. Communication between departments should improve to ensure all teams are working together for the purpose of providing residents with a consistent approach to their care. Care Homes for Adults (18-65 years) Page 10 of 35 Individual risk assessments should be carried out regarding residents ability and readiness to respond to an emergency in evacuating the building. Quality Assurance monitoring should be developed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 11 of 35 Details of our findings
Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 35 Choice of home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission process ensured peoples needs were properly assessed. This helped decide if the facilities and services could meet needs and preferences of individuals and support a decision to offer a placement in the home. Evidence: There was a protocol to follow when people are being admitted. Procedures followed show the process to accepting people to the home and included health and social agency referral and assessment, and an assessment conducted by the home. There had been admissions since the last key inspection. Copies of assessments completed by health and social care professionals were available for reference. Residents identified needs linked to their plan of care, for example, personal care, mental health care needs, family, communication, diet, and medication. Planned admissions supported people who were detained under the Mental Health Act to stay at the home on leave. This period of time involved a more thorough assessment being carried out to make sure the placement would be suitable and all identified needs could be met safely.
Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: The manager said that prior to a decision being made to accept a potential resident, their needs were discussed with staff and health and social care professionals. This ensured all parties were agreed the resident could be supported as they required. A placement contract was given to residents, who were also given a resident handbook that included a welcome to the home, the terms and conditions of residence and other essential information they need to know about life in the home and of their rights. Care Homes for Adults (18-65 years) Page 14 of 35 Individual needs and choices
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning supported some residents to take control of their lives, and make good decisions and choices in achieving this. Evidence: Several care plans were looked at in detail. Care plans belonging to residents living in the Mews had good information recorded and linked very well to residents needs. The method for planning peoples care was good. Specialist help required for residents was identified, and details of specialist support were recorded. The plans were person centred and what was important to residents receiving care was recorded, for example, I do have the ability to be able to perform my own personal hygiene needs, however I do sometimes lack motivation. I need prompting and encouraging to my personal care. Desired outcome. To maintain a level of personal hygiene that is socially acceptable to myself and others. How identified needs were to be supported was clear and risk managed. In the main house care plans did not include person centred planning adequately and were vaguely written. Brief examples of this was terms used such as Requires assistance, or encourage, gave no indication of what
Care Homes for Adults (18-65 years) Page 15 of 35 Evidence: this would involve. Equally directions to spend time with ... to assess mental stability, had no structure written into this, such as time and frequency. Intervention may therefore be dependent on staff availability. Not all care plans had been reviewed properly. The manager said all care plans were to be written using a person centred format and were currently being done. Where person centred care planning had been used, identified problems and management of identified risk had been agreed. Where limitations were in place, residents knew about them and had been involved in deciding how these would be managed and understood how these agreements helped them. An excellent example of this was I agree to allow staff to enter my room on a daily basis to ensure that my environment is safe, clean and tidy. I agree staff may remove any items which are considered hazardous to mine or others well being. Other examples of risk however, such as when bathing a resident, showed identified risks not being managed properly. These meant residents did not have a consistent approach to care by all staff when dealing with the risk and staff were vulnerable to accusations that could be made. Some residents had benefited from being involved in writing their own care plans. They had meetings with staff and other health and social care professionals involved in providing their support, and their care plans had been written to combine health and social care needs. A key worker system was in operation, however the full potential of this needs to be developed. This would enable staff to take responsibility in giving a more person centred approach to resident care, and have accountability within their role. Some care plans had been reviewed. Less than half the staff who provided written comments for this inspection considered they always or usually received up to date information about the needs of people they cared for, however it was noted the remaining staff responses indicated sometimes and in three instances never. People, who were able to make choices and decisions about their lives, were supported to do so. Those who provided written comments for this inspection considered they could do what they wanted to do. Where residents lacked this capacity, staff or other professionals made decisions on their behalf with advocate support where required. Some residents managed their own money which was given to them each week. Arrangements were in place for the purchasing of items such as cigarettes on their behalf. Proper accounting meant receipts were kept and records showed all transactions made were accounted for, providing good audit trail. Care Homes for Adults (18-65 years) Page 16 of 35 Lifestyle
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals had a degree of independence and opportunity to take part in chosen activities, access community resources and keep in touch with families and friends. The meals provided were adequate in providing for their tastes, choices, and diet. Evidence: People were out and about during the day when the inspection took place. The manager said residents were helped to develop skills that included social, emotional, communication, and independent living skills, and were encouraged to use community resources. Some residents had successfully moved into independent living in the community. Records seen showed residents in the closed care and Mews were helped to develop skills that included social, emotional, communication, and independent living skills, and encouraged to use community resources. This should be extended to the main house as care planning was not always clear regarding identifying short term goal setting to reach long term aims. How this is managed should provide some
Care Homes for Adults (18-65 years) Page 17 of 35 Evidence: structure for residents rather than an ad hoc arrangement, and ensure any barrier to support residents achieve maximum independence during difficult times is identified, recorded, and planned for. Activities were provided for residents. They were varied to suit all tastes such as bingo, karaoke, in house entertainment, community outings, home baking and cheese and wine tasting. Staff who provided written comments for this inspection considered the home did well by Meets the health and social needs of clients to high standard usually, and Clients appear to and report being happy at the home. Staff also considered improvements could be made with More robust OT department to include therapy groups sessions etc, and Take them out more or interact more, like cards or games or stimulating things with them. written comments from residents included, They could take us out more, to the pub or to town. we could go for meals or for a walk. I have to do these things alone. There was sufficient evidence to show residents had opportunity to develop and maintain important family relationships. Residents visited their family and went out for meals and shopping with them. Where residents were at risk or vulnerable in the community, this had been identified during assessment. Weekly planners for some residents were used to help provide some order in their lives. For example they knew when they had occupational therapy, or cleaned their room. Visits into the community were encouraged. Residents did not have as part of the basic contract price, the option of a minimum seven-day holiday outside the home they helped to choose. One resident said he was going on holiday he had arranged. The manager said the home was managed in a manner aimed to avoid any institutional routines. However some practices were institutional such as the distribution of cigarettes and drinks. Observations of staff at work showed they treated individuals with respect. Staff who provided written comments for this inspection thought the home did well as The care staff work well and really do care for the clients and do the best they can. All bedrooms had locks on their doors and residents who could manage their own keys. Observations made during meal times showed residents requiring assistance were given sensitive support by staff. Discussions with staff during this period showed staff had a good understanding of individual needs and requirements with diet and nutrition. Meals appeared to be nourishing and menus seen were varied. Special diets were catered for. Two residents in the mews who were interviewed said they did their own shopping and cooked their own food. They received a weekly food allowance for Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: this purpose. Residents on the mews thought the way meals were delivered sometimes meant they were not as warm as they could be, and overall could improve. Written comments from residents included, The kitchen staff sometimes do really nice meals. And about meals, they should all come reasonable and in an appropriate way. Care Homes for Adults (18-65 years) Page 19 of 35 Personal and healthcare support
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health and general wellbeing was being monitored, with support being provided to access health care services. Medication was managed safely. Evidence: Records showed people using the service were registered with a General Practitioner and that appointments had been made and kept. Appointments had also been kept with care coordinators, consultants, and community health services as required, such as dental visits and routine medical checkups. Care plans instructed staff to support resident with personal care, however this was not always structured to ensure this was given according to individual wishes. It appeared key working did not support resident personal care that was provided as a routine. For example when residents were bathed was determined on each shift by the nurse in charge. This could be when agency staff were on duty, who may not know the resident and therefore be unaware of any significant changes to report. Minutes of the house staff meeting in February 2009 showed this was a problem for carers. It was noted nurses, seniors and some carers do things differently causing some confusion and problems, and bathing of residents was not evened out properly, with long
Care Homes for Adults (18-65 years) Page 20 of 35 Evidence: bathing lists particularly at weekends. Staff had some training in mental health care, to support them in providing the right approach to care for people with mental health problems. Residents had health care risk assessments for example reduced mobility, pressure sore risk. Blood pressure and nutrition were also being monitored; however one resident with weight loss did not have an action plan to deal with weight loss and refusal to be weighed. The home operated with a monitored dosage system for medication. Records of residents medication were kept, and registered nurses had responsibility for the administering of medication. Some residents self medicated following a risk assessment completed, to ensure this would be done safely. Those records seen were up to date and complete. Storage of medication was good, and medications opened with a limited shelf life were dated. However given the large number of residents accommodated in the home a more thorough assessment of this standard by a pharmacist inspector would be beneficial. Care Homes for Adults (18-65 years) Page 21 of 35 Concerns, complaints and protection
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure provided guidance on raising complaints supporting residents to raise any issue of concern they may have. There were policies and procedures and staff training in adult protection issues, however the lack of contractual agreements for staff, and staff monitoring arrangements, meant residents may not be fully protected. Evidence: Residents were generally aware of how to make a complaint. Staff spoken to said they knew what to do if residents or other people had any concern. A record was kept of any complaint made and of outcomes of investigations. The procedure was displayed in the home and included in information given to residents when they are admitted. There have been no complaints received at the Commission about this service. Information contained in the AQAA stated Staff have access to written guidance about safeguarding adults. They received training during their induction and annually as part of the training in strategies for crisis intervention and prevention. Staff are very clear about their responsibilities to report any suspected abuse. Staff who provided written comments for this inspection indicated they knew what to do to protect residents and procedures to be followed. Policies and procedures for safeguarding adults were available in the home. Records showed some staff training in Protection Of Vulnerable Adults (POVA) was provided. A copy of an induction
Care Homes for Adults (18-65 years) Page 22 of 35 Evidence: programme showed this topic would be covered, however there were no formal records available to confirm this. Staff interviewed during inspection were clear of their responsibility and obligation to follow correct procedures in reporting under POVA should this be necessary. Staff however did not have any formal contractual agreements when they started work that would include the homes code of conduct and practice that included protection issues such as financial protection. Staff were trained in handling aggression properly. Interaction between staff and residents was seen to be respectful during inspection with staff showing an understanding of individual needs. Written comments from residents living in the home indicated staff usually treated them well. One resident was not happy generally and another resident expressed being too afraid to order a hot meal. Written comments from staff said the home did well as clients appear to and report being happy. One written comment from staff expressed concern as not all staff treated residents as they should in the manner by which they spoke to them, as residents have have a mental health problem and are sick. Care Homes for Adults (18-65 years) Page 23 of 35 Environment
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was warm, comfortable, and generally maintained. This meant residents were provided with accommodation that met their needs. Evidence: Heightside is a large, spacious home set in its own grounds. Accommodation is provided in three areas, the main house, the mews and close care. One resident who provided written comments said we have beautiful grounds and units. Written information received for this inspection, identified areas of improvement made following the last inspection and included, ongoing refurbishment in all areas of the house and new furniture for bedrooms. Residents had an active role in choosing furniture and soft furnishing, paintings and colour schemes where appropriate. And Two members of staff are now providing a house keeping service to the units and check daily to ensure that health and safety issues are identified and addressed. The home is set in its own spacious grounds with large well maintained lawns and walking areas. There are ample areas residents can sit out and enjoy the views weather permitting. Accommodation is provided in three units, The House, a detached mansion type
Care Homes for Adults (18-65 years) Page 24 of 35 Evidence: property, the Mews and Close Care. Bedrooms in The House are in single and shared rooms, in the Mews single and shared apartments and in Close care single rooms with a separate bungalow that accommodates four people. During a tour of Heightside the following observations were made. In the House, the lounge and hallway carpet was new and home was very clean, tidy, well lit, and smelt fresh. The lounges were comfortable and residents were able to walk about freely. The dining area would benefit being brighter in colour to provide residents with a more pleasant eating area and the floor needed re polishing. The hard flooring leading to the kitchen required some repair to crumbling tiles/concrete. Bedrooms were comfortable and residents possessions accommodated very well. They were clean, and furniture, bedding and floor coverings were suitable for residents needs. One window frame identified in the last inspection as needing an adequate opener for ventilation had been replaced with another two done at the same time. Bathrooms were clean but some attention to minor maintenance such as tiling was required. There were ample bathrooms and toilets to meet with residents needs. Some areas in the Mews could be improved in particular two flats. The kitchen area in Close care needed some upgrading, although the manager said there were plans for improvements and residents had been consulted. During inspection residents enjoyed sitting out in the courtyard and some tended to bedding plants they had sown. There was a nice atmosphere in this area where residents could sit and chat together. There were no call points in the apartments for residents to summons staff in an emergency. This is potentially unsafe as residents may become unable to alert staff in difficulties, and whilst residents living together may support each other this way, it is not guaranteed they will do so. Water temperatures at source were being monitored regularly, however it was noted in records there are still readings of low temperatures. This needs to be investigated and all water temperatures for bathing should be controlled at 43 degrees Celsius plus or minus two. Laundry facilities were adequate, clean and organised. The home was very clean, tidy, and smelt fresh. Care Homes for Adults (18-65 years) Page 25 of 35 Staffing
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers of staff employed, training provided, and relatively safe recruitment practices, meant residents should be protected, and their needs effectively met. Evidence: Information received at the Commission from the home for this inspection indicated new care staff are given a twelve week induction training programme and registered nurses also are inducted to orientate them into the home. Staff records Rotas seen for the previous weeks and day of inspection showed the numbers of staff on duty at any given time to cover essential duties such as keeping the home clean and give residents one to one support where needed and commissioned. The manager said staffing levels in the home allowed for staff to meet the needs of the residents, and was aimed at supporting a person centred approach to care. Several new staff had been recruited. Their records showed recruitment checks to be complete and met with legislative requirements for Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) register check being applied for, prior to employment. There was no written confirmation to show information disclosed which could question an applicants suitability, had been fully considered. More care should
Care Homes for Adults (18-65 years) Page 26 of 35 Evidence: be taken with checking application forms to ensure there is a sound employment history that is checked during interview. Although all employees had two references, references applied for should include at least a request from the last employer. Staff who provided written comments all said their recruitment involved having checks done such as CRB and references. Staff were not given a contract of employment. Staff who provided written comments for the inspection generally said their induction training partly covered everything they needed to know. Records of induction given were not readily available, however staff on duty said this had been completed. Staff also stated they needed training relevant to their role to help understand and meet individual needs of people they provide care to. Regular formal supervision was not given. Staff did meet throughout the day at various times to discuss resident care and receive delegated duties from the nurse in charge. Some staff who provided written comments , considered they regularly had enough support from the manager; however it was concerning that a significant number of staff indicated sometimes and in three instances never. Information received at the Commission showed the percentage of care staff trained to a National Vocational Qualification in care level 2 or above was over fifty percent. Heightside House is now involved with the Lancashire Workforce development Program, and has access to funding and training that meets the needs of the workforce, and has a service level agreement with external training providers to ensure that training issues for individual and groups of staff are addressed. Staff interviewed during inspection said they enjoyed their work. Written comments with regards what the home did well included The care staff work well and really do care for the clients and do the best they can. Some of the nurses are also excellent. And Staff are friendly and approachable. Their views on the service showed they considered there was usually enough staff to support residents, but to improve, there should be More staff to take residents out. Care Homes for Adults (18-65 years) Page 27 of 35 Conduct and management of the home
These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was managed and run in the best interests of the residents. Evidence: The manager of Heightside is qualified and experienced to run the Home. He was aware of the need to keep up to date with practice and continuously develop skills required for the job, and is supported in his role by unit managers and senior staff. He meets regularly with the corporate manager and provider to discuss the business plan for the service. Whilst there is no specific budget allocated for refurbishment this is ongoing and plans for major work on the Mews is in place. The home sent us their annual quality assurance assessment (AQAA), that gave us information we asked for. Overall the self assessment indicated the conduct and management of the home ensured it was run in the interests of the residents, respecting individuals rights and ensured residents best interests were safe guarded. To ensure Equality and Diversity was considered, information for staff about the needs of people from different religions and cultures is supplied to the units. Policies and procedures are available on each unit identifying how staff and residents should
Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: deal with and expect issues related to race, gender, disability and sexual orientation to be dealt with, including clear guidelines for staff ensuring zero tolerance of any discrimination. Residents have access to an advocate at Heightside House and through the East Lancashire advocacy service for independent Mental Capacity Advocate representation. Heightside holds Investors In People award and external (ISO9001:2000) monitoring award. Residents meetings were held, however not many residents joined in. Formal feedback from residents in how the service meets their needs, about staffing and their environment should be obtained, and where necessary advocates used. There was evidence however some residents were consulted about changes planned and their views were noted. Staff had meetings occasionally. The last meeting held was in February. Topics discussed were relevant to development plans to improve service delivery. Staff who completed questionnaires for this inspection considered the home did well and commented The management also has an open door policy so that residents and staff can come and chat to management with any urgent issues, however it was felt that Communication between departments could improve vastly. Information received at the Commission showed regular maintenance of the homes fixtures, fitting and equipment. Policies and procedures for safe working practices were in place. Staff training records included fire safety and fire drills were carried out. However consideration should be given to carry out risk assessments on residents ability to respond to a full building evacuation in other circumstances such as major gas leak. Care Homes for Adults (18-65 years) Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 6 15(1) In order to ensure care is provided in a consistent manner, everyone living at the home must have a plan of care that includes clear and up to date directions as to how their personal, psychological, health and social care needs are to be met. People using the service must have opportunities to be involved in drawing up their care plans so that they can have a say about how their care is to be provided. (Timescale of 30/09/07 not met) 31/08/2008 2 20 13(2) Medicines must be given as 30/06/2008 prescribed. Staff must record the reason for any omission. Care Homes for Adults (18-65 years) Page 30 of 35 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action 1 6 15 Residents care plans must 31/07/2009 include all identified needs and provide clear detailed instructions for staff, on how to meet these needs. This would provide residents with a more person centred approach to their care and personal development. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 23 21 Proper arrangements must be in place to monitor staff working in the home and ensure they are confident they can raise any issue of concern regarding the care and welfare of residents to senior managment. This will ensure any unacceptable practice is dealt with promptly. 31/07/2009 2 29 23 An emergency call system must be provided for residents living in the Mews. This will enable them to summon help in an emergency. 28/08/2009 Care Homes for Adults (18-65 years) Page 31 of 35 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 3 34 19 The recruitment process must include obtaining full employment history. It is essential that information disclosed as a result of any checks carried out is fully considered with a written account made of the circumstances to support a decision to employ. This will ensure the right people are employed to care for residents. 31/07/2009 4 34 17 Staff must receive the terms 31/07/2009 and conditions of their employment. This is to make sure residents staff and employer are protected. 5 36 18 Staff must be given regular formal supervision that provides them with support to do their work professionally. This will help to ensure only qualified and competant staff care for residents. 31/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 6 Residents should have a daily living plan linked to their
Page 32 of 35 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations assessed needs to ensure they are cared as they wish and require. 2 3 9 14 To manage risk effectively, guidance should be clear for staff to know what to do and keep safe. Short term goal planning should be managed to provide some structure for residents rather than an ad hoc arrangement. Residents living long term in the home should have as part of the basic contract price the option of a minimum seven day holiday they help to choose and plan. Daily routines should not be institutionalised and should allow for a more person centred approach to meeting needs. How meals are provided for residents living in Close care and the Mews should be reviewed and delivery improved to ensure meals are hot and appetising when they arrive. Residents should be given the opportunity to have a flexible and consistent support programme for personal care, by staff who are respectful and knowledgeable about their individual needs. Health risk such as weight loss should have a clear action plan written to deal with problems identified in monitoring this. Contractual arrangements for staff should be made to ensure they comply with the homes ruling regarding no acceptance of gifts, or be beneficiary in any will or bequest. The reason for the low water temperature in some rooms should be investigated and measures taken to ensure the temperature is around 43 degrees Celsius plus or minus 2. Attention to minor repairs for example tiling in bathrooms and the floor leading to the kitchen to prevent further deterioration. Staff meetings should be at least six times a year, and a written record kept. . The use of agency staff should be reduced by recruiting sufficient permanent staff to work in the home. More care should be taken when accepting an application 4 14 5 16 6 17 7 18 8 19 9 23 10 24 11 24 12 13 14 33 33 34 Care Homes for Adults (18-65 years) Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations form to ensure it is complete and satisfactory in providing a work history. Gaps in employment should be explored during interview and a record made of any explanation given. 15 16 35 38 Staff training records should be kept up to date. Communication between departments should improve to ensure all teams are working together for the purpose of providing residents with a consistent approach to their care. Quality Assurance monitoring should be developed. Individual risk assessments should be carried out regarding residents ability and readiness to respond to an emergency in evacuating the building. 17 18 39 42 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 35 of 35 - 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!
