Inspection on 12/06/07 for Heightside House Nursing Home

This inspection was carried out on 12th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heightside House Nursing Home 11/06/09

Heightside House Nursing Home 03/06/08

Heightside House Nursing Home 30/05/06

Heightside House Nursing Home 30/05/06

Heightside House Nursing Home 06/12/05

Heightside House Nursing Home 06/12/05

Heightside House Nursing Home 10/06/05

Heightside House Nursing Home 08/06/05

Heightside House Nursing Home 08/02/05

Heightside House Nursing Home 08/02/05

Heightside House Nursing Home 11/08/04

Heightside House Nursing Home 11/08/04

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Heightside House Nursing Home Newchurch Road Rawtenstall Rossendale Lancashire BB4 9HG Lead Inspector Jane Craig Unannounced Inspection 12th June 2007 09:30 Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 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 Heightside House Nursing Home DS0000061144.V343410.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 and Care Homes for Adults 18 – 65*. 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. Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heightside House Nursing Home Address Newchurch Road Rawtenstall Rossendale Lancashire BB4 9HG 01706 830570 01706 220206 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) Randomlight Limited Mr Graham Joseph Glascott Care Home 78 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (72), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (72), Physical disability (3), Physical disability over 65 years of age (3) Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. When the named persons in the categories of PD and PD(E) cease to reside at the home, the categories of registration must be varied to reflect this change. Staffing for service users requiring nursing care will be in accordance with the Notice dated 4th November 1997. The service must, at all times, employ a suitably qualified and experienced person who is registered with the Commission of Social Care Inspection as the manager of Heightside. 30th May 2006 Date of last inspection Brief Description of the Service: 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 communal space 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 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 have 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 Close Care 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. Information received from the home on 12th June 2007 indicates the range of Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 5 weekly fees is £800 to £1,400. Additional charges are made for hairdressing, transport (not included in a resident’s care plan) and some activities or trips outside the home. Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Heightside House Nursing Home on the 12th and 13th June 2007. The visit was carried out by two regulation inspectors. At the time of the visit there were 61 people accommodated. The inspectors met with a number of people using the service and spent time observing their interactions with staff. Wherever possible they were asked about their views and experiences of living in the home and some comments are quoted in this report. Of thirty surveys sent out prior to the inspection, only two were returned by people using the service. Discussions were held with the registered manager and several members of staff. A tour of the premises took place and a number of documents and records were viewed. This report also includes information submitted by the manager before the inspection visit. What the service does well: Staff supported people living at the home to make decisions about their daily lives. This meant that they had some choice and control over their lives. There were guidelines in place when people were not able to make decisions, usually for reasons of safety. Staff treated people living at the home with respect and made sure that their legal rights under the Mental Health Act were upheld. The people living at the home were supported to maintain contact with family and friends. This enabled them to continue with personal and family relationships. Staff supported people living at the home with their personal care in the way that they wished this to be done. This meant that the people living at the home had some control over the care they received. All complaints were recorded and responded to. This meant that the people living at the home could be confident that their concerns would be listened to and acted upon. A number of people living at the home said that they liked the staff and got on well with them. This showed that the people living at the home were happy with the service provided to them. One person said, “I am very fond of them, they have been good to me.” Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 7 The home is run by a qualified and competent manager who is committed to raising the standards of care. Staff said the manager was supportive and a person living at the home said, “it is run just so.” What has improved since the last inspection? What they could do better: Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 8 People living at the home must be involved in the decision to move rooms or transfer to other units. This is so that they can express their opinion about whether they wish to do this or not. There should be information in the Service User’s Guide and the contract about sharing of bedrooms and when it might be necessary to move rooms. People who may wish to come and live at the home need to be aware that this may happen and under what circumstances. Although there had been some improvements, not everyone had been assessed by staff from Heightside before they were admitted. Senior staff should make sure that they carry out an assessment on everyone so that they can make sure that the staff and services at Heightside can meet the person’s needs. Not all of the care plans were thorough enough to make sure that staff had all the information they needed to help the person living at the home to meet their needs. The manager and the Head Chef should ensure that the concerns expressed by some people living at the home about the amount and quality of food are investigated and addressed. This is so that everybody receives a diet that is to his or her liking and needs. Medication records and administration of medicines must be improved so that the health and well being of people living at the home is protected. In order to maintain dignity privacy screens should be available in all shared rooms so that people can use them if they wish. There should be a water supply to all wash hand basins so that hygiene can be maintained and infection does not occur. The means of keeping windows open should be safe. The practice of propping them open with articles could cause an injury if anyone removed the prop and the window shut onto their hand. The recruitment procedures must be thorough for all new staff. This is so that it can be assured that they are suitable to work with vulnerable people and protects the people living at the home. 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. Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The admission process ensured that people had enough information to make a decision as to whether the home was suitable for their needs but the lack of assessments by staff with specific knowledge of the home could result in inappropriate placements. EVIDENCE: The information given out to people who were thinking of using the service had been reviewed and updated. Despite previous requirements there was still not enough relevant information in the service user’s guide or the residents’ handbook about agreements for shared rooms and options to have single room accommodation. Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 11 The files of people recently admitted to Heightside contained various assessments, care plans and hospital discharge reports. However, not everyone had been assessed by a senior member of the Heightside staff team before they were offered a place at the home. This meant that people’s needs were not assessed in relation to the environment, staffing structures and current resident population at Heightside. Staff said that they had access to information about new people and had opportunities to discuss their needs before they were admitted. Everyone living at the home had been offered a contract since the last inspection. The contract detailed the key terms and conditions of residency. Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most people were supported to maximise their independence by making decisions and taking responsible risks but shortfalls in the risk assessment and care planning processes meant that not everyone living at the home were completely protected. EVIDENCE: There had been some improvements in care planning across the three units. For example, interventions to assist people to manage their mental health were generally more relevant. There was also some good information on one Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 13 plan to assist someone to meet his or her religious and cultural needs. However, there were still some shortfalls. One of the people admitted to the home about two weeks before the visit did not have any care plans. The care plan for another person did not indicate that they were vegetarian. Although on the day of the visit the unit staff and kitchen staff were aware of the person’s dietary needs, any new or temporary staff may not be. Not everyone had opportunities to be involved in drawing up or reviewing their care plans. Most plans had been reviewed regularly and some had been altered or re-written when the person’s needs changed. However, some review notes were very brief and did not give an indication of the person’s progress towards meeting their goals. The more able and independent people living at the home made choices and decisions about all aspects of their daily lives. One person talked about going on holiday by himself and another said that they could do what they wanted during the day. Staff made decisions on behalf of less able people, usually based on knowledge of their likes, dislikes and preferences. There was also an advocate on site to assist in this process. People were still being moved around the home. In some cases there was evidence that people were consulted and agreed to the move. For example, there were very detailed records of the consultation and support process for people temporarily moving from Close Care to The House. In other cases there were no records that people had been asked or had reasons for moving explained to them. The care notes for one person stated “room change”. One person living at the home said he had been in a single room in The House and had been moved next door to share with someone else. He said he didn’t know the reason for this but he also said he was not bothered about it. Most people had risk assessments and management strategies on their files. Some were positive and addressed safety issues whilst enabling people to move towards independence. For example, going out unescorted and use of equipment when cooking. One person said, “I signed to say I did not want any checks at night because I didn’t want to be woken up.” Other risk assessments and management strategies placed restrictions and limitations on people in order to protect themselves or others. In some instances these risk assessments were not being adhered to. For example one person whose risk assessment indicated close observations at all times was seen walking around without a staff escort. Another person, who was on a unit staffed primarily by females, told the inspectors he would like to go out but he was not allowed to without male staff. A member of staff confirmed this. However, it was found that he did not have a current risk assessment or management plan that placed those restrictions upon him. Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 14 The company still acted as agent for the majority of people living at the home. The manager stated that people’s savings were being deposited in a special residents’ account, which meant that should the company fail this money would be safe. There were records of personal allowances handed over to people and records if any money was handed back for safekeeping. One person said he could always ask the staff to get his money if he was going out. The amounts of money held on the individual units exceeded the amount recommended in the financial policy, although the manager stated that there was sufficient insurance cover to allow for this. Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 16 The majority of people received the support they needed to lead their chosen lifestyle. EVIDENCE: People who were able to organised their own time. Those who were safe to do so went out alone and pursued their own activities. One person talked about going out on the bus to the shops and another person was getting ready to go away on holiday at the end of the week. A number of people had jobs either inside or outside the home. The daily records for one person showed that the staff were helping him to try to find some suitable occupation. A number of people were being supported to move towards independent living. One person said that he did his own shopping, cooking and cleaning. He was given a weekly budget, which he said was, “enough to live off each week.” Opportunities for people who were not so independent had improved. Staff on one of the units said they organised games and other activities when they had time but there was no evidence of this during the visit. There were more opportunities for people to go out, either one to one with staff or in small groups. The activity budget increased during the summer to take into account the cost of transport. Despite these obvious improvements there were still a number of people who were not engaged in any meaningful activity or occupation and most of the care plans did not have any directions for staff about how people’s needs in this area could be met. Restrictions or special arrangements for visiting were included in the statement of purpose and on individual care plans. People who went out independently had opportunities to meet new people. For example, one person had a wide network of friends within the local Asian community. Staff supported less able people to keep in touch with family and friends. Staff talked about how they supported people living at the home who were in long-term relationships. People’s basic rights were outlined in the statement of purpose and the residents’ handbook. There were records on most care plans to show that people who were subject to restrictions under the Mental Health Act 1983 had had their rights explained to them. However, this was not consistent across all the units. During the course of the inspection staff were seen to treat residents respectfully. Assistance with personal care was given in private and staff were observed knocking on bedroom doors before entering. Many of the people who were asked about the meals said they were not completely happy. A number of people said they did not get enough to eat at lunchtime. One person said, “it wouldn’t keep a budgie alive,” and another said, “the food’s alright, just not enough of it.” Other people’s perceptions were different, one person said, “I get plenty to eat, too much sometimes,” and another commented that, “the amount is just about right.” Several other Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 17 people complained about the quality of the food. One said, “food’s not up to much here, very hit and miss,” and another said, “the food’s edible but could be better.” Again there were some people who had opposing views. Concerns about food had been apparent for some time and had prompted a recent survey. Some remedial measures had been put into place and the chef was intending to attend the next residents meeting to listen to the problems firsthand. Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The personal and health care needs of people using the service were met but some people were at risk of harm because of shortfalls in the way medication was managed. EVIDENCE: Care plans generally provided detailed directions about the level of support people needed to manage their personal care needs. There were also some person centred plans that included people’s preferences. The inspectors observed that staff provided assistance with personal care at times that suited the people living at the home. Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 19 Care plans generally included health care risk assessments and management strategies that were relevant to the individual’s needs. For example, people with reduced mobility had moving and handling assessments and plans. People identified as being at risk of losing weight, either because of their physical or mental health, had care plans in place to reduce the risk. Care plans to manage wounds were thorough. One of the staff from The House took on the role of link tissue viability nurse and acted as a resource for the rest of the staff team. Although there were not always care plans in place, it was evident from speaking to people that they were referred to outside professionals and they thought their health care needs were met. For example, one person said he had a yearly appointment with the practice nurse to monitor his blood pressure. Several people said that they were well looked after by the staff. One said, “I’ve been in hospital and I didn’t like it, I’m glad to be back.” Another commented, “I like it here, they look after me very well.” The records of medication received into the home were not complete, which meant that there was no clear audit trail. Some staff used appropriate codes on Medication Administration Record (MAR) charts when they omitted medicines. Others did not. For example, one person had missed five doses of one particular medicine out of a potential fifteen, with no explanation why. There were records of medicines disposed of. In most cases handwritten amendments to MAR charts were double signed but not always checked. For example, newly prescribed medication for one person had been written onto the MAR chart of another, which could have resulted in the second person receiving medication not prescribed for them. Some people had clear criteria sheets to guide staff when to give ‘when required’ and variable dose medicines but this tended to be confined to The House. MAR charts were not always re-written when doses of medication changed. This meant that staff could not easily track the date of the changes. The MAR chart for one person stated one tablet to be given but staff were giving two without any apparent instruction from the person’s doctor. Staff had altered a MAR chart to increase the dosage of a tablet. This action was based on what they thought the person was prescribed. However, the current prescription was for the lower dose but this had not been checked. Stock balance was good. There was no excess and no one had run out of medicines. People who managed their own medication had assessments and care plans in place. One person said that staff gave him two days supply and then checked that he had taken it. Storage was safe, although the facilities on the temporary Close Care were not adequate. Temperatures of storage rooms were monitored and kept within acceptable limits. Registered nurses, some of whom had attended refresher training, administered all medication. Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service were safeguarded by the complaints and protection procedures applied in the home. EVIDENCE: There was a copy of the complaints procedure in the residents’ handbook, which had been given to everyone living at the home. There had been six complaints since the last inspection, two of which were from people using the service. Records showed that all six complaints had been investigated and responded to. People who completed surveys indicated that they knew who to speak to if they were not happy. It was also evident from talking to people during the visit that they felt able to make complaints. Staff had 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 spoken with during the inspection were clear about their responsibilities to report any suspected abuse. They Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 21 were aware of who to report to both internally and outside the home. The manager had experience of reporting allegations to the adult protection team. The risk assessments and care plans to manage verbal and physical aggression had improved. Staff also received training on managing aggression. Any incidences of restraint were clearly recorded. Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most areas of the home were safe, clean and comfortable but some shortfalls compromised the safety and privacy of people living at the home. EVIDENCE: Major refurbishments were underway in parts of the home. The Close Care Unit had closed temporarily to allow building work and redecoration to be Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 23 carried out without endangering the safety of people living on the unit. People had moved across to a newly refurbished area on the first floor of The House. This area had six bedrooms, decorated and furnished to a high standard, and a combined lounge/dining area. Some other bedrooms in The House had been decorated and re-furnished. The manager stated that there were plans to refurbish the ground floor of The House next. Whilst looking around The House some issues were identified as needing attention before the planned renovation took place. Several sash windows were being propped open with plant pots and other objects, which could cause an injury if anyone removed the prop and the window shut onto their hand. There were at least two bedrooms and a shower room/toilet where there was poor or no water flow to the hand basin. This was of particular concern in the bathroom, as people could not wash their hands after using the lavatory. Whilst some rooms had new soft furnishings, other beds were made up with linen and counterpanes bearing hospital logos, which did not look homely. There were two shared rooms in The House that did not have privacy screens. One of the rooms also contained a commode, which showed signs of having been used in the bedroom, possibly in view of the other resident. A number of people said they were satisfied with the environment. All areas of the home were clean and tidy at the time of the visit. Some staff were following procedures to control the risk of the spread of infection, for example, when handling laundry, disposing of infectious waste and using colour coded cleaning equipment but there were others who were not. For example, staff were soaking commode pans in the bath instead of washing them in the sluice. As well as being unhygienic this practice could increase the risk of infection spread because the bath water temperature would not be hot enough to disinfect the pans. The manager had identified a member of staff to undertake infection control training and cascade it to other members of the team. Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service were supported by a consistent and qualified staff team but recruitment practices were not thorough enough to provide complete safeguards. EVIDENCE: Staff working on The House said there were improvements in the staffing levels on that unit although there were still a few shifts being covered by agency staff. One of the staff commented that the current skill mix was good. Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 25 Some of the staff working on The Mews did not think there was always enough staff to take people out. A number of people living at the home said that they liked the staff and got on well with them. One person said, “The only problems I get are with residents, not with staff, they are fine.” Another person said, “I am very fond of them, they have been good to me.” The files of three newly recruited staff were looked at. Two files were complete and showed that thorough pre-employment checks had been carried out. The other member of staff had commenced work without appropriate references. This meant that there was a lack of information about the careworker’s character and fitness to work with vulnerable people. The manager carried out checks to ensure that nurses were registered with the Nursing and Midwifery Council. The induction training programme for new staff met the twelve-week common induction standards. Registered nurses went through an induction to orientate them to the home. One nurse said that she had spent the first week shadowing a more experienced nurse. Opportunities for other training had improved. Not all staff had received training in the safe working practice topics but training sessions planned over the next two months should address any shortfalls. Fire safety training was up to date. The manager stated that as from July the training would be increased to twice yearly. There were sufficient staff with a first aid qualification to ensure that there was always someone on duty to respond to a health emergency. A number of staff had done further training in mental health awareness and physical health care issues. 62 of care staff had achieved NVQ to at least level 2. Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a competent manager who ensured that the service was run in the best interests of people living there. Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 27 EVIDENCE: The registered manager is a first level nurse with several years experience of managing mental health services. He holds an NVQ level 4 in management and has recently completed a course to train staff in strategies for crisis intervention and prevention. Since taking up post the manager has made a number of improvements to the service but acknowledges that there is still some way to go. A member of staff described the manager as very supportive, and one of the people living at the home said the manager “has got everything off to a tee.” The home held an external quality monitoring award (ISO9001: 2000). There were no recommendations outstanding from the last assessment in November 2006. The service is in the process of being assessed for the Investors in People Award and the manager waiting for feedback from a recent inspection carried out by East Lancashire Primary Care Trust. Internal audits that were carried out on care plans and medication practices had ceased. Residents’ meetings were held every month but minutes showed a very poor attendance. One person said he did not go because, “it’s always the same people ask the same things.” Minutes of staff meetings were on display and showed that staff were able to discuss ideas for improvements to the service. The manager planned to introduce an internal audit and quality assurance system based on the East Lancashire model. Information submitted by the registered manager showed that servicing and maintenance of all installations and equipment were up to date. Fire alarms, systems and equipment were serviced regularly. Environmental risk assessments and risk assessments for potentially hazardous substances had been reviewed and brought up to date. Heightside House Nursing Home DS0000061144.V343410.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 Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 2 2 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 4 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT Standard No Score 37 3 38 X 39 3 40 X 41 X 42 3 43 X 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Heightside House Nursing Home Score 3 3 2 X DS0000061144.V343410.R01.S.doc Version 5.2 Page 29 Yes 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 YA6 Regulation 15(1) Requirement 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 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. (Previous timescale of 31/12/05 not met) 2. YA7 12(2) People living at the home (or their representatives) must be involved in the decision to move rooms or transfer to other units within the home. (Previous timescale of 31/12/05 not met) Full and accurate records of all medicines received and DS0000061144.V343410.R01.S.doc Timescale for action 30/09/07 31/07/07 3. YA20 13(2) 17(1) 31/07/07 Page 30 Heightside House Nursing Home Version 5.2 administered must be maintained to ensure people are given the correct medication. 4. YA20 13(2) Staff must administer medication 31/07/07 in accordance with the prescribers’ instructions so that people who use the service receive the correct amount of medication at all times. Directions should be clearly recorded so that staff know how to give the medication correctly. (Previous timescale of 08/12/05 not met) Instructions on MAR charts must 31/07/07 accurately reflect the instructions on the medicine container. (Previous timescale of 30/06/06 not met) In order to ensure that staff are fit to work with vulnerable people, the registered person must ensure that all preemployment checks are carried out before a member of staff commences work at the home. 31/07/07 5. YA20 13(2) 6. YA34 19(4) schedule 2 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 YA1 Good Practice Recommendations Information about shared rooms and protocols for moving people around the home should be included in the service user’s guide and contract. Staff from the home should assess people thinking of DS0000061144.V343410.R01.S.doc Version 5.2 Page 31 2. YA2 Heightside House Nursing Home moving into the home with regard to the environment, the skills of the staff group and people currently living at Heightside. 3. YA7 The sum of money kept on the unit for each resident should be in line with that stated in the policies and procedures. To ensure the safety of everyone living at the home, all risk management strategies should be adhered to. The improvements in the level of activities should be built upon to ensure that everyone living in the home has equal opportunities for meaningful occupation. The registered person should continue to seek to address the complaints about food, to ensure that people living at the home are provided with meals that satisfy at least the majority. In order to achieve consistency and to prevent under and over medicating, the criteria for the administration of when required and variable dose medication should be clearly defined and recorded Privacy screens should be made available in all shared rooms so that people can use them if they wish. There should be a water supply to all hand washbasins. Windows should not be propped open if the original catches are not in place 9. YA30 In order to control the risk of the spread of infection, commode pans should be washed in the sluice area. 4. 5. YA9 YA12 6. YA17 7. YA20 8. YA24 Heightside House Nursing Home DS0000061144.V343410.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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. Heightside House Nursing Home DS0000061144.V343410.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. 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!