Inspection on 03/06/08 for Heightside House Nursing Home

This inspection was carried out on 3rd June 2008.

CSCI found this care home to be providing an Adequate service.

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 5 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 12/06/07

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 28/09/2008.

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 3rd June 2008 09:30 Heightside House Nursing Home DS0000061144.V365856.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.V365856.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.V365856.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 (78) of places Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - 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 12/06/07 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 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 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 Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 5 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 resident’s care plan) and some activities or trips outside the home. Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A key unannounced inspection, which included a visit to the home, was conducted at Heightside House Nursing Home on the 3rd and 4th June 2008 by two inspectors. There had been two additional visits since the last key inspection. These were carried out on 9th October 2007 and 5th February and were to check on the progress towards meeting the requirements from the previous key inspection. We found that some progress had been made by the second visit and some of the requirements were met. At the time of this visit there were 67 people living at the home. The inspectors met several of them and asked about their views and experiences of living at Heightside. Some of their comments are included in this report. Six people living at the home were case tracked. This meant that the inspectors looked at their care plans and other records and talked to staff about their care needs. Seven people living at the home and four of the staff team completed surveys about the home. Their responses were taken into account when compiling the report. During the visit discussions were held with the registered manager, members of the staff team and a visitor. The inspectors looked round the home and viewed a number of documents and records. This report also includes information from the Annual Quality Assurance Assessment (AQAA), which is a self-assessment that the manager has to fill in and send to the Commission every year. What the service does well: Staff supported people living at the home to make choices and decisions about their daily lives, which gave them control and independence. People who were not able to make their own decisions had help from staff who knew them well and could make choices on their behalf. Staff helped people to keep in touch with their family and friends. Most people said they were satisfied with the meals. There was plenty of variety and the chef added new dishes regularly. The service catered very well for people who had special diets for cultural or religious reasons. Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 7 Staff made sure that people had regular checks ups with their doctors, dentists and opticians. Anyone who had a problem with his or her health was referred to the appropriate professional. One person said that he had not been very well and staff had been good with him. 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. Over half of the care staff held an NVQ level 2, which is a nationally recognised qualification in care. Some staff were going to start the next level of training. What has improved since the last inspection? What they could do better: Not everyone living at the home had an opportunity to be involved in drawing up their care plan. This meant that they might not be able to make decisions about what support they wanted. 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 in the way they preferred. Not all of the care plans were up to date, which meant that new or temporary staff might not know what the person’s current needs are. Care plans should be in place to make sure that staff help people to understand their rights under the Mental Health Act. Staff should ensure that they carry out regular blood pressure and weight checks for people who need them. Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 8 Medication records must be clear and accurate and all medicines must be given as they are prescribed. Some areas of the home that are not included in the immediate refurbishment plan should receive attention to ensure that everyone has a good standard of comfort and hygiene. Staff should receive the training they need to ensure they are competent to do their jobs. New staff should have an assessment at the end of their induction training to make sure that they have understood and can put into practice the information they have learned. Other staff must have relevant health and safety training such as moving and handling. Care staff should also have more training in topics that help to increase their understanding of mental health needs and care. Staff should have regular supervision with their line manager in order to exchange information and to get feedback as to how they are performing their role. Alternative arrangements should be made to support and supervise staff who work opposite shifts to their line manager on The House. Systems for checking the quality of the service should include ways of finding out what people using the service think and any suggestions they may have about improving 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.V365856.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.V365856.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 good 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 to meet their needs and staff had sufficient information to be able to confirm that the person’s needs could be met. EVIDENCE: The statement of purpose and service user’s handbook had been updated in the last year. People thinking of moving into the home were given written information about Heightside and had an opportunity to discuss the information with a senior member of staff. Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 11 Most people spoken with said they were happy with their choice of home. Some people who returned surveys indicated that they had not been involved in the decision to move to Heightside but this may be because of a lack of appropriate establishments to meet their needs. One person wrote, “I had to go somewhere and here was available at the time.” People were not admitted unless staff from Heightside had assessed them. This was to ensure that they met the criteria for admission and that the home and staff skills were suitable to meet their needs. The assessments seen were balanced with meaningful information about the person’s strengths and achievements as well as needs. Records showed that staff from the home kept in touch with prospective residents and kept their assessments up to date if they were going through a long discharge process. There was a placement contract on all the files seen but they were not all signed either by the individual or by a representative from the home. As previously recommended information about the protocol for shared rooms had been added. Heightside House Nursing Home DS0000061144.V365856.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. The care planning process was not thorough enough to ensure everyone was involved in setting their own goals and that staff had sufficient information to support people to meet their needs in the way they preferred. People were supported to maximise their independence by making decisions but risk was not always managed effectively. EVIDENCE: Six sets of care files were looked at as part of the case tracking process and Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 13 others were looked at with regard to specific issues. Everyone had a set of care plans but the standard of information was variable. Some were person centred and gave staff clear directions about the way in which the person preferred to be supported. This meant the person was more likely to receive consistent care. Others gave vague instructions such as ‘one to one time’ or ‘reassure’. It was evident from talking to staff that they knew people very well. For example, one of the registered nurses was able to give a precise account of the most effective way to help one person who had negative thoughts. However, these directions had not been added to their care plan, which meant that new or temporary staff might not be aware of them. One of the people who were case tracked was on a section of the Mental Health Act 1983. There was no information or care plan to ensure that staff working on the unit were completely aware of what that meant in terms of the person’s rights or their own responsibilities. A member of staff had discussed the person’s right to appeal with them and offered them support in the process but again this was not formalised in a care plan to show that this is usual practice. Care plan reviews were not always as regular as they needed to be. For example one person’s plans had not been reviewed for a number of months, despite the fact that there had been changes in their needs, care and behaviour. The inspectors were told that reviews had slipped because of recent staff shortages and in some cases staff were having to review care plans in their off duty time. Even when reviews were carried out care plans were not always amended and in some cases evaluation notes described the person’s needs and directions for care better than the plans. This made it difficult for staff to know what support they should be providing without having to look back through all of the review notes and could result in out of date care being given. A member of staff who completed a survey indicated that they were usually given up to date information about people using the service but wrote, “some (nurses) are better than others at passing on information and keeping care plans up to date.” Consultation with people about their care plans was inconsistent. People who were case tracked from The House had not been involved in drawing up their plans, although staff said they discussed them as much as they were able. On Close Care people were involved as much as possible. Part of the plans were written in language that was acceptable and meaningful to the person rather than referring to medical and diagnostic terms. However, some of the directions for support were not as easy to understand. If someone on Close Care was unable or unwilling to be involved in care planning the advocate looked at the plans on their behalf. Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 14 People who were able to make choices and decisions about any aspects of their lives were supported to do so. Most of the people who returned surveys indicated that they could decide what they wanted to do all 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. A multi disciplinary team meeting had been arranged to discuss future health care for one person who lacked the capacity to make their own decisions. There was more consultation about room changes. Minutes of a staff meeting showed that the procedure to be followed in the event of a room change included discussion with the person and other professionals involved in their care. The company still acts as corporate appointee for a high number of people. Some people had individual bank accounts. Staff were observed helping one person to sort out a query he had with his bank. It was an very good example of staff providing the right level of support to ensure the person maintained his independence without overstretching his abilities and causing anxiety. Other people’s money was held in a residents’ account. Most people handled their own personal allowance, which was given to them each week. There were records of money handed over for safekeeping and of any withdrawals. A random sample of records were checked against money held and found to be accurate. There had been some improvements in risk assessments. Across the three units there were good examples of risk management strategies that supported people to move towards independence or protected people from harm. However, there were still some that were not being followed or were out of date. Heightside House Nursing Home DS0000061144.V365856.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.V365856.R01.S.doc Version 5.2 Page 16 The majority of people received the support they needed to lead their chosen lifestyle. EVIDENCE: There were some positive comments about the home. One person said, “I am happy enough here.” Another person who returned a survey wrote, “I am glad I moved to this home, I am very happy and well cared for.” People who were able to organised their own time. Those who were safe to do so went out alone and pursued their own activities. Most people who were asked said there were enough activities going on to suit them. People talked about activities they enjoyed such as snooker, the domino tournament and a recent cheese and wine tasting event. The plan for one person showed that she was regularly consulted about social activities and had developed new interests and friendships since being at the home. In addition to the usual group activities and games, there were more opportunities for people to have one to one activities. People who were working towards moving to their own place had regular one to one input to improve their domestic skills. People living in The House also had more individual staff time. The care records for one person showed that she found groups difficult but regular one to one time had improved her communication with staff. A member of staff had been recruited who had specific responsibilities to provide activities for people who were difficult to engage. The annual quality assurance assessment (AQAA) showed that the manager plans to expand the Occupational Therapy department to continue to improve the range of activities to suit people’s individual needs. People were supported to keep in touch with family and friends. One person said that staff took him to see his family. Staff were also working with another person to help them to use public transport to be able to keep in touch with friends independently. A number of staff talked about how they were trying to give people more opportunities to go out. The nurse in charge of activities organised regular trips out for small groups of people. She discussed how this was partly to aid their move towards independence by helping them to increase their confidence and abilities in social settings. Other staff said they took advantage if they had good staff numbers to ensure people had escorts to go out locally. Senior staff said that extra staff could be made available to facilitate specific activities. There were some good examples of staff putting core values into practice. At lunchtime a member of staff spent time with a person who had communication difficulties, until they were sure what the person wanted to eat. Other staff Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 17 were seen to respect people’s privacy and promote dignity. However, there were still some institutionalised practices, such as displaying a timetable for cigarettes and drinks. Staff were also observed asking people, in hearing of other residents, about their toilet needs. Most people who were asked said the meals were “OK” or “alright.” One person said, “most of the time the meals are good, just now and again they are rubbish.” People agreed that the portion sizes had generally improved. They said they had choices at every meal and records of meals served showed that people were offered plenty of variety. Some people had special diets. Separate meals were purchased from an outside caterer for residents who ate Halal and Kosher meals. More care could be taken with pureed meals. At the time of the inspection these were served with all the food mixed together with no attempt to puree foods individually for different tastes. The inspectors observed people being assisted to eat in a sensitive way with one to one help. Heightside House Nursing Home DS0000061144.V365856.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 health care needs of some people living at the home may not be met because of shortfalls in medication administration. EVIDENCE: Plans to assist people with their personal hygiene were generally individualised to ensure that the person received the type and level of support they needed. However, some staff felt that people did not have enough choice or flexibility about bathing routines. Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 19 People had health care risk assessments and management strategies that were relevant to their individual needs. For example, people with reduced mobility had moving and handling assessments and plans. Everyone had an assessment of pressure sore risk and pressure distribution aids were in use where a risk had been identified. Some of the nutritional risk assessments were not complete. There were plans in place to manage minor wounds. One of the nurses from The House took on the role of link tissue viability nurse and acted as a resource for the rest of the staff team. Some people had care plans to monitor their blood pressure and weight every month. These were not always followed, for example, one plan showed there had been no checks for six months. Records showed that another person had refused to be weighed for two consecutive months. There was no evidence that staff had asked the person more than once in each month. There was evidence that people were referred to outside professionals for advice about physical health care. For example, one person had been referred to hospital because of decreasing mobility. Another had been referred for help because of swallowing difficulties. Plans were in place to ensure that advice from other professionals was communicated and acted upon. Surveys indicated that people received the medical support they needed. One person said he had recently been unwell and staff had been good to him. A number of people on The Mews administered their own medication. They all had assessments and care plans on file. Some had not been reviewed on a regular basis and were not up to date. The plan for one person indicated that random checks should be made to ensure that they were still managing their medicines safely. There was no evidence that any checks had been carried out. Medicines received into the home were usually recorded on Medication Administration Record (MAR) charts. Methods for recording medicines carried over from the previous month were not consistent. In some cases the records were not accurate and in others there were no records at all, which meant it was difficult to carry out audits. One MAR chart showed that medicine prescribed once a day had been signed as given twice a day for two days. The records of medication carried forward were not clear; therefore it was not possible to tell whether this was a recording error or evidence of a more serious administration error. A few MAR charts were not clear and it was not possible to check whether people had received their medicines as they were prescribed. Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 20 There were appropriate records of medicines disposed of. These were double signed to reduce the risk of mishandling. There were no records of leave medicines for one person on The Mews. There were some gaps on MAR charts with no explanation as to why the medication had not been given as prescribed. Most people had criteria sheets to guide staff when to give ‘when required’ and variable dose medicines. However, MAR charts did not always clearly state when a medicine was to be given ‘when required’ instead of a regular dose. This could result in staff giving medication inappropriately Staff usually recorded in the daily notes if ‘when required’ medication was given. However, the notes for one person did not accurately cross reference with the MAR chart. This meant that staff could not evaluate care effectively. The MAR chart for the same person also indicated that on one occasion they had been given two tablets but the MAR chart clearly stated one tablet was to be taken. Medicines were stored safely and temperatures of storage areas were usually kept at the recommended level. Medicines with a limited shelf life were dated on opening. Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. People could be confident that complaints would be acted upon. Inconsistencies in strategies for managing aggressive behaviour could put people using the service and staff at risk. EVIDENCE: There was a copy of the complaints procedure in the residents’ handbook, which had been given to everyone living at the home. Most people who returned surveys indicated that they knew who to speak to if they had a complaint. One person wrote, “I don’t know who I am supposed to talk to but I find it easy to tell staff if I have any problems.” Staff who returned surveys indicated that they knew what to do if anyone raised concerns to them. The AQAA indicated that two complaints had been made directly to the home since the last inspection. Records showed that these were investigated and action taken to prevent reoccurrence. Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 22 One of the standards in the induction training covered safeguarding adults. Staff also received training in safeguarding as part of the training in strategies for crisis intervention and prevention. Staff spoken with were able to discuss the indicators of abuse and knew their responsibilities to report any allegations to the manager. However, one of the more senior staff was not completely clear about how to deal with an allegation should they be in charge of the home at the time. From information received on the AQAA and notifications sent to the Commission it was apparent that the manager was knowledgeable about safeguarding procedures. He had made appropriate referrals to social services. People who had aggressive behaviour had care plans in place but the standard was not consistent. One person had clear records of aggressive incidents. Their daily notes confirmed that staff were seeking specialist help and there were strategies in the care plan to assist staff to support them. Another person’s plan had not been re-written for two years and did not include any meaningful information about the person’s individual behaviour or strategies for staff. New and temporary staff were made aware of risks and risk management strategies but they might not always have the experience to use the correct approach. Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 23 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 homely, safe and clean but some shortfalls compromised the comfort of people living at the home. EVIDENCE: Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 24 The programme of extensive refurbishment was ongoing. The alterations to Close Care had improved the communal space and bedrooms had been refurbished. A resident said he was happy with his room and his lovely view. Bedrooms on the ground floor of The House had been redecorated, furnished and re-carpeted to a good standard. They were awaiting delivery of new armchairs for the lounge. Other areas of The House were still in need of attention. The velux window in one bedroom had been screwed shut for safety reasons and the room was uncomfortably hot. The person using the room confirmed it got too hot and said she had to keep the door open, which did not protect her privacy and dignity sufficiently. The manager said he would look into an air conditioning unit for the room until the window could be replaced. Some of the small rooms in the bungalow in Close Care unit were also hot and lacked adequate ventilation. A toilet/shower room on the first floor of The House had no water supply to the hand basin, which meant that people could not wash their hands after using the toilet. Other bathrooms in The House and The Mews were in need of attention. The manager said bathrooms and kitchens were next on the list for renewal, after current building work on Woodvillas was completed. A number of bedrooms had new bed linen. However, throughout the House and The Mews there were several beds with hospital linen or linen that was worn, mismatched and in some cases in holes. Some of the pillows were also misshapen and flat. Nursing and care staff on the units were monitoring temperatures of hot water in bath and shower rooms. Records showed that the temperature of the hot water on Close Care was consistently lower than recommended. Because staff were not aware of what the temperatures should be, they had allowed this to continue. This meant that people were being asked to bathe in uncomfortably cool water. The standard of cleanliness was generally good on the House and Close Care. People who returned surveys said the home was usually fresh and clean. However, there were several areas on the Mews, including the stairs and outside landing to the flats, and several bedrooms, that were in need of a deep clean. The bed linen on some of the beds on The Mews was stained and grubby. The nurse said that there was a weekly bed change but there was no reason why this could not be increased. The laundry was sufficiently well equipped for the size of the home. Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 25 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, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service were protected by recruitment practices but there were not always sufficient staff, with appropriate training, to meet their needs. EVIDENCE: There had been recent difficulties in recruiting staff and for a time there had been low staffing numbers and high use of agency staff. Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 26 Some staff on The House said they were happier about staffing levels. New staff had been recruited but agency was still used more than they would like. This was also the case on The Mews where two out of the three staff on the first day of the inspection were agency staff. Staff who completed surveys mentioned problems with staffing levels. A resident who completed a survey wrote, “Sometimes agency staff don’t know what I mean.” There were still not always enough staff to escort people who wanted to go out from Close Care and The Mews. One member of staff said that there were not a lot of times when there were more than the minimum number of staff that had to be on the unit. To assist with recruitment difficulties the manager had engaged an employment agency to identify suitable candidates to fill vacancies throughout the home. Although the staff were employed by the agency for the first three months, staff from Heightside completed most of the recruitment process. Letters inviting applicants for interview indicated that a resident may be on the interview panel. The files of three new staff were inspected. All information and documents were in place except the agency had not provided a full employment history for one person. All pre-employment checks were carried out before any applicant started work. All new staff were given a copy of the Skills for Care common induction standards. They were allocated a mentor who helped them through the programme and who signed them off when they had achieved the expected outcomes. However, there was no formal assessment to ensure that all staff were achieving the outcomes to the same standard. As part of their induction new staff worked for a short time on all three units shadowing experienced staff and getting to know all the residents throughout the home. One member of staff described their induction as very structured. Another said they were thrown in at the deep end after two days. The improvements in training noted at the last key inspection had not been sustained. There had been no moving and handling training for almost two years. This meant that staff working on The House were carry out moving and handling techniques without appropriate training, which could impact on the health and safety of both residents and staff. The manager said they had been let down by training providers and courses were planned in the next month. Other training in safe working practice topics was not up to date. There were no records of infection control training and staff working in the laundry said they had not had any recently. Records showed that the in-house mental health awareness training was not as frequent, which meant that new staff would not be likely to have had any theoretical training. The AQAA showed that 60 of care staff held an NVQ level 2. A number of care staff had also enrolled on the level 3 training. Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 27 Two unit managers supported the manager in the day to day running of the home by line managing staff and carrying out supervision. However, the unit manager for The House was working full time to cover shifts and did not regularly see staff working on the opposite shift. At the time of the inspection some of the staff working on The House commented on this. Three members of staff who returned surveys indicated that they never met with their manager. One wrote, “we never seem to get much information from managers at all.” Another commented, “my manager is usually on opposite shift patterns to mine,” and the third wrote, “Support from the management could be better.” Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 28 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. Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 29 The home was run by a competent and experienced manager but with little consultation with the people who lived there. 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. He keeps his skills up to date with regular training. The home held an external quality monitoring award (ISO9001: 2000). There were no recommendations outstanding from the last assessment in November 2007. The service also holds the Investors in People award. The manager said that satisfaction surveys were sent out to all residents earlier in the year but the return was so poor that there were no results to analyse. Records of residents’ meetings also showed a very poor response and some meetings there were only the staff and advocate present. Other ways of eliciting residents’ views were discussed with the manager. Fire alarms, systems and equipment were serviced regularly. The manager stated that remedial actions recommended following a recent fire safety inspection had been carried out. Fire safety training was running at the time of the inspection. The number of fire drills had decreased. There had been none in Close Care and The Mews for nearly two years. Records showed the last one in The House was six months ago. This meant that staff did not have sufficient opportunities to put procedure into practice and increase the chances of knowing how to respond in the event of a fire. The AQAA showed that servicing and maintenance of gas and electrical installations and equipment were up to date. Moving and handling equipment was serviced regularly. Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 30 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 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 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 3 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT Standard No Score 37 3 38 X 39 2 40 X 41 X 42 2 43 X 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Heightside House Nursing Home Score 3 2 2 X DS0000061144.V365856.R01.S.doc Version 5.2 Page 31 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 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) 2. YA20 13(2) Medicines must be given as prescribed. Staff must record the reason for any omission. Assessments and care plans for people who are administering their own medicines must be kept up to date and checks must be carried out as stated in the plan. DS0000061144.V365856.R01.S.doc Timescale for action 31/08/08 30/06/08 3. YA20 13(2) 30/06/08 Heightside House Nursing Home Version 5.2 Page 32 4. YA23 13(4)(c) To ensure the safety of everyone living at the home, all strategies to manage risks caused by aggressive behaviour must be kept up to date. They must be clearly understood and followed by staff. 30/06/08 5. YA35 18(1)(c) In order to ensure the health and 30/09/08 safety of people living and working in the home all staff must receive health and safety training that is relevant to their roles. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA19 YA20 Good Practice Recommendations Staff should ensure that they carry out regular blood pressure and weight checks for people who need them. To assist staff to carry out audits of medicine administration, records of medicines received and carried forward from the previous month should be clear and accurate. In order to ensure there is a clear audit trail, staff should keep records of medicines given to anyone going on leave. There should be a water supply to all hand washbasins. There should be adequate ventilation in all bedrooms so that they are maintained at a comfortable temperature. To ensure people’s comfort and safety hot water temperatures in bath and shower rooms should be maintained at approximately 430c. 5. YA30 Bed linen should be changed as frequently as needed by the individual and all areas of the home should be kept DS0000061144.V365856.R01.S.doc Version 5.2 Page 33 3. 4. YA20 YA24 Heightside House Nursing Home clean. 6. YA33 Senior staff should assess the skill mix of staff on a daily basis and avoid, wherever possible, agency staff outnumbering permanent staff. The induction programme should include an assessment of competency to ensure that all new staff achieve the outcomes to the desired standard. Care staff should receive training to help them to understand the mental health needs of people living at the home and help to support them. 8. YA36 Alternative arrangements should be made to support and supervise staff who work opposite shifts to their line manager in The House. Quality monitoring systems should include methods of eliciting the views of people who use the service. There should be regular fire drills to give staff the opportunities to put procedure into practice and increase the chances of knowing how to respond in the event of a fire. 7. YA35 9. 10. YA39 YA42 Heightside House Nursing Home DS0000061144.V365856.R01.S.doc Version 5.2 Page 34 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.V365856.R01.S.doc Version 5.2 Page 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. 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