Inspection on 30/05/06 for Heightside House Nursing Home

This inspection was carried out on 30th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Heightside House Nursing Home 11/06/09

Heightside House Nursing Home 03/06/08

Heightside House Nursing Home 12/06/07

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 HOMES FOR OLDER PEOPLE Heightside House Nursing Home Newchurch Road Rawtenstall Rossendale Lancashire BB4 9HG Lead Inspector Jane Craig Unannounced Inspection 30th May 2006 08:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 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 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.V287485.R01.S.doc Version 5.1 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. 6th December 2005 Date of last inspection Brief Description of the Service: Heightside House is registered to provide nursing care for up to 78 people, aged 18 and over, 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. 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. 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 19th May 2006 indicates the range of weekly fees is £600 to £1,000. 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.V287485.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection visit took place over 2 days and was carried out by 2 inspectors. The services and facilities were assessed against both the National Minimum Standards for 18 to 65 year olds and the National Minimum Standards for Older People. It was agreed with the registered person that due to the number of residents in both categories and the complexity of the facilities offered that 2 separate reports would be produced, reflecting the 2 sets of standards. Although the reports contain many similarities the reader should refer to the report most relevant to the prospective resident to be accommodated. At the time of the visit there were 65 residents accommodated in the home. The inspectors met with a number of residents. Time was spent observing interactions between staff and residents. Wherever possible residents were asked about their views and experiences of living in the home and some of their comments are quoted in this report. Discussions were held with the registered manager and members of staff. The inspectors made a tour of the premises and looked at a number of bedrooms. Records and documents were viewed. What the service does well: Sends out information to prospective residents so that they have enough information about the home to make a choice about whether they want to move there or not. Staff encouraged residents to make decisions about their daily lives. There were guidelines about when they were not able to, usually for reasons of safety. Staff treated residents respectfully and made sure their rights were regarded. Residents said that staff gave them their privacy. One said, “Staff let me have a bath on my own but sometimes shout to see I’m alright.” Most of the residents said they liked the meals. One said they had “no favourites, I like them all.” They said there was plenty of choice and they were even able to have things that were not on the menu. The catering staff had recently won a food safety award after the environmental health inspection. There was a clear complaints procedure. Records showed that formal complaints were investigated and acted upon. Some residents said they would speak to the manager if they had any complaints but others said they would go to someone outside the home. Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 6 The home was kept clean and tidy. One of the residents said the domestic “does her best to keep it clean.” A number of residents said they were happy with their rooms. One said, “nice room, wouldn’t want to swap it,” and “my room’s very nice, big enough, but it needs repainting.” The way new staff were recruited protected residents. All staff had thorough background checks to make sure they were suitable to work with vulnerable residents. What has improved since the last inspection? What they could do better: Heightside staff did not assess prospective residents before they offered them a place at the home. This meant that staff did not have a clear picture of the Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 7 resident’s needs and whether the environment and the staff team at Heightside could meet them. Residents did not have a contract or a statement of terms and conditions when they moved into the home. This meant that they did not have any written information about the service they could expect and what the rules of the home were. This could lead to misunderstandings. The way residents’ money was looked after by the staff in the home had improved. However, residents’ savings were all put into a company bank account. This meant that residents were not earning interest and their money could be in danger if anything happened to the company. There was a lack of written information and direction, which could result in residents not receiving the correct care. For example, care plans did not give staff enough information about the residents’ health and social needs and how they were to be met. Residents were not consulted about their care and their goals and wishes for the future were not recorded. Risk assessments that should protect residents and staff were not always in place and some of the care plans to help staff to deal with harmful behaviours were no thorough enough. Staff did not manage residents’ medication well. They were not keeping adequate checks on residents who looked after their own medicines. The medicine records were not clear and safe. Some practices, such as sharing medication, are not safe and must be stopped. There were still areas of the home that needed redecoration and new furnishings but the manager said there was a plan to decorate and refurnish a number of rooms. Although the main laundry was well equipped to do the washing for all of the residents some items of bed linen and clothing were still being done on The Mews and Close Care. This could be a cause of the spread of infection. There were not enough registered mental nurses (RMN) employed at the home this meant that not all the nurses had the training and qualifications to fully understand residents with mental health needs. There was a lack of mental health training for other nurses and care staff. Not all of the staff had completed up to date health and safety training, which may place residents and staff at risk of harm. There were not enough staff who held a first aid qualification. 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. Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents had access to information to help them decide whether the home was suitable for them but there were no contracts to clearly state what service they would receive on admission. The lack of pre-admission assessment by Heightside staff could result in inappropriate placements. EVIDENCE: The manager stated that prospective residents received copies of the statement of purpose and resident’s handbook. Both documents contained relevant information about the services and facilities offered at the home but the handbook needed to be reviewed and brought up to date. The files of two new residents contained various assessments and care plans completed by health and social care professionals. There were no preadmission assessments carried out by Heightside staff. This meant that residents’ needs were not assessed in relation to the environment, staffing structures and current resident population at Heightside. Prospective residents were offered introductory visits and staff said that it was after these visits that Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 10 staff and the resident made the final decision about admission. Residents did not receive written confirmation that their assessed needs could be met at the home. Some staff had done some topics of mental health training but not all had received this. There was also a lack of Registered Mental Nurses employed at the home. This had the potential for mental health needs not to be recognised or appropriately met. Residents were not issued with a contract or terms and conditions of residency. This meant that they did not have information on the overall care and services they were to receive and the rights and obligations of themselves and the registered person. Intermediate care was not provided at Heightside. Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ received appropriate personal support but their physical and emotional health care needs were not always recorded or met. Shortfalls in care plans and risk assessments meant that staff did not have sufficient direction to meet residents’ needs. Medication policies and practices did not always protect residents. EVIDENCE: The standard of residents’ care records varied. Some of those seen were very detailed. Care plans generally provided very detailed directions for staff as to how personal support should be offered. Two residents on The House had personal cleansing charts which had not been completed. This meant there was no record that residents’ personal care needs were being met. The improved staffing levels on The House meant that staff were able to assist residents with extra aspects of personal care. One resident said “The other day one of the carers did my nails for me.” Some of the care plans did not completely address residents’ personal social and health care needs. The assessment for one resident in The House stated that she had vaginal and rectal prolapses but there was no indication of this in the plan of care. This Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 12 resident also had a wound on her foot and there was no mention of this in the plan of care. There was a dressing plan that stated the dressing was to be renewed every 3 days. This was last recorded as being done on 20/05/06. Residents in The House did not have care plans relevant to their mental health needs. The assessment for one resident stated that he had a history of verbally threatening behaviour but there were no directions on how to respond to this in the plan of care. This resident had also been seen by a Consultant Psychiatrist and had been diagnosed as having signs of a dementia. There was no mention of this in the plan of care. Health assessments were done for risk of developing pressure sores; nutrition and moving and handling. Weights were also recorded. One resident on the mews was recorded as having lost 8 kgs in one month. There was no action taken to check that this was an accurate weight record or to monitor this. A resident on the Mews was able to independently check his blood sugar levels. He had the correct equipment for this and kept a record of the results. He was aware of what was ‘normal’ and when to tell staff if they differed from this. There was a good plan for one resident on The Mews who had specific continence needs. On The House one of the residents whose plan of care was viewed had a problem with continence and used continence aids. This was not mentioned in the plan of care. Not all of the plans had been reviewed each month. Residents were not routinely involved in drawing up their care plans, although one resident had signed all of the reviews done in April 2006. There was a form seen in one plan of care for assessment of the resident’s willingness and ability to participate in care planning but this had not been completed. More than one resident said they would like to see their care plans. Care staff were still not being consulted about residents plans or reviews which meant that the staff who were closest to the residents did not have any involvement in planning their care. There was a contract for care in the plan for one resident. This was referred to in one of the problems in the plan of care. The contract was not up to date as it contained inaccurate information about him letting staff buy his cigarettes. There was no evidence it had been reviewed since being written in 2004. The self-medication policy had been revised but other policies for the management of medication were out of date. The standard of medication management varied across the home. Improvements were noted in The House but there were still shortfalls in The Mews and Close Care. A few residents from The Mews administered their own medication. The risk assessment and care plan of one resident had not been reviewed for over a year and there had been eleven months between spot checks. There were some gaps on Medication Administration Record (MAR) charts, without reasons why the medicine had been omitted. Some handwritten entries did not accurately reflect the directions on labels. They were not always signed and witnessed. Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 13 Dose changes were not always signed and dated. There were records of medicines received into the home. Records of medicines disposed of were not up to date in all areas and not all staff were aware of the protocol for disposing of unwanted medicines. There was evidence of secondary dispensing on one unit. Medication was being shared on one unit. Storage was secure but storage temperatures were not monitored on each unit. A number of residents were prescribed when required and variable dose medicines. There was no criteria for when this should be given for residents on Close Care and The Mews. There was a new confidentiality policy which stated that disciplinary action would be taken if staff were to breach confidentiality. The policy was accessible to residents through the advocate. All resident information was stored securely. Despite a previous recommendation, there were no records of residents’ wishes in respect of the care and treatment they would want at the time of their death. Discussions took place with staff regarding the importance of these records in view of the number of residents who had lost contact with their families. The policy group had drawn up a new policy for staff on the care of the dying. Despite previous recommendations, the service user’s guide did not include information regarding the residents rights to remain in one area of the home after they reached 65 Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were not enough suitable activities inside and outside the home to meet the social and recreational needs of all residents. Residents were supported to make decisions about their daily lives. Residents were supported to form and maintain appropriate relationships with family and friends. Residents received a varied and nutritious diet of their choosing. EVIDENCE: Some residents had their hobbies and interests recorded on assessments but none of these had been developed into a plan. There were improvements in level of activities. In addition to providing 1:1 support to residents who wanted to increase their domestic skills, the therapist had developed a programme of social activities. Some residents said they enjoyed the various activities. One said, “I like it when they have the karaoke,” others said they liked bingo and the dominoes tournament. Some residents said there was still not enough to do and one said, “I get bored at times.” The manager stated that there were plans to recruit extra staff to provide more wide-ranging activities for residents. Residents who went out unescorted were able to go out when they chose. Residents said they went to the shops, for a drink in the village and “just round Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 15 and about.” Two residents talked about a holiday they had arranged for themselves. A number of other residents were dependent on staff to take them off site. The therapist was trying to arrange transport and staff for regular trips into the local community for these residents. Arrangements had also been made to bring in services from the local community. A hairdresser regularly visited for a full day and a local minister had agreed to hold church services at the home. Many of the more independent residents had opportunities to meet new people within the local community and staff supported other residents to keep in touch with family and friends. One resident said, “My brother comes every Wednesday to see me”. Staff had written guidance on how to respond to residents forming intimate/sexual relationships. The manager stated that although staff had not received training they had been involved in some discussions around the policy. Two members of staff said that they would seek advice from nurses as to whether relationships were consensual or not. Residents were still being moved between units. Records did not show an appropriate level of consultation and there was no evidence that the on-site advocate was involved on behalf of residents unable to make their own decisions. Residents’ comments about the meals were generally positive and included: “no favourites, I like them all,” “the food’s alright,” and “sometimes meals are good, sometimes not right clever but the puddings are usually good.” New dishes had been added to the menu following consultation with residents. Records of meals showed that residents were offered a balanced and varied diet. Residents said there was enough choice. One said, “you can have more or less what you want.” Records showed that residents could request, and usually received, meals that were not on the menu. Kitchen staff said that they were not always kept informed of residents’ likes and dislikes. They had some information for residents on Close Care but not the other units. They also said they were not always informed if a new resident had a special diet. The issue of residents not receiving an early morning drink had been resolved. A resident said, “I get a brew now at 7o’clock. Staff have a flask or make you one.” Staff said the system for transporting meals to Close Care and The Mews was “the best they have had.” Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints and adult protection procedures ensured that complaints and allegations were acted upon. Harmful behaviours were not always understood or managed effectively. The home’s policies and staff practice ensured residents’ rights were upheld EVIDENCE: The complaints procedure was accessible to residents. There had been two complaints since the last inspection, one from a resident. Records showed that the manager had investigated and responded within appropriate timescales to both. One resident said that he would tell the manager if he had any complaints. Another said he didn’t feel comfortable telling staff so he would talk to his social worker. Staff had written guidance on how to receive complaints. Residents who were subject to legal restrictions had their rights explained to them. Plans indicated that residents’ cigarettes were to be restricted because of fire risk. One resident also said, “they take money and cigarettes off me and I have 2 cigs an hour because I am very generous sometimes” (giving cigarettes away). A member of staff said, “we sometimes have to make decisions for residents because they are very vulnerable.” Risk assessments were in place but had not been reviewed or updated which may lead to residents being unnecessarily restricted. Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 17 The revised policy dealing with the protection of vulnerable adults included very detailed guidelines on how to recognise and respond to any allegations of abuse. Some staff had received training in the protection of vulnerable adults and the manager stated there had been some in-house discussions around the policy. Local authority guidance, “No secrets in Lancashire” was displayed in the staff office in The House. The manager was fully aware of his responsibilities and had experience of reporting allegations and making appropriate referrals to the POVA list. Individual residents had care plans for dealing with aggression and self harm. Some were detailed; others did not give clear information on triggers or responses. Some staff had received training in strategies for crisis intervention and prevention which included practical strategies for management of aggression. Use of restraint was clearly documented within incident reports. Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 23, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was wellmaintained and provided residents with a suitable and safe living environment. Bedrooms suited the needs and lifestyles of the residents but the layout and furnishings of some of them detracted from the homely feel and comfort of the residents. Overall the home was clean and hygienic but there were some laundry practices may present a hazard to the health of residents and staff. EVIDENCE: Some of the maintenance and redecoration highlighted at the last inspection had been carried out. New dining furniture had been purchased for The House and The Mews, the damp area in bungalow 11 was being investigated and there was some new equipment in the main kitchen. During a tour of the premises a number of other areas were identified as requiring repair, redecoration or new furnishings. These were discussed with the manager who stated that The House was undergoing a full refurbishment with The Mews and Close Care to follow. Several residents said they were satisfied with the environment. Their comments included “nice room wouldn’t want to swap it,” Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 19 and “my room’s very nice, big enough but it needs repainting.” Some bedrooms were very homely and personalised but others were quite sparse. For example, there was hospital type bed linen and lino on the floor in most of the bedrooms in The House. The statement of purpose and service user’s guide indicated that residents would only be accommodated in a shared room if they had made a positive decision to share. Despite a previous recommendation there was no information to tell residents that they may have to share with someone new if one of the places became vacant. There had been an improvement in the water flow in the bathroom on Close Care but one of the bathrooms in The House was still inadequate. Records of bath water temperatures in Close Care and The Mews showed that the water was regularly below 400c. One of the residents said the bath water was “only aired.” Another resident said they had have a bath in the main building because the water in their flat was “stone cold.” The head of maintenance said this would be remedied. The Parker Bath in The House had not been moved and was still inaccessible to residents who required a wheelchair or hoist. All areas of the home were clean and tidy. One resident said that the domestic “does her best to keep it clean.” Some policies to control the spread of infection had been re-written but there were no records to evidence that staff had received updated infection control training. One resident whose job was to move laundry stated that he wore disposable gloves when he handled the bags. Potentially infectious items of laundry were still being washed on Close Care, even though there was no evidence that the machines could wash at high temperatures. Residents’ personal clothing was still being washed in the kitchen of The Mews. The main laundry was well equipped and organised. One resident said, “they look after your clothes – it’s pretty good.” Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The qualifications of the registered nurses were not always appropriate which meant that they may not have the skills and knowledge to deliver the care needed. Staffing levels were satisfactory but the high use of agency staff meant that the care may not be delivered in a consistent manner. Recruitment procedures were thorough, ensuring that residents were safeguarded. Training on start of employment was enough to ensure that new staff had the knowledge to be able to do their work and opportunities for training for all staff had increased. EVIDENCE: There was a definite shortage of Nurses who held the Registered Mental Nurse qualification. This was of particular concern for the Close Care unit, where there were no Registered Mental Nurses working at all. The residents accommodated on this unit were more likely to present with disturbed behaviour and need the input of an appropriately qualified Nurse. A high number of Agency staff were also being used, there being at least one day when the Close Care Unit was staffed solely by Agency staff. This had the potential to affect the continuity of care for the residents. There were Registered Nurses working in The House, with two being on duty each day. Only two of these were Registered Mental Nurses, one on day duty and one on night duty. Staffing levels in The House had improved and those staff spoken with said, “staffing levels are better than last inspection,” and “better staffing – still short at weekends.” A member of staff spoken to said Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 21 that she thought they could do with more regular staff so that the number of Agency staff used could be reduced. In The Mews there was only one Registered Mental Nurse, who worked night duty. A member of staff on The Mews said there had been no improvements in the staffing levels but because of reorganisation of staff things were better. The staff files for new members of staff were examined. There was evidence that an application form was completed and an interview was held. A recently employed member of staff said that a resident had been on the interview panel and she thought this was “really good”. All the relevant documents needed to ensure that staff were fit to be employed were seen in the files. These included: two references; CRB checks; proof of qualifications; confirmation of the Personal Identification Number for the new Registered Nurse. All new staff received a copy of the staff handbook and the General Social Care Council’s code of conduct. Discussion took place on the fact that if a reference is not taken from the last employer there should be a file note in place to state why. . New staff attended an induction day before they started work at Heightside. This initial induction included orientation to the home, fire procedure and philosophy of care. All new starters, regardless of their grade, then went on to complete a 12 week induction programme which met the standards of the national training organisation. The staff handbook indicated that staff training was compulsory especially in safe working practice topics, however, records showed that mandatory training was not up to date. Some staff had undertaken mental health training but this was not widely available, which, given the shortage of RMNs, meant that there was a lack of suitably qualified staff. Not all staff had received training to ensure that the needs of residents from diverse cultures were understood and met. Notices were posted in staff offices for future training courses and staff could nominate themselves. 57 of care staff held an NVQ at level 2 or above. Other staff had enrolled on the course. Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had a competent manager who had improved record keeping practices and was putting systems into place to monitor and improve the quality of care. Residents financial interests were not fully safeguarded. Most health and safety practices provided safeguards for residents. EVIDENCE: The manager had registered with the Commission for Social Care Inspection since the last inspection to the home. He is a first level nurse with several years experience in managing services. The manager was nearing completion of the NVQ level 4 in management and was planning to become a trainer for crisis intervention and prevention training. Systems were being put into place to improve the running of the home. Staff discussed the benefits of having stable management. One said, “on the whole much better, more organised.” Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 23 The home held an external quality monitoring award (ISO9001: 2000). There were no recommendations outstanding from the last assessment in December 2005. The registered manager was also in the process of applying for the Investors in People award. Recent audits of care plans had highlighted shortfalls. The manager had allocated extra time to trained staff to try to rectify the problem but this had not been completely effective. The manager held regular management and staff meetings. Staff said they felt able to “bring things up.” A resident satisfaction survey was held in Dec 2005. Results of the surveys were discussed at management meetings for each head of unit to address. There was no action or development plan or evidence that any shortfalls had been addressed. A number of requirements and recommendations made during previous CSCI inspections remained outstanding. The Inspectors were informed that residents’ monies went into a client account. The registered manager did not have any information to hand about the account or what money each resident had in this. This information was received from Head Office by the end of the inspection. However, the bank statement seen did not indicate that residents’ monies went into a ‘Clients’ account. There was also a record of bank charges of £15 made. This appeared to have been paid by the residents. There were large withdrawals for three residents and receipts were available to show where the money had gone to. There were records to show that the personal allowances were paid to each resident, and whether this went to savings, for cigarettes purchase or as spending money. These records were cross-referenced against cigarette purchase records and the record of cash received by residents and found to be correct. Some money was kept in the manager’s office. There was a record of deposits, withdrawals and the balance. The day-to day management of residents’ monies had improved on the units. Records were kept of the cash received by a resident and any amount saved there for them. Some of these balances were checked against the records and found to be correct. Some of the residents in the Mews had a large amount of money. The staff on The House were aware of £20-00 limit, but on The Mews a member of staff thought it was £100-00. There was insurance coverage for residents’ cash and belongings. There had been improvements in the record keeping practices in the home. The manager had started a review of all policies and procedures and several had been re-written. As previously recommended the access to records policy stated that residents could have access to all their personal records and care plans. Some staff still appeared to be reluctant to encourage this. Although there had been improvements in the levels of notifications, the manager had not notified The Commission of at least three incidents affecting the health and well being of residents. A series of fire lectures were being held around the time of the inspection visit. Fire drills were carried out regularly. Records showed that staff received Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 24 further instruction and extra practise after an unsuccessful drill. Servicing and testing of fire systems, alarms and equipment were up to date. Maintenance and servicing of other installations and equipment was up to date. Only 7 members of staff had received first aid training and the manager was unable to guarantee that there was a qualified first aider on duty at all times. Environmental risk assessments and risk assessments for potentially hazardous substances had not been reviewed for some time and some were out of date. Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 1 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 2 18 2 2 X 2 2 2 2 x 2 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 3 2 2 Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5(1)(b-c) Requirement All residents must be provided with a contract or statement of terms and conditions.(Previous timescale of 31/03/06 not met) Residents must be assessed by Heightside staff prior to being offered a place at the home.(Previous timescale of 31/01/06 not met) All prospective residents must receive confirmation in writing before they are admitted that their needs can be met at the home. (previous timescale of 08/12/05 not met) All residents must have a plan of care that includes clear directions as to how residents’ personal, psychological, health and social care needs are to be met. (Previous timescale of 31/12/05 not met) Plans must be available to the resident and drawn up in consultation with them, where appropriate. (Previous timescale of 31/12/05 not met) Timescale for action 31/08/06 2. OP3 14(1) 30/06/06 3. OP3 14(1)(d) 30/06/06 4. OP7 15(1) 31/08/06 5. OP7 15(2) 31/08/06 Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 27 6. OP7 15(2) 7. OP8 13(4) 8. OP9 13(2) 9. OP9 13(2) 10. OP9 13(2) 11. OP9 13(2) 12. OP9 13(2) 13. 14. OP9 OP9 13(2) 13(2) Plans must be kept under review and reflect current practice. Residents must be consulted about any revision. (Previous timescale of 31/12/05 not met) Risks to residents’ health must be assessed and kept under review e.g. high weight loss. Residents must be reviewed and referred, where necessary, for specialist advice. (Previous timescale of 31/12/05 not met) Policies and procedures for medicines management must be revised and made available to staff. (Previous timescale of 31/03/06 not met) A record must be maintained of all medication leaving the custody of the home. (Previous timescale of 08/12/05 not met) Staff must monitor residents who self medicate and review risk assessments.(Previous timescale of 08/12/05 not met) Medication must be administered according to the prescribers instructions. Where there is a clinical decision to omit the medication this must be clearly documented. Nurses must abide by the Nursing and Midwifery Council guidelines for the administration of medication. (Previous timescale of 08/12/05 not met) Medication prescribed for one resident must not be administered to another resident. Medication must never be shared.(Previous timescale of 08/12/05 not met) Instructions on MAR charts must accurately reflect the instructions on the medicine container. The practice of secondary dispensing of medication must cease. DS0000061144.V287485.R01.S.doc 31/08/06 30/06/06 30/09/06 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 Heightside House Nursing Home Version 5.1 Page 28 15. OP12 16(2)(mn) 16. OP12 12(2) 17. OP17 13(4) 18. OP19 23(2)(b) 19. OP27 18(1)(a) 20. OP30 18(1)(c)(i ) The registered person must, after consultation with the residents, ensure that opportunities to engage in appropriate leisure, social and community activities are provided. Residents must be consulted about their social interests and these should be recorded.(Timescale of 30/11/04 not met) Residents and/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) The registered person must ensure that appropriate risk assessments are conducted and risk management strategies recorded on care plans. The risk assessments must be kept under review. (Previous timescale of 31/12/05 not met) All areas of the home must be kept in a good state of repair. (Previous timescale of 31/03/06 not emt) There must be at all times sufficient and suitably qualified, competent and experienced persons working at the home to meet the needs of the residents. Consideration should be given to the balance of male and female staff in particular areas. (Previous timescale of 08/12/05 not met) Health and safety training must be made available to all staff. The training must cover safe working practice topics. (Previous timescale of 31/03/06 not met) 30/09/06 30/06/06 31/08/06 31/10/06 02/06/06 30/09/06 Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 29 21. OP30 18(c)(i) 22 23. OP33 OP35 24 20(1)(ab) 24. OP37 37(1)(e) 25. OP38 13(4)(a) Staff must receive further training specific to the mental health needs of the residents. (Previous time scale of 31/03/06 not met) The registered person must ensure that there is an annual plan for service development. Money paid into a bank account on behalf of residents must be either in their own name of a designated ‘residents’ account. (Previous timescale of 31/12/05 not met) The registered person must notify the Commission of any event that affects the well being or safety of a resident. (Previous timescale of 08/12/05 not met) The registered person must ensure that risks to the health and safety of residents and staff are minimised. This would include: Fitting perspex to the low level windows in The House as identified in the risk assessment Servicing of the passenger lift Servicing of gas systems and appliances in the home 30/09/06 31/07/06 31/07/06 02/06/06 31/07/06 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 OP1 OP7 Good Practice Recommendations The resident’s hand book should be reviewed and brought up to date Care plans to address residents’ cultural and religious needs should be further developed to provide clear information for staff. DS0000061144.V287485.R01.S.doc Version 5.1 Page 30 Heightside House Nursing Home 3. 4. 5. 6. 7. 8. 9. 10. OP7 OP7 OP7 OP8 OP9 OP9 OP9 OP11 11. 12. 13. 14. 15. 16. OP12 OP18 OP21 OP22 OP23 OP26 17. 18. 19. OP35 OP35 OP38 Care staff should have involvement in drawing up and reviewing residents’ care plans. The use of Consent to Treatment Forms and Care contracts should be reviewed. If there is a system for recording staff assistance with residents’ personal care, then this should be completed appropriately. Mental health needs and management strategies for residents should be clearly documented. Criteria for the administration of when required and variable dose medication should be clearly defined and recorded. There should be a record of the storage temperatures for medications. A second member of staff should witness all hand written annotations to Medication Administration Record charts. The service users guide should include information regarding the service users rights to remain in one area of the home as they become older. Service users wishes regarding terminal illness and after death should be sought and recorded in order that their wishes can be respected. Residents should have opportunities for escorted visits into the local community. Care plans should include clear information on how self harm and harm to others should be managed. The flow of water to certain baths should be regulated to ensure that residents can have a bath at a comfortable temperature. The position of the Parker bath should be reviewed so that residents can use this facility. The protocol for shared rooms should be included in the statement of purpose and service user’s guide. Bed linen and towels should not be washed in the laundry on Close Care. Laundry should not be handled in food preparation areas and the use of the kitchen in The Mews for doing laundry should be reviewed. The registered manager should have access to the records to show how the money banked for residents is apportioned. The sum on money kept on the unit for each resident should be in line with that stated in the policies and procedures. There should be a qualified first aider on duty at all times. Heightside House Nursing Home DS0000061144.V287485.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 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. 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