Inspection on 06/12/05 for Heightside House Nursing Home

This inspection was carried out on 6th December 2005.

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 30/05/06

Heightside House Nursing Home 30/05/06

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 08:30 6 and 7 December 2005 th th 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.V256860.R01.S.doc Version 5.0 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.V256860.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Heightside House Nursing Home Address Newchurch Road Rawtenstall Rossendale Lancashire BB4 9HG 0161 428 9616 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.V256860.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. All bedrooms currently accommodating 3 service users be reduced to double occupancy bedrooms by 31st March 2005 Where 2 service users currently share a bedroom, this level of occupancy must not increase When a service user in a bedroom currently accommodating 3 service users ceases to reside at the home, the occupancy of this room must not increase above 2 (two). 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. 8th June 2005 4. 5. 6. 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. Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by 2 inspectors and took place over 2 full days. The previous statutory inspection was done on 8th June 2005 and information on the findings of this can be obtained from the home or from www.csci.org.uk There had been no additional visits to the home. At the time of this inspection there were 64 residents accommodated at the home. 29 in The House, 10 in Close Care and 25 in The Mews. The residents ranged in age from 30 years to 80 years. 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. The inspectors met with residents from each area and spent time 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 manager, deputy manager, nursing staff, several members of the care team and ancillary staff. A tour of the three units took place and a number of documents and records were viewed. Detailed notes were taken, which have been retained as evidence of the inspection findings. What the service does well: What has improved since the last inspection? Some staff had received training to help them to understand residents’ mental health needs. However, sessions should be repeated to make sure that more staff have opportunities to improve their knowledge and help residents’ to meet their needs. Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 6 The manager had found a new way of transporting meals to residents in The Mews and Close Care. When it is up and running it should mean that residents meals are kept at the right temperature. The system should be safer for staff. New gas pipes and safety shut off valves had been fitted in the kitchen, which made the environment safer for staff and residents. There had been some improvements in the environment, new windows had been fitted in some areas of The Mews. Some areas in The House had been redecorated and new carpets laid. The number of carers with NVQ qualification had increased to 45 , which almost meets the standard. This means that staff had been given knowledge to enable them to undertake their work in a competent manner. Efforts were being made to involve residents in the review of policies and procedures. The Policy Group had been reformed and the advocate was obtaining residents views and bringing these to the group. What they could do better: Senior staff said they visited residents before they came into the home but there were no records of the visits. Residents’ needs must be fully assessed before they are offered a place at the home to ensure that their needs are understood and can be met. Residents must be given a statement of terms and conditions, to let them know what services and facilities are to be provided at the home. Any residents who fund their own care must be provided with a contract that states the fees to be paid. Care plans for residents on The Mews and The House were not adequate and did not tell staff enough about the residents’ needs and how they were to be met. Following admission a plan of care must be prepared that sets out all of the resident’s personal, health and social care needs. The plan must tell staff precisely how they should meet these needs. The plan should be written with the input of the resident if possible. The plan should be kept under review so that the information in it is current and accurate. The use of risk assessments must be included so that all risks are identified and actions taken to minimise these. Residents were not always involved in making choices and decisions about things that affected them. Residents were sometimes moved to different rooms or units without proper consultation. The manager should make sure that residents are only moved when it is of benefit to them. The resident or their family must be involved in the decision. Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 7 Although the level of social and recreational activities had improved slightly, most residents said there was still not enough to do. One resident said that staff did not have enough time to sit and talk to her. Another said that she used to enjoy word games with staff but recently they had been too busy. The amount and range of activities must be increased to improve the quality of life of all residents. Many residents living in The House did not have locks on their bedroom doors and some shared rooms on The Mews did not have privacy screens. The registered person should give more consideration to residents’ rights to privacy. Staff were not always given clear direction on how to care for residents who had ongoing health care needs. Possible new risks to residents’ health were not always noted. There had been very little progress made to address the medication requirements made after the last inspection. The manager must make sure that medicines are handled safely and that good records are kept. In order that residents live in as safe, attractive and comfortable environment as possible, attention should be given to some areas of the environment. In particular, curtains should be provided on Close Care in order to make the area more homely and reduce draughts. The dining room furniture in The House should be of a style that is safe and comfortable for residents to use. Regular servicing of appliances and equipment must be done at the due dates. There were not always enough staff on duty in The House. Residents said that staff often did not have time to sit down and talk. Staff talked about not always having enough time to provide care in the way they would want. There must be enough staff at all times to meet the needs of the residents. The induction training programme for new staff should be improved to make sure they are familiar with the home and the correct ways of providing care to residents. Staff must have up to date training in health and safety in order to protect residents and themselves. The systems and records kept in respect of residents’ financial affairs were sadly lacking and did not protect residents. There was no evidence that money lodged in a bank account was ‘safe’ or records to show who was owed what amounts. Some of the internal records kept by staff were incomplete. They did not fully enable it to be shown that residents had received the amount of money it was alleged they had. The client group accommodated have mental health problems that may affect their memory, understanding and perception of their financial transactions. The current systems and records are leaving staff open to allegations of abuse with little evidence to support what they have actually done. Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 8 Not all records that should be kept in a care home were in place. Many of the policies and procedures were out of date and did not reflect how staff worked. Record keeping practices must improve. 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.V256860.R01.S.doc Version 5.0 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4 The lack of assessment by staff with specific knowledge of the facilities and services provided at Heightside may result in residents being inappropriately placed. Residents’ mental health needs were not always recognised or appropriately met. Residents were not made aware of the terms and conditions of their residency, which may result in false expectations and misunderstandings. EVIDENCE: One new resident of 65 years of age and over had been admitted to The Mews since the previous inspection. The file for this resident contained a copy of assessments and reports completed by health and social care professionals. A senior member of staff from Heightside said they had visited the resident before their admission but there were no records of this visit. There was no evidence that the prospective resident had been assessed to ensure that the information provided by the referrer was relevant. The assessment should also take into account the resident’s needs in relation to the environment, staffing structures and current resident population at Heightside. There was no evidence that the resident had received written confirmation that their needs could be met at Heightside. Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 11 As required following the last inspection, there had been some staff training in mental health issues. One member of staff said she had found the training very useful in helping her to understand aspects of residents’ behaviour. However, only a few staff had attended training and the sessions had not been repeated. The lack of appropriate interventions on some care plans showed that that not all aspects of residents’ health and social care needs were understood or met. Residents had mixed views about whether their needs were met. Contracts, previously issued to residents, had been recalled for further consultation and development. There had been no progress made since the last inspection. None of the current residents had a statement of terms and conditions of residency. Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 12 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 A lack of consistency in the care planning process meant that staff were not always provided with the information they needed to meet residents’ needs. Residents’ healthcare needs were not always identified or addressed appropriately. The lack of adequate risk assessments and management strategies potentially placed residents at risk of harm. Personal care was provided to suit residents’ preferences and in a way that protected their dignity. Residents knew that confidential information was handled appropriately. The lack of suitable locks on bedroom doors and the absence of screens in shared rooms showed a disregard for residents’ privacy. There were some shortfalls in the management of medicines, which may place residents at risk of harm. Residents’ wishes regarding care during terminal illness and after death were not sought and therefore could not be acted upon. EVIDENCE: The standard of residents’ care records varied considerably across The House and The Mews. A new assessment format had been introduced and most residents had been re-assessed. There were some very good assessments for residents living in The House, which provided the staff with a clear picture of residents’ health, personal and social strengths and needs. The one seen on Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 13 The Mews had not been commenced. None of the assessments seen were signed and dated. The standard of care plans varied. Some provided staff with very clear details as to the actions they were to take to meet the resident’s needs. One resident, admitted to The Mews nearly five months ago, did not have any care plan at all. The assessment for this resident from other professionals identified legal issues under the Mental Health Act 1983. The care plan did not reflect this. There was no evidence that the resident had been made aware of restrictions placed on them or their right to appeal. Care staff on The House and The Mews did not routinely read the care plans. An assessment of residents’ willingness and ability to participate in care planning had been introduced. Only one plan of care had evidence that the resident had been consulted about and agreed to their care. Plans for residents’ who required help with personal care were clear and detailed. There were examples of good practice on The House where directions for staff took into account residents’ personal preferences. Residents spoken with were happy about how staff helped with their personal care. However, staff working on The House said because of low staff numbers they had “a dilemma between what they wanted to do for residents and what they could do”. They also said that the lack of staff restricted residents’ independence, as it was quicker to do things for residents rather than with them. Residents in The House and The Mews did not have care plans relevant to their mental health needs. There were still inadequacies in the way residents’ physical health care needs were met. Two residents were identified as being at risk of developing pressure sores. The care plans did not specify any action or equipment to manage this. The records for one resident showed problems with continence, but there were no directions to staff on the type or size of aid to be used. Some of the medication policies and procedures were out of date. Risk assessments for residents self -medicating had not been reviewed and there had been no compliance checks since April 2005. Staff from The House were not sure of the procedure to follow if a resident wished to self medicate. Records were kept of medication received but there were no records of medicines leaving the home. The system for disposing of waste medication was not fully operational and the manager was trying to remedy this at the time of the inspection. There were some gaps on Medication Administration Record (MAR) charts. Staff on The House conducted audits every week and investigated the reasons for the omissions. Handwritten amendments to some of the MAR charts in The House were not signed and witnessed. There were improvements in the way Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 14 medication was handed to residents going on leave but there was no record of medication returned. Storage areas were generally clean, tidy and secure. Records showed that storage temperatures sometimes rose as high as 280c but there were no measures to control this. Temperatures were not monitored daily in all areas. Several residents accommodated in The House were prescribed Lactulose and Gaviscon. There was only one bottle of each in use, which may indicate that medication is being shared. There was a small amount of excess stock of dressings in The House. Opening dates were not recorded on eye drops. A number of residents were prescribed medication to be taken only ‘when required’. Criteria for the administration of this medication should be clearly defined and recorded. This will ensure that medication is given only in the correct circumstances and this may help to reduce the risk of over- or undermedication. During the course of the inspection staff were seen to treat residents with respect and personal care was provided in private. Some residents had their preferred term of address stated on their plan, this should be recorded for all residents. Some of the residents on The Mews had locks on their doors and where able they managed their own keys. Not all rooms in The House had locks and there was no evidence on the care plans seen, that they had been given a choice. Privacy screening was available in most shared rooms with the exception of two bedrooms in The Mews. When asked about the screening the resident said it had not been there for ages but he would like one. From discussions with residents it was evident that most were aware that their notes and other personal information was confidential. Some were aware that staff must not talk about them to other residents or outside of the home. One resident said, “they tried to explain it to me, I understand what it means.” None of the residents knew what to do if they thought confidentiality had been breached. A previous recommendation to make the confidentiality policy more accessible to residents remains in place. 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 was reviewing policies and guidelines for staff on the care of the dying. The service users guide should include information regarding the service users rights to remain in one area of the home as they become older. Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 15 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 and 15 Residents were able to make decisions about their daily routines but in some cases inadequate consultation resulted in significant changes being made without residents’ views and wishes being taken into account. There was an inequality of opportunities for residents to participate in activities inside and outside the home. This resulted in some residents being under stimulated. Residents were supported to maintain relationships with their families and friends. Residents were provided with a varied and balanced diet but the meals were not to everyone’s taste. EVIDENCE: There was a lack of planning around social and recreational activities. None of the care files seen included specific plans for appropriate stimulation. Some residents were able to occupy themselves. Many went out regularly and some had small jobs around the home. A part time occupational therapy post had been created and there had been a slight increase in the level of social and recreational activities provided in the home. Residents said they had enjoyed games of bingo, karaoke and pizza nights. College courses and other projects had also been discussed with residents who were interested but there were no firm plans at the time of the inspection. The therapist spent one to one time with some residents helping them to improve their domestic skills. Residents and staff were not clear about how often activities were to be provided and on the day of the inspection the therapist had to cover nursing staff duties due to Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 16 holidays. Many residents said there was still not enough to do. Several put this down to lack of staff time. One resident said, “I like doing the word puzzles. They still do them but not for the past couple of days as they’re too busy.” This resident also said “I wake up early because I go to bed early. That’s because there’s nothing to do.” Another resident said, “There’s not much to do – I watch TV and go for a smoke”. Residents, who were able, said they made decisions about most aspects of their daily lives and routines. One resident said “I go out most days and do my own thing”. Many residents still had their cigarettes restricted. Most residents were happy with this arrangement. One said “I get my cigarettes given to me every day. It’s best because the others are always saying ‘give us a fag’.” One of the plans seen made mention of these restrictions and stated that resident agreed. Residents had been transferred to different units or moved rooms within their unit. There is no evidence that these moves were always for clinical reasons. There was no evidence that residents had been given a choice about moving or that an advocate had been involved. The visiting policy enabled residents to have visitors at any time and allowed for residents to refuse to see visitors if they wished. Staff supported residents to keep in contact with their families. This was especially evident on The Mews where residents had periods of overnight leave. Staff made arrangements with families, arranged transport and medication. Despite an ongoing recommendation staff had not been provided with guidelines or training on issues arising from residents forming intimate relationships within the home. Staff were unclear about whether such relationships would be encouraged or discouraged. New dishes had been added to the menus after consultation with residents. Comments about the meals were mixed. Several residents said the meals were alright, others said it depended what was on the menu. One resident said there was plenty of choice and another that the meals were very good. Residents in The House were no longer being served a cooked breakfast during the week unless they specifically requested it. Their views about this were mixed. Two residents said they did not mind the change. Three others said breakfasts were not as good. Staff said the change was in response to a healthy eating drive and to lower cholesterol in residents’ diets. However, there was no evidence that residents had been consulted about their wishes and no evidence that individual resident’s dietary needs had been reassessed. A resident on The Mews commented that residents who got up early were not always allowed a hot drink until breakfast time at 08.30, this must be addressed. Following previous requirements a new system for transporting food to residents in The Mews and Close Care had been identified and was due to commence the next week. Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 17 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): 17 and 18 Residents who were subject to restrictions were not always provided with the necessary information, which may result in them being denied their legal rights. A lack of understanding and written guidance in protection issues may result in incidents going unrecognised and unreported. The lack of understanding about restraint may result in under or over use. EVIDENCE: Awareness of residents’ basic rights was included in the induction training. Some residents were subject to restrictions under the Mental Health Act 1983. Not all had had their rights under the act explained to them or received the required information. Protection of Vulnerable Adults was included within the induction training programme and several staff had received more in depth training. However, not all staff spoken with were aware of abuse issues or how to report any alleged incidents. The abuse policy had been altered but still did not include contact details for the adult protection team. Although the home had a policy of restraint as a last resort, many staff were still unclear about the whole issue. The daily reports for one resident on The House made constant reference to her attempting to leave the premises. One report referred to the front door being locked as a means of restricting or restraining her from leaving. There was no risk assessment or plan of care to show that this restriction was in her best interests and protected her rights. Training in strategies for crisis intervention and prevention is due to commence in January. The training should also include guidelines on the use of restraint. Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 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, 20, 21, 22, 23, 24 and 26 The home was well-maintained and provided residents with a suitable and safe living environment. The layout and furnishings of some of the communal areas detracted from the homely feel and comfort of the residents. Bedrooms suited the needs and lifestyles of the residents. Overall the home was clean and hygienic but there were some areas that may present a hazard to the health of residents. EVIDENCE: Residents were able to bring in their own possessions and some of the bedrooms were highly personalised. At the time of the inspection none of the bedrooms were used for more than two residents. The manager said that there was an unwritten protocol regarding the use of shared rooms when one resident moved out. This was still not included in the service users guide. From a tour of the premises it was obvious that efforts had been made to improve the appearance of the home. A new carpet had been fitted in the corridors and office on The House and many areas had been redecorated. The carpet to the lounge area had been ‘taped’ across a tear. The manager said Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 19 that a new carpet was on order. Doorframes and doors looked scuffed and would benefit from attention. Some of the coverings to the armchairs in the lounges were ripped or worn. The reception/lounge area in The House did not appear as crowded as on other visits. The furniture in the dining room on The House was not suitable for the physical problems and dependencies of the residents. The type of chair provided did not allow residents to be able to sit in comfort and safety whilst having their meal. Neither of the main reception/lounges in The Mews or Close Care provided a homely and comfortable environment. New windows had been fitted in some rooms and others were to be installed. Although Bungalow 11 had been redecorated there still seemed to be a concern with a damp patch on the wall according to the resident who lived there. This should be kept under scrutiny to ensure the problem does not reoccur. There were some minor areas that should be repaired: a loose cold tap in Bungalow 9 & 10; a blemished wall in the corridor of Bungalow 9 & 10; the fridge freezer in Flat 15 not working; the carpet at the front door of Flat 16 ‘lifting’; the fridge freezer in Flat 16 requiring cleaning, defrosting and new shelves; and some walls throughout damaged through lack of doorstops. The furniture to the lounge on Close Care was looking shabby. A number of windows in bedrooms and in the lounge area were draughty and in windy weather the doors to the lounge were said to keep blowing open. This reduced the temperature of the room. The dining room floor in Close Care had been sealed to improve hygiene in this room. The position of the Parker Bath in The House made it inaccessible to residents requiring a wheelchair or hoist. This meant that frailer residents could not get the benefit of this bathing facility. Staff said that they would like to be able to use this bath for some of the residents who would benefit from it. Staff said that the bath on the ground floor of The House was very slow filling. This caused the temperature of the water to be reduced by the time there was sufficient water to have a bath. Other aids and equipment were in place to assist residents with mobility needs. The shower room on Close Care did not have a vent and there was no heating. The bath on Close Care was also said to be slow filling, creating problems with the temperature of the water. The overhead shower was not working. Some of the residents on The Mews had locks on their doors and where able they managed their own keys. Not all rooms in The House had locks and there was no evidence on the care plans seen, that they had been given a choice. One of the former three bedded rooms in The House had been split to make one single and one shared room. Although the rooms were not furnished at the time of the inspection, it was noted that the intended positions of the beds in the shared room meant that residents would be sleeping in very close proximity. They would have very little space to carry out personal care tasks Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 20 behind a privacy screen. This will be looked at in more detail during the next inspection, when the rooms are furnished and occupied. Towels and bedding for the Close Care Unit was still being washed in the laundry on the unit but the machines did not allow for washing at high temperatures. The laundry in The Mews was sited in the small unit kitchen, which meant that laundry was handled in an enclosed food preparation area. Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 21 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 and 30 The number of staff on The House was insufficient to ensure that residents needs could be fully met at all times and potentially placed residents at risk of harm. Some staff felt that the use of all female staff in some areas created a potential risk to themselves. The level of health and safety training was inadequate and compromised the health and safety of residents and staff EVIDENCE: There was a duty rota for each unit that showed the name, grade and hours worked by each member of staff. The number of staff on duty on The House was insufficient for the needs of the residents, particularly in the evening. This was thought to be due to the fact that several members of staff finished duty at 6.00 pm. The duty rota showed that on Monday 5th December 2005 there had been two Registered Nurses and one carer on duty in the evening. One of the Registered Nurses had had to leave The House for some time to attend to a problem in another part of the site. This had left The House with an extremely low and insufficient staffing numbers. Residents said that they felt that the staff were too busy to do things with them and they gave examples of the little touches that they missed e.g. sitting and talking, doing word puzzles. One member of staff said, “There is not enough time to have one to one. I feel bad keep putting them off.” One resident also commented that the number of agency staff on The House was “too many.” Staff working on The House said they were now doing things for residents rather than with them, as this was quicker. This meant that residents’ needs in respect of independence were not being met. Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 22 Staffing levels in Close Care were appropriate for the number of residents. One member of staff expressed concern about the fact that on some days there might be all female staff on duty in Close Care, which left them feeling vulnerable when caring for some particular male residents who may become disturbed. This was of particular concern as no training in crisis intervention and prevention had yet been done. Staff on The Mews said there were not always enough staff for observation and to provide residents with the one to one time they needed to work on improving their self care skills. Staff said there were improved opportunities for training. Various in-house courses were available to care staff and some of the senior staff were undertaking management and leadership courses. The induction programme needed further development in order to meet the latest standards set by the National Training Organisation. One member of staff said their induction training was mainly self directed study. They could not remember having a first day induction with a senior member of staff or an orientation to the home and key policies. Their training booklet did not show evidence of this. There was no assessment of competency following induction training. Although training in safe working practice topics had improved it was still not up to date. There were 31 carers employed. 9 of these had NVQ level 2 in care, 4 had NVQ level 3 in care and 1 had NVQ level 4. This gave 45 of the care staff with an appropriate NVQ qualification. Another 5 carers were currently enrolled on an NVQ course. Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 23 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, 37 and 38 The home was managed by a competent and experienced person. Residents had opportunities to make their views of the home known and to influence the development of the service. Residents’ monies were not deposited in an appropriate bank account and there were no accountable records on site to demonstrate what amounts were owed to each resident. This meant that the financial interests of residents were not fully safeguarded. Record keeping did not provide safeguards for residents. The lack of servicing and maintenance in some areas meant that the health and safety of residents and staff were not fully safeguarded. EVIDENCE: A new manager, who was a first level nurse with several years experience in management roles, was appointed earlier in the year. At the time of the inspection the Commission for Social Care Inspection had not received an application to register the manager. Staff comments about the way the home was run were generally very positive and the manager was described as Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 24 supportive and knowledgeable. There was also a comment that communication from the manager and upper management was poor at times. There were regular management meetings involving the unit managers and heads of other departments. Whilst staff said they found these useful, there were also comments that actions plans were developed but not always followed up. The home held an external quality monitoring award (ISO9002). A reassessment was planned for the following week. Resident surveys, seeking views on various aspects of the facilities, services and care, had been sent out. The manager planned to analyse the questionnaires and draw up an action plan with the unit managers and heads of departments. Residents were also able to air their views during resident meetings but attendance was generally poor. Staff views and suggestions were sought during staff meetings. Despite the quality monitoring systems some of the shortfalls noted during the inspection had not identified. Requirements to improve practice were not always acted upon in a timely manner. Many of the policies were out of date and did not reflect current practice. The policy group had reconvened and several key policies were under review. The manager stated that four residents met with the advocate to discuss draft policies and give opinions, which were fed back to the group. None of the residents were interested in joining. The policies and procedures for Heightside said that residents could open a bank account if they wished and could manage their own money. In practice few residents were able to take up this option and only one person managed their own money. Only one resident had actually been supported to open a bank account and arrangements were in the process for two others to do so. The arrangements and records kept on site were not suitable. These were fragmented with money being kept in the Administration office, on the individual units and in a Randomlight company bank account. No one person had a clear picture of how much money each resident had. There was a lack of understanding of staff of the financial procedures and how these operated. A previous requirement regarding record keeping had not been fully met. Some records, required to be kept in respect of residents, were not on their files. Information relating to residents and staff was stored securely. Despite previous recommendations, the records policy still stated that residents must have written permission before they could access their records. This policy should not apply to care plans and should be revised. There had been several incidents affecting the health and welfare of individual residents since the last inspection. The Commission for Social Care Inspection had not been notified of any of the incidents. The exposed gas pipes in the kitchen had been replaced with appropriate gas piping and emergency cut off valves were fitted. A new fire procedure was on Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 25 display and staff had received fire safety training. Servicing of fire alarms, systems and equipment was up to date. Fire alarms were tested. There were no recommendations following a recent inspection from the fire officer. Maintenance and servicing of electrical installations and appliances were up to date. Gas boilers were serviced but there was no certificate of work in respect of the gas systems and appliances in the kitchen. Maintenance of the passenger lift was overdue. Accident records complied with data protection legislation. However, the manager was unable to confirm that there was a qualified first aider on duty at all times. There were some environmental risk assessments in place. The plan to fit Perspex to low level windows in The House had not been actioned. Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 26 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 X 1 2 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 2 18 2 2 2 2 2 2 2 X 2 STAFFING Standard No Score 27 2 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 1 X 2 2 Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 27 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. Standard Regulation Requirement Timescale for action 1 OP2 5(1)(b-c) All residents must be provided 31/03/06 with a contract or statement of terms and conditions. 2 OP3 14(1) Residents must be assessed by 31/01/06 Heightside staff prior to being offered a place at the home. 3 OP3 14(1)(d) All prospective residents must 08/12/05 receive confirmation in writing before they are admitted that their needs can be met at the home. 4 OP4 18(c)(i) Staff must receive further 31/03/06 training specific to the mental health needs of the residents. 5 OP7 15(1) All residents must have a plan of 31/12/05 care. The plans must include clear directions as to how residents’ personal, psychological, health and social care needs are to be met. (Timescale of 31/10/04 not met) 6 OP7 15(2) 31/12/05 Plans must be available to the resident and drawn up in consultation with them, where appropriate. Plans must be kept under review and reflect current practice. Residents must be consulted about any revision. (Timescale of 30/11/04 not met) Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 28 7 OP8 13(4) Risks to residents’ health must be assessed and kept under review e.g. risk of developing pressure sore risk. Residents must be reviewed and referred, where necessary, for specialist advice. Policies and procedures for medicines management, including self-administration, must be revised and made available to staff. A record must be maintained of all medication leaving the custody of the home. (Timescale of 30/06/05 not met) Staff must monitor residents who self medicate and review risk assessments. 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. (Timescale of 30/06/05 not met) Medication prescribed for one resident must not be administered to another resident. Medication must never be shared. 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 DS0000061144.V256860.R01.S.doc 31/12/05 8 OP9 13(2) 31/03/06 9 OP9 13(2) 08/12/05 10 OP9 13(2) 08/12/05 11 OP9 13(2) 08/12/05 12 OP9 13(2) 08/12/05 13 OP12 16(2)(mn) 31/03/06 Heightside House Nursing Home Version 5.0 Page 29 about their social interests and these should be recorded.(Timescale of 30/11/04 not met) 14 OP12 12(2) 31/12/05 Residents and/or their representatives must be involved in the decision to move rooms or transfer to other units within the home. The registered person must ensure that residents are provided with drinks when they get up early. The registered person must ensure that a record is kept of any limitations agreed with the resident as to their freedom of choice and power to make decisions. (Timescale of 30/04/05 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. (Timescale of 31/10/04 not met) The manager must ensure that all staff understand the procedures for reporting any alleged incident of abuse. All areas of the home must be kept in a good state of repair. The damp area in Bungalow 11 must be kept under review. Appropriate furniture suitable to meet the needs of the residents must be provided. Dining chairs must be of an appropriate design for residents to safely use these. 08/12/05 15 OP15 16(2)(i) 16 OP17 17(1)(a) Schedule 3 28/02/06 17 OP17 13(4) 31/12/05 18 OP18 13(6) 31/12/05 19 OP19 23(2)(b) 31/03/06 20 OP22 16(2)(c) 31/03/06 Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 30 21 OP27 18(1)(a) 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. Health and safety training must be made available to all staff. The training must cover safe working practice topics. (Timescale of 31/10/05 not met) The Commission for Social Care Inspection must receive an application to register the manager. Money paid into a bank account on behalf of residents must be either in their own name of a designated ‘residents’ account. There must be records to show how the money is apportioned and these must be balanced on a regular basis. There must be a record to show an acknowledgement that resident has actually received the sum of money alleged. The registered person must ensure that all records required for the protection of residents and for effective management are in place. (Timescale of 31/07/05 not met.) 08/12/05 22 OP30 18(1)(c) (i) 31/03/06 23 OP31 8 31/12/05 24 OP35 20(1)(ab) 31/12/05 25 OP35 Schedule 4 (9)(b) 08/12/05 26 OP37 17 & 26 Sch 3 & 4 31/01/06 27 OP37 37(1)(e) The registered person must notify the Commission of any event that affects the well being or safety of a resident. (Timescale of 10/06/05 not met) 08/12/05 Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 31 28 OP38 13(4)(a) 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 31/01/06 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 3 4 5 6 7 8 9 10 11 12 Refer to Standard OP7 OP7 OP7 OP8 OP9 OP9 OP9 OP9 OP10 OP10 OP10 OP11 Good Practice Recommendations All care records should be signed and dated by the person(s) drawing them up. Care staff should have involvement in drawing up and reviewing residents’ care plans. The use of Consent to Treatment Forms should be reviewed. 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. The date of opening should be clearly marked on eye drops and other items with limited shelf-life when in use. A second member of staff should witness all hand written annotations to Medication Administration Record charts. A current copy of the British National Formulary should be available for reference (not more than 12months old). Residents’ preferred term of address should be recorded on their care plan. Residents should have access to the policy on confidentiality. Privacy screening should be available in shared rooms. The service users guide should include information DS0000061144.V256860.R01.S.doc Version 5.0 Page 32 Heightside House Nursing Home 13 14 15 16 17 18 19 20 21 22 23 OP13 OP15 OP17 OP18 OP18 OP21 OP22 OP23 OP23 OP24 OP26 24 OP30 25 26 OP35 OP35 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. Staff should receive training on dealing with issues arising from residents forming relationships. Residents should be consulted about changes to the menu. Residents should have their rights under the Mental Health Act 1983 explained to them. The details of who to contact, together with their telephone numbers should be included in the abuse procedures. Crisis intervention training should include guidance on when the use of restraint may be appropriate. 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 manager should give consideration to the intended positions of the beds in the newly created shared room in The House. The protocol for shared rooms should be included in the statement of purpose and service user’s guide. Residents should be consulted about whether they want a lock on their bedroom door. Their wishes should be recorded and reviewed at intervals. 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 induction training programme should meet the specifications of the national training organisation and should include: Orientation to the home Discussion of key policies An assessment of competency The balance of money held should reflect the amount actually in the money pouch for each resident. The sum on money kept on the unit for each resident should be in line with that stated in the policies and procedures. Staff should be familiar with the policies and procedures in respect of residents’ finances and be aware of their role and responsibilities in respect of these. DS0000061144.V256860.R01.S.doc Version 5.0 Page 33 Heightside House Nursing Home 27 28 29 OP35 OP37 OP38 The insurance cover for sums of money kept should be checked to ensure that these are not exceeded for any one resident. The access to records policy should reflect that all residents have access to their care plans There should be a qualified first aider on duty at all times. Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 Page 34 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. Extracts may not be used or reproduced without the express permission of CSCI Heightside House Nursing Home DS0000061144.V256860.R01.S.doc Version 5.0 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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