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Inspection on 08/06/05 for Heightside House Nursing Home

Also see our care home review for Heightside House Nursing Home for more information

This inspection was carried out on 8th June 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Any information received about residents was handled in a confidential manner. The staff were aware of the importance of not discussing information about residents with those not involved in their care. The residents` privacy and dignity was respected. Staff approached them in a respectful but friendly manner. There were obvious good relationships between the majority of the residents and the staff. The residents were provided with bedrooms that were clean and nicely decorated and which they could personalise to their own taste if they wished. They had a choice of lounge areas. There was a maintenance team employed at the home. This meant that virtual immediate attention was given to any repairs that may be needed at the home. The assessments for the chemicals and cleaning products used at the home was very detailed. This ensured that only the least hazardous and most appropriate products were used. It also ensured that staff were aware of any first aid actions to be taken if the product was mis-used.

What has improved since the last inspection?

Even though most of the standards remain unmet, there had been slight improvements in many areas since the last inspection. Some of the care plans contained more details about the residents` mental health needs and how staff could help them. Residents were beginning to be consulted about important that affected them, for example being moved to different units. The medicine administration records for residents living in The Mews had improved since the last inspection. The way that staff were recruited to work at the home was better. The manager made sure that only staff who had been through the proper checks were able to start working with the residents. The induction training programme for new staff had been developed and improved. Existing staff said there were more opportunities for training.

What the care home could do better:

Following admission a plan of care should 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 and then kept under review. This is 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. The amount and range of activities must be increased so that the quality of life of all residents is enhanced. There were some mixed views but more than one resident said "there`s nothing going on" or "it can be very boring". This lack of activities detracts from residents` quality of life. Access to local community events, for those less independent residents should also be explored as well as in-house activities. The standard of record keeping must be improved. For example, shortfalls were seen in records of medicines administered to residents living in The House.

CARE HOMES FOR OLDER PEOPLE Heightside House Nursing Home Newchurch Road Rawtenstall, Rossendale Lancashire BB4 9HG Lead Inspector Jane Craig Unannounced 08 09 10 June 2005 09:00 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 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 F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Heightside House Nursing Home Address Newchruch Road Rawtenstall Rossendale Lancashire BB4 9Hg 0161 4289616 0161 3745357 Telephone number Fax number Email 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 with Nursing (N) 78 Category(ies) of Mental disorder, excluding disability or dementia registration, with number - over 65 years of age (MD(E) 72 of places Mental disorder, excluding learning disability or dementia (MD) 72 Physical disability (PD) 3 Physical disability over 65 years of age (PD(E) 3 Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 All bedrooms currently accommodating 3 sevice users be reduced to double occupancy bedrooms by 31st March 2005 2 Where 2 service users currently share a bedroom, this level of occupancy must not increase. 3 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 aboe 2 (two) 4 When the named persons in the category of PD and PD(E) cease to reside at the home, the categories of registration must be varied to reflect this change. 5 Staffing for service users requiring nursing care will be in accordance with the Notice dated 4th November 1997. 6 The service must, at all times, employ a suitably qualified and experienced person who is registered with the Commission for Social Care Inspection as the manager of Heightside. Date of last inspection 08 and 09 February 2005 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 consists of 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 comprises 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 F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by three inspectors and took place over 2 full days. This was the first statutory inspection since April 2005. An official notice regarding fire safety had been given to the deputy manager during the inspection of 8th February 2005. One additional visit had been made to the home since then to monitor progress towards meeting the requirements. At the time of this inspection there were 64 residents accommodated at the home. 32 in The House, 9 in Close Care and 23 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. During the course of the inspection the inspectors spoke with many of the residents and obtained their views on different aspects of living in the home. Discussions were held with the 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. What the service does well: Any information received about residents was handled in a confidential manner. The staff were aware of the importance of not discussing information about residents with those not involved in their care. The residents’ privacy and dignity was respected. Staff approached them in a respectful but friendly manner. There were obvious good relationships between the majority of the residents and the staff. The residents were provided with bedrooms that were clean and nicely decorated and which they could personalise to their own taste if they wished. They had a choice of lounge areas. There was a maintenance team employed at the home. This meant that virtual immediate attention was given to any repairs that may be needed at the home. The assessments for the chemicals and cleaning products used at the home was very detailed. This ensured that only the least hazardous and most appropriate products were used. It also ensured that staff were aware of any first aid actions to be taken if the product was mis-used. Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: 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 F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 8 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 standard(s) 2, 3, 4 and 6. The lack of training for staff meant that residents’ mental health needs were not always recognised or appropriately met. Not all residents were issued with contracts. This meant that they did not have any written information about their terms and conditions of residency. EVIDENCE: As a requirement was made at the previous inspection for standard 4, and a recommendation for standard 2, these were monitored on this inspection. Contracts were not seen on the files for those residents who were 65 years or over, as recommended for standard 2. The deputy manager stated that the contracts were under review and would be supplied to all residents in the near future. Steps had been taken to enhance the care of residents with physical health needs by the recruitment of a registered general nurse, as required under standard 4. The requirement for staff to receive training in mental health issues to ensure that they had the knowledge and skills to identify and meet the needs of the residents had not been completed. Residents’ views as to whether their needs were met at the home varied. Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 9 No new residents of 65 years of age or over had been admitted since the previous inspection. This meant that the assessment and admission process could not be properly monitored on this inspection. Heightside does not provide intermediate care. Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 10 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 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. Residents’ wishes regarding care during terminal illness and after death were not sought and therefore could not be acted upon. The recording of administered and omitted medication in The House must improve. Residents were treated with respect and their right to privacy upheld but in some cases inadequate consultation resulted in care being planned without residents’ views and wishes being taken into account. EVIDENCE: As a recommendation was made at the previous inspection for standard 11, this was monitored on this inspection. There were no details in the plans of care about the residents’ wishes in respect of death and dying. 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. Policies and guidelines for staff on the care of the dying had not been reviewed and updated. Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 11 The standard of residents’ care records varied considerably. Most records did not include an up to date assessment of needs. Some care plans contained elements of good practice and provided clear directions for staff as to the type and amount of support residents’ required to meet their needs. Some of the care plans were reviewed regularly. However, the review notes were scanty and did not indicate the progress made in meeting needs or achieving goals. Care plans were not updated as and when changes occurred. There had been minor improvements in the way in which residents’ mental health care needs were identified and addressed. However, this was not consistent across the home and several residents did not have any care plans relevant to their mental health needs. Residents’ physical health needs were not always addressed. There were insufficient details to enable staff to fully complete catheter care for one resident or to recognise “significant changes” in a diabetic resident’s health. Two residents were identified as being at risk of choking, but only one had evidence of having been referred to specialised input i.e. Speech and Language Therapist. One of these residents did not have a nutritional assessment on file. Most residents were being weighed regularly as previously recommended. Risk assessments for moving and handling and risk of pressure sores were on most files. These were not routinely reviewed, even when a moderate risk had been identified and daily notes indicated changes. Risk management policies stated that risk would be identified, assessed and appropriately managed but practice did not always reflect this. Some files contained clear risk assessments and management strategies, others identified risks but there were no control measures. The assessments for two residents stated they were at high risk of self harm. Neither of these residents had a risk assessment or care plan to direct staff as to how the risk could be minimised whilst enabling maximum freedom and independence for the resident. Many residents were able to go out on their own and some travelled long distances, staff explained that the benefits outweighed the risk but there were no assessments or records to support these decisions. The level of consultation varied. It was not usual practice in The House to consult with residents. When asked about care plans residents said “I don’t know whether I’ve got one but I don’t particularly want to see it.” Another resident told the inspector “I would like to look at it if staff helped me.” Some of the files seen included the preferred term of address. This should be recorded for all residents. Residents did not have access to the policy on confidentiality. During the course of the inspection staff were seen to treat residents with respect and to uphold their right to privacy. Residents living in The Mews and Close Care had locks on their doors and those who were able managed their own keys. This was not the case for all residents living in The Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 12 House. Residents should be given a choice as to whether they wish a suitable lock to be fitted and assessed as to their capability to manage their own key. The documentation and handling of medication on the Close Care unit remained at a good standard. Medicines management on The Mews unit was to a higher standard than at the last inspection, however the documentation of medicines passing to residents for self-administration needs to be improved. Some Medication Administration Record charts in The House contained many gaps, making it impossible to tell whether residents had received their medication or not. Evidence was seen that some medicines had been omitted in error, whilst others had been administered but not signed for. Whilst it was recognised that some nurses recorded their actions clearly and accurately, the standard of recording by other trained nurses was poor and placed residents at risk. Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 13 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 standard(s) 12, 13, 14 and 15 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 and unable to participate fully in community life. Residents were supported to maintain relationships with their families and friends. Residents were provided with a nutritious and varied diet. However, practices for transporting meals potentially placed service users and staff at risk of harm and must be changed. EVIDENCE: Residents views about their opportunities to take part in activities were varied. A few residents had voluntary work outside and others had jobs around the home. One resident said “I go to college twice a week and the rest of the time I do my own thing.” Another said “there are more things to do, if there’s enough staff we do things like play cricket – things are better.” A member of staff who worked periodically at the home also thought that the level of activities had improved. However, two residents said “there’s nothing going on, a lot of classes have stopped” and another said “nothing’s changed, it can be very boring.” Staff working in the house said that they did try to engage residents in activities if they had enough staff and time but most residents did not want to do anything. For residents in The House their day was loosely structured around meals and the need for assistance with personal hygiene. Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 14 From observations during the inspection it became apparent that those residents who were motivated and able to occupy themselves were encouraged to do so, whereas many of the others, were under stimulated. There was a lack of emphasis on social care in some areas. Documents introduced to record residents social interests and capabilities had not been completed and staff had not received any training in planning and facilitating activities. Previous requirements and recommendations made under this standard had not been actioned. Residents who were able to go out alone made full use of community facilities. One resident said they went into the town nearly every day and others said they went shopping and to the pub. Several residents were able to use public transport to go further afield. On the day of the inspection one resident had been out by himself on a day trip to Blackpool. A few care plans included directions for staff to escort residents for walks or to the shops or pubs. One of the staff said that whilst this happened sometimes, it was often difficult because working on minimum staffing levels meant that it left no scope for staff to be away from the unit. This issue was being addressed by the recruitment of an extra carer to work between Close Care and The Mews. There were very few opportunities for more dependent residents in The House to access community facilities. Staff said this was due to lack of staff time and residents’ general lack of motivation. The visiting policy enabled residents to have visitors at any time and allowed for residents to refuse to see visitors if they wished. Despite a previous recommendation staff had not been provided with guidelines or training on issues arising from residents forming intimate relationships within the home. Some staff said that they thought it would be useful to have some direction, especially if one of the residents was considered to be particularly vulnerable. Several residents said the food was good. One said “the food’s very nice, there’s nothing wrong with it.” Residents and staff thought that the new way of ordering meals, only two days in advance, was much better. Menus were displayed and residents were able to check what they had ordered for each meal. The five-week menu had not been reviewed, as recommended, but the chef said he had begun to introduce new dishes and would conduct a full review of the menu in the near future. Residents had access to snacks and drinks throughout the day and night. Risk assessments and care plans to support residents cooking their own meals were not always available. One resident who was self catering required a special diet but there was no evidence that staff assisted him with this or monitored his compliance. The system for transporting food to The Mews and Close Care had not been reviewed, despite two previous requirements to do so. The current method of using shopping trolleys is unhygienic and satisfactory temperatures cannot be maintained, which potentially places residents at risk of harm. Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 15 Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 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 standard(s) 16, 17 and 18 There was a clear procedure for dealing with complaints which ensured that residents complaints and concerns would be dealt with appropriately. Staff had a thorough understanding of adult protection issues ensuring that any allegations would be dealt with appropriately. Residents who were subject to restrictions were not always provided with the necessary information, which may result in them being denied their legal rights. EVIDENCE: The complaints procedure had been reviewed and contained the appropriate information about how complaints would be handled. There had been no complaints made to the home or directly to the Commission since the previous inspection. The procedure was displayed and residents said they knew who to complain to. One resident said he had made 2 complaints in the past and these had been acted upon. Another said that if he had a complaint he would tell the unit manager who would do something about it. Staff were aware of how to receive and deal with complaints. Protection of vulnerable adults was included in the induction training and most staff had also attended more in-depth training sessions. Staff spoken with were aware of the issues and their responsibilities in reporting any allegations. One member of staff mentioned the whistle blowing policy and another talked about the POVA register. The Abuse policy did not make it explicit to staff about what to do if they suspected or witnessed an incident. There was an improvement in the number of risk assessments and care plans for residents who were aggressive. Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 17 Awareness of residents’ basic rights was included in the induction training and in the staff handbook. Some residents were subject to restrictions under the Mental Health Act 1983. There was no evidence to indicate that their rights under the act had been explained to them or that they had been given the required information. Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 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 standard(s) 19, 20, 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 made positive comments about the environment. The inspectors were told: “it’s alright, I like it,” “it’s not a bad place to be,” and “I’m quite happy living here.” There had been improvements in consultation with residents regarding room changes. Since the last inspection there had been improvements to the décor across the three units. The home was well maintained and records showed that repairs were carried out in a timely fashion. There was a damp area on the outer wall of Bungalow 11 in The Mews. A resident said this was a long standing problem that the registered person had failed to address and the room could not be Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 19 decorated until the problem was resolved. Four of the recommendations made by the Environmental Health Officer had been actioned. Residents were generally happy with their bedrooms and made comments such as: “I love my room”, “I come to my room to chill”, and “I’ve got my room just how I like it.” There had been improvements to the décor and furnishings in the bedrooms in The House. From a tour of the premises it was obvious that 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 deputy manager said that there was an unwritten protocol regarding the use of shared rooms when one resident moved out. This should be included in the service users guide. There had been no change in the use of the communal space in The House. Most residents still sat in the reception/lounge area. One resident said “it’s too crowded, sometimes we have to bring hard chairs (dining chairs), there’s not enough space for people to sit.” During the course of the inspection residents were observed arguing about seating in this area. The other lounge was still under used except by very dependent residents who were generally not mobile. Neither of the main reception/lounges in The Mews or Close Care provided a homely and comfortable environment. The staff on Close Care said they had requested curtains in an attempt to improve the area but these had not been provided. 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. The temperature of the hot water in this bath was consistently too low to allow it to be used. Other aids and equipment were in place to assist residents with mobility needs. As recommended at the previous inspection, residents who had jobs transporting laundry had been provided with basic instruction in infection control procedures. One resident said “I always wear gloves and I wouldn’t touch anything if a bag burst open.” At the time of the inspection the home was generally clean, tidy and hygienic, although there were some areas of concern. There was an offensive odour in the lounge areas of The House and in one of the bedrooms. The inspectors were told this was because the carpet cleaner had broken and not been replaced. The floor covering in the dining room of Close Care continued to present a potential hazard. As noted at two previous inspections, despite regular cleaning, food debris could not be removed from the crevices of the uneven surface. The dining room was also the designated smoking area and the tables were badly marked with cigarette burns, which made them unsightly. There was new equipment in the laundry on Close Care 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 F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 Staffing levels met the agreed minimum. Extra staff had been recruited to ensure that the needs of residents were met. The recruitment practices of the home provided safeguards for the residents. Improvements in staff training meant that staff were working towards a greater knowledge and understanding of residents’ needs. EVIDENCE: Examination of duty rosters showed that the staffing numbers of nursing and care staff on each of the units met the minimum agreed by the previous registration authority. Staff said the levels were generally sufficient but didn’t leave much scope for extras, for example taking residents out. An extra carer had been recruited for The Mews and Close Care, which should help to address this situation. There had been a particularly high level of use of agency staff over the past two weeks but this was due to covering sickness and was considered unusual. Most of the previous vacancies had been filled. The unit managers had a better understanding of deployment of agency staff to ensure that residents always received consistent care from permanent staff. A system of internal rotation meant that permanent staff became familiar with each of the units. One resident on Close Care remarked that they had a lot of staff from The House working with them. There had been a significant improvement in the recruitment practices since the previous inspection. The files of four new employees were seen. CRB disclosures had been obtained prior to them starting work at the home. Other documents required to be obtained and kept were on file. A system to verify Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 21 the registration status of trained nurses had been introduced and letters were sent out to remind nurses when their registration was due for renewal. There had been improvements in staff training. Staff said there were more opportunities and a training matrix evidenced a rolling programme of training in various subjects. The deputy manager was working towards introducing mental health topics, including managing challenging behaviour. The induction programme for new staff had improved. All staff had two days induction training with their mentor to cover health and safety, policies and procedures. The documentation to evidence that this Induction had been completed had not yet been returned and retained in the file for all new employees. The full induction, over four weeks, comprised some taught sessions and some selflearning, followed by an assessment to demonstrate knowledge. Progress had been made with NVQ training. 33 of care staff had attained the qualification and the deputy manager said she had access to unlimited places and would nominate other staff. Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35, 37 and 38 Many of the policies and procedures were out of date and did not safeguard the rights and best interests of the residents. Changes to the manner in which residents’ money was handled meant that their financial interests were safeguarded. The record keeping practices in the home were not thorough and did not protect residents. The lack of health and safety training and potentially unsafe equipment placed residents and staff at risk of harm. EVIDENCE: A previous recommendation about not pooling residents’ monies had been addressed. These were now handled individually and a personal bank account had been opened for some residents. Following a previous recommendation there had been an increase in care plans and agreements with regard to restriction of cigarettes Despite a previous recommendation, the access to records policy still stated that residents must have written permission from the manager to access their care records. A policy group had been set up to review all policies and Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 23 procedures. One of the aims of the group was to make the written policies more appropriate and “resident friendly”. However, there were no resident representatives in the group. A previous requirement regarding record keeping had not been fully met. Some records that are required to be kept in respect of residents were not on their files. The Commission had not received any reports of unannounced visits to the home by the registered provider. Several incidents including residents going missing from the home and other events affecting the well-being or safety of residents had occurred since the previous inspection. The Commission had not been notified of these. Not all measures to ensure the health and safety of residents were in place. Two previous requirements to fit an emergency gas shut off in the kitchen and to enclose the exposed gas pipes in the kitchen had not been met. Staff training in safe working practices was not up to date, although some progress had been made. Not all portable electrical appliances in residents’ bedrooms had been tested. None of the electrical equipment in the kitchen had test stickers. Certificates in respect of servicing and maintenance for some gas appliances and the fire control panel were not accessible at the time of the inspection. There were no risk assessments for safe working practice topics. Steps had been taken to meet the requirements regarding fire safety that were made at the previous inspection. Most fire doors had been repaired to ensure proper closure, although the lounge door in The House was still not fitting into the frame. Staff had received fire safety training and regular drills were carried out. A fire risk assessment had been drawn up. The fire procedure was still under review. This must be displayed and all staff made familiar with its content. Despite these shortfalls some progress had been made since the previous inspection. All registered nurses and senior carers were qualified in first aid, ensuring that there was always a first aider on duty. Accidents were recorded appropriately and audited every month. The assessments of potentially hazardous substances were excellent. Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 24 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 2 x 2 x N/A 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 2 2 x 2 2 2 x 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 2 2 x x x x 3 x 2 2 Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 25 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation 18(1)(c ) Requirement Staff must receive training specific to the mental health needs of the residents. (Timescale of 30/11/04 not met) Care plans must be available to residents and drawn up in consultation with them, where appropriate. The residents plans must be kept under review and reflect current practice. Residents must be consulted about any revision. (Timescale of 30/11/04 not met) Residents’ plans must include directions as to how their psychological, physical, personal and social care needs are to be met. (Timescale of 31/10/04 not met) The registered person must ensure that the assessment of residents’ needs is kept under review. (Timescale of 31/05/05 not met) The registered person must ensure that a record is kept of any limitations agreed with the service user as to the service user’s freedom of choice and power to make decisions. (Timescale of 30/04/05 not met) Timescale for action 30th September 2005 30th September 2005 2. OP7 15(2) 3. OP7 15(1) 30th September 2005 4. OP7 14(2)(a b) 30th September 2005 30th September 2005 5. OP7 17(1)(a) Schedule 3 Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 26 6. OP8 13(4)(c ) 7. OP8 13(4)(c ) 13(5) 8. OP8 12(1)(a) 9. OP9 13(2) 17(1)(a) Schedule 3(i) 10. OP9 13(2) 17(1)(a) Schedule 3(i) 11. 12. OP9 OP12 13(2) 16(2)(mn) 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) Where a risk has been identified, assessments of pressure sore risk must be kept under review. Residents with swallowing difficulties must be reviewed and referred, where necessary, for specialist advice. (Timescale of 31/10/04 not met) The registered person must make provision for the health and welfare of residents. This would include nutritional needs. A record must be maintained of all medication received, administered and leaving the custody of the home including medication passed to residents (or relatives) for selfadministration or for administration away from the home. Medication must be administered according to the prescriber’s instructions. Where there is a clinical decision to omit medication this must be clearly documented. Nurses must abide by the Nursing & Midwifery Council guidelines for the administration of medication. Arrangements must be made for the disposal of waste medication. 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 30th September 2005 30th September 2005 31st July 2005 30th June 2005 30th June 2005 31st July 2005 30th September 2005 Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 27 13. OP15 13(4)(c ) 13(5) 14. OP19 23(2)(b) 15. OP26 16(2)(k) 16. OP26 16(2)(j) 17. OP37 17 & 26 Schedules 3&4 37(1)(e) 18. OP37 19. OP38 13(4)(c ) 20. OP38 18(1) 21. OP38 23(4)(e) about their social interests and these should be recorded. (Timescale of 30/11/04 not met) The registered person must review the current system for transporting the food from the kitchen in the main house to Close Care and The Mews. (Timescale of 30/04/05 not met.) The registered person must ensure that the home is kept in a good state of repair. The damp area on the outer wall of Bungalow 11 must be attended to. The registered person must ensure that all parts of the home are kept free from offensive odours. The registered person must make arrangements for maintaining satisfactory standards of hygiene. This would include attention to the dining room floor in Close Care. The registered person must ensure that all records required for the protection of service users and for effective management are in place. The registered person must notify the Commission of any event which affect the well-being or safety of a resident. An emergency gas shut off must be provided in the kitchen The exposed gas pipes in the kitchen of The House, between the cookers must be encased. (Timescale of 31/01/05 not met) Health and safety training must be made available to all staff. The training must cover all safe working practice topics. The registered person must ensure that staff are aware of the procedure to be followed in 31st July 2005 31st July 2005 30th June 2005 30th September 2005 31st July 2005 10th June 2005 31st July 2005 31st October 2005 30th June 2005 Page 28 Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 case of fire. 22. OP38 23(4)(c ) The registered person must make adequate arrangements for containing fires. The fire door in the second lounge in The House must fit closely into the frame. The registered person must ensure that all equipment is maintained and in good working order. This would include the testing of portable electrical appliances. 30th June 2005 23. OP38 23(2)(c ) 31st July 2005 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 OP2 OP7 Good Practice Recommendations Residents should be provided with contracts or statements of terms and conditions of residency. Consent to treatment forms should specify what residents are consenting to. The practice of cigarette allocation should be individually assessed for each service user and a written record produced of decisions made on their behalf. Mental health needs and management strategies for residents should be clearly documented. Consent to administration of medication should be obtained and recorded in care plans Where medication is passed to residents (or relatives) for administration away from the home, it should be in the original container from the pharmacy or prepared in accordance with guidance issued by Royal Pharmaceutical Society of Great Britain. Criteria for the administration of when required and variable dose medication should be clearly defined and recorded. A second member of staff should witness all hand written annotations to Medication Administration Record charts. In order to count stocks of tablets hygienically, a counting triangle, or other device should be obtained. Where variable doses may be administered, the actual F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 29 3. 4. 5. OP8 OP9 OP9 6. OP9 Heightside House Nursing Home 7. 8. OP9 OP10 9. OP11 dose (e.g. number of tablets) given should be recorded. The date of opening should be clearly marked on eye drops and other items with limited shelf-life when in use. 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 plans. Residents should have access to the policy on confidentiality. The policies and procedures regarding care of a dying service users and after death should be reviewed. 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. Activities should be organised and conducted by people qualified to do so. Staff should receive training on dealing with issues arising from residents forming relationships. The menus should be reviewed with involvement from residents. Service users who prepare their own meals should have a risk assessment and care plan to support this practice. There should be evidence to indicate that residents have had 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. The use of the communal space in The House should be reviewed and developed to meet the varied needs of the residents. The temperature of the hot water in the Parker Bath should be maintained at a level close to 43oC The protocol for shared rooms should be included in the statement of purpose and service user’s guide. Following the bedroom audit, residents should be consulted about suitable locks on their bedroom doors. Assessments should be completed for the residents holding the keys to their own bedroom doors. 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 F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 30 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. OP12 OP13 OP15 OP15 OP17 OP18 OP20 OP22 OP23 OP24 20. OP26 Heightside House Nursing Home 21. 22. 23. 24. 25. OP28 OP30 OP37 OP37 OP38 should be reviewed. 50 of care staff should be qualified to NVQ level 2. That documentation to evidence that the two-day Induction programme has been completed is returned to the office and retained in the member of staff’s file. It was recommended that the policies and procedures be reviewed with the involvement of service users. The access to records policy should reflect that all service users have access to their own care plans. Risk assessments for safe working practices should be carried out for all areas of the home. A statement of policy for safe working practices should be produced. Heightside House Nursing Home F57 F07 S61144 Heightside V224190 June 8th 9th & 10th 2005 Stage 4.doc Version 1.30 Page 31 Commission for Social Care Inspection 1st floor, Unit 4 Petre Road Clayton-Le-Moors, Accrington Lancashire. 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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