Inspection on 12/07/06 for Heliosa Nursing Home

This inspection was carried out on 12th July 2006.

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

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

Other inspections for this house

Heliosa Nursing Home 13/11/06

Heliosa Nursing Home 05/10/05

Heliosa Nursing Home 10/05/05

Heliosa Nursing Home 28/10/04

Heliosa Nursing Home 05/07/04

Heliosa Nursing Home 23/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Heliosa Nursing Home 54 Boundary Lane Congleton Cheshire CW12 3JA Lead Inspector June Shimmin Key Unannounced Inspection 12th July 2006 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heliosa Nursing Home Address 54 Boundary Lane Congleton Cheshire CW12 3JA 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) 01260 273 351 01260 297794 Takepart Limited Mrs Lyndis Swinden Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 42 service users to include: * Up to 42 service users in the category of OP (old age, not falling within any other category. 5th October 2005 Date of last inspection Brief Description of the Service: Heliosa can care for up to 42 older people requiring nursing care. The home was originally three cottages built in the early 1800`s and was converted for use as a nursing home in 1970. The home is detached and has a private garden. It is located in a quiet residential area of Congleton. The town centre of Congleton is approximately two miles away. The home is on two floors and there is a passenger lift and staircase to the first floor. There are a variety of aids and adaptations around the building to allow residents to move about more independently. The owners have recently extended the home to provide an additional 11 single bedrooms with en suite facilities. All of the bedrooms are single and thirty-one bedrooms have en suite facilities of toilet and wash hand basin. The home has a dining room and three lounges. The current weekly fees range from £473.35 to £560. Further details regarding fees are available from the manager. Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit was part of the service`s first key inspection. It was carried out on 12th July, 2006 by June Shimmin, regulatory inspector and lasted nine and three quarter hours. The pharmacy inspector, Elaine Bray, accompanied the regulatory inspector during part of the inspection. A further visit was made to the home on 20th July, 2006 to give the manager feedback about the site visit. During the inspection conversations were held with residents, relatives and a visiting GP and social worker. 11 residents/relatives returned written comment cards. A partial tour of the building was also carried out. There were 37 residents living at the home on the day of inspection and a further two residents in hospital. What the service does well: What has improved since the last inspection? The living environment of residents has been improved by the addition of more lounges. Headboards have been provided for all beds. Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 6 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. Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 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 the following standard(s): 1, 2, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents funded by social services do not receive full information about the home on admission. The health care needs of residents are not documented by Heliosa nurses prior to them taking up residency. This means that Heliosa cannot be sure that it can fully meet the needs of residents. Intermediate Care is fairly well managed. EVIDENCE: A copy of the Statement of Purpose (information leaflet) was available in the former reception area. This needed to be updated to reflect the addition of the extension. The complaints section did not include the address or telephone number of the CSCI, although a poster was displayed near the former entrance. A laminated copy of the aims of the service and principles and Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 9 standards of direct care was placed in each bedroom. This gave the address and telephone number of CSCI but did not explain the context or function of CSCI. A Service User Guide (information leaflet) was available but had not been distributed to all residents or relatives on request. The contract included a copy of the Service User Guide (information leaflet). The contract of a resident recently admitted was seen and contained details of fees. It was signed by the resident`s next of kin. The complaints section referred to CSCI, but did not include its full address or telephone number. The registered manager said that contracts were provided for all privately funded residents but no statement of terms and conditions was available for residents funded by social services. The care records of three residents were looked at, including the care record of a resident admitted under the Intermediate Care scheme. This scheme enables residents to benefit from a short period of rehabilitation before returning home. Although there were written assessments by health and social care professionals of each resident, there was no record of an assessment by the registered manager or another senior nurse at the home and qualified to conduct an assessment. The registered manager said that senior nurses had carried out assessments of residents prior to admission but that the assessments had not been documented. Three residents were having their needs reassessed because the home was unable to meet their needs. Heliosa continues to accept residents under the Intermediate Care Scheme. Care plans had been provided for most identified needs. Two sets of care plans were available, one by the care home and a further set by the Intermediate Care Team, which was confusing. The resident had a moderate degree of inability to communicate and understand, which was the resident`s principal care need. There was no care plan addressing this need either from Heliosa or the Intermediate Care Team. Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Not all health care needs are met and care plans are not individualised. The management of medicines is poor. The principles of privacy, respect and dignity are put into practice. EVIDENCE: The care plans of four residents were looked at, including one resident admitted under the Intermediate Care Scheme. The care plan for the resident admitted under this scheme was adequate. Three care needs had been identified and pre printed care plans described the care to be provided. However, the care plans had not been individualised. For instance a care plan for sleep referred to the resident having a disturbed sleep pattern due to pain but there was no reference to how this was to be managed. The mobility care plan needed to be updated as it referred to the resident`s walking aid as being a wheelchair although the resident was seen walking with a stick. There was no reference in the care plan to a recent fall at the home except in the progress records. There was no mention of the degree Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 11 of supervision needed and the need to promote the resident`s independence. The resident`s principal care need related to a reduced ability to understand and communicate but there was no care plan for this need. The care plan of a resident with a pressure sore was poor. The last entry for this was on 08/05/06 which stated that the resident had a pressure sore on the buttocks, which was being dressed daily and the resident was being nursed on a specialist mattress. It also stated that the resident was getting better. There was no reference to the size, depth, colour and grade of the pressure sore. There was no description of the location of the pressure sore on a “body map.” The only reference to a dressing was in a separate “dressing book.” Prior to this, the last review was on 20/11/05. Care plans for other care needs were provided but the care plan was difficult to follow as it was very disorganised. There was no care plan for communication where this had been identified as being very difficult. A consent form for the use of bedrails had been completed and a risk assessment for use of bedrails had been reviewed. Risk assesments for the use of an air mattress and falling out of bed had not been reviewed. There was no attempt made to evaluate care delivery and care plans were just dated and initialled. A nutrition risk assessment was incomplete. Risk assessments for the prevention of pressure sores and moving and handling had been completed once in August 2005. The resident had been weighed monthly and was now 5st 7lbs. In August 2005 the resident weighed 6st 10lbs. The nursing home GP was aware of this weight loss and said that the weighing scales may have been faulty at that time. The scales were checked by a technician in February 2006. The weight chart stated that the dietician was involved in the resident`s care. The resident had also been seen by a continence advisor. The resident was being nursed in bed and had limited communication, but was able to respond by touch and smiles. There were no fluid or food charts in the room and when questioned a carer said that none were provided and that staff were not asked to complete a record of this even though the resident was losing weight and prescribed dietary supplements. The third care plan was poor. Pre printed care plans had been put in the file with the name of the resident. None had been signed or dated and there was no attempt to individualise care. There were no care plans for communication, emotional needs and confusion where these had been identified on admission. A nutritional risk assessment had identified the resident as being at high risk. The resident had lost 15 pounds in weight in six weeks. The Nursing Home GP had not been made aware of this weight loss. A number of pre printed risk assessments were all completed on admission but again had not been individualised, signed or dated. A risk assessment for the prevention of pressure sores had not been completed although the resident was at high risk from the evidence of the resident`s medical history. There had been no evaluation of the resident`s care since admission. Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 12 Although a request had been made by the Nursing Home Scheme GP for particularly vulnerable residents to be weighed on a weekly basis, this request had not been carried out. The home did not use the Body Mass Index to identify these residents which is a good tool as it differentiates between residents who are underweight and seriously underweight. It was also identified that care staff may be using incorrect weighing techniques. The fourth care plan was adequate. Pre printed care plans and risk assessments had been provided but not individualised to the resident`s needs. These had been reviewed every month but needed to contain a more detailed evaluation, for instance about the resident`s mood and emotional needs. There was evidence of referral to other health care professionals when needed. There was no risk assessment for the use of bedrails or for swallowing where these had been identified as risks. The nutritional risk assessment indicated that there was a high risk of malnutrition but the resident`s weight loss amounted to half a stone in the previous year. The care plan indicated that the resident was sometimes nursed on a mattress on the floor for the resident`s own safety. However, there was no evidence of consent to this by the resident or of discussion with health professionals about alternative methods of maintaining the resident`s safety. The inspector raised concerns with the manager regarding the poor care plans. A CSCI pharmacist inspected the medicines because of concerns raised by the lead inspector. The pharmacist inspector was on site for four and a half hours, looking at the medicines and associated records. Issues were discussed with the proprietor and another registered nurse on duty. An immediate requirement to improve was made at the inspection. The home has medicines policies written by an external organisation that do not describe medicine management at Heliosa. There is a lockable medicine room that is too small to store forty-two residents’ medicines in an organised way. There were more of some medicines than the residents needed. Some had date expired. Many medicines that were labelled only to use for so long after opening had no date of opening marked to be sure that they were still fit to use. The date of dispensing on the pharmacy label was some months ago. The medicine records caused concern. Where staff had hand written items on the records the directions were not clear, complete or accurate. There were a large number of unexplained gaps in the records, sometimes for days at a time. The records of medicines received were not seen so it was difficult to evidence whether the medicines that had not been signed for had been given. Residual stock levels were not carried over beginning of the new month’s records to keep track of items not used continuously. Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 13 The records in the controlled drug book did not accurately show the stock in the cupboard. Records of the receipt of controlled drugs were not signed. There was approximately 50ml shortage of one resident’s morphine mixture compared with the records. The inspector raised concerns regarding the poor medication practice. The proprietor informed the inspector that she has arranged medicines refresher training later in the year for all trained staff. She acknowledged that she had “not had her finger on the pulse” but had relied on the registered nurses to work within Nursing and Midwifery Council Guidelines on medicines. Staff interactions with residents demonstrated that residents were treated with dignity and respect. Residents made positive comments about staff such as “endlessly patient” and “treated with dignity.” Some written comments indicated that staff had little time to sit and talk to residents due to inadequate staffing levels. Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Group social activities are provided but there is little evidence that the individual social care needs of residents are met. Although the standard of catering is good staffing levels in the afternoon are inadequate so that the dietary needs of all residents may not be met. EVIDENCE: Information provided by the registered manager before the inspection included the following activities: music for health, entertainers, bingo, board games, cards, pub day and barbecue, television, radio and newspapers. Outside the home activities such as a luncheon club, boat trips and visits to a garden centre were described. A number of residents were enjoying listening to an entertainer during the inspection. A boat trip had been organised for 12 residents for the following week. There was nothing written in care plans to demonstrate that individual social care needs had been addressed. Written comments included, “lack of stimulation for residents”, “there is usually some entertainment which we are always welcome to attend” and “not very often.” Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 15 Heliosa does not employ an activities coordinator and staff have little time to provide activities. Residents said that they could join in activities if they wanted and were also able to stay in their own room if they preferred. They were also offered choice in relation to food. A cooked breakfast was available on request. There was a sufficient gap between meals. For instance the evening meal was served between 5 and 6 30pm. The cook finishes work at 2 30pm which means that care staff are involved in warming up food, serving food, assisting residents to eat and clearing away after the evening meal. This puts staff under a lot of pressure and may mean that residents do not have enough assistance to eat. There are two sittings at lunch so that staff have time to assist residents but fewer staff available in the afternoon and evening. Written comments made were, “food is very good” and “I enjoy breakfast and lunch, but I do not like to have sandwiches every day for tea, but they sometimes offer me soup.” The evening meal was a choice of turkey or cream cheese sandwiches or cheese oatcakes (needing to be reheated) followed by pineapple and cream. The spiritual needs of residents are met. Clergy from local churches visit Heliosa on a regular basis and provide a service for those wishing to join in. A resident from a European country is living at the home. Due to dementia the resident is unable to communicate verbally. However, staff have made contact with a person in the local community to see if the resident could talk in the birth language. This proved unsuccessful. Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are aware of their right to complain. Not all complaints may be recorded, which means that residents` concerns might not be taken seriously. Residents are protected from possible abuse. EVIDENCE: Heliosa has a complaints book and the registered manager said that no complaints had been received. A complaints procedure was displayed near the former main entrance to the home. This referred residents and relatives to the CSCI rather than suggesting that they speak to the registered manager in the first instance. A Service User Guide (information leaflet) was available but had not been distributed to all residents or relatives on request. This contained a copy of the complaints procedure. An anonymous concern was received by the CSCI, which was looked at during the inspection. Most residents wrote that they knew how to complain. However, one relative stated that complaints had been made but nothing was seen on the complaints book. Staff spoken to said that they would report any incidents of suspected abuse to the registered manager or the senior nurse on duty. Written information provided by the home before the inspection stated that Heliosa has policies and procedures on adult protection and prevention of abuse and whistleblowing. Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 17 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a wellmaintained and comfortable environment, which encourages independence. EVIDENCE: The owners have built an extension since the last inspection, incorporating eleven single bedrooms with en suite facilities. The standard of decoration and fixtures and fittings in the extension is very good. The extension also provides a new assisted bath, wet room shower and two toilets with disabled facilities. The laundry has been relocated to the extension and is of a good standard. Older parts of the home, which had been closed during refurbishment have been reopened so that there are now three lounges and one dining room in total. The manager said that part of one lounge is to be converted to a second dining room. A new office for nursing and care staff has been built but not yet Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 18 occupied. This is located by the front door and the windows also overlook the lounges so that staff will be able to observe residents in two lounges. The registered manager has a new office and a staff room is also being provided. The main entrance to the home had been moved to the side of the home and access has been improved. During a tour of the building it was noted that Heliosa is kept clean, tidy and hygienic. Written comments were made that the nurse call bell is not always answered promptly. The nurse call bell was activated. Staff came to the room within a few minutes. In the older part of the home the only bathroom on the first floor had a sign saying that it was out of use. Several rooms on this floor did not have an en suite toilet. Although some of these rooms were vacant, a resident occupied one room without a toilet. There was a commode in the room. The owners said that the toilet was functioning but that the bathroom had been closed whilst waiting for a builder to repair the damp areas on the external walls of this part of the home. This building work was outstanding from the previous inspection in October 2005. The owners said that the toilet was functioning and would provide a risk assessment for use of the room and make it available for use. Heliosa provides a range of adaptations and equipment suitable for the needs of residents with disability. Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff are highly regarded by residents and relatives, but it is not always clear whether staffing levels are adequate to meet the dependency needs of the residents. Recruitment practices are unsafe. Staff do receive training but the induction process is not thorough. EVIDENCE: Comments such as “absolutely super” and nothing is too much trouble” were made about staff. Since the last inspection the number of residents at Heliosa has increased from 35 to 42. The registered manager did not send staffing rotas to the CSCI before the inspection as requested. There has been no increase in staffing to meet the greater demand for care. At the last inspection a requirement was made about inadequate staffing levels. Care staff work twelve hour shifts, which can lead to staff feeling tired and overworked. Staff said that they had little time to stop and chat and that having to perform laundry and kitchen assistant duties increased their workload. The registered manager is a Registered Nurse who is supernumerary and not included in the staffing rota, making it difficult to evidence when she is performing nursing duties. If the registered manager wishes to be included as a working member of staff the hours worked must be recorded on the rota. Only one resident said that staff were always available when needed. The following comments Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 20 were typical, “more good staff needed,” “waiting too long to go to the toilet we need help and can`t go ourselves.” A comment about staff taking their lunch break together was made. The same comment was made at the last inspection. During the inspection there was a period of time after lunch when no carers were visible in the main lounge and help had to be sought from a nurse in the office, who could not see what was going on in the main lounge. The inspector raised concerns about staffing levels. Recruitment records for four members of staff were looked at. One registered nurse had started work on the 28th February 2006 but a security check was not received until 11th May 2006. The registered manager had also not verified the personal identification number of this nurse or another nurse before they started work. Other records were satisfactory, although one reference for the nurse without the initial security check was not particularly complimentary. The inspector raised concerns about recruitment. Staff do receive training but the induction process is poor. Information provided by the home before the inspection indicated that ten staff had attained NVQ level 2 or above which equated to 50 of the care staff. There were no training records on file for the four staff members whose staff files were looked at. There were also no induction records on file. Two new staff members were spoken to. One said that she had received a very good induction and been given a book to read. She had met with the manager and discussed the work, residents and her training needs. This staff member had previous care experience. The second staff member had not worked in the care environment before. She had been working at the home for two months but had received very little in terms of an induction. Nothing had been recorded. However, she did have someone to whom she could talk, a mentor. The registered manager showed the inspector a copy of the Skills for Care foundation standards, which she was going to implement. Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 21 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management and administration of the home needs improving to ensure that it is run in the best interests of residents. The home is generally well maintained. Quality assurance mechanisms are not a reliable indicator. EVIDENCE: The registered manager is a first level registered nurse and has a management qualification. The registered manager is well regarded by staff and described as being approachable. Heliosa achieved the Investors in People award in November 2004. The registered manager had delegated a quality assurance package from an external provider to a senior nurse. The audit indicated few problems at the home in relation to care planning and medication. This was not an accurate reflection of the home thereby making the system unreliable. Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 22 The home provided the CSCI with information before the inspection, which indicated that family members handle residents` monies. This information also stated that equipment and installations at the home have been regularly maintained and serviced. A fire officer had visited the home in May 2006 but a report was unavailable. The latest fire risk assessment was dated 19 May 2006 and was conducted by both owners. Fire records indicated that fire equipment was checked regularly. Although fire drills were held on four dates in April 2006 and three dates in May 2006 it was not possible to check whether all staff, including night staff, had attended as there was no training checklist. The door of a cleaning cupboard was found to be unlocked. This contained cleaning materials, which would harm residents if ingested. Several residents were observed being transported in wheelchairs without footplates, which could cause their feet to become trapped. Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 2 3 X X X 3 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5a Requirement The registered person must ensure that all residents receiving nursing care receive a written statement of terms and conditions on the day of admission. The registered person must provide written evidence that the care home has conducted an assessment of residents` needs and that this has been kept under review. The registered person must ensure that a detailed care plan is provided for all residents on admission to the home and which is individualised to their needs. The residents` care plans must be kept under review, changes recorded and the plan updated to reflect changing needs. Timescale for action 12/10/06 2. OP3 14 12/10/06 3. OP7 15 12/10/06 4. OP7 15 12/10/06 Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 25 5. OP7 13 The registered person must ensure that risk assessments are completed on admission for all identified risks and are kept under review. The registered person must ensure that residents are protected from developing pressure sores and that accurate documentation is maintained in respect of this. The registered person must ensure that accurate documentation is kept of residents with pressure sores and the actions taken by nurses to heal the pressure sores. The registered person must ensure that action is taken to identify residents at risk of malnutrition and a record of this kept. 12/10/06 6. OP8 13 and 15 12/10/06 7. OP8 13 and 15 12/10/06 8. OP8 13 and 15 12/10/06 9. OP8 and OP15 13, 15, 16 The registered person must Schedule ensure that a record is 4 (13) maintained of the food and fluid given to vulnerable residents. 13 The registered person must make arrangements for records of the medicines audit trail to be kept to the required standard. 12/10/06 10. OP9 12/07/06 11. OP9 13 The registered person must 31/08/06 ensure that policies and procedures reflect how medicines are managed at the home. Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 26 12. OP9 13 13. OP9 13 The registered person must make arrangements for all medicines to be checked at least monthly to ensure they are in good condition and held in appropriate quantities. The registered person must make arrangements for controlled drugs to be handled and recorded properly. The registered person must make arrangements to audit the medicines and medicine records at appropriate intervals, at least weekly. Discrepancies and action taken must be recorded. The registered person must ensure that registered nurses employed at Heliosa manage medicines according to Nursing and Midwifery Council Guidelines. The registered person must ensure that there are adequate numbers of staff on duty for the evening meal to assist residents needing support. An accessible toilet must be provided for residents on the first floor who do not have en suite facilities. An additional member of staff must be employed for the evening meal to reheat and serve food, clear away food/dishes and load the dishwasher. Adequate staffing levels must be provided at all times. (Previous timescale of 15/11/05 not met) DS0000018732.V296394.R01.S.doc 12/07/06 12/07/06 14. OP9 13 12/07/06 15. OP9 13 12/07/06 16. OP15 18 12/10/06 17. OP21 23(2)(j) 12/10/06 18. OP27 18 12/10/06 19. OP27 18 12/10/06 Heliosa Nursing Home Version 5.2 Page 27 20. 21. OP27 OP29 18 Care staff must not perform laundry and kitchen assistant duties. 19Schedul All staff working at the home es 2 & 4 must have a satisfactory enhanced disclosure from the Criminal Records Bureau before starting work. (Previous timescales of 10/06/05 and 15/11/05 not met) The personal identification number of all nurses must be checked before the nurse takes up employment. The registered person must develop an effective quality assurance system. Cleaning materials must be kept securely locked at all times. Wheelchairs must be kept in good working order at all times and footplates must be used. 12/10/06 12/10/06 22. OP29 19 Schedules 2&4 24 13 13 12/10/06 23. 24. 25. OP33 OP38 OP38 12/10/06 12/10/06 12/10/06 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. Refer to Standard OP1 OP1 OP1 OP6 OP7 Good Practice Recommendations The Statement of Purpose and Service User Guide should be updated to reflect changes at the home in relation to staffing and facilities. A copy of the service user guide should be given to all service users or their representative. The Statement of Purpose and Service User Guide should include the full address and telephone number of the CSCI within the complaints procedure. Care plans should be provided to address communication and emotional/psychological needs of residents. Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 28 5. 6. 7. 8. 9. 9. 10. 11. OP8 OP8 OP12 OP12 OP21 OP27 OP30 OP38 Care staff should receive training in correct weighing techniques. The Body Mass Index (BMI) should be used to identify residents who are underweight or seriously underweight. Care plans should demonstrate how the individual social care needs of residents are being met. The manager should consider employing a person to deliver individual and group activities. The building work to the ground and first floor bathrooms should be completed so that residents in that part of the home have access to toilets at all times. Two members of staff should be working on the floor at all times, including during meal breaks. Staff training records and copies of certificates should be kept on file. The registered person should develop a training matrix to demonstrate when staff attend mandatory training such as fire drills and fire training. Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Heliosa Nursing Home DS0000018732.V296394.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!