Inspection on 22/11/05 for Heritage Care Centre

This inspection was carried out on 22nd November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Heritage Care Centre 11/08/06

Heritage Care Centre 06/04/05

Heritage Care Centre 03/10/04

Heritage Care Centre 01/06/04

Heritage Care Centre 04/05/04

Heritage Care Centre 13/01/04

Similar services:

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Henry Nihill House

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

CARE HOMES FOR OLDER PEOPLE Heritage Care Centre 30 Gearing Close Tooting London SW17 6DJ Lead Inspector Janet Pitt Unannounced Inspection 22nd November 2005 10:00 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 Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Heritage Care Centre Address 30 Gearing Close Tooting London SW17 6DJ 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) 020 8682 9050 Lifestyle Care PLC Praxedes Priscillia Chibanda Care Home 72 Category(ies) of Dementia (35), Old age, not falling within any registration, with number other category (37) of places Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing levels on the Ground Floor AM: Two qualified nurses and six care staff PM: Two qualified nurses and five care staff Night: One qualified nurse and three care staff Staffing levels on the First Floor AM: Two qualified nurses and five care staff PM: Two qualified nurses and five care staff Night: One qualified nurse and three care staff The above staffing levels are to be implemented once the home is fully occupied. The inspector has agreed with the organisation an incremental scale of increasing staffing levels as service users are admitted to the home. Ancillary Staff Administrative Staff 40 hours per week Domestic Staff 2 hours per resident per week Cook/Chef 40 hours and 16 hours at weekend Kitchen Assistant(s) 105 hours per week Laundry Staff 1 hour per resident per week Activities Co-ordinator 40 hours per week Maintenance 40 hours per week The number and distribution of nurses, care staff and ancillary staff must be reviewed at regular intervals by the registered owner. If at any time, the evidence indicates that there is insufficient staff of any category available to meet the assessed needs of service users, the NCSC will require additional staffing as appropriate. Date of last inspection Brief Description of the Service: Heritage Care Centre is a purpose built home comprising of three storeys. The ground floor and first floor have the communal areas and bedrooms of service users. The second storey has the kitchen, laundry and staff areas. Accommodation is provided in single rooms with ensuite facilities. All rooms conform to the space requirements of the Standards. Service users are encouraged to bring in personal possessions. The home is arranged in four discreet units. Nursing care is provided for service users and there is a separate dementia unit. All service users have access to a safe level garden, where seating is provided. There is a passenger lift available. Heritage Care Centre is situated on the site of the Old Tooting Bec Hospital within a housing Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 5 2. 3. complex and is accessible by public transport, which is approximately ten minutes walk from the home. The home has adequate parking spaces for visitors. Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was undertaken unannounced on 22nd November 2005 and 8th December 2005. A total of three inspectors visited the home, the inspection lasted six and a half hours. The inspection focused on requirements form the previous inspection and core standards needing to be inspected. Medication, care records and staff files were examined. The inspectors’ spoke with five visitors, three staff and two residents during the course of inspection. What the service does well: What has improved since the last inspection? The family spoken with advised that many aspects of the home had improved since the arrival of the current manager, including the quality and continuity of staff, the décor and the food. Requirements from the previous inspection relating to medication; adult protection and recording of training have been complied with. Although there have been no Protection of Vulnerable Adults investigations since the previous inspection, the manager stated that this area is covered on Induction training for all staff members. Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 7 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. Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Residents are assessed on admission and care must be taken to make sure that details of lifestyle and social history are taken, and assessments are fully completed, to enable care needs to be identified. EVIDENCE: Residents are assessed prior to and on admission. The assessments examined were noted generally of a good standard and identify care needs, however care must be taken to ensure they are completed fully. One assessment did not contain details of the social history of the resident or their mental health status; this did not provide significant information about the resident. There needs to be evidence of resident/representative involvement consistently. A copy of the Service Users Guide is available in the reception to the home, this details what service is provided. Contracts for residents are held on file, the contracts detail what is provided for the fee. Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 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): 7,8,9,10 and 11 Residents can be confident that their medicines are handled and administered in a safe manner. Residents are treated with respect and their privacy is protected. Progress has been made on identifying needs, but emphasis must be placed on specialist health needs and life events, to make sure residents are cared for holistically. Daily records have improved, but further work is required to make sure care is accurately recorded. EVIDENCE: Residents care plans examined contained appropriate basic information including photograph, date of admission, next of kin. Residents’ preferred terms of address were recorded. Each resident has a named nurse, who was identified on the care plan. Specific care plans had been developed where necessary in areas identified at assessment such as skin integrity, continence and risk of falls. Staff said that all residents’ care plans are updated quarterly. This was confirmed by the examination of care plans. Care plans contained evidence of Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 11 monthly monitoring of healthcare issues dependency and nutritional assessments. including regular weighing, Some care plans contained little information regarding residents’ personal or family history. A number of care plans contained a section headed ‘Important Life Events’, although this section was blank in the sample of plans examined. Improvements have been made in recording daily care, there was detail on food and fluid intake and the number of hours slept. Daily care notes are recorded for each resident, however there needs to be further improvement of the type of information recorded to make sure that all care given is recorded accurately and residents are not at risk of not having their care needs met. Care also needs to be taken with legibility of writing in care documentation, as there were instances of illegible writing. Residents’ preferences following death were recorded but in some cases very briefly, for example, “inform daughter”. The member of staff reported that a general practitioner visits the home twice each week and that the local surgery responds well to requests for home visits. Staff said that referrals to specialist services, such as tissue viability or speech and language therapy, are available through the general practitioner. There is space within the care plans to detail wound conditions, but this must be consistently completed at each dressing change to indicate what is occurring. Staff were observed to deliver care in a way that maintained residents’ dignity. Residents were encouraged to perform tasks for themselves where possible. Cleaning staff knocked before entering rooms. Staff addressed residents with respect. Residents’ medications are administered, handled and stored in a safe manner, which protects residents from risk of receiving incorrect medication. Staff within Heritage care have worked hard to ensure there is a clear auditable trail of medications into and out of the home. Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 12 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): 13 and 15 Residents are able to receive visitors in private and their visitors are made to feel welcome. Mealtimes are a social experience and residents can be confident that they will have a varied menu and assistance if needed. EVIDENCE: The inspectors were invited to have lunch with two residents and their families. The resident’s family on one unit reported that they are able to arrive for visits at any time and that they are made welcome by staff when they visit. On the other unit the inspector observed staff sitting with residents to assist them with eating, the relative confirmed that was the usual practice by care staff. Lunch was served in an unhurried manner and staff were attentive to residents needs. The menu indicated a choice of food and special diets can be catered for. The manager reported that the introduction of ‘finger foods’ for residents on the dementia unit had proved to be a success. This was reflected in the monthly weights of residents, which had either remained stable or increased. Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 13 The chef advised that she aims to meet all residents when they are admitted to the home to establish their preferences. The chef is committed to providing a range of options that reflect residents’ personal and cultural preferences. The chef reported that she liaises with nursing and care staff should residents have specific dietary needs. Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 14 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 Complaints are responded to in a proactive manner and actions is taken to address any issues. EVIDENCE: Inspection of the home’s Complaints log demonstrated that concerns raised by residents or relatives receive an appropriate response. Complaints recorded related to laundry, food and the approach of one member of staff. Correspondence on file provided evidence that the manager had investigated complaints appropriately and implemented systems designed to address the issues raised. The manager reported that there had been issues with delicate items of laundry, which are now separated into a green bag, to make sure they are washed appropriately, without causing damage to the clothing. One relative said that the manager made sure that ‘complaints were sorted out’ at a local level and they had ‘no concerns’. Since the previous inspection there have been no protection of Vulnerable Adults investigations within the home. Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 Residents lived in an environment, which is suitable for their needs. Minor repairs need to be carried out in a timely manner, to make sure that all facilities are available for residents use. EVIDENCE: Residents live in a safe environment, which is generally well maintained. Minor repairs were needed to a toilet seat in one bathroom and one shower room, to make sure that residents could access all facilities. There was evidence of personalisation in residents’ rooms and the home was clean and tidy at the time of inspection. There were sufficient numbers of hoists and adaptations around the home; to enable residents needs to be met. Each of the four units has day space and there is a level garden, which is accessible. Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 16 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, 29 and 30 Residents are protected from harm, by the home’s recruitment process and are supported by staff that are trained and competent to do their job. EVIDENCE: A member of staff identified a number of areas which had improved these included staff training, staff ratios and staff morale. There also has been better care provision in specialist areas (for example support from continence specialists). The introduction of a keyworker system and more individualised care planning has had a positive impact on residents care. Staff training in specialised areas has been made available, for example syringe driver management, catheter care and pain management. The member of staff advised that Lifestyle Care also makes relevant training sessions available to residents’ relatives. Courses in ‘mandatory’ training, including health and safety, food hygiene and fire safety, are repeated frequently to ensure that all staff are up to date with their qualifications in these areas. Records examined confirmed this and it was noted that there has been significant improvement in the recording of training. The member of staff also said that staff are encouraged to attend NVQ training relevant to their roles and that all staff receive one-to-one supervision six times each year. Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 17 Staff/training notice boards on each unit offered infection control training which staff had booked themselves on. Current infection control guidelines were also displayed on the notice board, as was the most recent CSCI report for the home. There has been an adjustment to staffing levels since the previous inspection. The manager explained that there is now an extra carer on the ground floor; this was in response to increase care needs of residents. Staff were noted to be visible within the units. Residents are protected from potential harm by the home’s recruitment procedure. Staff files examined contained all the required information of the Regulations and Schedules and details of appropriate checks being made. Comments received from visitors regarding staff of Heritage Care included ‘all staff are kind and caring ‘ and ‘fantastic’. The manager reported that uniforms had recently been introduced for all staff. The manager said that feedback from residents and visitors has been positive, with many people reporting that they find the uniforms useful in identifying staff and their roles. Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 18 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, 32, 33, 36 and 38 Residents live in a home, which has a proactive and responsive manager and staff team, who aim to make sure that Heritage Care is the ‘residents home’. Residents and relatives views are listened to and acted upon. EVIDENCE: One nurse said that she had completed her adaptation training with Lifestyle Care and that she had worked at the home since January 2004. The member of staff stated that the current manager “has helped us improve” and had been a positive influence since her arrival. The member of staff stated that communication amongst staff has also improved, with senior staff and unit meetings held weekly. Staff demonstrated an awareness of procedures to be followed in the event of a fire. Staff reported that one person on each unit is the designated officer in charge in the event of a fire. The last training delivered by the Fire Officer took place on 7.11.05 and was attended by 27 staff. The manager advised that Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 19 night staff were included in this training. The manager said that the home’s fire alarm system; emergency lighting and call bell system were to be checked on the 28.11.05. The manager advised that Lifestyle Care was conducting an internal Quality Assurance audit at the time of inspection. A record of accidents and incidents affecting residents is maintained and contains information required within the Standard. There is a twenty-four and forty-eight hour review process in place when a resident falls, which makes sure that potential injuries are identified. Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X 3 X 3 Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 21 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 OP3 Regulation 14 (1) (c) Requirement Timescale for action 31/03/06 2 OP7 15 and Sch 3 (k) 3 OP8 Sch 3 (3) (k) 23 (2) (b) 3 OP19 The registered person must ensure that residents or their representatives and involved in the assessment process and assessments are fully completed. The registered person must 31/03/06 ensure that the daily records of care give specific details in relation to the care given and are individual to each service user. (Previous timescale of 6/6/05 not met) The registered person must 31/03/06 ensure that wound conditions are documented at each dressing change. The registered person must 31/03/06 ensure that minor repairs are carried out in a timely manner. Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 22 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 Refer to Standard OP9 Good Practice Recommendations It is recommended that the pharmacist is consulted to ensure that the correct date of dispensing is on medicines. Heritage Care Centre DS0000031140.V269205.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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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