CARE HOMES FOR OLDER PEOPLE
Heron Hill Care Home Esthwaite Avenue Kendal Cumbria LA9 7SE Lead Inspector
Marian Whittam Unannounced Inspection 13th June 2007 08:30 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 Heron Hill Care Home DS0000059537.V334854.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. Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Heron Hill Care Home Address Esthwaite Avenue Kendal Cumbria LA9 7SE 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) 01539 738800 peterw@abbeyhealthcare.org.uk Abbey Healthcare (Kendal) Limited Janet Barton Care Home 86 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (50), Old age, not falling within any other of places category (28), Physical disability (4) Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 86 service users to include: up to 28 service users in the category of OP (old age not falling within any other category) up to 50 service users in the category of DE(E) (Dementia over 65 years of age) up to 4 service users in the category of DE (Dementia under 65 years of age) up to 4 service users in the category of PD (Adults with physical disabilities) Date of last inspection 16th May 2006 Brief Description of the Service: Heron Hill is a new purpose built home caring for up to 86 people with nursing needs and opened to residents in October 2004. It is in a residential area with access to the bus routes and train station and the town centre of Kendal is about 2 miles away. There is a car park at the front of the home. The home is on three floors and there is a passenger lift to all floors. All the bedrooms are single and have en suite bathrooms with showers. There are 2 communal bathrooms and toilets on each floor and separate communal lounges and dining rooms on each floor and an activities room on the first floor. The home has a statement of purpose and service user guide for prospective residents available on admission. A copy of the most recent inspection report is displayed on the notice board in the foyer of the home along with the results of the home’s own satisfaction surveys and the complaints procedure. The scale of fees charged ranges from £700.00 to £800.00 as at the date of this inspection. There are additional charges to residents for hairdressing, private chiropody, papers and magazines and any personal toiletries. Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Two regulation inspectors and a regulation manager carried out this unannounced visit that forms part of a key inspection. The pharmacist inspector assessed medication standards during the visit through inspection of relevant documents, storage and meeting with Janet Barton, the manager, and other staff. The pharmacy inspection took four and a half hours. Medicines were checked on McKenzie unit. Controlled drugs were checked on each of the three units. Before this site visit information was gathered on the service from the providers. Information on the services provided was also gathered from residents using questionnaires before the visit. Before the inspection some relatives and medical professionals who come into contact with the home had been contacted to give their views on the home. Concerns raised by residents, relatives and other stakeholders have been included in planning the inspection. Information was provided by the activities of other agencies involved with resident’s care including GP surgeries and social services. Two inspectors arrived at 08.30 in order to speak with staff and observe morning activities and breakfast time. A regulation manager also spent time during the day on McKenzie unit using the ‘short observation framework for inspectors’ (SOFI). This observational tool is used to observe interaction between residents and staff and gain information and insight into how well people’s needs are being met. Time was also spent looking around the home talking with residents in the lounges and in their own bedrooms, speaking to the nursing and care staff, activities staff and cleaning staff, observing any activities in progress and looking at care plans. Policies and procedures, systems for recording complaints, financial records and personnel and training records were looked at in the afternoon as well as other records required by regulation. What the service does well:
The home is well maintained and provides a comfortable, well decorated environment for the people living there with a choice of lounge areas to use. The bedrooms are well furnished and coordinated. Several people were happy to show the inspectors how they had made their rooms more personal by bringing in their own possessions, pictures and items that held significance for them. The care plans in use are detailed and focused on the individual and they are developed with people living there wherever possible and/or with help
Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 6 from their relative/advocate. The social assessment used is also very informative and useful to help staff in relating to residents as individuals and for developing activities around what individuals want. Overall the staff were observed to interact well with residents, some more easily than others, but the observational tools used (SOFI) indicate that the majority of the interaction between residents and staff is positive. One resident said that “staff are great” and comments made about their politeness. The menu offers residents a choice and people’s dietary needs are well catered for with a well presented, balanced and varied selection of good quality meals. The service keeps good records of receipt, administration and disposal of medicines that showed that medicines are handled well. The service also keeps good records for medication so it is clear what medication residents have received and all medications can be accounted for. Good records are also kept of visits from doctors including any changes to medicines. The home has a good standard of record keeping that has been improved over time and is being maintained. The home has some useful systems for monitoring and informing local social services of any changes in the assessed needs of residents admitted through social services to keep them up to date with their care The home has responded well to meeting requirements made at inspections and in learning from past mistakes and worked well with monitoring from other agencies to provide a more consistent service, What has improved since the last inspection?
More Adjustable nursing beds have been purchased and the manager plans for 10 to be bought under the annual business planning. New flooring has been laid in the room designated for those who chose to smoke and improvements are being made to the ventilation system to minimise any effects on other residents. Redecoration and general maintenance throughout the home is ongoing as the need arises. The service now does regular checks on stocks of controlled drugs so that any discrepancies can be identified and investigated promptly to protect the people living there. Most regular medication is being given as doctors intended it to be and the improvements found at the last visit in receipt, administration and disposal of medicines have been maintained overall. Following review the pre admission assessment has been further improved to give more depth of information and included a pre admission mental health assessment tool to ensure any such needs can be prepared for in readiness for admission. The employment of a dedicated activities coordinator and another due to start part time has improved the opportunity for people to have more meaningful
Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 7 activities. It was evident from discussions with people living in the home and staff that this is an improvement and is working effectively The provision of a more varied range of activities and a greater emphasis on involving people living in the home in deciding on recreational opportunities is evident. The new piano in Nightingale lounge has been useful and allows more spontaneous musical sessions to happen which people were seen to enjoy. The home has now achieved the target of 50 of care staff with NVQ level 2 or above in care and is continuing to train more staff to that level so improving the skills of staff for people living there. The organisation continues to support its staff to improve their spoken language skills where they do not have English as their first language. The home has worked with the local authority on an English language programme and more staff are attending and finding it useful. Overall the management and staff have maintained the improvements they have made during previous visits and have as a result demonstrated consistency. What they could do better:
There is a statement of purpose and service use guide available in the home however these need some updating and improving to make sure that the information on the services provided is up to date, clear and in sufficient detail to leave no one thinking of using this service in doubt as to the range of general and specialist services on offer to meet individual needs. This includes up to date information on staffing in the home, the number and size of the rooms in the home and fire precautions and emergency procedures. In this way people thinking about using this service can make a fully informed choice about whether or not the home is suitable for them. Consideration should also be given to providing information in different formats, such as large print and audio to meet particular needs. The service has worked to improve all its medication systems but still has work to do to ensure that residents always receive medication as prescribed by the doctor so that their conditions are managed safely and effectively. Staff must always follow individual care plans so that medicines are given appropriately and to prevent residents receiving unnecessary medication that could affect their health. Medication has also sometimes been crushed before administration but there was no record of this being discussed with people involved in the care of the resident regarding its appropriateness and effectiveness. Ordering procedures must also be reviewed as medicines sometimes run out for periods of up to five days and so some people were unable to receive the medication they needed for their conditions. Whilst staff are generally sensitive to maintaining individual dignity there are occasional slips in good practice that senior staff should be looking out for,
Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 8 such as ensuring courses at a meal are always fed separately when a person needs help. Also those using continence aids should always be helped to use these discreetly Although the environment for people living in the home is of a good standard, consideration should be given to finding ways to make the environment more accessible for people with dementia and ways found to promote recognition of bedrooms and other areas to promote people’s independence. Whilst staff levels are sufficient to meet care needs it remains necessary to keep levels always under review and adjusted promptly as necessary to reflect and meet the needs of the current group of people living there. 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. The summary of this inspection report can be made available in other formats on request. Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1, 2 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an effective admission procedure and an assessment of needs is completed prior to admission and this is used as a basis for the plan of care. EVIDENCE: Individual care plans are in place for all the people living in the home and the overall improvements in documentation, admission and assessment procedures and record keeping, seen at the last visit, have been maintained. A comprehensive initial assessment is completed on admission to the home to help make sure that the home can meet individual needs and to identify personal preferences. Following review the pre admission assessment has been improved to give more depth of information and included a pre admission mental health assessment tool to ensure any such needs can be prepared for in readiness for admission.
Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 11 Social, cultural, communication and religious needs, personal interests and recreational needs have been discussed with residents and families, assessed and results then written in the care plans. The registered manager or senior nursing staff assesses all new residents prior to their admission and this is used as a basis for the plan of care. Where appropriate care management plans have been obtained from social services before admission. The home has useful systems in operation with local social services to make sure they are kept informed of changes in the assessed needs of residents admitted through social services. Information is available about the home for prospective residents and their families in the statement of purpose and service users guide and is also on display in the foyer. This does however need some updating and improving to make sure that the information on the services provided is up to date, clear and in sufficient detail to leave no one in doubt as to the range of general and specialist services on offer to meet individual needs. Also up to date information on staffing in the home, their numbers, relevant qualifications and experience, the number and size of the rooms in the home and fire precautions and emergency procedures. In this way people thinking about using this service can make a fully informed choice about whether or not the home is suitable for them. Consideration should also be given to providing information in different formats, such as large print and audio to meet particular needs although the manager said if asked for this would be provided. Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7, 8, 9, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of residents are being assessed and planned for within individual care plans to promote peoples health, personal and social care needs. EVIDENCE: Informative care plans have been developed for all the people who live in the home from their initial assessments and with their involvement or their family. This ensures a personalised care plan is developed with them that reflect both the personal and healthcare needs as well as social and emotional needs. A social history is completed which helps to give staff a better understanding about the individuals personality and what is important to them, this is particularly valuable for people who are unable to communicate themselves. The health care records are also detailed and up to date with regular reviews and evaluations of care. This was particularly evident in the care and
Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 13 management of wounds and included specialist advice and support on a regular basis. Management plans are in place for specific problems and needs. There was evidence of changes in conditions and needs being acknowledged, recorded and responded to in a timely manner ensuring people were getting the care they need, including referrals to other agencies. The staff also complete a handover care record noting any significant events, which is passed onto the nurse on duty who in turn at the end of each shift completes a daily care record on each persons care plan. This helps ensure pertinent information is shared with the other shift and so continuity of care is promoted. Overall the staff display an awareness of the importance of providing sensitive support that supports a persons dignity and their personal beliefs. There were some occasional exceptions when this was not evident which senior staff need to be watching and correcting. For example one person with dementia who had a catheter bag did not have this discreetly concealed whilst they sat in the lounge so others passing could not see it. This did not promote their privacy and dignity nor did starting to feed ice cream and potato together at end of main course and start of pudding on McKenzie unit. . Another person spoken with on the nursing unit said staff helped them as they wanted and they had a bath everyday as they wanted, which their records confirmed and said of their care “it couldn’t be better”. Records for receipt, administration and disposal of medication are good and it is clear which medicines residents have received and all medication could be accounted for. The service has recently introduced regular stock checks of controlled drugs to ensure that they were handled properly and to identify, and deal with, discrepancies without delay. Most regular medication was given as doctors intended and improvements found at the last visit maintained overall. However some medication for “when required” sedative medication for one person, was not being managed properly and their care plan was not followed placing residents at risk of unnecessary treatment and over-sedation that could affect their health. The person who was prescribed, “when required” sedation received it at least once and sometimes twice a day. Although there were care plans in place to ensure appropriate use these were not being followed and the daily progress reports failed to justify why it was administered. Medication was sometimes crushed before administration but there was no record of this been discussed with people involved in the care of the resident regarding the appropriateness of this. Ordering procedures must also be reviewed as medicines sometimes ran out for periods of up to five days and residents were unable to receive the medication they needed. Heron Hill Care Home DS0000059537.V334854.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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are able to make lifestyle and day to day choices, follow their own interests if they want and maintain social and family contacts. EVIDENCE: Since the last inspection a new activities coordinator had been appointed who is responsible for planning and facilitating activities both in the home and in the local community. It was evident from discussions with people living in the home, relatives and staff that this was working effectively. Discussions with the coordinator indicated an enthusiasm and understanding of individual preferences and different needs. There have been recent trips out at resident’s suggestions such as to a bowling alley for an evening out and some of the men living there are going to the local pub on Fridays for an evening out, which is a popular choice amongst some more active people living there. On the day of our visit in the morning a group of people got together in one of the communal lounges for a music/sing-along activity. The activity coordinator and a member of care staff supported the group activity, which was enthusiastically received. This was obviously a popular event and provided people with a stimulating and enjoyable social activity.
Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 15 An activity plan for the week is displayed on each unit with a morning and afternoon activity planned for each day, which people could chose to attend. The coordinator also goes around all units each day to remind people what is on. This included tabletop activities, reminiscence groups, exercise sessions, music sessions and entertainment, floor games, a quiz and social outings in the local area. Staff had a good awareness of people’s abilities and encouraged and supported people to participate in some cases on a one to one basis, such as the manicures. Some people spoken with preferred to be less involved in planned activities choosing to watch television in their bedrooms, listen to their music and read and one person spent a lot of time on their computer. One person said “its just I prefer my own company”. Some people were going out for walks with staff when their condition and staff numbers remaining made this safe. A further part time activities coordinator has just finished induction and it is hoped will cover arts and crafts activities when they start work. The planning and provision of recreational opportunities is more person centred than at previous visits and is making better outside community links. The coordinator was very aware of the people living there as individuals and tried to use their life experiences as a starting point for social and cultural pursuits. Records were kept of the value of different activities for people and further ideas and areas to look at and social inclusion plans form part of the care plan. There is information on advocacy services and from the Alzheimer’s society on this condition and leaflets about help with fees and care notices in the foyer. Also there are notices reminding people living there that they have the right to see their care plans at anytime. During the day there was a relaxed atmosphere on the units with staff enjoying a healthy social banter with people as they went about their work and supported people. One inspector joined a group of people for lunch in the dining room on Cavell unit where they had been given a choice of two hot meals or a cold alternative earlier in the day. For some people who are not able to make a choice there was detailed information on the care plan regarding their nutritional needs likes and dislikes, which enabled staff to make suitable choices on their behalf to promote a healthy and balanced diet. The food served was well presented using fresh ingredients. For people who required pureed food the food had been liquidised separately which enabled people to still enjoy the different flavours and also looked appetising. Some people required staff support to eat their meal, this was done in a sensitive way with staff sitting alongside the person and providing encouragement and support in a dignified manner. However one person being assisted to eat on MacKenzie unit received less sensitive support when given ice cream and potato together at end of main course and start of the pudding. Heron Hill Care Home DS0000059537.V334854.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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16, 17 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives are able to express their concerns through an effective and accessible complaints procedure and protection is promoted by an efficient adult protection policy and practices. EVIDENCE: The home has a complaints procedure that is displayed on units within the home, the system in use logs complaints raised for investigation and the procedure is available in the statement of purpose and service users guide. Copies of correspondence and details of investigation are kept on file and the manager copies CSCI into records of formal complaints investigations, outcomes and actions are recorded in the log and on file. In addition there are contact numbers for other agencies including social services and the Commission for Social care Inspection (CSCI). There have been 12 complaints received in a 12 month period and all of these have all been responded to within the 28 day timescale stated in the procedures. Records indicate that the complaints procedure is being followed and the organisation has responded effectively to complaints that are brought to them. The manager reports back to other agencies involved with complaints about care, including social services and PCT as commissioners of care and the CSCI as regulators.
Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 17 Day to day issues that people raise can be dealt with by nursing staff on the units if brought to their attention or passed to the manager if they cannot resolve it. Adult protection procedures are in place and local multi agency guidance available to staff and additional information on contacting the lead agency for rapid referral. There are also detailed procedures regarding Protection of Vulnerable Adults (POVA) processes and on referral to the POVA register. The home has acted quickly, following its own procedures, where adult protection issues have arisen and have worked well with lead agencies and regulators to try to protect people when this has been needed. Training records show staff are being given training on adult protection and responding to suspicions of abuse and staff spoken with confirm this. During the visit the clinical manager, who has been trained on safeguarding vulnerable adults, was holding a teaching session for a group of staff on safeguarding practices. An examination of the teaching tools showed that practical scenarios were being used to help teach staff about detecting and preventing abuse and these included considering the different expectations of other cultures and ethnic groups. Training videos are also in use and staff spoken with were able to explain what they felt they would do if they suspected a resident was being abused and were aware of POVA issues. Staff spoken with said that they felt able to raise any concerns they have and one said they were “not afraid to raise issues”. There are satisfaction surveys in the foyer for residents, relatives, staff and healthcare professionals to fill in with their views and opinions to encourage people to put forward opinions and suggestions for improvements. There is evidence that these suggestions have been acted upon. Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19, 20, 21, 22, 23,24, 25 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 the people living there to live in a safe, well-maintained and comfortable environment with equipment and aids that encourage independence. EVIDENCE: The home has dedicated cleaning staff to maintain a clean and hygienic environment and there were 2 on each unit during the visit. There were no lingering malodours noted on any of the units and all areas visited were clean and hygienic. Staff were observed to be following infection control procedure and staff have liquid hand gels that they were using appropriately. Gloves and protective aprons were available on each unit and being used. There is sufficient communal space in lounges and dining rooms for people to relax or join in an activity on each of the units and a separate hairdressing
Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 19 room on Nightingale and an activities room on Cavell, although the dining room on McKenzie can be crowed when full. All bedrooms are single rooms and have their own en suite toilet, hand basin and shower and there are separate toilets close by and bathrooms with assisted bathing aids. Bedrooms are well furnished and the soft furnishings coordinated. Bathrooms, toilets and showers are all sufficiently large enough to allow wheelchair access and for the use of equipment. Care assistants were observed on all units using moving and handling equipment to assist residents. This was done maintaining resident’s dignity and with explanation and in line with the care plans. Satisfactory sluicing and laundry facilities are separate from resident’s facilities. There are suitable adaptations in the home, with handrails in corridors, a passenger lift and moving and handling equipment in place to make people comfortable and promote their independence. Call bells are in resident’s bedrooms, toilets, bathrooms and communal areas. Those nursed in bed were observed to have bells at hand. Adjustable nursing beds are used following assessment and the manager has just bought more of these beds. Several residents spoke with the inspectors and showed us around their bedrooms. Many had brought in their own possessions and pictures to make the rooms more personal Although the environment is comfortable and clean it was observed that because all the bedroom doors are the same type it could be confusing and hard for people with dementia to tell one room from another. Some people are not able to easily recognise their doorplate and number making them more reliant on staff to find their way around. Several people on Cavell were heard asking which was their bedroom. It would make the environment more accessible for people with dementia if ways to differentiate areas of the home like their bedrooms and toilets could be found that were meaningful to them. This good practice measure would promote easier recognition and support personal independence. Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of care staff on the duty rota are sufficient to meet resident’s personal and health care needs. EVIDENCE: Based on discussions with care staff and nursing staff and from observations during the visit the staff work well together as a team with a good mix of experience. They have clear lines of accountability and communication between them is generally good. Staff members spoken with said they “felt comfortable raising issues” and said management were “approachable and supportive”. Regular staff meetings take place on each of the three units, which provide another opportunity to discuss relevant issues and ensure a continuity of care is maintained. Records show the meetings are well attended and staff members confirmed that they contribute to the agenda for them. On the day of this visit there were sufficient staff on the day and night rota and on duty during the visit to meet resident’s personal care needs. There were two registered nurses and 5 care staff on the rota and on duty for the 31 people presently living on Nightingale general nursing suite during the busy morning period. Cavell, the EMI nursing suite with currently 28 people living on the unit had two qualified nurses and four care staff on duty during the morning period.
Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 21 Although there were a large number of people with high dependency there was a relaxed atmosphere and people’s needs on the whole were attended to in a timely manner. However some people who needed staff assistance to move were sat in the dining room after their meals for some time, which is not ideal and could have been avoided if a member of staff was available to support them in the lounge area. On Nightingale a member of catering staff helped at the meal so freeing a staff member. The staffing levels on each of the units should be kept under review to make sure they reflect the needs of the current group of people living there. Overall the atmosphere on McKenzie unit was calm and relaxed. There were four members of staff on duty during the day, one nurse and three carers. Staff are receiving a good level of training including a thorough induction to the home and training in both core and specialist subject areas, such as palliative care and dementia awareness training. One senior carer said, “I love my work, I am encouraged to train” they also felt the feedback they got at appraisal was “constructive” and felt that morale was much improved amongst the staff. All mandatory training is up to date and staff said training requests were responded to and personal development was encouraged and supported. NVQ training is provided and the home has over 50 of care staff with this qualification at level 2 and some at level 3. Some staff have also been on an English Language course (ESOL) as English was not their first language and several others are due to take it to improve their English language skills. Originally a pilot this scheme has been so successful it is now being run by social services on a more established basis to help improve language skills. The home has an annual training plan for this year drawn up involving the manager, clinical manager and staff covering individual training needs. Staff records and their comments on the recruitment process indicated that the homes procedures are being followed. Satisfactory recruitment and selection procedures, Protection of Vulnerable adult (POVA) and Criminal Record Bureau (CRB) checks and nursing registrations checks have been done been for the staff. There has been only one staff member leave since the last inspection and no agency staff have been used. Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 22 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 32, 33, 35, 36, and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is open and there are quality monitoring systems in operation to promote and safeguard the best interests and welfare of people living there. EVIDENCE: The home has a suitably qualified and experienced manager who is registered with CSCI. One survey response from a relative was very positive and noted that under the present manager “the care has much improved”. There is also a deputy or clinical manager in post who assists the manager especially in training and overseeing clinical areas in the home and has proved an effective addition to the management structure. There are clear lines of accountability
Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 23 for staff within the home and nurses and carers spoken to were clear about their roles. Staff spoken with said they have regular staff meetings and minutes show the topics discussed. Staff do have a grievance process if they want to raise more formal concerns with management and staff spoken with said the manager was “supportive and approachable”. And another said that the manager “always listens” even though she is very busy. Staff members, both care and nursing, confirmed they felt there was good teamwork and some talked about the benefits of staff meetings and having regular supervision. Records show that senior staff provide regular formal supervision where staff can discuss practice issues or concerns and training and personal development issues. Items discussed at the staff meetings also indicate that practices are monitored by senior staff to promote good practice and the following of procedure. Quality audit questionnaires are completed by relatives/visitors, professional agencies and residents, after which the manager prepares an annual report and looks closely at any issues raised for action and displays the results in the home. This years survey is due to be collated. Survey results are presented in an easy to follow pictorial format. There are also regular resident’s and relative’s meetings to allow for general discussion and feedback. The home manager has a separate business plan for the year based on monitoring and looking at service provision across departments and what the home intends to do over the coming year. This includes purchases such as nursing equipment including 10 more nursing beds and a plasma digital television for use by the residents. The manager and senior nursing staff have done reviews of procedures and working systems in the home in line with changes in practices or legislation and undertake audits of aspects of the service such as recruitment practices to ensure good practice is maintained. The providers require a quality assurance report monthly and information is gathered in respect of changing needs for social services in respect of their clients. Policies and procedures are in place to protect financial arrangements. Only small amounts of money are kept on resident’s behalf and these are recorded and checked for accuracy by the administrator and manager. There are working practices in place to minimise the risk of accidents and the home has a comprehensive range of policies and procedures in place to help promote the protection of residents and staff. Records of testing and cleaning indicate that the home has systems in operation, and training given, to promote resident health and safety. Records showed that fire training had been given to staff and fire risk assessments updated in line with new legislation. Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 25 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 OP9 Regulation 13 (2) Requirement The registered person must ensure that medicines are given as prescribed to prevent residents receiving unnecessary medication. (This was to be met by 15/04/07) Care plans for managing medication must be followed to make sure residents receive safe and effective treatment. Procedures for crushing medication before administration must be reviewed to ensure it is appropriate and safe to do so. Procedures for ordering medication must be reviewed to prevent them running out so residents always have the medication they need. Timescale for action 01/08/07 2. OP9 13 (2) 01/08/07 3. OP9 13 (2) 01/08/07 4. OP9 13 (2) 01/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 26 No. 1. Refer to Standard OP1 Good Practice Recommendations The statement of purpose should contain up to date information on staffing in the home, their numbers, relevant qualifications and experience, the number and size of the rooms in the home and fire precautions and emergency procedures so that people thinking of using this service will have clear information to help make an informed choice. Senior staff should be monitoring and correcting any slips in practice so people’s dignity is always upheld during daily routines and at mealtimes. If people’s needs mean thy use a catheter bag this should be discreetly concealed to ensure individual’s dignity is always maintained. Ways of making the environment more accessible for people with dementia should be explored and ways found to make recognition of bedrooms and other areas easier for them to promote people’s independence. The staffing levels on each unit should be kept under review and should be adjusted as necessary to reflect and meet the needs of the current group of people living there. 2. 3. 4. OP10 OP10 OP22 5. OP27 Heron Hill Care Home DS0000059537.V334854.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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