Inspection on 16/05/06 for Heron Hill Care Home

This inspection was carried out on 16th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Heron Hill Care Home 29/09/09

Heron Hill Care Home 23/07/09

Heron Hill Care Home 26/05/09

Heron Hill Care Home 02/06/08

Heron Hill Care Home 13/06/07

Heron Hill Care Home 07/03/07

Heron Hill Care Home 14/11/05

Heron Hill Care Home 22/04/05

Heron Hill Care Home 15/12/04

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 Heron Hill Care Home Esthwaite Avenue Kendal Cumbria LA9 7SE Lead Inspector Marian Whittam Unannounced Inspection 16th May 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 Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 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.V289330.R01.S.doc Version 5.1 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 Abbey Healthcare Homes Limited Mrs Susan Williams 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.V289330.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 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 14th November 2005 Brief Description of the Service: Heron Hill is a new purpose built home caring for up to 86 residents. It 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 for prospective residents and service user guides are available and in resident rooms 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 complaints procedure. The scale of fees charged ranges from £650.00 to £750.00 as at the date of this inspection. There are additional charges to residents for hairdressing, chiropody, dental care, papers and magazines and any personal toiletries needed. Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place on 16/05/06 with three regulation inspectors spending seven and a half hours in the home and a pharmacy inspector spending five and a half hours in the home. Before the site visit information had been gathered on the service from the providers. Information on the service provided was also gathered from residents using questionnaires before the visit. Before the inspection some relatives had contacted the inspector about their experiences in the home. Concerns raised by residents, relatives and other stakeholders were included in planning the inspection. Information was provided by other agencies involved with residents care. The morning was spent looking around the home talking with residents in the lounges and in their own bedrooms, speaking to the nursing and care staff, cleaning, kitchen and laundry staff, observing activities, speaking to activities coordinators and looking at care plans. Twenty residents were happy to speak to the inspectors about their experiences of living in the home and two visitors to the home. Policies and procedures, systems for recording complaints 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 provides a well maintained, comfortable and homely environment and residents spoken with told the inspectors that the staff helped them as they asked. Residents spoke well of staff caring for them. Staff were observed to interact well with residents and spent time talking with them and asking them what they wanted to do. Residents said how good the décor was in their rooms and several were happy to show the inspectors how they had made their rooms more personal by bringing in their own possessions and with pictures they had done during the art class. The food provided is well presented and varied. There is a relaxed atmosphere at meal times and residents are not hurried with their food. The home has worked hard to provide a varied activities programme and is continuing to develop this part of the service. Residents taking part in the activities enjoyed them especially the aromatherapy and art. The home is undertaking audits and has responded well to meeting requirements made at inspections and in learning from past mistakes and feedback from other agencies. Medicines storage is of a good standard. Staff are keen to improve medicines handling and act on advice promptly at the time of the inspection to ensure Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 Page 6 that risks to residents were kept to a minimum, for example, attending to medication query with a resident’s GP. What has improved since the last inspection? What they could do better: Although admission assessments have improved and are being done the home needs to make sure that the standard of assessment is consistent. Also that following the pre admission assessment the home is sure the nursing staff have the skills to provide the care or task needed to meet particular needs, in one case with male catheterisation, when a resident comes in. Although overall the improvements in the standard of care plans has been maintained it is still not always consistent in detail about some aspects of care such as tube feeding regimes. The psychological health of residents is not always regularly monitored even on those with diagnosed conditions that may deteriorate. The home must also make sure when doing any re assessments, such as continence, that the records are done by all staff to provide an adequate record and basis for re assessment. Whilst recording and monitoring of wound care is satisfactory, there are photographs of individuals wound areas in the care plans. Whilst this is a good Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 Page 7 monitoring tool there is no recorded evidence of consultation with and consent from residents and/or their representatives to take and retain such pictures. This does not promote resident’s choice and right to privacy and dignity. The system for receiving and checking stocks of medicines must be reviewed and improved to avoid medicines being out-of-stock and to enable residents to receive all the medicines that they need. Care plans need to be complete and accurate for management of some aspects of healthcare and medicines administration particularly with regard to “when required” or “as directed” medication so that residents receive a consistently high quality level of care. In order to improve information the home should make it clear to residents that they have the right to see their personal records if they wish. The home should also consult with residents and families on the promptness with which staff attend to residents when asked and take appropriate actions. The food provided is of a good standard however the cook should more routinely consult with residents and their representatives about menus and resident opinions on the food. Despite there being a complaints procedure in the home there is a need to make its use more obvious to visitors and improve the way verbal complaints and concerns raised by residents, relative and also staff are recorded and seen through. Residents and relatives can then feel confident that all their concerns are taken seriously and acted upon systematically. Staff should be clear about the need to record and pass on any verbal complaints and concerns brought to them to the manager. Access to call systems with an accessible alarm facility must be improved to ensure they are easily accessible for all residents in communal areas having regard for their conditions. Despite hygiene policies and procedures being in place staff’s adherence to hygiene good practice and guidance on preventing the spread of infection must improve to promote a uniformly good standard of hygiene. Domestic staff must always be provided in sufficient numbers to maintain a clean and hygienic state free from unpleasant odours at all times. The home should consider the way it arranges chairs in the lounges to maintain a more inclusive, homely atmosphere rather than institutional around the walls arrangements. The home does review aspects of its service however to improve annual development planning for the home it needs an annual development plan in place for the home based on a systematic cycle of planning. Where surveys are done and opinions sought the results should be collated and made available in the home and to the CSCI to improve communication. Some aspects of record keeping need improvement to protect resident’s interests. Records must be kept of water temperature testing at outlets and of fire drills in the home. Please contact the provider for advice of actions taken in response to this Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 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.V289330.R01.S.doc Version 5.1 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 and 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessments of needs are being done before and following admission including information from other agencies to promote the meeting of needs but assessments are not always consistently detailed to ensure all needs can be met by staff. Written information is available to residents in the statement of purpose and service user guide to help them make an informed choice. EVIDENCE: Individual resident care plans are in place and the overall improvements in documentation, admission and assessment procedures and record keeping, seen at the last visit, have been maintained. However some assessments were more detailed than others and the social assessment for one resident had not been done with them. Specialists have been consulted Macmillan nurse, intermediate support team, consultant, tissue viability nurse. However some male residents had been admitted to the home with urinary catheters when there were no nursing staff trained to replace them when needed. A GP had to attend to perform a nursing practice for these residents. Staff training was scheduled on male catherisation as this training need is now recognised. Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 Page 11 However at the time of admission these residents had been admitted when nurses did not have the skills to perform this aspect of care. Residents have been given contracts and survey responses and home records confirm this. Social and religious needs, hobbies and recreational needs have generally been assessed and written in the care plans. Some gave detailed pictures of social and recreational needs although for one resident seen this had not been done at all. Where appropriate care management plans have been obtained from social services. Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 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. However, it is not always done consistently to ensure all residents health and personal needs and preferences are met. Care staff treat residents with respect during care but some nursing care recording practices do not promote personal privacy. Medicines handling is in need of improvement in line with good practice guidelines. EVIDENCE: All residents have an individual care plan and these have generally been reviewed at least monthly. Risk assessments are in place including for those at risk of falls. There was evidence within social assessments that residents and where appropriate relatives had been involved in them. Some residents with dementia were not able to offer an opinion or sign their care plans. Generally care plans are clear, well laid out and gave detailed information for care staff to follow, reviewed monthly and evaluated. Appropriate risk assessments have been done. Where particular needs had been identified plans were in place for mangement, for example a resident with particular Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 Page 13 communication needs had a management plan to follow and evaluations of that including advice from the speech therapist . However this standard of planning is not always consistant. When recording giving personal care staff do not make it clear what has been done for example stating if a bed bath or long bath has been given. Some residents spoken with said they did not always get a bath as they wanted but a shower. One resident with a feeding tube did not have clear and detailed information on the amount of feed to be given and the rate to be delivered and time. One resident had a recorded problem with changing continence needs that required reassessment, monitoring had been started on continence but the chart had not been completed by all staff rendering the reassessment process useless. Residents weight is being recorded and monitored. However the psychological health of residents is not always monitored regularly, some psychological needs are assessed as part of individual plans but it was not done routinely on EMI residents with identified conditions. However staff are able to show a knowledge of residents mental health needs. Generally residents agreed privacy was respected and dignity maintained when being assistied with care, with meals and using equipment for mobility. Residents said they saw their GPs in private and that staff were good and very nice. Wound plans are in place, however in the care plans for some residents with wounds or pressure sores there were photographs of their wounds. There is no evidence or documentation that residents and/or their representatives have been consulted and consent given to take and keep copies of the photographs. Staff have received training on palliative care and using syringe drivers, used in the terminal stages of illness. Training has been given by a local hospice and the Macmillan nurse service. Policies and procedures for caring for the dying are in place. The pharmacist inspector examined medicines handling and found that some aspects of administration of medicines is poor. The quality of medicines handling particularly with regard to documentation required improvement in order to safeguard health and wellbeing of residents Improvement was noted in some aspects of medicines handling though further improvements are needed. A more detailed report of medicines administration is available from the CSCI Penrith office. Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 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. A programme of organised activities is provided that take into account resident’s preferences and suggestions. Choices about daily life and routines, contacts with family and friends where expressed were being maintained according to the residents recorded wishes. The home offered a varied menu and choice of food and catered for special dietary needs. EVIDENCE: The home has a programme of daily group and individual activities and organised social and musical events. Information on daily and occassional events is on the notice board and outside the activity room, including residents suggestions and residents say they are asked to participate, some said they preferred not to. One resident spoken with has a flat screen TV and Sky’ so liked to stay in their room and watch that. Residents were observed during an art session in the activities room and in group activities in the lounge. In one lounge residents were taking part in a group activity, others discussing a current interest topic and one reading the paper. Staff were observed talking with residents as their work routines allowed. Some seating in the lounges was set out around the wall and appeared insitutional rather than inclusive. Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 Page 15 One of the residents on Cavell suite was going to have an aromatherapy massage that they said they really enjoyed having. The homes 2 activities coordinators were in the home on each floor morning and afternoon 5 days a week. One residents plan showed how they structured their day around activities they enjoyed. Religious needs and preferences are recorded. Religious services, holy communion and visits from residents own religious ministers are being provided, although some chose not to participate. Care plans showed consultation on interests and assessment of this and on social inclusion. Some residents say they would like to be able to go out more, into town or shopping, The home is in the process of getting its own transport to do this for residents. Residents said that they could come and go as long as staff knew, have their meals where they wanted and see who ever they wanted to. Residents spoken with made a variety of comments about the food in the home. One said that “the meals are OK” and there is a choice of meals. Another that the food was “rather like hospital food and could do better”. Another that they really enjoyed their food. The menus provided by the home are on 4 week cycle showed a varied diet with a choice of food with lunch as the main meal. These were on display in the dining rooms but staff did not know which week they were on so could not explain to residents. It was hard to tell easily what the menu was for that day and there were no other formats to suit residents. There was no evidence that the cook consulted regularly with residents over menus before preparing them. Lunch was attractively presented and as stated on the menu for that day. Residents in the dining room were given assistance if needed and time was taken over the meal. Hot and cold drinks were provided. Information was available in the home on contacting advocacy services, some residents had legal representatives who acted upon their behalf and in financial matters. Personal records are available if a resident requests to see them and stored securely otherwise. Residents spoken with were not aware of this. Residents had brought their own posessions with them and many rooms were personalised to their taste. Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 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 . This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure and recording system that was displayed in the home. However some relatives did not have confidence in the way concerns and complaints raised are dealt with. Adult protection procedures were in place and training provided on this to staff to promote resident safety and wellbeing. EVIDENCE: The home has a complaints procedure to make a complaint formally, logs written complaints for investigation and the procedure is available in the service users guide. The complaints procedure is displayed on the home’s notice board and includes information on contacting the CSCI. However comments from relatives suggests that they are not always sure where to get information on making a complaint or how it is followed up and why concerns they raise with staff are not looked at under that procedure. Entries in care plans and comments from relatives indicate that there have been times when concerns about aspects of care have been raised and not always seen through to a satisfactory conclusion by unit staff. There is no evidence that such concerns are always passed to the manager to record,investigate or monitor as a valid concern/ complaint. Systems are in place regarding resident’s finances and the care of any money kept in the home for them. Adult protection procedures are in place and local multi agency guidance available to staff for guidance. Training records show staff are being given training on adult protection and responding to suspicions of abuse but not on POVA. Some newer staff spoken Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 Page 17 with had not had this and so were less familiar with the procedure. Training videos are in use. Staff spoken with were, however, able to explain what they felt they would do if they suspected resident abuse and were aware of POVA issues. Residents spoken with and survey comments indicate that residents knew who to speak to if they were unhappy with something. The manager has not recorded any written complaints since the last inspection. The manager’s office is by the front door and she is available in the home to speak with residents or visitors if they want to raise concerns. Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Heron Hill is well maintained and bedrooms and social areas are decorated and furnished to a satisfactory standard to provide a comfortable and homely environment for the people who live there. Infection control procedures are in place but some staff practices did not always support these. Aids and adaptations are provided to promote resident’s independence. EVIDENCE: The furniture, fittings and décor are in good condition and routine maintenance is being done. The lounges, dining rooms and residents rooms seen are warm, well furnished and comfortable with good lighting. Call bells are in resident’s bedrooms and the communal areas. However in lounges these are not always made easily accessible for residents with poor mobility if no one else is present to assist them. All bedrooms have their own en suite toilet, hand basin and shower and there are separate toilets close by and bathrooms. Satisfactory sluicing and laundry facilities are separate from resident’s facilities. Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 Page 19 Care assistants were observed using moving and handling equipment to assist residents’ from wheelchairs into easy chairs in the lounge. This was done maintaining resident’s dignity and with explanation. Several residents showed the inspectors their bedrooms and many had brought in their own possessions and pictures to make the rooms more personal. One new resident said that, the manager had discussed with them bringing their own possessions into the home before they came in. Some seating in the lounges was set out around the wall and appeared insitutional rather than inclusive and homely. The home has infection control policies and procedures and provide staff training. However a strong odour of urine was noted in a small number of resident’s bedrooms, a used commode was left in a bathroom, a used urine drainage bag, contents and tubing left open in a bathroom and used bed linen and used clinical waste bags observed in more than one resident’s bathroom. . Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 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 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 adequate. 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 adequate to meet resident’s personal and nursing care needs. Procedures for the recruitment of staff are satisfactory offering protection to people living in the home and staff training and supervision is being given suited to meeting resident’s needs. EVIDENCE: Only 1 domestic There are sufficient staff on the rota day and night and on duty during the visit to meet residents care needs. There are two registered nurses and 5 care staff on the rota and on duty for 30 residents on Nightingale suite during the busy morning. Cavell, the EMI suite was staffed with two registered nurses, one of whom was an RMN and five carers during the morning period. There is one registered nurse on the afternoon shift. The second floor EMI suite has 17 residents and a registered nurse on all shifts and 2 carers at present. This unit opened in February 2006 and is not yet full. There was only one domestic providing cleaning cover over all 3 floors on the day of the visit. This was due to sickness but such a level is not adequate to ensure standards relating to cleanliness and hygiene are maintained and to prevent unpleasant odours. Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 Page 21 One new resident’s relative said that they had found the staff to be, “helpful and welcoming”. Another new resident said, “staff are very nice” and another that they “like the staff” and that there are “plenty around to help”. However comments form relatives and suggest that residents sometimes have to wait for attention. Resident’s surveys from CSCI and comments during the visit indicate that staff do provide the care and support they need but for some they sometimes did have to wait for staff to be free. There had been 25 new members of staff since the last visit as resident numbers have increased and the second floor unit has opened. Nine staff have left since the last inspection including the registered manager. Staff turnover has slowed and the use of agency staff. Staff meetings are held and there is a grievance process for staff to use to raise concerns with management. Satisfactory recruitment and selection procedures Protection of Vulnerable adult (POVA) and Criminal Record Bureau (CRB) checks and nursing registrations checks had been followed for the staff. Staff training records indicated that appropriate training was being provided and induction training. NVQ training is underway and the home is making good progress in sending staff on this training to meet the standard. A unit manager was away on a course on tube feeding to enable her to provide training for staff. New staff were able to outline their training and induction and shadowing other staff before working alone. Nursing, care and ancillary staff spoken with did not raise any concerns about their work or access to training. Staff spoken with said they felt supported and had access to training. Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The acting manager has an understanding of the areas in which the home needs to improve to provide a consistent and safe service for residents. The home is reviewing aspects of its performance through self-review, surveys, audit and consultations that include seeking the views of residents, staff and relatives to affect the way the home is run. Some aspects of written recording are not consistent to promote resident’s interests. EVIDENCE: The registered manager left at the end of January this year and a temporary manager is in post. The temporary manager is familiar with the home and is aware of areas the home needs to improve and develop. They have begun the process for registration with CSCI. There are recorded staff meetings and resident/family meetings in the home to allow the sharing of opinions and ideas. The manager has done reviews of procedures and working systems in the home and undertakes audits of aspects Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 Page 23 of the service. Changes have been made to policies and procedures and new ones started where review has shown shortfalls. A quality assurance report is required monthly by the providers quality assurance system. However although there is evidence that the management team does plan and review aspects of the service there is no written annual development plan for the home that underpins the reviews being done and what the annual objectives are to improve outcomes for residents. There are surveys on display and available in the home to allow all visitors and health and social care professionals like doctors, district nurses and social workers involved with residents in the home to give their opinion and feedback on services. When collated the results these need to be displayed. Policies and procedures are in place to protect financial arrangements. Only small amounts of money is kept on resident’s behalf and these are recorded and checked for accuracy by the administrator and manager. Records and servicing contracts indicate that the home has systems in operation and training to promote resident health and safety. There is evidence that appropriate testing and cleaning being carried out to reduce the risk Legionella and water temperature testing to reduce the risk of scalds to residents. However when testing water temperatures records of the outlets tested must be kept. Records showed that servicing and maintenance of equipment is being done. Records showed that fire training had been given to staff and emergency equipment is checked and appliances serviced. However the home must record when staff fire drills take place. Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 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 3 3 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 3 2 3 3 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 2 Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 Page 25 Are there any outstanding requirements from the last inspection? NO 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. 2. Standard OP3 OP4 Regulation 14 (1) 18 (1) Requirement All aspects of individual need must be consistently assessed before admission to the home. Following individual assessments the home must ensure that the nursing staff have the necessary skills to deliver the nursing services the home offers to provide. Care plans must include detailed and accurate information on feeding regimes including rate and volume. Continence reassessments must be completed in care plans and professional advice sought. Resident’s psychological health must be monitored regularly. Administration The registered person must ensure that there is a continuous supply of medicines at all times. Record keeping The registered person must ensure that care plans contain appropriate detail relating to medication and health care such as DS0000059537.V289330.R01.S.doc Timescale for action 17/07/06 17/07/06 3. OP7 15 (1) 17/07/06 4. 5. 6. OP8 OP8 OP9 13 (1) 13 (1) 13 (2) 17/07/06 17/07/06 01/07/06 7. OP9 17(1)(a); 17(3) 01/07/06 Heron Hill Care Home Version 5.1 Page 26 clear documentation of specific health and medication management issues updating following hospital discharge care plans for use of “when required” sedative medicines 8. OP9 13 (2) Record keeping The registered person must ensure that administration and reasons for non-administration are documented. Record keeping The registered person must ensure that medicines administration records document the dose of medicine administered the correct time of administration time of once weekly osteoporosis medicine in relation to other medicines and breakfast hand-written MARs must be signed, checked and dated Record keeping The registered person must ensure that there is a system for checking medication for new residents. 11. OP10 12 (4) Photographs must not be taken 17/07/06 and retained of resident’s wounds without appropriate consent having been obtained to do so. A record must be made of all 17/07/06 complaints and concerns made by residents and relatives or persons working in the home and the actions taken to resolve them. Call systems with an accessible 19/06/06 alarm facility must be easily DS0000059537.V289330.R01.S.doc Version 5.1 Page 27 01/07/06 9. OP9 13 (2) 01/07/06 10. OP9 13 (2) 01/07/06 12. OP16 17 (2) Schedule 4 13. OP22 16 (1) (2) 23 (1) Heron Hill Care Home 14. OP26 13 (3) 15. OP27 18 (1) 16. OP33 24 17. 18. OP38 OP38 13(4) 23 (4) available for all residents having regard for their conditions. The home must ensure that staff follow hygiene good practice and guidance on preventing the spread of infection Domestic staff must always be provided in sufficient numbers to maintain a clean and hygienic state free from unpleasant odours at all times. There must be an annual development plan in place for the home based on a systematic cycle of planning, evaluation and review. Records must be kept of water temperature testing at outlets Records must be kept of fire drills in the home. 19/06/06 19/06/06 17/07/06 16/07/06 16/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP8 OP9 OP14 OP15 OP16 Good Practice Recommendations Staff should make it clear in the care plan in recording personal care what aspect of personal care has been given. Medicines with limited expiry after opening should be marked with the date of opening. The home should make it clear to residents that they have the right to see their personal records if they wish. The cook should consult with residents and their representatives about menus and resident opinions on the food. The home should make sure its complaints procedure and reporting process is made highly visible and easily available on all units at all times for all visitors to the home. DS0000059537.V289330.R01.S.doc Version 5.1 Page 28 Heron Hill Care Home 6. 7. OP16 OP20 Staff should be clear about the procedure to pass on all complaints and concerns brought to them whilst on duty to the manager. The home should consider the way it arranges chairs in the lounges to provide a more inclusive, homely atmosphere rather than institutional around the walls arrangements. The home should consult with residents and families on the promptness with which staff attend to residents when asked and take appropriate actions. The home should continue its current progress towards 50 of care staff with NVQ 2. Where surveys are done and opinions sought the results should be collated and made available in the home and to the CSCI. 8. 9. 10. OP27 OP28 OP33 Heron Hill Care Home DS0000059537.V289330.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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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