Inspection on 02/06/08 for Heron Hill Care Home

This inspection was carried out on 2nd June 2008.

CSCI found this care home to be providing an Adequate service.

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 13/06/07

Heron Hill Care Home 07/03/07

Heron Hill Care Home 16/05/06

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Heron Hill Care Home Esthwaite Avenue Kendal Cumbria LA9 7SE Lead Inspector Marian Whittam Unannounced Inspection 2nd June 2008 09:30 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.V365018.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.V365018.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 (Huntingdon) Ltd 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.V365018.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 13th June 2007 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 £612.00 plus nursing contribution (social services fees) to £700.00 plus nursing contribution (private funded) as at the date of this inspection. There are additional charges to residents for hairdressing, private chiropody, papers and magazines and any personal toiletries. Additional charges for people living there who fund their own fees privately do not apply. Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This site visit to Heron Hill Nursing Home forms part of a key inspection. It took place on 02.06.08 and we (The Commission for Social Care Inspection, CSCI) were in the home for seven and a half hours. Information about the service was gathered in different ways: • Annual Quality Assurance Assessment document completed by the manager identifying what the service does well and what could be improved and how they plan to achieve the improvements. This was returned to CSCI in good time before the visit. • The service history. • Interviews with residents, relatives, visiting professionals and staff of various grades in all departments on the day of the visit. • Observations made by us in the home during the visit. • Completed questionnaire survey forms from people living in the home, their relatives, staff working there and from healthcare professionals coming into contact with the service. During the visit we spent time with people living in the home and talking to them about their experiences. We looked at care planning documentation and assessments to ensure the level of care provided met the needs of those living in the home and made a tour of the building to inspect the environmental standards and spent time with them in the communal areas at different times of day. We observed activities and records of what is provided. Staff personnel and training files were examined and a selection of the service’s records required by regulation. The pharmacist inspector also visited the service as part of this key inspection and assessed the handling of medicines through the inspection of relevant documents, storage and meeting with the manager and residents. This inspection took five and a half hours. What the service does well: The home is being 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 comfortable and the service provides aid and equipment people need to promote effective care. Several people were happy to show the inspectors how they had made their rooms more personal Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 6 by bringing in their own possessions, pictures and items that held significance for them. The care planning system in use generally focuses on the individual and they are developed with people living there wherever possible and/or with help from their relative/advocate. The service puts a lot of effort into developing and maintaining social activities and the people organising this are enthusiastic and residents appreciated and commented on this saying, “ There is an excellent person who provides entertainment”. People speak well, overall, of the staff and care they give and we saw that they generally interacted well. A relative told us, “The staff all seem to care about all the residents in the way they behave towards them”. 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. There are robust recruitment systems in place to protect residents’ interests and staff have access to a range of training to develop their skills and knowledge for the benefit of people living there. What has improved since the last inspection? The Statement of Purpose has been updated and improved to make sure that the information on the services provided is up to date for people who may be considering using the service. The service has also reviewed its pre admission assessments to try and get detailed information to make sure they can meet people’s needs before they come to stay. The manager had reviewed procedures for managing medicines that are liable to misuse (called Controlled Drugs). These medicines are checked every day so that discrepancies are identified and dealt with promptly. Improved working relationships with some GP practices have been developed to improve the service to residents. The numbers of staff achieving NVQ in care continue to increase to improve staff skills. Recently to improve infection control alco-gel dispensers have been fitted on the ground floor and at the entrance for staff and visitors to use to help minimise infection risks. Also soap dispensers and towel dispensers have been fitted in toilets to cut down on the risks from cross infection. The service has implemented an infection control audit to monitor the effectiveness of practices and procedures and has a link nurse for this who also provides training for staff. Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 7 As part of its annual development plans the service has bought more nursing beds, this improves people’s comfort and makes moving and handling practices safer. Outside we saw that improvements have been made to the patio areas, extending them and providing garden furniture, making this a more comfortable and attractive place for people to sit out. The activities coordinator has been working with residents on a project to help promote easier recognition for people of their personal bedrooms and so support their independence. What they could do better: The service should take care to make sure that peoples’ care plans are always updated if their personal care choices change so they consistently receive the care they want. Care plans relating to medicines should contain clear detail of how they are managed to ensure people receive safe and consistent treatment. Care plans for administration of “when required” medication should be more detailed so that staff have clear instructions to follow and to make sure people get appropriate treatment. Some medication practices still need to be improved and maintained to protect residents’ health. There must be a system put in place for checking for unexpected changes in medication to prevent errors being made. Medication should be checked on receipt and any unexpected changes should be queried promptly so that people receive the correct treatment. Medications that have not been administered for a long time should be reviewed with the doctors and administered if indicated to make sure people get the treatment they need To reduce the risk of mixing-up medication the service should make sure that medicines are prepared for administration at the time that they are given and not beforehand. Appropriate hygiene measures, such as hand washing, should always be followed when administering medicines, especially eye drops, to reduce the risk of cross-infection. Support must be given promptly to people who need this at mealtimes so they get their food hot and are assisted in a way that always promotes their dignity and enjoyment of meal times. The use of appropriate dining aids such as plate guards should also be considered where people have problems at meal times to promote their independence. The staffing levels are generally being improved on the general nursing suite but should also be looked at on Cavel EMI suite. They should be reviewed and adjusted as necessary to reflect and meet the needs and dependency of the current group of people living there. As part of such a review the manager should look at the current work shift patterns to make sure staff do not work excessive hours in order to maintain staffing as this may affect the staff’s ability to work safely and consistently for residents with complex needs. Record keeping is of a generally good standard but when dealing with Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 8 resident’s cash we recommended that to promote 2 people witness and sign and that someone who does not normally handle the cash transactions carry out a regular audit on this. This would be an extra safeguard for the residents and administrator. We were concerned that during the visit we found inconsistencies in the evidence we had obtained through formal surveys and that gained through more informal conversations with people in the home. The Provider must review the support available for those who wish to raise concerns about practice matters. This includes strengthening whistle blowing and grievance procedures, considering the effectiveness of different management styles and methods of communication and staff support. This may help to create a more open, inclusive atmosphere and more robust whistle blowing processes. 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.V365018.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.V365018.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, 3, 4 and5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission procedure ensures a full assessment of needs is completed prior to admission and that there is information for people to find out about the home before going there. EVIDENCE: The Statement of Purpose and service user guide for the service has recently been updated and improved so prospective residents and their families have up to date information to help them in their choice of home. The information was clear and states what the service offers to provide and what it does not. There is also a colour brochure with photographs of the home inside and out to give people an idea of the environment and facilities. The information the service provides can be made available in other formats if required and requested by people to meet particular needs. Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 11 People told us they had information about the service before they moved there and survey responses supported this. For some people we talked to their families had been given the information acting upon it for them. The notice boards in the foyer of the home also give information about what is going on in the home and the daily menu choices. There are also useful information pamphlets for people to take and satisfaction surveys for people using and coming into contact with the service to complete if they wish. The manager or nursing staff do the pre admission assessments before they accept a resident to try to make sure that they can meet their needs and prepare their admission. Prospective residents and relatives are encouraged to visit the home and look round before making a decision. There is a trial period following admission followed by a care review to make sure that the home is meeting peoples’ needs and expectations. We looked at eight peoples’ pre admission assessments that had been done to make sure the home was able to meet an individual’s needs before they came to live there. The pre admission assessments we looked at contained the relevant information from which to develop an individual care plan. We discussed with the registered manager and clinical manager the need to include as much as possible about the individual resident in the assessment process to get their thoughts and feelings before admission so any particular issues or difficulties could be planned for and supported. Where the care assessment has been done by social services a copy is included in the care plan. Where appropriate other care agencies and professionals have been involved in providing information before admission and advice after admission. The service does not provide intermediate care. Heron Hill Care Home DS0000059537.V365018.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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s health and personal care needs are being assessed and planned for within individual care plans but extra care is needed to ensure that medicines are administered safely and hygienically. EVIDENCE: All residents have an individual plan of care that is clearly set out and easy to follow. The information in the plans was well organised and is based on initial assessments and set out individual’s health, nursing and personal care needs, including individual clinical risk assessments. Care plans set out the health and personal needs and nursing problems and the nursing and care actions needed. A social history is completed which helps to give staff a better understanding about the individual’s personality and what is important to them, this is particularly valuable for people who are unable to communicate themselves. Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 13 The health care records are generally detailed in relation to personal and nursing care and up to date with regular reviews and evaluations of care. However, we looked at a care plan for one person that stated it was their choice to have a bath twice a week, we spoke to them and they had asked for this. Daily records showed they had only ever been assisted to have a shower since admission. We spoke to the manager who said their choice in this respect has changed. In that case this should be clear for staff in the plan and if their choice has not changed a bath should be given. Care plans did not always give clear instructions on the use of “when required” medications. For example, some people were prescribed sedatives on a “when required” basis. On occasions two different sedatives were prescribed for the same person. The care plans did not include sufficient detail on choice of medication and under what circumstances they should be given. This may result in people receiving inappropriate and inconsistent treatment. Records show that people have good access to health care services and appropriate health care professionals to support individual needs such as dietician, speech and language therapists, physiotherapists and tissue viability nurses. Survey responses from local GPs and those we spoke to during the visit indicated that usually the service seeks advice and acts upon it to achieve people’s health care needs. We discussed how the service seeks to promote communication with local surgeries with the manager who has been trying to improve this. One practice now visits on a weekly basis to see their patients and this can be effective in improving continuity of care. Records of medication are being well kept and treatments received by the people who live there well documented. Overall medicines are managed adequately but extra care is needed to ensure that medicines are administered safely and hygienically. For example, on one occasion some tablets had been dispensed into a medicines pot with a slip of paper bearing the residents name for administration at a later time. This practice increases risk of medicines getting mixed up and people receiving the wrong treatment. On another occasion the nurse did not wash her hands before and after giving eye drops, some of which were antibiotics, and this could result in cross-infection. People we spoke to who lived there spoke well of the nursing and care staff and that they listened to them. One person told us that, “the nurses and carers are very good and nothing is too much trouble for them”. We spoke to several staff members and overall they displayed an awareness of the importance of providing sensitive support to people. This was evident for one person whose condition was deteriorating and the care management and support was clear in their plan. Visiting relatives told us they were kept well informed and the care they and the resident had received from staff was supportive and responsive to the changing condition and their palliative needs. Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 14 At lunchtime on Nightingale unit we observed at least 3 people wait up to 20 minutes for assistance with their meals and consequently got cold food. Another person had great difficulty getting food onto their cutlery and was not offered any aids to help them. This does not promote a person’s dignity or recognise their individual physical needs and assistance and support must be given promptly and appropriate aids should be used to promote people’s independence when eating. Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 15 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 using the service have a choice of good quality food and have opportunities to take part in group and individual activities and to follow their own interests if they want and maintain social and family contacts. EVIDENCE: We saw from surveys received before the visit, from observations during the visit and from talking with people living there that opportunities for general social and recreational activities in the home are being provided. All care plans had a social assessment and personal profile developed with them and their families to provide useful information and background on interests, hobbies and religious and cultural needs. We spoke with the activities coordinator who organises and leads activities, some in groups such as music and exercise and some on a one to one basis. They displayed great enthusiasm for their role and one person said that they wanted “to compliment the activities man, he was really good”. The activities coordinator was in the home during the visit and we saw him involved in both group and individual activities with people. There is also another part time activities person who concentrates more on art and crafts with people. The coordinator produces a weekly programme and Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 16 keeps detailed records of the activities people have taken part in, what they have enjoyed and any particular needs that have to be considered. People told us they did not have to take part in anything if they did not want to and one person told us that they do not really like activities but was always asked, they liked to watch television in their room but did like the visits from the ‘PAT dog’. The service has its own mini bus and several people have taken part in day trips out which they had enjoyed. It also helps people maintain community links and take part in outside activities such as bowling and for one person to keep up attendance at a luncheon club. The service also provides a mini bus service for family and friends leaving from Barrow In Furness every other Thursday to help make it easier for them to visit and stay in touch. There is also a computer for use by residents and relatives. The recently introduced ‘Newsletter’ also has information on activities and forthcoming events such as the planned Summer Fete. People have access to religious services within the home and pastoral support from clergy of their choice We visited the kitchen, which was clean and well equipped and spoke with the cook. There is a four week menu that offers choice and variety. People we spoke to told us the food was good and the survey responses supported this. We joined people at lunchtime in one of the dining rooms and saw that the food was well presented and people had chosen what they wanted and were offered second helpings. 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. Staff did give prompt assistance to the majority of people at lunch. We saw that staff were busy taking meals out to people who wanted to eat in the rooms but some staff stayed to help people to eat and enjoy their food. We saw that three people had hot food placed in front of them but they were unable to eat it without assistance. Staff did come to help but this was up to 20 minutes after the food had been given to them and so it was cut up and served to them cold, which could not have enhanced their meal. We saw one person struggle to get their food onto the cutlery and the use of aids such as plate guards should be considered where people have such problems to promote their independence and dignity. Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. The complaint, whistle blowing and adult protection procedures and training in the home promote the interests of people living there. Staff reluctance to ‘whistle blow’ could undermine the robustness of systems to protect people. EVIDENCE: The home has a clear complaints procedure that is displayed within the home and in the service user guide and gives contact numbers for other agencies including social services and the Commission for Social Care Inspection (CSCI). Survey responses indicate residents and relatives do, overall, know how to make a complaint and those made have been responded to appropriately. One person raised a complaint with us during the visit regarding the management and we discussed this with the manager during the visit and their approach to it. The person did not have a service user guide with information on making a complaint and staff provided one during the visit. We looked at the procedure and system in use that records complaints raised for investigation and keeps copies of correspondence and details of investigation on file. The manager copies CSCI into records of formal complaint investigations. There have been 12 complaints received by the service since the last inspection and all of these have all been responded to within the 28 day timescale stated in their procedures. Records indicate that the complaints procedure is being followed and the organisation has responded to complaints that are brought to them. The manager reports back to other agencies Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 18 involved with complaints about care, including social services and PCT as commissioners of care and the CSCI as regulators. One relative commented, “I have written a couple of letters in the past and they have always been dealt with effectively and efficiently”. 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 with lead agencies and regulators to protect people when this has been needed. There have been four safeguarding adults referrals made to social services since the last visit. Training records show staff are being given training on adult protection and responding to suspicions of abuse and both staff surveys and the responses of staff we spoke to with supported their understanding of the importance of this. There are clear whistle blowing procedures in place for staff to report concerns about colleagues and managers. We spoke to staff across departments and in different posts and levels of seniority and found in conversation a general reluctance on their part to use such ‘whistle blowing’ systems to report poor practices. Although aware of the procedures staff could not confirm to us that they would feel supported if they “blew the whistle” on practice issues. It is a matter of concern that staff express reluctant to speak out on matters that concern them because they do not have confidence in being supported by the senior management. Staff surveys did not support the views on management support found during the visit. Clearly there is inconsistency in the opinions being expressed formally by staff and informally. Such inconsistent findings suggest that there may be a lack of robustness in whistle blowing procedures. The Provider must review the support available for those who wish to raise concerns through whistle blowing and grievance procedures to ensure they feel able to report practice matters. Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 19 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, 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 environment within the home is of a consistently good standard providing resident’s with a well maintained, well equipped, clean, safe and homely place to live. EVIDENCE: The home is well maintained with a high standard of decoration and provides a fresh, clean, tidy and homely environment for residents appropriate to meet the needs of residents. The lounge and dining areas are comfortable and well furnished with good lighting and seating suited to a variety of social activities. The home has a programme of maintenance and safety testing and clear records are kept on this for examination including the servicing of moving and handling equipment. The service has its own maintenance person to attend to day to day matters and we saw them at work during the visit. Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 20 The service has procedures in place for infection control and is in the process of implementing a new audit system for infection control. Training records indicate that the staff have been given training on infection control. Laundry facilities are provided and situated away from the main living and food preparation areas. There are separate domestic and laundry staff covering 7 days a week and the staff hours have recently been increased to keep up with the workload. We visited the laundry which was well ordered and clean spoke to the laundry staff who were clear about the procedures to be followed reduce the risks of cross infection. The units have a sluice facility and disinfector to promote good hygiene. Recently ‘alco-gel’ dispensers have been fitted on the ground floor and at the entrance for staff and visitors to use to help minimise infection risks. There is sufficient communal space in lounges and dining rooms on each of the units for people to relax in or join in an activity. These areas were well lit and warm. We saw activities taking place in the lounge areas on Cavell during the day. There is a separate hairdressing room on the ground floor and an activities room on the first floor. Outside we saw that improvements have been made to the patio areas, extending them and providing garden furniture, making this a more comfortable and attractive place for people to sit out. All the 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. Bathrooms, toilets and showers are all sufficiently large enough to allow wheelchair access and for the use of moving and handling equipment. The bedrooms we saw were comfortable and well furnished and the soft furnishings coordinated. Many people have chosen to make their rooms more personal by bringing in their own items, such as pictures, photographs and ornaments. We spoke to people living there who confirmed that generally the home was clean and tidy. There is a range of equipment available, nursing beds, bathing aids and adaptations to help residents make the most of their independence and to get about the home. As part of its annual development plans the service has bought more nursing beds, this improves people’s comfort and makes moving and handling practices safer. The activities coordinator has been working with residents on a project to help promote easier recognition for people of their personal bedrooms and so support their independence. We saw this especially on Cavell, where people with dementia live, and where many people had created picture frames to go on their doors with pictures and images that held meaning for them. Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient staff who are trained and competent on duty to meet resident’s personal and health care needs but the practice of working long hours may undermine their long term effectiveness in dealing with some people’s complex and challenging needs. EVIDENCE: We spoke with several staff during the visit, nursing, care, support and ancillary staff and from what we saw and what people told us the staff work well together as a team with a good mix of experience and support each other in their work. Residents and relatives generally spoke well of the staff, one relative commented, “The staff in charge seem very knowledgeable about their responsibilities, as one would expect. There is a regular turnover of additional staff, I suppose due to the stressful nature of the job”. Staff rotas were clear and legible and observation during the visit indicated the home has sufficient staff on duty with a range of skills and experience to provide personal and nursing care for people living in the home. We discussed with the manager the need to monitor dependency levels on the nursing suites and adjust staffing levels accordingly. Staff levels on the nursing unit (Nightingale) have already been increased due to higher dependency levels. We examined rotas on Cavell EMI suite and found that the level of dependency on there was also high with falls risk assessments for many people at high risk Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 22 requiring supervision. We saw that many people wandered around the unit and that assessments indicated that as many as half the people living there needed some help at mealtimes. We recommended to the manager they review the staffing with regard to current dependency levels on the suite to make sure all needs could be consistently met. The rotas on Cavell suite indicated that many staff worked 12 hour shifts, as many as 5 in a row well in excess of their contracted hours and some had only short breaks between night and day shifts. We asked staff about this and found that this was not unusual and they sometimes felt under pressure to do this to keep staffing at a good level, sometimes at short notice. We discussed the staffing arrangements with the manager and examined the nursing and care staff rotas. We also discussed the physical and emotional pressures on staff providing care and support for vulnerable people generally and particularly when working long hours for long periods with people with dementia. Care plans show people on the unit have a range of complex and challenging needs and high levels of dependency both physical, psychological and social. We recommended the manager look at and review existing work shift patterns to make sure that staff are not having to work excessive hours to cover vacancies, holidays or sickness as this may affect the staff’s ability to work safely and consistently for residents. A contingency plan should be in place for such cover. Staff have individual training records and there is an annual staff training programme in place. These records and staff survey responses indicate that staff are receiving a good level of training including induction training and mandatory training such as moving and handling, infection control as well as more specialist subject areas, such as palliative care and dementia awareness training. Training is booked for staff on the new mental capacity act, resuscitation and first aid. NVQ training in care is well established and a high percentage of care staff have this qualification at level 2 or above. Staff records and their survey comments on the recruitment process indicated that the home’s procedures are being followed. We looked at recruitment records and found all safety checks were 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. Fourteen members of nursing/care staff have left in the last 12 months. Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 23 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, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are quality monitoring systems in operation to promote and safeguard the best interests and welfare of people living there but there are inconsistencies around management approaches that may affect staff inclusion in the way the home is run. EVIDENCE: The home has a suitably qualified and experienced manager who is registered with CSCI. In discussion with the manager we found she had an understanding of what needs to be done to continue to develop the services for people living there. Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 24 The registered manager and clinical manager have been effective in developing systems and monitoring practices to improve the services offered to people living there. Records indicate staff are given regular formal supervision and those we spoke to confirmed this. We talked with several staff in the home and their general comments indicated that their satisfaction with aspects of the management approach to some staff was not entirely positive. We were concerned from comments made to us that the running of the home may not always be open, transparent and supportive of the individual. However the survey responses from staff did not raise this issue and were more positive. Staff spoken with said they have regular staff meetings and minutes show the topics discussed. Staff do have a formal grievance process if they want to raise more formal concerns with management. However in conversation with staff some comments made indicated that staff did not have confidence in using the formal process for raising practice concerns. There were evident differences in the opinions being expressed formally and informally to us by staff and the differences suggested there may be a lack of transparency in management processes. The Provider must address this and review the support available for those who wish to raise concerns through whistle blowing and grievance procedures. This may help to create a more open and positive environment. There are quality monitoring systems in place and annual development is planned for improvements and capital expenditure. The providers require a quality assurance report monthly and information is gathered in respect of changing needs for social services respect of their clients. Quality audit questionnaires are easily available for relatives/visitors, professional agencies, staff and residents. The results are collated by the manager who prepares a report and looks at any issues raised for action. There are also regular resident’s and relative’s meetings to allow for general discussion and feedback. 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. We checked personal allowance files and all was in order. We noted that routinely only one person, the administrator, signs for cash transactions and recommended that to promote good practice when dealing with residents cash that 2 people witness and sign. This would be an extra safeguard for the residents and administrator. We also recommended that someone who does not normally handle the cash transactions carry out a regular audit on the cash and allowance files. Record keeping is overall of a good standard within the service. Discussions with the manager, observations and records confirmed that safety checks are being done and moving and handling and emergency equipment is being maintained and serviced through annual service level agreements. Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 25 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.V365018.R01.S.doc Version 5.2 Page 26 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 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 3 3 3 X 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 2 3 X 2 3 3 3 Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 27 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. Standard OP9 Regulation 13 (2) Requirement Timescale for action 16/06/08 2. OP10 12 (4) 3. OP16 12 (1) (5) There must be a system for checking for unexpected changes in medication to prevent errors being made and people getting the wrong treatment. Support and assistance must be 20/06/08 given promptly to people who need this at mealtimes so people’s dignity and independence is always upheld. The Provider must review the 20/06/08 systems and support available for those who wish to raise concerns through whistle blowing and grievance procedures. This will help ensure residents best interests are promoted. Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 28 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. 6. 7. Refer to Standard OP7 OP9 OP9 OP9 OP9 OP15 OP27 Good Practice Recommendations Care plans should be updated if a person’s personal care choices change so they receive the care they want. Medicines should not be prepared for administration in advance but should be prepared at the time that they are due to reduce the risk of tablets getting mixed up. Care plans relating to medicines should contain clear detail of how they are managed to ensure people receive safe and consistent treatment. Appropriate hygiene measures should be used when administering medicines to reduce the risk of crossinfection Medicines that have not been given for a long time should be reviewed with the doctor and administered if indicated. The use of appropriate dining aids such as plate guards should be considered where people have problems at meal times to promote their independence. The staffing levels on Cavel EMI suite should be reviewed and adjusted as necessary to reflect and meet the needs and dependency of the current group of people living there. The manager should review the current work shift patterns to make sure staff do not work excessive hours in order to maintain staffing as this may affect the staff’s ability to work safely and consistently for residents. The management approaches in the home should ensure that there is an open, positive and inclusive environment for both residents and staff. We recommended that to promote good practice when dealing with resident’s cash that 2 people witness and sign. This would be an extra safeguard for the residents and administrator. We recommended that someone who does not normally handle the cash transactions carry out a regular audit on the cash and allowance files to promote residents interests. 8. OP27 9. 10. OP32 OP35 11. OP35 Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Regional Contact Team 3rd Floor Unit 1 Tustin Court Port Way Preston PR2 2YQ 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 © 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 Heron Hill Care Home DS0000059537.V365018.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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