Inspection on 29/09/09 for Heron Hill Care Home

This inspection was carried out on 29th September 2009.

CQC 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 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 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 16/02/2010.

Key inspection report Care homes for older people Name: Address: Heron Hill Care Home Esthwaite Avenue Kendal Cumbria LA9 7SE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marian Whittam     Date: 2 9 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Heron Hill Care Home Esthwaite Avenue Kendal Cumbria LA9 7SE 01539738800 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): peterw@abbeyhealthcare.org.uk Abbey Healthcare (Huntingdon) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 86 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: 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 Brief description of the care home Heron Hill is a new purpose built home caring for up to 86 people with nursing needs and it opened to residents in October 2004. It is in a quiet residential area with access to the bus routes and the train station. The town centre of Kendal is about 2 miles Care Homes for Older People Page 4 of 32 Over 65 50 28 0 4 0 4 2 6 0 5 2 0 0 9 Brief description of the care home 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 homes own satisfaction surveys and the complaints procedure. The scale of fees charged ranges from 633.31 pounds, plus nursing contribution (social services fees) to 831.30 pounds plus nursing contribution (private funded). 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. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means that 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 29.09.09 and three inspectors were in the home for six hours. The Pharmacist inspector also visited the service as part of this key inspection. Information about the service was gathered in different ways: 1. This was our, ( The Care Quality Commission, CQC) second key inspection of Heron Hill Nursing Home within six months so an Annual Quality Assurance Assessment (AQAA) was not requested again in so short a time period. The AQAA is a self assessment and a dataset that is completed annually by all providers of registered services. It is one of the ways we gather information from the providers of services about their service and how they believe they are meeting outcomes for the people Care Homes for Older People Page 6 of 32 living there and using their service. The AQAA also gives us statistical information about the individual service and trends and patterns in social care. 2. We looked at all the information we have about the service, any changes they have made and how the management has dealt with any complaints or safeguarding vulnerable adults. We looked at what the management has told us about things that happened in the service, these are called notifications and are a legal requirement. We looked at the previous key inspection and any calls or visits we have made to the home since their last inspection. 3. We spent time talking to people who live at Heron Hill during the day and spent time with them at meal times. This helps us to see what happens during their day and ask what they think about the way the home is run for them. We also spent time talking with staff who work there on the night and day shift to get their experiences of working there. 4. We looked at any relevant information we had received from other agencies and organisations and any written comments people have made to us. During the day we spent time talking with people living at Heron Hill while they were in the lounges, dining rooms and also in private in their rooms. We looked at care planning documents and assessments to make sure that people received the level of care they needed and expected. We made a tour of the premises to look at the environment people lived in and what facilities were available to them. We also looked at staff training and recruitment files and a sample of records and safety assessments required by regulation. Our pharmacist also assessed the handling of medicines through the inspection of relevant documents, storage systems and meeting with the deputy manager and staff. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? The service has improved the way it handles medication. Records are good and regular audits are done to monitor progress, and to identify problems that can be dealt with quickly to keep residents safe from errors. The manager should continue to do this regularly to maintain the improvement in medicines handling seen at this inspection. It will also help establish a sustained track record of delivering good performance in medicines handling and managing improvement. The records for administration of when required medication gave information on why the medication was needed. This was good as it allowed easier monitoring of a persons condition, and it also showed that medication was given as needed and in accordance with the care plan. The service has made sustained improvements to the support it provides for people at meal times, including having more than one sitting for meals and having enough staff to try to make sure people can be supported individually to enjoy their meals. Improvements have been made to the management of complaints since our last visit. Concerns and complaints records indicated that complaints are now being fully recorded and outcomes and actions clearly stated, followed up and addressed fully. We found that incidents and allegations affecting the welfare of people living at Heron Hill are being reported to the appropriate agencies and followed up promptly. The new Care Homes for Older People Page 8 of 32 manager had been reviewing the way complaints are handled to see if there are more ways to improve the system. Since the last inspection all notifiable incidents reports required under regulation have been sent to CQC. Cleaning audits have now been put in place to monitor cleaning issues and the problems identified with lingering smells. Two more domestic staff have been employed to improve the general cleaning and carpet/upholstery cleaning regimes. Heron Hill now has a permanent manager in post who is suitably qualified and experienced for this role and holds both general and mental health nursing registrations. They are presently in the process of applying for registration with the Care Quality Commission (CQC). This process needs to be completed and the manager registered to fully meet the standard We spoke with several staff working in different areas of the home during the visit. They commented on there being a feeling of teamwork and lately a more relaxed atmosphere. What they could do better: On a few occasions we found medicines that had been refused by people, or were no longer required and were disposed of, had not been recorded so that they remained unaccounted for. An accurate record or all medicines that have been disposed of needs to be kept. This includes making sure that the running balances of medicines liable to misuse recorded in the controlled drugs register are always correct following disposal of medicines as sometimes these had not been amended. A formal procedure for checking medications following the discharge of residents from hospital needs to be put in place so that any changes to medication can be checked. Complaints handling has been improved but for good practice that the manager should audit the complaints procedure as part of quality monitoring to make sure the improvements are maintained and the system continues to improve. Generally the home is clean and tidy but but in some areas on Cavel and MacKenzie suites there were some lingering odours of urine evident. Whilst action is now being taken on this the manager needs to monitor the effectiveness of the new cleaning regime and equipment to make sure it is being effective in the long term in reducing and eliminating odours. The number of nursing staff with mental health nursing qualification is low in relation to the number of people living there with forms of dementia. The manager should make efforts to recruit RMNs or consider ways of supporting their registered general nurses gain qualifications in Dementia care so they have more specialised nursing knowledge of the varied conditions and behaviours. This would make sure that the skill mix was more suited to the needs of people with dementia and give a resource for other staff. Staff files we looked at indicated some newer staff had not received supervision as planned and some people had not had recent supervision although due. We recommend that the manager and unit managers make sure that supervision is done as planned with staff and at least six times a year. Care Homes for Older People Page 9 of 32 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People thinking of coming to live at Heron Hill are provided with information about the home and they have their individual needs assessed . Evidence: The home has a statement of purpose and service user guide that is subject to review, to keep the information up to date as changes occur. The service also has a colour brochure with photographs of the inside and exterior of the home to give people an idea of the facilities and location. The information in the Statement of Purpose and the service guide can also be made available, if requested in other formats to suit individual needs. There was a good level of information available for people and families to help them make a decision about using the service. There are useful information and leaflets on the notice board and in the foyer including information on The Mental Capacity Act, peoples access to their records and helplines and support agencies. The notice board has information about what is going on in the Care Homes for Older People Page 12 of 32 Evidence: home, including the activities programme, the menus, the latest satisfaction survey results and previous inspection reports. There are satisfaction surveys available in the foyer for use by anyone coming into the home to complete for feedback on their contact with the home. The new manager intends to undertake the pre admission assessments with people before they come into the home. The assessments we saw had all been done by someone qualified to do so and these were signed and dated when carried out. The assessments are to help make sure that the staff can be sure they will be able to fully meet peoples individual needs and expectations when they move in. People thinking of coming to live in the home, and their families, are welcome to visit the home beforehand and look around and speak with staff and other people living there. The new manager favours an open door policy for residents and families and staff and relatives we spoke to confirmed this was the case. There is a trial period for people following their admission to the home that is followed by a review of care with the person and their representatives and support agencies to make sure the home is meeting their individual needs and expectations. We looked at the pre admission assessments that had been done for people living in the home and at seven peoples in detail. Senior nursing staff had undertaken pre admission assessments in a persons home or other care setting. The assessments we saw covered the relevant areas of individual need and were in sufficient detail to identify what support and care a person would need on admission. We could see from peoples care plans that they had their admission assessments done promptly when they had come into the home and that these were being developed with people or their families where appropriate. We saw that where a care management plan had been done by social services a copy was obtained and information included in their assessments. This was also the case with information from nursing and medical professionals involved in peoples care. Care Homes for Older People Page 13 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Heron Hill have their health, personal and social care needs assessed and planned for. Medication handling and monitoring helps ensure peoples health and well being are promoted. Evidence: All the people living at Heron Hill have an individual plan of their care developed and this is generally well set out and easy to follow. We looked at care plans on all the three suites in the home and looked at seven peoples in more detail. We could see that the information in the plans had been based upon the initial assessments made before and on admission and set out peoples health, nursing and personal care needs. Generally initial assessments on admission had been done within 24 hours of coming to live in the home. Relevant clinical assessments had been done for each individual including nutritional needs and risk, falls, mobility and moving and handling needs and skin care and tissue viability. Care plans and strategies for management were in place and generally up to date. Care plans were being evaluated and changes made and all plans we saw were being fully reviewed on a monthly basis. Some entries in daily care records were not very detailed in what personal care had actually been given but had Care Homes for Older People Page 14 of 32 Evidence: general covering statements. The manager should consider making daily care records more detailed and recording the actual care and support provided and not a general covering statement. We could see that health care interventions and visits by professionals were being recorded and action taken when changes had occurred. Significant events sheets had been completed including evaluation and intervention sheets and what actions were taken to support and manage behaviours. The care plans we saw were person centered in style including family history, social contacts, important life events, social links, pets, choices and decision making, health wishes, spiritual needs, hobbies and interests, unfulfilled wishes and dreams. These provided a good picture of what mattered to people and what they wanted and this is especially important when supporting people living there who have communication difficulties. We talked with relatives visiting people in the home about the admission and care their relative received. Those we spoke with confirmed they were involved with the admission process which included sharing information about their relatives needs and preferences for the assessment and care plan. One relative we spoke to said they were Very happy with the home and that their relative Had settled in well and staff had got to know him quickly and made him welcome. Everyone is friendly and sociable. During the visit we observed that staff interacted well with the people living there and supported them as they wanted. We spoke with people living at Heron Hill to ask if they felt their privacy and dignity were maintained. Those who wished to and could express their opinions were positive on this aspect. One person told us they had lived in the home over a year now and told us that staff Always knock before they come in and always ask and explain before they do anything. One person told us I like it here, staff help me as I want. They praised the night staff for helping them get up early, as they preferred, and taking their time with them. As part of our inspection we carried out a pharmacy inspection and checked handling of medication on Nightingale Unit and, overall, we found that this had improved from our last inspection. We looked at records for the receipt, administration and disposal of medication and these were well completed to clearly show the treatment received by residents and reasons why medication was omitted. On only a few occasions we found medicines that had been refused by residents, or were no longer required, and were disposed of but had not been recorded so that they remained unaccounted for. The manager should ensure that staff keep an accurate record or all medicines that have been disposed of. We counted a sample of medicines and compared these with Care Homes for Older People Page 15 of 32 Evidence: records to check if they tallied and to show they were administered in the prescribed dosage. All but one of the samples were in order and this one discrepancy was discussed with the manager. We checked peoples files for information on changes to medication. All the changes seen on the administration records following visits by doctors were recorded in their files along with reasons for the changes so that it was clear that these were intentional. We also checked that changes made on one administration record were accurately transferred to the next record at the start of the new four-weekly cycle so that treatment was not interrupted. These records were all in order with no errors so that residents received their medications as prescribed by their doctors. We also checked a sample of care plans for the management of complex and when required medication and these were in order so that staff had clear guidance to follow to ensure treatment is safe and effective. The records for administration of when required medication also gave information on why the medication was needed. This was good as it allowed easier monitoring of a persons condition, and it also showed that medication was given as needed and in accordance with the care plan. We discussed with staff the medication of a resident who had recently been discharged from hospital. We wanted to see if medication was checked properly to make sure that any changes were intentional. We were told that in this case the actual medication that was returned with the resident was checked against the previous record and this was then updated. There was no written confirmation from the hospital of the medicines required by the resident. It was clear that staff did not have a formal procedure for checking medication such as ensuring written confirmation from the ward. It is recommended that this be reviewed by the manager so that the medicines received by residents after discharge are double-checked and changes can be confirmed as intentional. We checked medicines liable to misuse called controlled drugs and these were in order on all three units. The manager should make sure that the running balances are correct when medicines have been disposed of as sometimes these are not amended. Regular audits are done to assess the quality of medicines handling and to identify problems promptly so they can be managed quickly and effectively to reduce risks to residents from errors. The manager should continue to do this regularly to help maintain and to continue the improvement in medicines handling seen at this inspection. This will also allow the service to show a more sustained track record of managing and maintaining improvement in its handling of medicines. Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at Heron Hill have a choice of meals available to them and have the opportunity to take part in organised social activities or follow their own interests. Evidence: We spent time with people living in the home and observing their activities and staff interaction on all the three units during the visit. From our observations during the visit and from records and speaking to people living in the home and their relatives we could see that there are opportunities available for people to take part in a programme of organised activities and social events. The activities programmes are on display in the foyer and on the different suites and these include music and movement sessions, quizzes, 1 to 1 sessions, bingo, gardening, soft ball games, sing alongs and music. The programme offers people different activities morning and afternoon. The home also has a hairdresser who visits weekly for those people who want this service. During our visit we saw music sessions in more than one lounge with the homes activities staff and in another care staff were involving people with a soft ball game throwing it into a basketball hoop. This activity encouraged exercise and also social interaction. There was a healthy banter between residents and staff and people were obviously enjoying taking part. There are also planned social events with outside Care Homes for Older People Page 17 of 32 Evidence: entertainers and a popular musical entertainer has been booked for the following month. There are planned social outings, gardening sessions and art and crafts and manicure and hand massage on a 1 to 1 basis. Some people preferred not to take part in organised sessions and did not have to do so. One person on the nursing unit told us they had used the homes minibus to be able to attend a party they were invited to. The home provides opportunities for people to take part in religious observance or follow their own faith with access to their own priests or ministers. There is a regular multi denominational church service and holy communion for those who want it each month. The people we talked with who were visiting there told us they were made welcome by the staff and it was obvious that the staff knew them well. One relative who was visiting told us that their relative was now Eating well and we have seen a big improvement. There is always something going on here with plenty of activities. Staff are always chatting with people as they go about the home and always recognise us when we visit. We have no complaints it has been a good move for Dad. All the care plans we looked at had a personal profile and social assessment and preferences for people. Staff we saw with people spoke in a calm and kindly manner. We observed staff assisting people to mobilise using various types of hoists. On most occasions staff explained to people what was happening and reassuring them. The menus we saw and the food we saw being served to people at mealtimes was varied and nutritious and from what we could see and people told us was well presented and hot when served. The meals come from the kitchen area and are served by the staff. This was done in an unhurried and calm manner although many of people did need encouragement or assistance with their meals. The service has made sustained improvements to the support of people at mealtimes, including having more than one sitting for meals and having sufficient staff available to try to make sure people can be supported individually to enjoy their meals. We arrived as breakfast was being served and talked with one person who was going to the dining room to have cornflakes and a bacon butty. They told us the food was very good and that they chose meals the day before when staff came to ask them what they wanted. There is a four week rolling menu in place that is displayed on the notice board, which provides a good selection of healthy and nutritional meals. Individual nutritional assessments are completed and special dietary requirements were recorded. We could see that appropriate prescribed food supplements were in use for people with a poor diet. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Heron Hill have their interests and welfare protected by the complaints and safeguarding procedures that are in place. Evidence: The service has a complaints procedure, including timescales for action, and this is displayed throughout the home and in the service guide with contact numbers for appropriate agencies for support and information on advocacy services. The procedure is available in different formats, such as large print versions, should it be needed or requested. There have been four written complaints logged by the new manager since taking up their post and these were investigated appropriately by the manager. We looked at the recording forms used for these complaints and the responses and actions being taken to address them. We saw the recording was detailed and, where needed, prompt action had been taken to protect peoples interests, including suspending staff during investigations. This has improved since the last inspection and concerns and complaints records indicate that complaints are being fully recorded and outcomes and actions clearly recorded to make sure they have been followed up and addressed fully. The new manager had been reviewing the way complaints are handled to see if there are more ways to improve the system. We recommend for good practice that the manager audits the complaints procedure as part of quality monitoring to make sure the improvements are maintained and the system continues to improve. Care Homes for Older People Page 19 of 32 Evidence: There has been one investigation under safeguarding vulnerable adults procedures referred to social services by the new manager to protect peoples welfare and is being investigated by social services. There are clear adult protection procedures and guidelines in place to help protect the welfare of people living there and the local multi agency guidance is available for staff to refer to. The procedures are detailed and training records show that staff have been given training on safeguarding vulnerable adults and recognising what abuse may be. This should help staff be aware and act quickly should they suspect abuse. Staff we spoke to indicated that they had received this training and knew what the procedures were should a situation arise that needed referring to other agencies for someones protection. The home has whistle blowing procedures in place for staff to report concerns about the practices of colleagues and managers. Staff we asked about this were aware of the procedure and that this had been the subject of a review by the service providers. Staff we spoke with said that they had so far found the new manager to be very approachable and felt they would support them should they need to raise any concerns practice issues. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Heron Hill provides a comfortable and safe environment that is being well maintained and decorated to a good standard. Evidence: We made a tour of the building and the areas used by people living there. We found that the home was being generally well maintained and we saw the maintenance person attending to general maintenance matters during the day. Records are kept of any maintenance work needed and done. There is a programme of general maintenance and of testing of lighting, alarms and safety equipment and records are kept of this testing. There was a good standard of decoration within the home and it was clean but in some areas on Cavel and MacKenzie suites there were some lingering odours of urine evident. We spoke to staff member who said it is difficult to clean some of the furniture thoroughly as it is material and would still be wet the next day if done at night. We discussed these problems with manager who had already identified the problem and investigated.the causes. The manager had already begun to take action to manage this problem. New cleaning equipment had been purchased to try to deal more effectively with the problem of carpet and upholstery cleaning. Cleaning audits had been put in place to monitor cleaning issues and the problems identified and two more domestic staff employed to improve the general cleaning and carpet/upholstery Care Homes for Older People Page 21 of 32 Evidence: cleaning regimes. The home has domestic staff on each of the 3 suites and two more domestic staff have been employed to improve cleanliness and hygiene for the people living there. We recommended the manager to continue to monitor the effectiveness of their new cleaning regime and equipment to make sure it was effective in the long term in reducing and eliminating odours. There are policies and procedures in place for infection control. Training records indicated that staff have been given training on infection control. There are suitable sluice and disinfecting facilities on each of the 3 floors to promote good hygiene and these were clean, tidy and away from peoples rooms. There are also alco-gel dispensers on the ground floor and at the entrance for staff and visitors to use to help minimise infection risks generally. The laundry facilities are on the top floor of the home and well away from the areas used by the people living there. There are laundry staff to cover a 7 day period, although night staff will make sure any soiled bedding is laundered before they go off duty if needed. There is sufficient comfortable communal rooms in the home for people to relax in or join in social group activities. The communal areas are well lit and warm and there is an area on the ground floor for people to use the homes computer if they want and a smoking room for those who want to smoke. There is also a separate hairdressing salon on the ground floor. The people we talked with liked being able to get their hair done regularly. Outside on the ground floor there are pleasant patios with appropriate seating areas for people to use to sit out in good weather. All the bedrooms in the home are single occupancy and have en suite toilets, wash basins and showers for people. There are also separate toilets, shower rooms and bathrooms with assisted baths on all the floors. One person told us that although they had a shower in their en suite they liked to use The big shower room because there was Plenty of space to manoeuver. The bedrooms we saw were comfortable and well furnished and decorated and all the bedrooms now have nursing beds. There is a range of equipment in the home, bathing aids, nursing beds and moving and handling equipment to help people with mobility and independence. People we spoke with liked their bedrooms and many people on the dementia care suites had their own pictures or pictures of things that had meaning for them on their bedroom doors to help them recognise their own rooms and so make them better orientated and independent. Care Homes for Older People Page 22 of 32 Evidence: Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff on duty in the home to meet the personal and health care needs of the people living there. Evidence: We looked at the staff rotas and observed staff levels during the visit to assess if the staffing levels and skill mix on each of the suites was sufficient to meet the needs of the people living there. The rotas we looked at showed what staff were on duty, when and in what capacity. These and our general observations of staff levels and deployment during the visit indicated that there were sufficient staff on duty to provide general nursing and personal care for the people living there. We discussed with the new manager the need to frequently review staffing levels and skill mixes in light of any changes in dependency of the people being cared for. Staffing levels on both Nightingale, the general nursing suite and Cavel, the larger dementia care suite, had both been increased at the last inspection to help provide better support and prevent staff working long hours and we found that these staff increases had been maintained. However on the specialist dementia suites Cavel and the smaller MacKenzie suite we noted that there were very low levels of Registered Mental Nurses (RMN). Given that the home provides a nursing service for people with dementia there should be more nurses with this specialist training. We discussed this with the manager who was aware of the need to have sufficient specialist nurses in Care Homes for Older People Page 24 of 32 Evidence: their skill mix to support staff in the specialised care of people with dementia. Currently staff on the EMI suites are working on dementia study packs to help develop their knowledge and understanding to support the people living there. We recommended that the manager should make efforts to recruit sufficient RMNs or consider ways of supporting the registered general nurses to gain accredited qualifications in Dementia care. This way they would have more specialised nursing knowledge of the varied conditions and behaviours. This would make sure that the skill mix was more suited to the needs of people with dementia and give a resource for other staff. We spoke with several staff working in different areas of the home during the visit. They commented on there being a feeling of teamwork and lately a more relaxed atmosphere. Staff told us they received supervision and training to do their jobs. The individual staff training records, the annual training plan and the training matrix showed that they had been given induction training and that this had covered moving and handling, fire training, communication, food hygiene and abuse awareness. Records also showed that training was being made available in advanced care planning, dementia care, deprivation of liberty, dementia awareness and first aid and resuscitation. A high percentage of care staff do have NVQ level 2 in care, or at in the process of doing the course, and many have this at level 3 as well. Overseas staff are given additional support with a literacy and numeracy induction as well. We looked at a sample of recruitment records for some of the new staff. Overall the recruitment procedure was being followed and staff had all necessary security checks done and references taken up before they started work to help make sure they were suitable to work with vulnerable people. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The interests and welfare of the people living at Heron Hill are being promoted by the systems and procedures in place. Evidence: Heron Hill has a new manager in post, Mr Andrew Shewan, who is suitably qualified and experienced for this role and holds both general and mental health nursing registrations. Mr Shewan has previously been a registered manager and is presently in the process of applying for registration with the Care Quality Commission (CQC). This process needs to be completed and the manager registered to fully meet the standard . Since taking up the managers post Mr Shewan has improved the management structure in the home and has appointed a permanent Deputy Manager and ensured there are managers in place on Nightingale and Cavel Suites. Discussions are underway to put a manager in post on MacKenzie, the smaller EMI unit. These actions, when complete, should help ensure an appropriate management and structure of accountability for a home of this size. Care Homes for Older People Page 26 of 32 Evidence: There are quality monitoring systems in place within the service and the providers require a monthly quality report on any accidents or incidents reported in the home and reported to us (CQC). Policies and procedures are subject to review and the procedure files are available for staff to refer to on all the units. Satisfaction surveys are available within the home for people living there to use as well as those for relatives, visitors and visiting professionals so they can give feedback on the service. There are also residents and relatives meetings and records are kept of these and the topics discussed. We looked at the minutes of the last relatives meeting and these were positive. We looked at the regular monthly visit reports by the Regional Manager required by the regulations and as part of the service providers monitoring of standards in the home. The service has achieved accreditation with ISO 9000. This is the accepted standard for monitoring an organisations quality monitoring systems and procedures. Records and personal information about people living in the home are being kept securely. We looked at the procedures and records for monies kept for people living there and spoke with the administrator on the handling of personal finances. Each entry for peoples money is checked in and out by 2 members of staff. The individual money record sheets are being audited and the operations manager does a random check on his monthly visits. We found from training records and speaking to staff that they have received mandatory training on safe moving and handling, infection control, food hygiene, first aid and fire safety. Staff we spoke with told us that they had been given supervision, although some peoples had fallen behind, this it is now being addressed to bring it up to date. Staff files we looked at indicated some newer staff had not received supervision as planned and some people had not had recent supervision although due. We recommend that the manager and unit managers make sure that supervision is done as planned with staff and at least six times a year. Records indicate that fire safety equipment and moving and handling equipment is serviced under annual contracts and records for lift and hoist servicing were up to date. There was a fire risk assessment completed this year and fire alarms and detectors and emergency lights are regularly tested. The nurse call system has been checked regularly as are the water temperatures. We looked at a sample of records of accidents and incidents affecting people living in the home. The manager kept records of accidents and incidents in the home and information on this was passed to the provider for quality monitoring. Since the last inspection all notifiable incidents reports required under regulation have been sent to Care Homes for Older People Page 27 of 32 Evidence: CQC. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 It is recommended that the manager consider making daily care records more detailed and recording the actual care and support provided and not a covering statement on care. It is recommended that the manager introduce formal procedures for checking the medication of residents returning from hospital to ensure that it is up-to-date and to reduce the risk of errors The manager should make sure that the running balances of medicines liable to misuse recorded in the controlled drugs register are correct following disposal of medicines as sometimes these are not amended. It is recommended that the manager makes sure that staff record all medication when it is disposed of so that it can be accounted for. We recommend that the manager audits the complaints procedure as part of quality monitoring to make sure the improvements made are maintained and the system continues to improve. 2 9 3 9 4 9 5 16 Care Homes for Older People Page 30 of 32 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 6 26 We recommend that the manager continues to monitor the effectiveness of their new cleaning regime and equipment to make sure it was effective in the long term in reducing odours in the home. We recommended that the manager should make efforts to recruit RMNs or consider ways of supporting their registered general nurses to undertake post registration qualifications in Dementia care so they had more specialised knowledge of the varied conditions and behaviours. This would make sure that the skill mix was more suited to the needs of people with dementia. We recommend that the manager and unit managers make sure that staff receive one to one supervision at least six times a year and that it is done as planned with staff. 7 27 8 36 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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