CARE HOMES FOR OLDER PEOPLE
Heron Hill Care Home Esthwaite Avenue Kendal Cumbria LA9 7SE Lead Inspector
Marian Whittam Unannounced Inspection 7th March 2007 07:30 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.V326828.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.V326828.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Heron Hill Care Home Address Esthwaite Avenue Kendal Cumbria LA9 7SE Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01539 738800 peterw@abbeyhealthcare.org.uk Abbey Healthcare (Kendal) Limited Janet Barton Care Home 86 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (50), Old age, not falling within any other of places category (28), Physical disability (4) Heron Hill Care Home DS0000059537.V326828.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 86 service users to include: up to 28 service users in the category of OP (old age not falling within any other category) up to 50 service users in the category of DE(E) (Dementia over 65 years of age) up to 4 service users in the category of DE (Dementia under 65 years of age) up to 4 service users in the category of PD (Adults with physical disabilities) Date of last inspection 16th May 2006 Brief Description of the Service: Heron Hill is a new purpose built home caring for up to 86 residents. It opened to residents in October 2004. It is in a residential area with access to the bus routes and train station and the town centre of Kendal is about 2 miles away. There is a car park at the front of the home. The home is on three floors and there is a passenger lift to all floors. All the bedrooms are single and have en suite bathrooms with showers. There are 2 communal bathrooms and toilets on each floor and separate communal lounges and dining rooms on each floor and an activities room on the first floor. The home has a statement of purpose for prospective residents and service user guides are available on admission. A copy of the most recent inspection report is displayed on the notice board in the foyer of the home along with the complaints procedure. The scale of fees charged ranges from £700.00 to £800.00 as at the date of this inspection. There are additional charges to residents for hairdressing, chiropody, dental care, papers and magazines and any personal toiletries needed. Heron Hill Care Home DS0000059537.V326828.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Three regulation inspectors and a regulation manager carried out this unannounced key inspection. A pharmacy inspector carried out a pharmacy inspection on 20/02/07 prior to this key inspection. Before this site visit information was gathered on the service from the providers. Information on the services provided was also gathered from residents using questionnaires before the visit. Before the inspection some relatives and others who come into contact with the home had contacted the inspector about their experiences in the home. Concerns raised by residents, relatives and other stakeholders were included in planning the inspection. Information was provided by other agencies involved with resident’s care including social services. Two inspectors arrived at 07.00 in order to speak with night staff and observe breakfast time. A third inspector also spent time during the morning on Cavell unit using the ‘short observation framework for inspectors’ (SOFI). This observational tool is used to observe interaction between residents and staff and gain information and insight into how well resident’s needs are being met. Time was also spent looking around the home talking with residents in the lounges and in their own bedrooms, speaking to the nursing and care staff and cleaning staff, observing any activities and looking at care plans. Twenty residents were happy to speak to the inspectors about their experiences of living in the home and four relatives visiting the home. Nine members of the nursing and care staff were spoken with and asked questions about their working lives in the home. Policies and procedures, systems for recording complaints and personnel and training records were looked at in the afternoon as well as other records required by regulation. What the service does well:
The home provides a well maintained and comfortable environment for the people living there. Residents spoke well of staff caring for them, one said that they were “very good, helpful” and that they were “polite”. Care plans are detailed and had been agreed with residents or their relative/advocate if they were unable to sign. Relatives spoken with during the visit were also generally positive one saying how kind and thoughtful staff were. A full initial assessment is completed on admission to the home. The social assessment is also very informative including a social history, hobbies, interests and how Heron Hill Care Home DS0000059537.V326828.R01.S.doc Version 5.2 Page 6 people preferred to live their lives, which was very useful to help staff in relating to residents as individuals. Staff were observed to interact well with residents and observational tools used indicated that the majority of the interaction between residents and staff was observed to be good. Staff smiled at the residents and the residents responded with smiles and the staff chatted to the residents in a friendly way. Several residents were happy to show the inspectors how they had made their rooms more personal by bringing in their own possessions and with pictures and items that held significance for them. The food provided offers residents a choice and was well presented and varied. On the majority of units the meal times were relaxed and residents are not hurried with their food. The service had good records of receipt, administration and disposal of medicines that showed that medicines are handled well. Good records are also kept of visits from doctors including any changes to medicines. The home has responded well to meeting requirements made at inspections and in learning from past mistakes and worked well with monitoring from other agencies. What has improved since the last inspection?
Individual resident care plans are in place and the overall improvements in documentation, admission and assessment procedures and record keeping, seen at the last visit, have been maintained. Medicines storage is of an overall good standard and the improvements that have been made in medication management have been maintained since the last pharmacy visit. The security of medicines during medicines round was much improved and this keeps residents safe. Staff have been keen to improve medicines handling and act on pharmacy advice promptly to reduce risks to residents. Since the last visit and following feedback from the residents and relative’s satisfaction survey, the numbers of domestic staff have been improved to provide better cleaning provision. There are now 2 cleaners on each of the 3 units on 4 out of 7 days and 1 on the other three to improve overall levels of cleanliness and hygiene. The revised rotas that now have staff starting at 7am on Cavell unit has made a big difference to the atmosphere and provision of breakfast and drinks on the unit during the busy breakfast period and with the assistance given to residents. The morning routine was much more relaxed with residents being attended to in a timely manner. The home continues to support its staff to improve their spoken language skills where they do not have English as their first language. The home has worked with the local authority on a pilot language programme. Staff said that one of
Heron Hill Care Home DS0000059537.V326828.R01.S.doc Version 5.2 Page 7 them had recently been on the language course as English was not their first language. A new deputy manager has been appointed to assist the manager especially in clinical and training matters and this should help in the clinical monitoring of staff and in ensuring training and supervision are kept up to date. The home manager also now has a more formal business plan for the year based on monitoring and looking at service provision across departments and what the home intends to do over the coming year. This puts business and forward planning on a more systematic level. What they could do better:
The service has worked to improve all its medication systems but must still ensure that all medicines are administered as the doctor intends so that residents get effective treatment. The service should also show more clearly how plans of care are followed for the administration of “when required” medicines, particularly sedatives. The controlled drugs register on one floor also needs to be maintained and indexed better. Activities provision has fallen considerably in the home and needs to be improved and monitored. This includes making sure that resident’s views are taken into account in developing a programme and reinstating trips out and improving access to the local community. The environment of the home and cleanliness is generally of a good standard on the units but the unit managers should make sure that when the carpets are being cleaned is not done during meals times where residents are eating. This is not hygienic or conducive to a pleasant mealtime. Also the manager should consider improving the ventilation systems in the smoker’s room to reduce the smells from cigarette smoke so improving that area of the home for residents. Although residents have name cards on their bedroom doors many residents cannot easily read or understand these to identify their rooms. It would improve good practice in caring for individuals with dementia to personalise or differentiate resident’s bedrooms and other rooms to aid recognition and support their independence. Although all the core staff training has been provided specialist training such as Dementia care and awareness should be provided for all staff and training needs assessed to make sure staff working with residents with dementia and challenging behaviour have up to date training. Now that MacKenzie unit is fully occupied the manager must look again at the levels of staff and the skill mix and experience of staff on duty on this unit. Staffing levels need to be frequently reviewed in order to make sure they remain appropriate for the increased numbers and changing needs of the residents now living on that unit. Staff supervision records are inconsistent and some staff members have no records of supervision for lengthy periods of time. The manager keeps a
Heron Hill Care Home DS0000059537.V326828.R01.S.doc Version 5.2 Page 8 matrix of staff supervision sessions so she is aware of the inconsistencies and needs to continue to work to catch up and improve the situation. The home needs to keep working to help staff improve their English language skills and be consistently effective in communication with residents, relatives and visiting professionals as all these groups commented on the variability of staff language skills. 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.V326828.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.V326828.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 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments of needs are done before and following admission including information from other agencies to make sure residents needs can be met when they come to live in the home. EVIDENCE: Individual resident care plans are in place and the overall improvements in documentation, admission and assessment procedures and record keeping, seen at the last visit, have been maintained. An initial assessment is completed on admission to the home to help make sure that the home can meet individual needs and to identify personal preferences. Specialist medical and nursing resources have been consulted as needed for individual residents including the Macmillan nurse, intermediate support team, hospital consultant and tissue viability nurse.
Heron Hill Care Home DS0000059537.V326828.R01.S.doc Version 5.2 Page 11 Social, cultural and religious needs, personal interests and recreational needs have been discussed with residents and families, assessed and written in the care plans. Although the lack of an activities coordinator at the moment means that those assessed needs may not be fully met for all residents. Where appropriate care management plans have been obtained from social services. The home has developed useful systems with social services to make sure they are kept informed of changes in the assessed needs of residents admitted through social services. Heron Hill Care Home DS0000059537.V326828.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. The health and personal care needs of residents are being assessed and planned for within individual care plans and medication practices reflect good practice. EVIDENCE: All residents have an individual care plan and these have been reviewed at least monthly. There are completed risk assessments and monitoring charts for individuals in place including blood sugar, blood pressure, weight chart, nutritional assessments and skin and pressure area assessments. There are also a falls risk assessments and assessments for manual handling, continence and the use of bed rails. The social assessment is very informative including a social history, hobbies, interests and how people preferred to live their lives, which can be useful for staff in understanding the ‘whole’ person. Care plans overall are detailed and have been agreed with resident or their relative/advocate if they were unable to sign. There is an index of identified
Heron Hill Care Home DS0000059537.V326828.R01.S.doc Version 5.2 Page 13 needs at the start of each care plan with more detailed plans/strategies in place for each of the identified needs, which were being reviewed on a monthly basis. However one resident has epilepsy and although this was recorded in the care plan the guidance and information was very general and did not describe to staff how this condition presents and how the epilepsy is managed for that person. An epilepsy management plan should be developed with relevant information. Daily care notes were also being recorded that identified the personal and emotional support provided. In addition a record of health interventions and their outcomes are held on file with evidence of the home liaising with a good range of other services including the GP, Psychiatrist and social worker. An area of weakness was found in the lack of support and intervention for a small number of residents identified, as having nutritional needs and the home must take action to improve this and provide more information for staff on action to be taken and recording that. For more than one resident there was no record of a referral to the dietician or the use of food supplements following progressive weight loss. These care plans did not describe to staff how diet and nutrition would be managed to maintain weight and a healthy diet. Medicines were handled well overall and improvements made since the last pharmacy key inspection are being maintained. However, the manager needs to take care to ensure that staff administer all medicines as they are prescribed so that residents treatment is not affected. One resident had not always received pain killing medication as prescribed on their chart. Some medicines were given “when required” such as sedating medicines. The plans of care for residents receiving “when required” sedating medicines described the care to be given. This made sure that sedating medicines were only given when absolutely necessary and only after other care had been given. However, although these medicines were given infrequently, the records needed to be improved to show that the plan of care was followed. The controlled drugs register on one floor needs to be maintained better and indexes be clearer An inspection of the Cavell dementia care unit was undertaken by one inspector using the short observation framework for inspectors (SOFI). The observation showed that for the majority of the time the residents followed were in a happy or contented mood. There was significant time spent sleeping or dozing, and residents received a reasonable amount of attention from staff. The majority of the interaction between residents and staff was observed to be good. Staff smiled at the residents and the residents responded with smiles. The staff chatted to the residents in a friendly way, there was one carer whose manner was slightly more ‘brusque’ this appeared to be a language barrier issue rather than a problem with their care approach. An example of this is that after giving a resident a cup of tea the carer returned a few seconds later and said in a loud voice “ you like, yes” and then walked away. This was said as a statement rather than a question as they did not wait for the answer. However, none of the residents in the room appeared to be upset or concerned
Heron Hill Care Home DS0000059537.V326828.R01.S.doc Version 5.2 Page 14 in anyway about the carers manner and they were observed transferring residents in hoists which was done with a full explanation and with care. Heron Hill Care Home DS0000059537.V326828.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 adequate. This judgement has been made using available evidence including a visit to this service. There are limited opportunities for community contact or social and recreational interests, although residents do exercise choice in their personal routines and choice of meals. EVIDENCE: The home’s 2 part time activity co-ordinators have both recently left and the home is in the process of recruiting a full time replacement. The lack of dedicated activities staff has left the home with a shortage of staff available to support residents who need assistance and encouragement to participate in recreational activities and keep up their interests and hobbies. Staff were observed trying to encourage and provide group activities and have a chat on Nightingale and Cavell when they were not involved in care tasks, but there was very little meaningful activity for residents, that reflected their individual expectations and capabilities noted during this visit. Residents also commented that there were no outings and little in the way of contact with the local community since the coordinator had left.
Heron Hill Care Home DS0000059537.V326828.R01.S.doc Version 5.2 Page 16 However using observational techniques on Cavell (SOFI) examples of positive interactions were seen including with one of the nurses giving a resident their medication. Resident’s experience of meal times varied. On Nightingale and Cavell units meal times were more relaxed and a pleasant social occasion. On Cavell one of the staff was working solely in the dining room at breakfast serving and helping residents with their breakfast. They spoke to the residents using their preferred names and had obviously developed a good relationship with residents as they shared a joke, sang a song and had conversations with residents. Some residents chose to stay in their rooms for their breakfast, a choice that was respected by staff. Residents on all units enjoyed a range of different breakfasts and lunchtime meals and various hot or cold drinks. However on Mackenzie unit a different meal experience was seen where some residents were not being effectively assisted to eat their meals. One resident had a tray of cereal and a drink left for them on a table that was out of reach. After 20 minutes no one had come to assist them and their tea was cold and their cereal soggy and unappetising. Another staff member later moved the table and provided a fresh cup of tea. At lunch time the small dining room was cramped and crowded with most resident’s using it. The atmosphere was not calm and unhurried and there was little staff interaction with residents. Heron Hill Care Home DS0000059537.V326828.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 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure and recording system that is displayed in the home. Adult protection procedures are in place and being followed and training provided on this to staff to promote resident safety and wellbeing. EVIDENCE: The home has a complaints procedure that is displayed within the home, it logs written complaints for investigation and the procedure is available in the service users guide but not in alternative formats. The complaints procedure and information on advocacy services is displayed on the home’s notice board. Adult protection procedures are in place and local multi agency guidance available to staff for guidance. There have been 2 adult protection investigations within the home undertaken by social services. Twelve complaints have been received since the last key inspection and the home has investigated and responded to these using its own complaint procedures. Some relatives have raised concerns and the home has an effective complaints procedure to investigate these and reports back to other agencies involved with care including social services and PCT as commissioners of care and the CSCI as regulators. Training records show staff are being given training on adult protection and responding to suspicions of abuse and staff spoken with confirm this. Two
Heron Hill Care Home DS0000059537.V326828.R01.S.doc Version 5.2 Page 18 senior nursing staff have recently attended a ‘Training the Trainers’ course on protecting vulnerable adults run by local social services. This will allow them to train other staff and act as a resource in the home. Training videos are also in use. Staff spoken with were able to explain what they felt they would do if they suspected a resident was being abused and were aware of POVA issues. Heron Hill Care Home DS0000059537.V326828.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. Heron Hill is well maintained and bedrooms and social areas are well decorated and furnished to provide a comfortable and homely environment for the people who live there. EVIDENCE: The furniture, fittings and décor are in good condition and records indicate that routine maintenance and testing is being done. The home has a choice of well furnished lounges for residents and their visitors to use on all but the top floor where there is only 1 lounge. The lounges, dining rooms and residents rooms seen were warm, well furnished and comfortable with good lighting. Call bells are in resident’s bedrooms, toilets, bathrooms and communal areas. Those nursed in bed were observed to have bells at hand.
Heron Hill Care Home DS0000059537.V326828.R01.S.doc Version 5.2 Page 20 All bedrooms have their own en suite toilet, hand basin and shower and there are separate toilets close by and bathrooms with assisted bathing. Satisfactory sluicing and laundry facilities are separate from resident’s facilities. The environment was clean and hygienic throughout with no persistent unpleasant odours noted. However there was a strong smell of cigarette smoke in the foyer near the smoking room. This may be unpleasant for some residents and visitors and the manager should consider improving the ventilation for this room. A relative visiting Cavell commented that the home is, ”always clean, no smells. Although a relative visiting Mackenzie thought that there was sometimes a problem with smells at particular times of the day. The home has infection control policies and procedures and provides staff training on this with advice from the specialist infection control nurse. There were dedicated cleaning staff working alongside the care staff to ensure a clean environment was maintained. The home has increased its levels of domestic staff and 4 days per week there are now 2 domestics on each of the floors. During the morning bathrooms and some bedrooms were observed to be cleaned and communal areas and some bedroom carpets were shampooed. However the unit managers should make sure that carpet cleaning is not done during meals times where residents are eating. This was observed whilst one resident was having their breakfast and is not hygienic or conducive to a pleasant mealtime. Care assistants were observed on all units using moving and handling equipment to assist residents. This was done maintaining resident’s dignity and with explanation and in line with the care plans. Several residents spoke with the inspectors and showed us around their bedrooms. Many had brought in their own possessions and pictures to make the rooms more personal. Although residents did have name cards on their bedroom doors these were small and all alike to look at. Depending on their conditions and sight many residents could not easily read or understand these to identify their rooms. It is good practice in caring for individuals with dementia to personalise or differentiate areas of the environment to aid recognition and support personal independence. Heron Hill Care Home DS0000059537.V326828.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. The numbers and skill mix of care staff on the duty rota are adequate to meet resident’s personal care needs. EVIDENCE: There are sufficient staff on the day and night rota and on duty during the visit to meet resident’s personal care needs. There are two registered nurses and 5 care staff on the rota and on duty for the 32 residents on Nightingale general nursing suite during the busy morning period. Cavell, the EMI nursing suite with 34 residents was staffed with two registered nurses and five carers during the morning period. There is one registered nurse on the afternoon shift. All the staff interacted well with residents, who were complimentary about the care provided. There was a nice atmosphere in the unit with staff going about their work in an efficient but friendly manner with a pleasant “banter” between residents and staff. Starting additional staff at 7am on Cavell unit has made a big difference to the atmosphere and provision of breakfast and assistance to residents. The morning routine was relaxed with residents being attended to in a timely manner. On the second floor Mackenzie EMI unit, which now has a full complement of 20 residents, a registered nurse was on duty with 3 carers, one of whom was new to the unit. During the inspection it was seen that the resident’s on this
Heron Hill Care Home DS0000059537.V326828.R01.S.doc Version 5.2 Page 22 unit, as on all the units, had a range of complex personal and healthcare needs including involving 2 staff for moving and handling, helping with feeding and supervising and supporting a resident with unpredictable behaviour. Whilst staff on Mackenzie were managing to meet resident’s basic personal care needs they were generally hurried and stretched to get their work done and had no time for talking with residents, reassuring them or supporting them in activities and interests. This was especially obvious and significant as there is no activities coordinator working in the home at present. Now that the unit is full the manager must look again at the number of staff during the busy morning shift and the skill mix and experience of the staff on duty on this unit in order to make sure they are still appropriate for the needs of the residents. One relative who said they visited once or twice every week said “ the staff are really kind and thoughtful” and that they kept families informed, “Communication is excellent, they have even rung me through the night”. One relative spoke of how staff had emailed them when they were away for some months to keep them up to date with events. However this opinion was not uniform, as other relatives have contacted CSCI to express dissatisfaction with aspects of care and staffing. The home has effective complaint procedures to investigate any complaints made to them. Satisfactory recruitment and selection procedures Protection of Vulnerable adult (POVA) and Criminal Record Bureau (CRB) checks and nursing registrations checks had been followed for the staff. Staff spoken with confirmed the recruitment process they had gone through. Staff training records indicated that appropriate training is being provided and induction training. Although all the core staff training had been provided specialist training such as Dementia care and awareness should be provided for all staff and training needs assessed to make sure all staff working with residents with dementia and challenging behaviour have had appropriate training. NVQ training is underway and the home is making good progress in sending staff on this training to meet the standard. New staff were able to outline their training and induction and shadowing other staff before working alone. Nursing, care and ancillary staff spoken with did not raise any concerns about their work or access to training when questioned on this by the inspectors. Staff spoken with said they felt supported and had access to training. Staff also said one of them had also been on a language course as English was not their first language. One relative said “ some staff do not communicate as well as others” but that overall they had no complaints about staff. Heron Hill Care Home DS0000059537.V326828.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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager and senior staff have a clear understanding of the areas in which the home needs to continue its improvements to maintain a consistent and safe service for residents. EVIDENCE: The home has a suitably qualified manager who is registered with CSCI. Staff spoken with said they had staff meetings and that there is a grievance process for staff to use to raise concerns with management. Staff spoken to did not raise any issues about the management of the home and when asked about the management and its approach said that the manager was “supportive” and
Heron Hill Care Home DS0000059537.V326828.R01.S.doc Version 5.2 Page 24 they could “talk to her”. There are clear lines of accountability for staff within the home. A new deputy manager has been appointed to assist the manager especially in clinical and training matters. The home obtains the views of residents and relatives regarding the services they offer using surveys and at residents and relatives meetings. The results of the surveys are collated and displayed in the foyer and these were presented in a pictorial format. This survey is done annually and comments about cleanliness made in the last survey were acted upon with the employment of additional domestic staff. Surveys are also available in the foyer for opinions from staff and visiting professionals. The home manager also now has a business plan for the year based on monitoring and looking at service provision across departments and what the home intends to do over the coming year. The manager has and senior nursing staff have done reviews of procedures and working systems in the home and undertake audits of aspects of the service. Changes have been made to policies and procedures and new ones started where review has shown shortfalls. A quality assurance report is required monthly by the providers quality assurance system and such information recording changing needs given to social services in respect of their clients. Policies and procedures are in place to protect financial arrangements. Only small amounts of money are kept on resident’s behalf and these are recorded and checked for accuracy by the administrator and manager. Records and servicing contracts indicate that the home has systems in operation and training to promote resident health and safety. Records showed that fire training had been given to staff and emergency equipment is checked and appliances serviced. On examining staff supervision notes the records were inconsistent. Some staff members have no record of supervision for lengthy periods of time, and one none at all from Dec 05 until the last session in Feb 07. The manager keeps a matrix of staff supervision sessions so she was aware of the inconsistencies and was working to rectify the situation and catch up. Heron Hill Care Home DS0000059537.V326828.R01.S.doc Version 5.2 Page 25 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 2 X X 2 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 3 Heron Hill Care Home DS0000059537.V326828.R01.S.doc Version 5.2 Page 26 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 The registered person must ensure that medicines are given as prescribed. Timescale for action 15/04/07 2. OP27 18 (1) (a) The manager must make sure 28/03/07 that the numbers and skill mix of staff are adjusted according to the changing numbers and needs of residents on the units. 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. Refer to Standard OP7 OP8 Good Practice Recommendations It is recommended that a detailed epilepsy management plan is developed for the residents with this condition to guide staff and ensure the residents safety. More detailed guidance needs to be included in care plans relating to residents needs in relation to diet and nutrition following weight loss. Care should be taken to ensure that all records for Controlled Drugs are carefully maintained.
DS0000059537.V326828.R01.S.doc Version 5.2 Page 27 3. OP9 Heron Hill Care Home 4. 5. OP9 OP12 6. 7. 8. 9. 10. 11. OP22 OP25 OP26 OP30 OP30 OP36 Care plans could be more detailed to ensure that where appropriate medicines handling is tailored to resident’s individual needs. Activities provision needs to be improved and monitored so that resident’s views are taken into account in its development and trips out and community contact improved to meet those expectations. It is recommended the home environment and individual’s rooms are differentiated and personalised to aid recognition and promote independence. The manager should consider improving the ventilation systems in the smoker’s room to reduce the smells from cigarette smoke. The unit managers should make sure that carpet cleaning is not done during meals times where residents are eating. Specialist training for staff on good practice in Dementia care, dementia awareness and challenging behaviour should be provided for all staff. Staff should be supported to develop good language and interactive skills and this monitored for effectiveness. In practice. All staff should receive regular formal supervision and this should be clearly recorded. Heron Hill Care Home DS0000059537.V326828.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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