CARE HOMES FOR OLDER PEOPLE
Heron House Coronation Close March Cambridgeshire PE15 9PS Lead Inspector
Lesley Richardson Key Unannounced Inspection 1st May 2007 12:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Heron House DS0000024313.V335668.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 House DS0000024313.V335668.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Heron House Address Coronation Close March Cambridgeshire PE15 9PS 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) 01354 661551 01354 657291 heron.house@fshc.co.uk Four Seasons Homes (No 4) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Susan Ann Ward Care Home 95 Category(ies) of Dementia (17), Dementia - over 65 years of age registration, with number (42), Old age, not falling within any other of places category (36), Physical disability (17), Physical disability over 65 years of age (36) Heron House DS0000024313.V335668.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. A maximum of 36 places to provide nursing care under category OP. Up to 17 places to provide nursing care to category DE. DE service users to be accommodated in Wendreda unit only. A maximum of 42 places to provide nursing care to category DE(E). Physical Disability (PD) PD(E)) only in association with Dementia (DE DE(E)). 3rd May 2006 Date of last inspection Brief Description of the Service: Heron House is a purpose built home situated off a main road in a residential area of the market town of March. It is owned by Four Seasons Homes No 4 Ltd and provides care and support for up to 59 service users over the age of 65 years, including up to 17 service users with dementia. The home has 53 single rooms and 3 double rooms, 53 of which have en suite facilities. Resident accommodation is on one level. There are a variety of communal areas available to service users and the home provides bathing and additional toilet facilities with aids and equipment to enable the needs of service users to be met. Service users have easy access to the gardens and courtyards throughout the home. The home is situated approximately 1 mile away from the centre of March, where there is a range of shops, pubs and a post-office. Fees for the home range between £480 and £747. Copies of CSCI inspection reports are kept in the manager’s office for people to read. Heron House DS0000024313.V335668.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the annual inspection of this service and it took place over 6 hours and 10 minutes as an unannounced visit to the premises. It was spent talking to the manager and staff working in the home, talking to people and observing the interaction between staff and people who live there, and examining records and documents. Information obtained through returned questionnaires from relatives and visitors to the home was also used in this report. Four questionnaires were returned from relative and visitors to the home. Two requirements from the last inspection have not been met. There have been 3 requirements and 1 recommendation made as a result of this inspection. This is an adequate service. What the service does well:
The home provides care and accommodation for older people and people with dementia in a safe and pleasant environment. The care staff are polite, kind and friendly. They speak to people living at the home in a way that encourages rather than giving directions. Relatives who returned questionnaires were all very positive about the care staff and how the home cares for their relative. Comments include, “they look after my wife very well”, “they excel now”, “they run very well indeed”, “the staff, one carer in particular, have been very helpful indeed” and “they provide a caring service to my wife”. The home has started using the ‘Gold Standards’ framework for people who are coming to the end of their lives. This aims to give staff clear guidance about how they should care for people living at the home and their relatives at this time. Friends and relatives are able to visit at any time during the day and are made welcome at the home. People returning the questionnaires said the home lets them know if there are any concerns and if their relative needs or wants to see them. Staff members, people who live at the home and visitors all know who to speak to if they’re not happy with something or are worried. The home has close links with the local adult protection team and asks their opinion about incidents that happen in the home. Staffing levels are adequate and most of the time care staff are able to give a good standard of care. There are things that must be changed to make sure everyone at the home is cared for well all the time, but this is talked about in the section ‘what they could do better’, and there is nothing to suggest this is due to staffing levels. All staff complete ‘induction’ training when they first
Heron House DS0000024313.V335668.R01.S.doc Version 5.2 Page 6 start working at the home, which gives them basic health and safety information and a guide to how the home works. Other training is given as it is needed and specialist training is given to staff caring for people with specialist needs, like dementia. The manager is experienced in nursing older people and people with dementia. She is registered with the Nursing and Midwifery Council and has completed training and other qualifications in management, dementia and teaching. Records are kept that show health and safety checks are carried out at the required times and any money that is kept by the home on behalf of people who live there. What has improved since the last inspection? What they could do better:
There are three areas the home must focus on to improve the service they provide to people who live there. Although the environment in the home is good, there are two gardens and a courtyard attached to the dementia units that must be improved to give people a safe and pleasant area to enjoy the open air. These areas have not been developed since 2004 and means people with dementia have not had a safe area to sit outside for a long time. Heron House DS0000024313.V335668.R01.S.doc Version 5.2 Page 7 Staff must refer people to health care professionals if there are aspects of their care that need a specialist opinion. People who fall, have specific illnesses or challenging behaviour may all benefit from the advice these professionals can give. Staff members can also obtain guidance about the best and most up to date way to care for people. The home must become more stringent about the way it completes its recruitment checks so that everything possible is done to make sure new staff are safe to care for vulnerable people. Pre-written references are not acceptable as it is not possible to show whether they are authentic or not. Gaps in employment history must be looked at before staff start working, so that there is an explanation of what that person was doing between jobs. 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 House DS0000024313.V335668.R01.S.doc Version 5.2 Page 8 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 House DS0000024313.V335668.R01.S.doc Version 5.2 Page 9 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): 3 and 6 Quality in this outcome area is good. Assessments are completed before people move in, which means needs are identified and the proper care can be planned and given. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Assessments are completed by the home, and obtained from health and social care professionals, before people move in, which gives them information about the sort of help that person needs. The manager visits the person to carry out the assessment, and they also speak with relatives and other people who may be caring for that person at the time. This means the home has as much information as possible and can be sure staff members have the skills and experience to meet that persons needs before they move in. The home does not admit people for intermediate care or rehabilitation purposes. Heron House DS0000024313.V335668.R01.S.doc Version 5.2 Page 10 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): 7, 8, 9, 10 and 11 Quality in this outcome area is adequate. Most people at the home are cared for well, although not everyone has access to healthcare professionals and not all information is recorded in care records. Which means some people may not be receiving the most appropriate care to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are individual care plans for each person living at the home, which give staff guidance on how best to care for each person and meet their identified needs. Many of these are written with clear, detailed guidance and actions for staff to take to meet the identified need, and this is an improvement since the last inspection. However, one person had information about how to meet behavioural needs in letters from health care professionals that had not been included in the care plan. This information must be included in plans so that all staff are able to care for that person properly. Especially as information sent to CSCI by the home indicates significantly fewer incidents of concern by this person since being seen by the relevant health care professionals. Staff caring for the person on the day of inspection had a good understanding of his needs and how to approach him to minimise confrontation, and for that reason
Heron House DS0000024313.V335668.R01.S.doc Version 5.2 Page 11 a requirement will not be made on this occasion. Plans had been reviewed regularly, some as many as 8 times in one month, and although there was information about whether the plan remained appropriate, not all the actions asked of staff are evaluated. For example, where behavioural charts are kept, these are not always reviewed to show if any conclusion has been made. Care records show people have access to a range of health care professionals, such as chiropodists, dentists, specialist medical advice and community psychiatric nurses. However, this is not true for everyone living at the home. One person, who has a particular health problem, has not been referred to the relevant specialist nurse, or a specialist in falls or behavioural problems. Advice from any of these specialists may give staff a clearer indication of how to manage this person’s needs and reduce the number of falls occurring. Medication administration records (MAR) show an acceptable level of completion, which indicates prescribed medication has been given. There was one record that indicated a significant number (10 out of 22) of doses of a medication was not being given. There was more than one reason allocated to the alphabetical key for this and it was not clear which reason applied on each occasion. Staff said generally the reason would have been because the person was asleep. However, the medication is one that should be taken consistently for a number of weeks before building up adequate levels and becoming therapeutic. A review should be undertaken to see if it is still appropriate to give the medication and if so, any actions to be taken to make sure the medication is taken as prescribed. The controlled drug register in one part of the home did not have the name and address of the supplying pharmacy. Staff members said controlled drugs are supplied by one pharmacy only and were able to say where this is. The details were added to the register during the inspection. The home has started using one of the Dept of Health recommended end of life care pathways, so that people living at the home and their relatives can be better cared for during this period. People who live at the home said staff are pleasant, polite and caring. Staff members knock on doors and speak politely to people who live at the home. Relatives who returned questionnaires said staff are kind, helpful and provide a caring service to people living in the home. Time was spent sitting with staff and people in the dementia unit for older people and their relatives. A staff member is always available in the lounge area of this unit as it was identified that this is an area where people often fall. Apart from reducing the number of falls this strategy has built up staff rapport with people who use the lounge, making conversation more relevant to each person and giving meaning to the interaction. Heron House DS0000024313.V335668.R01.S.doc Version 5.2 Page 12 Heron House DS0000024313.V335668.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14 and 15 Quality in this outcome area is good. Choice is available to people living in the home, which means experiences match the individual person’s needs and wishes. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs two part time activities co-ordinators who arrange events, games and entertainment, and lists of activities available are placed in communal areas around the home. One person said she doesn’t usually participate in activities, as she prefers to stay in her room, but said there is usually something happening for people to do. Staff members were accompanying people going for a walk during the inspection; the atmosphere was motivating and full of energy as people went to dress appropriately for the weather conditions. There is an open visiting policy at the home and people are able to visit in private if they wish. One person said her daughter and son-in-law visit three times a week and visitors to other people said they come most days to see their relatives. Heron House DS0000024313.V335668.R01.S.doc Version 5.2 Page 14 Staff speak to people who live at the home in a way that enables choice, for example by letting them know of activities and asking if they would like to join in. People who live at the home said they are able to choose what they eat and what they do during the day. Three of the four people returning questionnaires said the home supports their relatives to live the life they choose. A copy of the menu covering two weeks in March and April was given to CSCI before the inspection. This shows people living at the home have a variety of meals over the week, including a choice of two main meals at lunchtime. People living at the home said the meals were alright and they generally liked most of the food provided, although one person said not all of the food was well cooked, for example Scampi had been over cooked and tough. Heron House DS0000024313.V335668.R01.S.doc Version 5.2 Page 15 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): 16 and 18 Quality in this outcome area is good. Information that is given to staff, people who live at the home and visitors means that complaints and adult protection concerns are dealt with properly. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been a significant reduction in the number of complaints made to the home since the last inspection, and information provided to CSCI before this inspection shows there has only been one. Records kept show the complaint was responded to appropriately and within the required timescale. The home reports incidents immediately and takes appropriate action in line with it’s own adult protection policy and the Department of Health’s ‘No Secrets’ guidance. There have been 19 referrals made by the home to the local adult protection team, but none that have resulted in a meeting or referral to the PoVA register. Staff said they receive training in understanding adult protection and those staff spoken to gave appropriate answers to questions about what they would do if they had concerns or witnessed an incident. Heron House DS0000024313.V335668.R01.S.doc Version 5.2 Page 16 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): 19 and 26 Quality in this outcome area is adequate. The environment inside the home offers people a safe and pleasant place to live, but there is little opportunity for some people to enjoy being outside in safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is clean and tidy, and the décor is domestic in appearance. There were no offensive odours for most of the inspection, although this occurred towards the end of the inspection. As this inspection was unannounced it suggests unpleasant odours are dealt with quickly and do not become an constant presence in the home. There are gardens at various locations throughout the home and an enclosed courtyard inside the home. However, there are lips and raised edges leading out to most of the gardens and differences in path and grass or gravel height in some of the gardens. This may not enable independent access by wheelchair users and means there are trip hazards for people able to walk.
Heron House DS0000024313.V335668.R01.S.doc Version 5.2 Page 17 Only one garden has been developed to provide a safe and suitable area for people to use. The other gardens and the courtyard need attention to bring them up to the same standard. These are the areas now available to people with dementia, but were identified as needing attention as long ago as 2004, although little has been accomplished so far. It appears that while care staff are able to provide skilled care to people with dementia, the needs of these people to be able to safely access outdoor areas is ignored. Heron House DS0000024313.V335668.R01.S.doc Version 5.2 Page 18 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): 27, 28, 29 and 30 Quality in this outcome area is adequate. Recruitment checks are not stringent enough to make sure all staff are safe to work with vulnerable people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All staff members complete induction training when they start working at the home, which covers how the home is run and mandatory health and safety training. Other training is given when it is needed and updated at regular intervals. This includes training in adult protection, training specific to people’s needs like dementia care or managing challenging behaviour, and training for needs that all or most people have, such as nutrition or continence care. The home has 20 of care staff with a national vocational qualification at level 2 or above. The recommended level is 50 of non-nursing qualified care staff with this qualification to make sure care staff have greater skills and knowledge, and are able to provide a higher quality of care. However, it is clear within this report that staff have the knowledge and understanding to meet the needs of people, especially those with dementia. Staffing numbers at the home provide an approximate ratio of one staff member to every 5 or 6 people living at the home during the day, although this drops to a ratio of 1 to 6-8 in the evening. Agency staff are occasionally used to supplement permanent staffing numbers. All the people returning questionnaires said their relatives receives the care and support they expect
Heron House DS0000024313.V335668.R01.S.doc Version 5.2 Page 19 and their needs are met. Staff members said numbers usually adequately covered staffing needs, but if levels drop due to sick leave they are not able to spend as much time with people who live there. The staff rota shows occasional drops in staffing levels from the above figures and this should be monitored to make sure it does not become a regular occurrence or have a detrimental effect on care provided. The files of two staff members were looked at to check recruitment and vetting checks have been completed. Both files contained required checks and documentation. However, in one file gaps in employment history have not been explored, employment dates were written in months and years or years only and there is an unexplained gap of over a year. Gaps in employment history must be explored to give a satisfactory written explanation obtained. References for one person from overseas were dated several months before the application for employment had been received. This means the home cannot be satisfied about the authenticity of these references as they have not requested them. Heron House DS0000024313.V335668.R01.S.doc Version 5.2 Page 20 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): 31, 33, 35 and 38 Quality in this outcome area is good. Checks are completed that show how the home maintains health and safety and is run in the best interests of the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in the position for one and a half years and is registered with the Nursing and Midwifery Council as a nurse. She has completed a NVQ level 4 in care and management. The homes annual quality assurance survey is scheduled for May and June this year and is co-ordinated and collated by the provider organisation head office. Staff at the home complete an annual self-audit, which covers all aspects of the home and how it works. Areas that do not meet required standards are reexamined on a monthly basis to make sure there is improvement. The
Heron House DS0000024313.V335668.R01.S.doc Version 5.2 Page 21 manager said this audit was completed recently and identified some similar areas needing improvement as this inspection. The home operates a ‘pooled’ money account for service users, which is monitored electronically and manually, to ensure accounts are kept separate. The majority of service users have relatives who help them to manage their finances, although a number of residents look after their own financial affairs. The home employs an administrator who acts as appointee for one service user. Information provided prior to the inspection shows maintenance checks and service visits have been completed at required intervals. Fire equipment seen at the inspection have been checked and serviced at required intervals. Heron House DS0000024313.V335668.R01.S.doc Version 5.2 Page 22 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Heron House DS0000024313.V335668.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13(1)(B) Requirement Timescale for action 10/06/07 4. OP29 19(1)(b) (i) 8. OP19 23(2)(o) People who live at the home must be able to obtain advice and treatment from a health care professional, to make sure they are being cared for in the most appropriate way. Pre written references must not 10/06/07 be accepted as satisfactory and gaps in employment history must be looked at before new staff start working at the home. This is to make sure new staff members are safe to work at the home. (Previous timescale of 15/07/06 has not been met). The gardens and courtyard must 31/08/07 be developed for people to use, so that people are able to experience a safe and pleasant outdoor environment. (Previous timescale of 31/07/06 has not been met). Heron House DS0000024313.V335668.R01.S.doc Version 5.2 Page 24 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 Refer to Standard OP9 Good Practice Recommendations Staff should review the reason medications are not taken by people in the home and contact the GP or pharmacist accordingly. Heron House DS0000024313.V335668.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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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