CARE HOMES FOR OLDER PEOPLE
Heron House Coronation Close March Cambridgeshire PE15 9PS Lead Inspector
Lesley Richardson Announced Inspection 23rd November 2005 9:55 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.V254461.R01.S.doc Version 5.0 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.V254461.R01.S.doc Version 5.0 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 Four Seasons Homes No 4 Limited Mrs Pauline Joan Walker Care Home 59 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (15), Old age, not falling within any other of places category (57), Physical disability over 65 years of age (57), Terminally ill over 65 years of age (57) Heron House DS0000024313.V254461.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 2 (two) named individual below 65 years of age for the duration of their residency. Up to 30 beds Nursing Care Date of last inspection 13th April 2005 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. An extension has recently been built and the original building is being refurbished. An application has been made to the Commission for Social Care Inspection for an increase to the total number of places available at 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. Heron House DS0000024313.V254461.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 8½ hours and was carried out as an announced inspection on 23rd and 25th November 2005. It was the second inspection of this home for the 2005-2006 year. Four and a half hours were spent examining records and documents and four hours were spent with service users and staff. A tour of the building was also undertaken during this time. The new manager was present during the inspection. Eight people who were living at the home, four visitors to the home and three of the staff on duty were spoken to during the inspection. Not all service users have the capacity to express their views. What the service does well: What has improved since the last inspection?
The home completes an assessment of people potential residents, and assessments from hospitals and/or social service departments are also asked for. This makes sure home has enough information to say if it can look after that person properly. If there are special individual arrangements for medication administration, these are recorded in the care records. Complaints are now dealt with according to the home’s policy and procedure, with written information about how the complaint has been investigated and the response give to the person making the complaint. Staff members have mandatory health and safety training when they start working at the home to make sure both they and the people who live there are safe. Additional training is also given to all staff to make sure they have the skills to properly look after the people who live there. Heron House DS0000024313.V254461.R01.S.doc Version 5.0 Page 6 The home has undergone a considerable amount of change since the last inspection. A new building is in use for people needing personal and nursing care. This provides a pleasant and comfortable area for them to live in. The original building is being renovated and outside areas have been changed to allow people who live at the home access to gardens and patios. These areas had not been accessible for a considerable amount of time and now provide areas that are nice to look at, can be walked or wheeled through and there are places to sit. Checks that must be made before new staff start working at the home are now mostly completed properly, although there are still some gaps. Periods where people were in full-time education or between employers must be looked at and explanations obtained. As all staff members, including overseas nursing staff, have Criminal Record Bureau and Protection of Vulnerable Adult checks before they start working at the home a significant improvement has been made in this area. What they could do better:
There has been a big improvement in the home since the new manager has been in post, although there is still work to be done to make sure people who live there are kept safe and are consistently given the care they need. Plans of care are written to advise staff members of the best and most appropriate way to care for each person at the home. Risk assessments must be completed to assess the levels of particular risks identified either before the person has come in to the home or because something has changed. A care plan must then be written to make sure that risk is reduced by giving specific care, or a particular care need is met properly. If this is not done, there is a risk that the person may be cared for incorrectly. The number of activities offered in the home must be improved, especially for people with dementia, as there is little activity aimed specifically for them. Activities that are appropriate have been shown to improve quality and meaning of life. The home must offer people who live there more choice in their everyday lives. Getting up and going to bed must not be the decision of care staff or when it is most convenient for them, but should be according to the resident’s individual choice. Although guidance from the Department of Health shows the home employs an adequate number of staff members, and the amount of staff sick leave has reduced in the last few months, there remains a feeling amongst people who live at the home and visitors to the home that there are not enough staff on duty. This has been discussed with the manager who is looking at working practice and organisation. The home is without a registered manager. An application to register a manager must be submitted to the Commission.
Heron House DS0000024313.V254461.R01.S.doc Version 5.0 Page 7 There is no information to show how the views and opinions of people who live at the home are gathered, or whether this information is considered if it is collected. The views of people who live at the home must be gathered regarding the quality of care at the home and how this may be improved. 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. Heron House DS0000024313.V254461.R01.S.doc Version 5.0 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.V254461.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 A pre-admission assessment of prospective service users ensures the home is able to meet service users needs. EVIDENCE: Pre-admission assessments are completed to ensure new service users needs are properly assessed and planned for. Assessments of need are also obtained from healthcare professionals and social service departments. This gathers as much information as possible about each person before they enter the home and ensures their needs can be met. A pre-admission assessment could not be found in one of the five service user files seen. However, as pre-admission assessment documentation has improved since the last inspection it is considered this standard has been met. Heron House DS0000024313.V254461.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Some progress has been made on improving arrangements to ensure that the personal and health care needs of service users are identified and met. Continued improvement is needed to make sure these shortfalls do not place service users at risk. EVIDENCE: Risk assessments and care plans are available for each service user to ensure personal and health care needs are identified and met in the most appropriate way. Two of the six service user files had needs identified on pre-admission or admission assessment that did not have corresponding risk assessments, and not all identified needs had associated care plans to provide information to staff members about how best to meet these needs. Not all plans were reviewed on a monthly basis and some plans had not been reviewed at all. Care records show the access each service user has to health care professionals, although these records were not always detailed and information was written in different places. This makes it difficult for staff to build a picture of a person’s health needs and the effect any treatment may have.
Heron House DS0000024313.V254461.R01.S.doc Version 5.0 Page 11 Two service users files contained the use of inappropriate terminology in descriptions and this was discussed with the manager during the inspection. Medication is administered by registered nurses and senior care staff to service users who are unable to or do not wish to administer their own medication. All staff members with the responsibility for medication administration are given training from a qualified source external to the home. The care records for one service user who had previously been administered medication covertly gave clear instructions for the reason for this and the process undergone to ensure this is the most appropriate method. Most service users responding to a survey from The Commission for Social Care Inspection said they like living at the home and feel well cared for, that staff treat them well and their privacy is respected. During the inspection service users said the carers and nurses are lovely. Relatives also said care staff were lovely and felt the care that was given to service users was good. All relatives and visitors responding to the survey said they could visit in private, although one person commented that a quiet room without television would be a nice alternative to the main lounge or a bedroom. Heron House DS0000024313.V254461.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 There has been little improvement in social activities, which are not well organised and only provide limited stimulation and interest for people living in the home. EVIDENCE: Activities are organised by the home on a routine basis and service users are able to watch television and play board games if they wish. Records show entertainment is provided for service users twice weekly. Service users files showed information had been obtained about their social interests and life histories, although this was not always detailed. Just over half of the service users responding to the survey said they felt their were suitable activities available in the home. However, 33 of service users felt there either were no or only some suitable activities in the home. Staff members working in the dementia unit said there are no activities specifically for these service users. The manager said the home has plans to employ staff specifically to work in this area. Service users said they do not always have a lot of choice about when they get up and go to bed, and this often has to fit in with work routines. Sometimes it took a long time for staff to answer call bells. One service user said she had
Heron House DS0000024313.V254461.R01.S.doc Version 5.0 Page 13 been got up so late in the morning she had to go straight in to lunch and had often not been taken to the toilet during the entire day. However, this service user also said that these issues were being resolved with the new manager and there is now more choice in how she lives her life at the home. Heron House DS0000024313.V254461.R01.S.doc Version 5.0 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Improvements have been made with evidence that service users feel their concerns are listened to and acted upon. EVIDENCE: The new manager said that she had found a number of complaints that had been made before her appointment, but had not bee n dealt with. Complaints made since August 2005 had been investigated and responded to as required in the home’s complaints policy and procedure. It was evident from service users conversations that verbal complaints made to the present manager were responded to and action taken to resolve them. The home has a complaints policy and procedure that gives guidance to staff, service users and visitors to the home about the process and what to do. 85 of visitors to the home who responded to the survey said they are aware of the complaints procedure and 67 of service users said know who to speak to if they are not happy with something. There have been two Protection of Vulnerable Adults (PoVA) issues since the last inspection, one as a result of a complaint. The home has begun to develop links with the local PoVA team and has had training from the lead practitioner. Just under 90 of service users responding to the survey said they felt safe in the home. Heron House DS0000024313.V254461.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26 The standard of the environment within this home is good, providing service users with an attractive and homely place to live. EVIDENCE: An extension has been built to the rear of the original building, and this now accommodates service users requiring personal and nursing care only. The original building is undergoing complete refurbishment and the home has submitted an application to increase the total number of places available. Areas in use by service users during the inspection were well decorated and maintained, they are accessible and safe for service users, with open communal spaces provided for relaxation. The outdoor areas previously identified as needing attention to ensure safe access by service users have been developed and provide attractive areas to sit or walk in. All areas visited were clean and pleasant smelling. Heron House DS0000024313.V254461.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30 Progress has been made in addressing staffing issues and as a result staff morale has improved. Although the procedures for the recruitment of staff have improved further improvement is required to offer greater protection to people living at the home. EVIDENCE: Staff rotas show that staffing numbers in the home are at acceptable levels and above those identified as being required using the Department of Health Residential Forum tool. However, service users said they often had to wait for assistance and all of the relatives and visitors who returned surveys said they felt there were not enough staff members available. Three of the eighteen service users responding to the survey also felt there is not enough staff. Relatives said there are areas within the home where staff members are busier and it is more difficult to obtain assistance. The manager said she felt this was a reflection of how workloads are organised rather than staff levels and that this is being addressed. She is working with staff members to change poor practice and ensure service users are able to obtain the assistance they need when they need it. In the four months since the new manager has been in post sick leave amongst staff members has halved. The files of three recently employed staff members’ shows the home undertakes most of the necessary recruitment checks to ensure the protection of service users. Enhanced Criminal Records Bureau (CRB) and PoVA are applied for and PoVA checks returned prior to staff members starting work at
Heron House DS0000024313.V254461.R01.S.doc Version 5.0 Page 17 the home. However, employment or education histories for two of these staff members were in months and years, and one person had given no details at all regarding further education. Gaps in employment had not been explored, one file did not contain a photograph of the staff member and one file had only one reference. The manager said all overseas staff members have now had CRB and PoVA checks applications submitted, which has been a requirement at the last two inspections. The home has a training matrix which shows which training events have been attended by which staff members and when this was. Mandatory health and safety training is given to all staff at induction and at required intervals. Medication training is provided for all staff members with the responsibility of administering medication, a 2 day dementia training course is also given to those staff working in the dementia unit. Specialist nurses and lead practitioners give training in other areas, such as continence and PoVA, to ensure staff members have the skills to care for service users appropriately. Heron House DS0000024313.V254461.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 37 and 38 Records are kept to a standard that ensure service users welfare, health and safety. EVIDENCE: The registered manager has left the home’s employment since the last inspection and a new manager is presently managing the home. An application must be submitted to register a manager. It is an offence under Section 11 of the Care Standards Act 2000 to manage a care home without being registered with the Commission for Social Care Inspection. Some visitors and service users expressed their concern about the staffing numbers, but there were also positive comments about the care given and the positive atmosphere in the home since the new manager was appointed. Heron House DS0000024313.V254461.R01.S.doc Version 5.0 Page 19 Results from a quality assurance survey undertaken before the last inspection are not available in the home. The manager said this will be checked with the provider organisation and a report obtained if there is one. 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. Checks are completed to ensure the health and safety of service users and the results of these are recorded. The fire safety policy and procedure is comprehensive and contains information on fire drills, fire prevention, escape routes, equipment testing and what to do in the event of a fire. Records were seen for fire safety, hot water temperatures, chlorination and portable appliance testing. These were all recorded as acceptable. Heron House DS0000024313.V254461.R01.S.doc Version 5.0 Page 20 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 1 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X X 3 STAFFING Standard No Score 27 2 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 X 3 3 Heron House DS0000024313.V254461.R01.S.doc Version 5.0 Page 21 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 OP7 Regulation 15(1), (2)(b) Requirement The registered person must prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. The registered person must keep the service user’s plan under review. (A previous timescale of 18/04/05 has not been met) The registered person must consult service users about their social interests. The registered person must consult service users about the programme of activities arranged by or on behalf of the care home. A programme of activities must be provided. The registered person must enable service users to make decisions with respect to the care they are to receive and their health and welfare. The registered person must ascertain and take into account their wishes and feelings. (A previous timescale of 15/05/05 has not been met) The registered person must not
DS0000024313.V254461.R01.S.doc Timescale for action 15/01/06 2 OP12 16(2)(m), (n) 31/01/06 3 OP14 12(2), (3) 15/01/06 4 OP29 19(1)(b) 15/01/06
Page 22 Heron House Version 5.0 (i) 5 OP33 24(1), (3) 6 *RQN Care Std Act2000 Sec11 employ a person to work at the care home unless he has obtained in respect of that person the information and documents specified in Schedule 2. The registered person must establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home. The system referred to in Paragraph 1 must provide for consultation with service users and their representatives. Any person who carries on or manages an establishment or agency of any description without being registered under this Part in respect of it shall be guilty of an offence. An application to register a manager must be submitted to the Commission for Social Care Inspection. 28/02/06 30/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP27 Good Practice Recommendations The manager should review the deployment and working practice of care staff to ensure there is adequate cover and care given is appropriate. Heron House DS0000024313.V254461.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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