Inspection on 25/03/08 for Heron House

This inspection was carried out on 25th March 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Heron House 20/11/08

Heron House 01/05/07

Heron House 03/05/06

Heron House 23/11/05

Heron House 13/04/05

Heron House 10/01/05

Heron House 26/08/04

Heron House 26/11/03

Heron House 26/09/03

Heron House 19/11/02

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Heron House Coronation Close March Cambridgeshire PE15 9PS Lead Inspector Elaine Boismier Unannounced Inspection 25th March 2008 10:00 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.V358620.R02.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.V358620.R02.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.V358620.R02.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)). 1st May 2007 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 Healthcare Ltd and provides care and support for up to 95 service users between the ages of 18 and 65 years of age. Most of the bedrooms are used for single occupancy rooms only and ensuite facilities are available. 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 can access 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 £343 and £1,010 depending on the needs of the residents. Additional costs include those for private chiropody, toiletries and newspapers. Further information about fees can be obtained from the care home. Copies of our CSCI inspection reports are available on request, from the home, or via our CSCI website at www.csci.org.uk Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We, the Commission for Social Care Inspection, carried out this unannounced key inspection, by two Inspectors between 10:00 and 18:10 and it took just over 8 hours to complete. Before the inspection we sent out surveys to relatives, residents and staff and some, but not all of these were returned. We received also from the Manager, a completed Annual Quality Assurance Assessment (AQAA). Information from the surveys and AQAA has been referred to in this inspection report. We spoke with visitors, staff, residents and the Manager and Regional Manager. We looked around the home, observed staff and residents’ activities and examined documentation. For the purpose of this inspection report people who live at Heron House, March, are referred to as “people” or “resident/s”. What the service does well: Heron House is a welcoming home with friendly and warm, caring atmosphere. Relatives and residents told us that staff were “very good” and we saw some staff looking after people in a kind and respectful way. People live in a home that provides spacious bedrooms that are light and airy. There are good systems in place in reporting allegations of abuse to safeguard people from such risks. There is a commitment, by the management of the home to continue to improve the standard of care and standard of the home environment. There are systems in place to check the safety of hoists, safety of portable appliance electrical equipment and emergency lights. Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The Statement of Purpose must be updated. We expect the home to manage this issue, rather than we make a requirement on this occasion. The home must have information about people’s needs before they move into the home. We expect the home to manage this issue, rather than we make a requirement on this occasion. The provision of intermediate care/rehabilitation should be researched more thoroughly. We expect the home to do this. People must be included in the care planning process. We expect the home to manage this issue, rather than we make a requirement on this occasion. Care plans must be followed when providing care. We expect the home to manage this issue, rather than we make a requirement on this occasion. Triggers that cause incidents of challenging behaviours should be identified. We expect the home to manage this issue. The records made when people are given medication must be improved and must include any reason why medication might not be given. A requirement has been made about this. People’s dignity must be respected at all times. A requirement has been made about this issue. Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 7 Activities provided must be meaningful. We expect the home to manage this issue. The temperature of food provided and how choice of food is offered should be improved. We expect the home to manage this issue. How the choice of food is offered, particularly to people with difficulties in remembering, should be re-considered. We expect the home to manage this issue. The manner of assisting people with their food should be done so in a respectful and dignified manner. We have made a requirement about this under Standard 10 of this report. The temperatures of hot water must be delivered at a safe level. A requirement has been made about this issue. 50 of care staff should have the NVQ level 2 in care. We expect the home to manage this issue. All required information about staff must be obtained before they start working. This is a requirement that has not been met on two previous occasions and an immediate requirement has been made. All staff must attend refresher training in fire safety and safe moving and handling techniques. Two requirements have been made about these issues. 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.V358620.R02.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.V358620.R02.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): 1,3 & 6 Quality in this outcome area is adequate. People have an adequate standard of information to assist them in their decision where to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Copies of the home’s Statement of Purpose were available in the main entrance foyer of the home. Examination of this indicated that information about the home, and the registered company, Four Seasons Healthcare Limited, is not current. This out of date information includes how to make a complaint to the former inspection authority, the National Care Standards Commission, which was replaced by the Commission for Social Care Inspection (CSCI) in April 2004. We have not made a requirement on this occasion as we expect this to be managed by the registered people. Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 10 According to the Manager a copy of our inspection reports are available on request. Six of the seven residents’ surveys we received said that the person had received enough information about the home before they moved in and visitors and residents we spoke with confirmed this also to be the case. Examination of a number of care records indicated that people have a full assessment of their needs before they move into the home. However a person admitted for rehabilitation had no such information. According to the Manager information is obtained via telephone conversation should there be an emergency situation arising in the community. Nevertheless we saw no evidence of such a telephone conversation, for the person who was receiving this type of care. We reminded the Manager that it is the registered person’s responsibility at all times to ensure that people admitted to the home can have their needs met and that the categories and conditions of registration are adhered to. We expect this area to be improved upon by internal management of the home, rather than we make a requirement on this occasion. The AQAA informed us that, since the inspection in May 2007, the home has introduced a rehabilitation service (see Standard 3 above). Discussion with the Manager indicated that this rehabilitation programme is for 6 weeks only and admission to the home is in consultation with the district nurse or GP. Currently there is no designated communal area or identified areas for people to practice their daily living skills. We have suggested the Manager studies our CSCI guidance on intermediate care. The person who was receiving this rehabilitation service care said they felt they had gained some benefit from their rehabilitation whilst at the care home. They told us that they were able to give their own medication at home, although they were not self-medicating whilst receiving their rehabilitation at the care home. There was no evidence in their care records that a discussion had taken place with the person, or a risk assessment, about this self-care practice. This could lead to the person becoming less independent, in giving their own medication, when they return home. Examination of the person’s care records indicated that they had received physiotherapy. Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 11 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 Quality in this outcome area is adequate. Staff have good guidance in how to care for people in a proper way although some people are at some risk to their health and safety due to medication issues. People’s dignity is often, but not always, valued. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We received one survey from a relative that told us the home usually meets the care and support needs of their relative. All of the 7 residents’ surveys said that their care and support needs were usually met and all of the surveys said that the person’s medical needs were met. Care records were of a good standard and provided information about people’s specialist needs. Risk assessments carried out were transferred in to care plans and how such assessed risks were to be managed. Reviews were carried out each month although these were not detailed. Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 12 There was insufficient evidence to suggest that care plans were drawn up in consultation with residents or their representatives. We expect the home to manage this issue, rather than we make a requirement on this occasion. A requirement, made following the inspection in May 2007, has been met as care records and direct observation noted that CPNs dieticians, physiotherapist, dentists, tissue viability nurses and GPs and DNS have attended the home. Weights of people were recorded every month and evidence that dieticians visit the home to provide specialist advice for people with unintentional weight loss. The outcomes were positive as people had gained weight or had stable weight thereafter. We noted someone assessed as at a very high risk of falls was wearing footwear that might not have been supportive, although the person’s care plan stated otherwise. We shared our concern with the Manager and expect this to be managed by the home. People were dressed in clean clothes and hair and nail care was of an acceptable standard. The Manager said that staff are to be trained in how to reduce the incidents of challenging behaviours by identifying the triggers that cause such incidents. We saw staff managing an incident of threatening behaviour by resident, in a calm and risk-reducing manner. A specialist pharmacist inspector examined practices and procedures for the safe handling and recording of medication. The storage of medicines is adequately controlled and provides an acceptable level of security for the protection of residents. There are good records made of when medicines come into and leave the home but there were some problems with the records made when medicines are given to people. There were a number of gaps in these records giving no clear indication of whether medicines had been given to people and, if they are not given, a reason why was not recorded. A requirement has been made about this. A member of staff was seen to given medication to residents at lunchtime in a way that was unhygienic and to complete the record in the wrong time box. This could result in people receiving doses of medication too close together during the day. A medicine that should have been dissolved in water before taking was offered to a resident without being mixed in water first. A requirement has been made about this. On a number of occasions residents had not been given their medication because they were asleep and no effort had been made by staff to vary to Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 13 times medication is given to make sure people receive the correct treatment. A recommendation was made at the inspection in May 2007 that staff should review the reason medicines are not taken by people in the home and contact the GP or pharmacist accordingly. This has therefore not been considered and a requirement has been made to ensure people receive their medication as prescribed. People told us that the staff were “very good” and we saw that staff were kind and respectful when caring for the residents. People’s dignity was not always respected, however, when a member of staff, we spoke with, described people, who needed help to eat their food, as “feeders”. (See also Standard 15 for a further example of compromise of dignity). A requirement has been made about this. Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 14 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 &15 Quality in this outcome area is adequate. People are provided with opportunities to live an adequate quality of life. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Of the 5 completed residents’ surveys 2 people were generally satisfied with the activities provided; 2 of the 5 surveys said that the home sometimes provided activities that the person could take part in. The remaining fifth survey said that they never took part in activities provided, due to them being unsuitable. The AQAA told us that the home employs 2 activity co-ordinators. People were seen to be listening to music and a member of staff danced and talked with people during this time. Examination of the activities plan was carried out and this was cross-referenced with people’s daily records and their activities during the inspection. There was insufficient evidence to suggest that meaningful activities are consistently provided and in accordance with the activities plan. We expect the home to manage this rather than we make a requirement on this occasion. Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 15 People we spoke with said that they were able to get up when they chose to and could choose when they went to bed. People told us they could receive visitors and we saw that this was the case. Three of the 7 residents’ surveys said that they usually liked the meals whereas the remaining 4 surveys said that the person sometimes liked the meals. The AQAA identified an area that the home could improve upon was the “…meal presentation for residents who cannot manage solid food.” Food, that had been pureed, we saw had been served in separate constituents. Comments that we have received in the residents’ surveys included, “He has never complained about the food except sometimes it is cold”. ….” “Invariably luke warm and plate filled far too full” and “Mostly the food is plentiful and reasonable quality. But it is not liquidised when she needs it unless requested each time.” We observed the mealtime in two of the units. We saw that the food left in the serving containers, during the time staff were helping some people with their food, could lead to the food becoming less than hot, for those other people still waiting for their meal. The Manager said that arrangements are in place to make sure that food is served at the right temperature. People we spoke with said that the food ranged from “Good” to “Ok”. One person said that their lunch was “horrible” although due to their condition, was not able to tell us why they did not like it. Other people we spoke with said that they had enjoyed their lunch. Staff told us that residents in the young dementia care unit, are asked the day before what they would like to eat for the following day. We were told that residents were asked again (as most of the people have memory impairment) what they would like to eat, at the time of the serving of the meal. We saw no choice offered before people were given their plates of food. The majority of staff sat with people and helped them with their food, one at a time. However we saw a member of staff, helping two residents at the same time, whilst the member of staff was standing over the residents. Such practice compromises people’s dignity. A requirement has been made under Standard 10 of this inspection report. Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 16 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 & 18 Quality in this outcome area is good. People are listened to and are safe from the risk of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We have received no complaint about the home since the inspection in May 2007. All of the 7 residents’ surveys said that the person felt staff listened to them and acted on what was said to them. All of the surveys said that the person knew how to make a complaint and usually knew who to speak to if they were unhappy about something. We received one survey from a relative that told us the person knew how to make a complaint and they were always satisfied with how the home responded to their concerns. A visitor to the home told us that they knew how to make a complaint but had no reason to; they were satisfied with the standard of care their relative was receiving. The majority of the residents, we spoke with, said they knew who to speak to if they wanted to make a complaint. Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 17 Of the 2 surveys we received from care staff both said that should a person make a complaint the member of staff would pass the complaint “to the right person.” The record of complaints showed that responses to complaints were of a listening nature. This was also demonstrated in 2 copies of minutes of residents’/relatives’ meetings held at the home. Concerns raised at the meetings were answered sensitively and in a positive manner. The AQAA told us that of the 11 complaints received in the last 12 months 98 of these had been resolved within 28 days. The AQAA told us also that 4 safeguarding (previously known as protection of vulnerable adults or POVA) investigations have been carried out in line with the local safeguarding procedures. A visitor to the home said that they were confident in the home’s safeguarding reporting procedures. Staff were able to describe what they would do if they were aware of an allegation or suspicion of abuse. All of the staff we spoke with said that they had attended training in abuse awareness and safeguarding procedures. Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 18 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): 19,25 & 26 Quality in this outcome area is good. People live in a clean and homely place although they are at some risk to their safety from hot water temperatures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is on one level and is well decorated. According to the Manager arrangements are in place to improve the existing décor for people with dementia. Bedrooms were of a good size, light and airy. Corridor walls had been provided with themed pictures such as movie stars and vinyl records and album covers. The Manager told us there is an intention to develop areas of the home for these to become more homely and to offer opportunities, such as “fiddle boards” for people with dementia. Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 19 A requirement was made following the inspection in May 2007 for the garden areas to be safe and pleasant for people to visit. Discussion with the Manager and observation of the garden areas indicated that this requirement has been met. Although in the early stages of development some of the garden areas were provided with sensory aids such as wall ornaments and paintings. Plants had been delivered and were waiting to be planted. Examination of the records for hot water checks was carried out and we discussed our views with the Manager, as we had doubts about the authenticity of the checks (all of the temperatures were recorded at the same value of 43 degrees centigrade and the style of writing was consistently uniform in appearance). The Manager acknowledged our doubts about the authenticity of these records. Due to our concerns we tested 3 areas where residents access hot water; a hand wash basin, a shower and a bath. The range of temperatures of the hot water, for these 3 areas, was between 44.9 to 48.5 degrees centigrade. People are therefore at risk of harm because firstly the hot water temperatures, we checked, were greater than that of 43 degrees centigrade and, secondly, the current method of how hot water temperatures are checked might not be safe. A requirement has been made. Three of the 7 residents’ surveys said that the home was always clean and fresh; the remaining 4 surveys said that the home was usually clean and fresh. We received some comments in these surveys that included, “…have had to clean plastic covers on bedrails myself on occasions – eg (sic) food splashes etc.” and “The cleaners are very good and clean the room and bathroom every day. There are occasionally (sic) offensive smells in the corridor - I think due to the fact that aerosols are not now allowed.” On the day of the inspection we found the home to be clean and free from stale odours. Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 20 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 & 30 Quality in this outcome area is adequate. People receive proper care from staff who are generally well trained although people are at risk due to unsatisfactory recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the 7 residents’ surveys said that staff were usually available when they were needed. A comment made, in one of these surveys said, “Obviously as in all businesses, some staff are better than others” and “I do feel that sometimes not all staff are aware of particular residents needs, this may be due to a lack of communication or supervision, or both.” A comment we received in a relative’s survey said, “It took some time before my mothers needs were understood by a majority of the staff. Recent changes instaff (sic) have not helped.” The AQAA told us that within the last 12 months 27 care staff have left their employment at Heron House. In one of the surveys from care staff we received the following comment, “There are not enough perement (sic) staff which lead to a very high number of agency. So the residents dont see a familiar face which leads to lack of personal care.” The AQAA has identified difficulties with Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 21 the recruitment of permanent staff, “due to local provision already in this area. The recruitment process has been time consuming.” Discussion with staff and the Manager indicated that some newly recruited staff do not stay in employment due to the nature of the hard work. However some of the staff we spoke with told us that they had worked at Heron House for a number of years and enjoyed their work. We found that people’s needs were being met, staff were providing attention to residents and call bells were promptly responded to. From the AQAA we have worked out that of the 46 care staff, that includes agency, pool or bank staff, 34.78 of care staff have NVQ level 2 or equivalent in care. This standard, standard 28, has therefore not been met. A requirement had not been met following two previous inspections and had been carried forward. This requirement was regarding information about staff. We examined 3 files of recently recruited staff. All required information was available in one of the three files. In the 2 remaining files there was satisfactory information available except there was no written information about gaps in employment history. For one member of staff there was a gap from Sept 2007 until the person started work at the home, in February 2008. For the other member of staff there was an unexplained employment gap of 4 months from May to September 2005 and an unexplained employment gap of 2 months from January to March 2006. In addition there was no year recorded for one of the dates; the record of employment history said,” August 19th to present.” We have issued an immediate requirement with regards to this serious concern. Examination of the staff training matrix and what staff told us, indicated that staff attend a range of training to include dementia care, medication and infection control. Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 22 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): 31,33,35,38 Quality in this outcome area is adequate. People benefit from an adequately managed home that could be safer. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager, who has the Registered Manager’s Award, has demonstrated good compliance with regulation 37. We have received a number of regulation 37 notifications that have informed us of untoward events occurring in the home such as residents’ falls and incidents of challenging behaviours occurring between residents. She demonstrated a good knowledge, to us, about individual residents and their needs. We also noted her commitment to improving the standard of the home’s environment and the standard of care of the residents. Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 23 In our (now changed) assessment of Standard 31, the standard rating of the management of the home also takes into account the outcome of Standard 29 (recruitment). Due to our findings, as reported in Standard 29, we have assessed that this standard, Standard 31, has not been met in full. Although a comprehensive result of a survey was presented to us, as part of the home’s quality assurance, there was no date on this document. It was therefore not possible to consider the results to be current without such authentication. The Manager informed us that Four Seasons Healthcare Limited have such surveys carried out, by an independent consultancy firm, at least each year. Copies of reports of visits, made by the Regional Manager to the home, were seen for January and February 2008. These reports included assessments of the environment, medication records and residents’ and visitors’ views about the home. We acknowledge that it is the first AQAA completed by the home. It could be improved upon with clearer reference to the standards. For example in the standard section for Daily Life and Social Activities there is reference to staff training in medication. Staff training is more appropriate to standards 9 and 30 for older people. Although the home “pools” people’s monies we saw that transactions are made in individual residents’ names. These transactions included money coming in and money spent, such as additional costs for chiropody and hairdressing. Records for safety checks on hoists, portable electrical appliances, fire drills and a check, by an external contractor for emergency lights, were seen and these were satisfactory. Records of fire alarm tests and the home’s own tests for emergency lights were not inspected on this occasion, but will be examined at a later inspection. The AQAA told us that 100 of catering staff and 33 of care staff have attended training in safe food handling. Staff told us that they had attended training in fire safety and moving and handling. Examination of the staff training matrix indicated that some staff had attended training in first aid although not all staff have attended current training in fire safety and safe moving and handling techniques. According to the records some staff had not attended such training since 2006. The Manager agreed with our findings. Two requirements have been made about mandatory staff training. Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 24 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 2 x 2 x x 1 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x 2 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 2 Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 25 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 OP9 Regulation 13(2) Requirement Medication must be given to residents in a hygienic way and as prescribed. This will prevent residents from risk of harm Records of when medicines are given to residents must be accurate and complete and a reason must be recorded when medicines are not given. This is to show that people receive the medicines prescribed for them. Residents must have their dignity respected at all times as part of their human right. Hot water temperatures and methods of checking these temperatures must ensure that residents are not placed at risk of scalding. Pre written references must not 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 and 10/06/07 has not been met). An immediate DS0000024313.V358620.R02.S.doc Timescale for action 15/04/08 2. OP9 13(2) 17(1)(a) 15/04/08 3. 4. OP10 OP25 12(4)(a) 13(4) 26/04/08 26/04/08 5. OP29 19(1)(b) (i) 25/03/08 Heron House Version 5.2 Page 26 requirement has been made. 6. OP38 13(5) All staff must attend training in safe moving and handling techniques to prevent the risk of harm to residents from poorly trained staff. All staff must attend training in fire safety to reduce the risk of harm to people in the event of a fire. 07/05/08 7. OP38 23(4)(d) 07/05/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Inspection Team 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Heron House DS0000024313.V358620.R02.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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