Inspection on 19/07/07 for Herons Lea Residential Home Ltd

This inspection was carried out on 19th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Herons Lea Residential Home Ltd Silford Cross Abbotsham Bideford Devon EX39 3PT Lead Inspector Jo Walsh Unannounced Inspection 09:00 19th July 2007 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 Herons Lea Residential Home Ltd DS0000069168.V336559.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. Herons Lea Residential Home Ltd DS0000069168.V336559.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Herons Lea Residential Home Ltd Address Silford Cross Abbotsham Bideford Devon EX39 3PT 01237 476176 01237 476313 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) Herons Lea Residential Home Limited Mrs Glenys Georgina Quill Care Home 17 Category(ies) of Dementia - over 65 years of age (17), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (17), Old age, not falling within any other category (17) Herons Lea Residential Home Ltd DS0000069168.V336559.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22/06/06 Brief Description of the Service: Herons Lea is a large detached property standing within three acres of wellmaintained, attractive grounds situated in the rural area of Abbotsham on the outskirts of Bideford. Herons Lea is registered to provide care for 17 service users in the categories of old age (OP), dementia - over 65 years of age (DE, E) and mental disorder - over 65 years of age (MD, E). The homes stated aim is to provide a high level of care for active and semi-active elderly and to ensure they will be comfortable and feel secure in a kind, family environment’. Access to the ground floor is level and there are chair lifts to assist with access to the first floor. Bedroom accommodation for service users is spread over three floors, with the manager also residing on the third floor. The home has a pleasant dining room/quiet sitting area and large comfortable lounge on the ground floor. The range of fees is £ 385 - £400 per week. The CSCI inspection reports are made available in the home. One is pinned to the notice board near to the dining area. Herons Lea Residential Home Ltd DS0000069168.V336559.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place during a week day in July and lasted for 5 hours. During this time, eleven people who live at Herons Lea were asked about their experiences living at the home. Time was also spent talking to the registered manager, the registered provider and two members of staff. The home had previously completed a questionnaire, which gives information about how the home maintains a safe environment and staff training and recruitment processes. In addition some key documents were looked at during the inspection, these included plans of care, records kept in relation to administering of medications, accident and incident records and the fire log book. This helps to assess the home ensures people who live there are safe and well cared for. Prior to the inspection surveys were sent to some of the people who live at the home, their families and visiting general practitioners. Their comments are included throughout this report. What the service does well: Herons Lea provides a very pleasant, well maintained and homely environment that people who live there enjoy, Comments included ‘’ this is a lovely home, so clean, we are very lucky to have such beautiful grounds to enjoy, I love going out for a walk around the grounds.’’ The staff team have good training and support to enable them to provide quality care. Most staff have worked at the home for a number of years and this provides a good continuity for the people who live there. Comments about the staff included ‘’ staff couldn’t be better, they really do look after us here, you can have a joke with them and nothing is too much bother.’’ One general practitioner said in a survey ‘‘a well run, loving and caring home.’’ The home provides a good range and choice of meals that are home cooked and take into consideration individuals’ likes dislikes and special dietary requirements. In all the surveys returned from people who live at the home, they rated the food highly. Herons Lea Residential Home Ltd DS0000069168.V336559.R01.S.doc Version 5.2 Page 6 There is a programme of activities on offer, which include art, games, exercises and paid entertainers. The people who live at Herons Lea are asked what they would like to do and on the day of the inspection 9 people were taken out for a drive and fish and chips at a nearby town. Those who remained said they had not wanted to go or were too frail. The home ensure that people are kept safe by good recruitment practices that mean people are only employed to work in the home once checks and references are obtained. What has improved since the last inspection? What they could do better: The quality of plans of care varies in the information provided for some individuals. The registered manager agreed that some staff are better at documenting individuals needs and preferred routines of daily living and has agreed to address this by ensuring all plans are reviewed by herself. The home must ensure risk assessments are reviewed for radiator covers to include all potential risks. Where risks are identified, a plan of action to reduce risks must be implemented. The registered provider has agreed to look at this as a priority. This will ensure that the home has a safe environment for residents. The home should also ensure risk assessments are completed for individuals where a potential for wandering has been highlighted as part of their initial assessment. Herons Lea Residential Home Ltd DS0000069168.V336559.R01.S.doc Version 5.2 Page 7 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. Herons Lea Residential Home Ltd DS0000069168.V336559.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 Herons Lea Residential Home Ltd DS0000069168.V336559.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Potential new people benefit from a good admission and assessment process, which ensures that the home can meet their needs. EVIDENCE: The assessment information for the three newest people was looked at and discussed with the manager and staff. The registered manager said that they visit the person in their own home or hospital and talk to them, their carers and any other relevant people involved in their care to ensure they gain a full picture of their needs. As the home does not provide waking night cover they assess their needs with this in mind to ensure they can provide the care and support needed. The information is recorded on a form and includes what individuals’ personal and health care needs are. This is then used to help inform the plan of care. Herons Lea Residential Home Ltd DS0000069168.V336559.R01.S.doc Version 5.2 Page 10 Staff spoken to said that prior to a new person moving in, the manager always goes through their assessment with them so they have a good idea of their needs. Staff appeared to have a good understanding of the needs and wishes of the new people who had recently moved into Herons Leas, which supports the fact that they have a good pre admission assessment process. One person who had recently moved in was able to confirm that she had been visited by the manager and had been asked about what sort of help they required. They said that they had been offered the opportunity to visit the home, but had relied on the fact their family had visited prior to moving in. One relative who returned a survey said ‘’two visits were made prior to my relative taking up residence. Both were fully informative and supportive of decision to having to place my relative in residential care.’’ Herons Lea Residential Home Ltd DS0000069168.V336559.R01.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 good. This judgement has been made using available evidence including a visit to this service. Individuals’ care is reasonably well planned ensuring staff have good information to ensure that person, health and social needs are met. EVIDENCE: A sample of four plans of care were looked in some detail at during this inspection. Several others were viewed in less detail. The quality of information in some care plans is better than in others, although all individuals have daily records, which staff complete each shift. The daily records are very detailed and give a good picture of what support and care is being offered, what health care needs people have and how these are being addressed. Staff spoken to confirmed that the daily records are their key documents to ensuring continuity of care. One said that when they had been off for a few days, they come in a little earlier to read up on the daily records, which enables them to see if individual needs have changed. Herons Lea Residential Home Ltd DS0000069168.V336559.R01.S.doc Version 5.2 Page 12 One plan of care did not have a risk assessment in relation to them wandering, but this issue had been highlighted in their daily records. The registered manager agreed that she would in future do a monthly audit to ensure that information detailed in daily notes is transferred to the main body of the plan of care, where changes had occurred. People who live at Herons Lea said in face to face interviews or their surveys ‘’ The level of care and attention is exceptional. We are very well cared for. Staff are very pleasant and helpful and see to all our needs.’’ Daily records of individual show that GP’s are called for, hospital appointments are followed up and if needed the district nurse team will visit to attend to anyone with nursing needs. One relative said ‘’ the care and attention is excellent, far better than we could offer, and we have no worries about our relative being there. If there is a health problem we are kept informed.’’ The home has a robust medication process that ensures medicines are safely stored, recorded and returned when necessary. The medication records were looked at and appeared up to date and accurate. Only staff that have received training in the safe handling and administering of medications takes on this role. None of the current people who live at Herons Lea look after their own medications. One of the new people who had recently moved in was asked if they were given a choice about staff looking after their medications. They said ‘’I am glad not to have to worry about any of that anymore, I am quite happy for staff to do this.’’ One relative said in their survey ‘’ It is essential that my relative takes their medicines to enable them to manage on a daily basis. This is something as a family we were not able to ensure happened due to their inability to understand how necessary it was- At Herons Lea they have managed this task marvellously, thus improving my relatives quality of life.’’ During the inspection staff were observed to be showing a great deal of respect in the way they cared for individuals. Examples of good practice noted, was staff offering drinks throughout the day, asking if they wanted a hot or cold drink. Staff were observed to be supporting individuals to eat their meal in an unobtrusive way, and sitting chatting to people, including them in their conversations. All the people spoken to on the day of the inspection said that they were treated with respect by staff. Those who returned surveys all ticked always for the question about do they receive the care and support they need. Herons Lea Residential Home Ltd DS0000069168.V336559.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): 12,13,14,15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who live at Herons Lea have a good range of activities that suits their needs and are supported to exercise choice and control over their lives. EVIDENCE: The home has a weekly programme of activities and something is offered most days. People are asked what they would like to do during residents’ meetings, which happen quarterly. Most people spoken to said they enjoyed the activities that include, arts and craft, bingo, quizzes and trips out to places of local interest. On the day of the inspection nine people went out for a trip to a local town for fish and chips and a look around. Two people said they really enjoyed going out on trips and were very much looking forward to that days outing. Several people also mentioned how much they enjoyed sitting out in the garden. The home has extensive grounds that are very well maintained and attractive. One relative has raised the issue about a fee of £12 being made for activities. This is clearly stated in the homes information, the statement of purpose and Herons Lea Residential Home Ltd DS0000069168.V336559.R01.S.doc Version 5.2 Page 14 the service users guide. Another relative said in their survey ‘’ It is really good that the home provides an activities programme that my relative seems to really enjoy.’’ The residents meeting minutes show that individuals are asked what sorts of activities they would like and this is followed up to try and provide outings and activities that people have requested. People were asked if they could have visitors when they wished and all who answered this question said yes, and that visitors were made welcome. One relative said ‘’ we are always made very welcome and offered food and drinks.’’ People who live at Herons Lea rated the food highly in surveys and face to face interviews. One person said ‘we are spoilt, there is always plenty of choice and always plenty of it.’ The homes menus show that a good range and choice of meals are offered, and staff were observed to offer drinks throughout the day. Herons Lea Residential Home Ltd DS0000069168.V336559.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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at Herons Lea can be confident that their concerns will be listened to and acted upon. EVIDENCE: People who completed surveys and those spoken to all said that they could talk to staff or the manager about any concerns they had. The home has a stated complaints procedure and document how they have worked to resolve any issues raised. Since the last inspection, one complaint issue has been dealt with satisfactorily by the home. The staff group have had training in helping them to understand what abuse is and what the warning signs are. They also undergo checks prior to being employed at the home to ensure they are suitable to work with vulnerable people. This helps to keep people who live at Herons Lea safe. Herons Lea Residential Home Ltd DS0000069168.V336559.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): 19,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is suitable for its stated purpose and people can be assured that the environment will be clean, homely and well maintained. Some improvements are needed to ensure that the environment is made safe for people who live there. EVIDENCE: During this inspection a tour was made of all communal areas and some of the bedrooms. The home is exceptionally clean and well maintained. All parts of the home were fresh smelling, and it was clear that staff work hard to ensure the environment is pleasant for the people who live there. Herons Lea Residential Home Ltd DS0000069168.V336559.R01.S.doc Version 5.2 Page 17 Since the last inspection, the home now uses a separate bathroom for sluicing of commode pans only. This helps to reduce the risk of cross infection. There are still a number of radiators that could present, as a risk for people, and this should be addressed to make the home as safe as possible from risks from hot surfaces. People who live at Herons Lea made the following comments about the home. ‘We are very lucky to have such a lovely place to live. The grounds are so lovely and well maintained. Its always lovely and clean.’’ Everyone spoken to and those who returned surveys were very positive about the environment. Herons Lea Residential Home Ltd DS0000069168.V336559.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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff group are knowledgeable and experienced to provide good quality care to the people who live at Herons Lea. EVIDENCE: Staffing levels are sufficient for the number and needs of the current resident group. Usually the home has two care staff a senior and two cleaners on duty. The home does not offer waking night cover, but the manager lives on the premises and does do regular checks on residents during the night. Surveys returned by residents indicated that there was enough staff to meet needs. Residents spoken to on the day of the inspection stated that their needs were being met by the staffing levels. Four of the 8 care staff has completed NVQ2 training and one is currently doing NVQ3. Over the last year staff have undertaken POVA, fire safety and first aid course. Herons Lea Residential Home Ltd DS0000069168.V336559.R01.S.doc Version 5.2 Page 19 Some staff has also done some training on dementia care. Staff spoken to said that they have opportunities to do further training if they wish, and all thought that they were well supported and encouraged to complete NVQ training. The staff files of the new newest staff member were looked at. They had two references, CRB and POVA Checks completed. This demonstrates that the home have robust recruitment processes in place to protect people who live at the home. Herons Lea Residential Home Ltd DS0000069168.V336559.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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the best interests of the people who live there. EVIDENCE: The registered manager is experienced and qualified and together with the registered provider they work to ensure that quality of care is reviewed. The home ensures it seeks the views of the people who live there with surveys and meetings. It would be useful if this information was collated and results made available to both the people who live at Herons Lea and CSCI. Herons Lea Residential Home Ltd DS0000069168.V336559.R01.S.doc Version 5.2 Page 21 Residents and staff spoken to said that their opinion was listened to. Staff stated that they work very much as a team and everyone works well together including the management. Records in respect of individuals’ finances were not seen on this inspection. The provider does not keep any cash in the home, but detailed audit records are kept of any monies spent on behalf of individuals and this has been looked at in previous inspections. Staff confirmed they receive training in all core areas of health and safety. The registered provider ensures that the environment is kept safe with regular servicing of equipment. This was not checked during the inspection as details were given as part of the pre inspection questionnaire. The fire logbook was viewed and seen to be well maintained. Risk assessments in respect of hot surfaces need to be reviewed and where risks are identified measures put in place to ensure risks are minimised. This will ensure the whole environment is made safe for residents. See section on environment for more details. Herons Lea Residential Home Ltd DS0000069168.V336559.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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X 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 3 X X X X X 2 X STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Herons Lea Residential Home Ltd DS0000069168.V336559.R01.S.doc Version 5.2 Page 23 YES Are there any outstanding requirements from the last inspection? 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 OP28 Regulation 13 Requirement The home must review risk assessments in respect of risks of burns. Where significant risks are identified solutions must be put in place to minimise risks. Previous date set for compliance 30/08/06 Timescale for action 30/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP25 Good Practice Recommendations The home should ensure that any risks identified in the assessment are risk assessed as part of their ongoing plan. This includes risks of wandering. The home should ensure that all radiators are covered to prevent the risk of burns. Herons Lea Residential Home Ltd DS0000069168.V336559.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 Herons Lea Residential Home Ltd DS0000069168.V336559.R01.S.doc Version 5.2 Page 25 - 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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