Inspection on 19/08/08 for Heslam Homes Limited

This inspection was carried out on 19th August 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Heslam Homes Limited 29/08/07

Heslam Homes Limited 25/07/06

Heslam Homes Limited 04/01/06

Heslam Homes Limited 09/08/05

Heslam Homes Limited 18/10/04

Heslam Homes Limited 19/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Heslam Homes Limited Heslam House 3 St Francis Road Blackburn Lancs BB2 2TZ Lead Inspector Jane Craig Unannounced Inspection 19th August 2008 09:15a 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 Heslam Homes Limited DS0000005825.V370386.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. Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heslam Homes Limited Address Heslam House 3 St Francis Road Blackburn Lancs BB2 2TZ 01254 201513 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) Mrs Carina Lamb Mr Philip Richard Lamb Miss Linda McCallion Miss Sharon Louise Park Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The registered provider should employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection The service shall at all times ensure that the minimum staffing levels in the home comply with the formula detailed below. The service must also ensure that as and when service users dependency levels increase the staffing levels are closely monitored and if necessary adjusted in response to any change. Up to and including 15 Service Users 08:00hrs - 22:00 hrs Management - 1 person on duty at all times Care Staff - 1 person on duty at all times 22:00hrs - 08:00 hrs 1 person on waking watch whose duties may include a small percentage of domestic work. 1 person on call in the vicinity (on the Campus or within approximately 3 minutes travelling distance) Ancillary Staff: Domestic - 25 hours per week Cook - 35 hours per week Up to and including 16-19 Service Users 08:00hrs - 18:00 hrs Management - 1 person on duty at all times Care Staff - 2 persons on duty at all times 18:00hrs - 22:00hrs Management - 1 person on duty at all times Care staff - 1 person on duty at all times A member of the management team to be on call at all times and clearly identified on the staff roster. 22:00hrs - 08:00hrs Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 5 2 persons on waking watch whose duties may include a small percentage of domestic work. One of the above to be designated as a senior person. Ancillary Staff: Domestic - 25 hours per week Cook - 35 hours per week Up to and including 20-24 Service Users 08:00hrs - 13:00hrs Management - 1 person on duty at all times Care Staff - 3 persons on duty at all times 13:00hrs - 18:00 hrs Management - 1 person on duty at all times Care Staff - 2 persons on duty at all times 18:00hrs - 22:00hrs Management - 1 person on duty at all times Care Staff - 1 person on duty at all times A member of the management team to be on call at all times and clearly identified on the staff roster. 22:00hrs - 8:00hrs 2 persons on waking watch whose duties may include a small percentage of domestic work. One of the above to be designated as a senior person. Ancillary Staff: Domestic - 35 hours per week Cook - 35 hours per week Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 6 Date of last inspection 29th August 2007 Brief Description of the Service: Heslam House is registered to provide personal care to a maximum of 24 older people. The home is a large detached property set in its own established and wellmaintained grounds. There is a large enclosed garden and patio area with seating for residents. Parking space is provided at the front and side of the building. Heslam House is located in a residential area of Blackburn, within easy reach of shops and other local amenities. The home has three lounges and one dining room. Bedroom accommodation is provided on two floors, the upper floor is accessed by a stair lift. All rooms are currently used for single occupancy. People thinking about using the service are given information about the home during a pre-admission visit. They are given a copy of the service user’s guide on admission and a copy of the latest Commission for Social Care Inspection report is displayed on the resident’s notice board. At 19th August 2008 the weekly fees for all residents were £383. The cost of newspapers, hairdressing and toiletries were not included in the fees. People were also charged extra for transport and escorts for routine hospital appointments. Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 7 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. A key unannounced inspection, which included a visit to the home, was conducted at Heslam House on the 19th August 2008. At the time of the visit there were 18 people living at the home. The inspector spoke with a number of them and some of their comments are included in this report. Three people living at the home were case tracked. This meant that the inspector looked at their care plans and other records and talked to staff about their care needs. As part of the key inspection surveys were sent out to people living and working at Heslam House. Eight people using the service and ten members of staff completed surveys. During the visit discussions were held with the manager, members of the staff team and two visitors. The inspector looked round the home and viewed a number of documents and records. This report also includes information from the Annual Quality Assurance Assessment (AQAA), which is a self-assessment that the manager has to fill in and send to the Commission every year. What the service does well: Before anyone moved into the home the manager visited them to assess what care they needed and to make sure that their needs could be properly met at Heslam House. Most people who returned surveys indicated that they were given enough information about the home to help them to make a choice about whether it was suitable for them. Care plans were person centred which meant that they took into account residents’ individual wishes and preferences. Plans were kept under review and brought up to date when the resident’s needs changed. Most of the residents who sent in surveys indicated that they usually received the care and medical support they needed. One wrote, “When I am ill doctors are always called and I receive good care.” At the time of the visit a resident said, “I am looked after very well.” Family carers said they were happy with the care their relative received. Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 8 Staff assisted residents in a friendly and polite manner. They were aware of the importance of promoting people’s privacy and dignity. A member of staff wrote, “Confidentiality and privacy are important issues in the home.” A resident said, “staff let me do my own thing and it keeps me independent.” There was open visiting at the home which meant that residents could see their visitors at times that were convenient to everyone. A visitor said that they were always made to feel welcome and were offered refreshments. Staff made sure that people had choices and were able to make decisions about their daily lives. One resident said, “I like to get up early; staff provide help when I want it.” Several residents said they were happy with home. One said, “I am very satisfied here, I made a good choice.” Residents were given a copy of the complaints procedure and those who returned surveys said they knew who to speak to if they were unhappy about their care. Many residents had personalised their rooms with ornaments, photos and soft furnishings. Everyone who was asked said they were happy with their bedroom. One person said, “My room’s comfortable enough and always kept clean.” Residents who returned surveys also said that the home was clean and fresh. The recruitment procedures were thorough which ensured that new staff were properly checked before they came to work at the home. This safeguarded residents. Over half of the care staff held a nationally recognised qualification in care, which helped to ensure they had the knowledge and skills to meet the needs of the residents. The service has a stable manager and staff team. A family carer said, “They all get on together and it makes a good atmosphere.” Several residents made very positive comments about the staff. One wrote, “I find Heslam House a friendly happy atmosphere and very homely, the staff are always happy.” Another said, “I am happy with staff, you can have a laugh and a joke, they are nice girls.” A member of staff also commented, “As far as I am concerned all the staff have a good relationship with the residents.” Residents had opportunities to make their views of the home known. Most suggestions or requests that were made were acted upon. What has improved since the last inspection? The manager and staff assessed any potential risks to residents’ health and drew up individual plans to try to reduce the risks. Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 9 There was a range of moving and handling equipment to help people who were not independently mobile. Staff had received training on how to use the equipment to ensure the safety of residents and themselves. The home had appointed an activities co-ordinator to organise social and recreational activities two afternoons a week. The number of trips out had increased, which some of the residents had commented upon. Residents who were asked said that there were enough activities going on for them. There had been improvements in the level of staff training. Staff attended regular refresher courses which helped to promote health and safety. Staff had also received training in fire safety. There were more practice drills so that they would know exactly what to do in the event of a fire. What they could do better: 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. Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 10 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 Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People thinking of moving into the home received sufficient information to help them to make a decision and staff received sufficient information to help them to understand the person’s needs. EVIDENCE: The statement of purpose and service user’s guide had recently been reviewed. People thinking of moving in were given copies of both documents along with a brochure, which provided them with comprehensive information about the home. Most people who returned surveys indicated that they received enough information about the home to help them to make a decision about moving in. One resident wrote, “I went for a look round and they made me feel welcome.” Another said they had been in the home before and returned because they Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 12 knew it was all right. New residents or their relatives were asked to complete surveys about the admission process. One person said they received a friendly welcome. People received contracts or terms and conditions of residence when they moved into the home. Anyone thinking of moving into the home had an assessment, which helped the manager to decide whether the service provided at Heslam House could meet the person’s needs. The manager also made sure that any health or social services assessments were obtained before people moved in. The manager discussed new residents with the staff team to ensure that they understood the needs of the new person. One member of staff wrote, “all new residents are introduced to everyone and all staff are made aware of their care plan.” Standard 6 was not applicable. Intermediate care was not provided at Heslam House. Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 13 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all of the care plans provided staff with the information they needed to satisfactorily meet people’s needs. Some medication practices were not completely safe and could place people at risk. EVIDENCE: Three sets of care records were inspected as part of the case tracking process. When a new person was admitted a 72-hour care plan was drawn up. This ensured that immediate needs were met whilst giving the person time to settle in. It also gave staff time to continue to assess and form a clear picture of the person’s longer-term needs. Each person had a profile, which contained detailed information about his or her individual abilities, needs and preferences in all areas of daily living. Care plans were person centred. They gave staff specific directions about how to Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 14 help the person to maintain their independence and how to provide assistance in the way the person preferred. Plans were reviewed every month. Some reviews included notes about people’s progress towards meeting their goals but most did not. Most care plans were amended as and when the person’s needs changed, which ensured that staff had accurate and up to date instructions to follow. There was evidence that residents or relatives had opportunities to be involved in care planning and reviews if they wished to. There was insufficient information on care plans about how to assist people who were confused and suffered memory loss. It was not clear whether they were receiving all the help they needed. For example, the manager was able to describe what was the best way to help one resident, and a relative, whose mother was confused, said that staff knew what to do to help her. However, a member of staff said they did not always know what to do or say. There were health care risk assessments on all three files. Some of the strategies for minimising the risk were individualised. For example, one told staff exactly how to walk with the person to lower the risk of falls. One resident had been referred to a team who specialised in helping people who were at high risk of falling. There was an assessment for nutritional screening. However, there was no equipment to weigh people who were not able to stand on bathroom scales. The manager said that staff judged weight change according to how the person looked. Other possible strategies were discussed with the manager, who said she would look at amending the relevant care plans. Following a previous requirement moving and handling equipment was available in the home and staff had received training in moving and handling techniques. Residents were referred to health care agencies as necessary. Advice from healthcare professionals was recorded in the relevant plan or medication record to ensure that it became part of day-to-day practice. Residents said they were well looked after. One said, “I have not been very well but the staff have looked after me, they got the doctor 3 times.” Family carers said they were happy with the care their relatives received and said that staff kept them informed of any changes. There were policies and guidance for the management of medicines and most staff who handled medication had received training. Medication was stored securely and at the recommended temperature. Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 15 There were records of medicines received at the beginning of the monthly cycle. However, extra medication for one person was sometimes received mid month but was not always recorded. There was an excess of tablets for this person but it was not possible to identify whether this was because of an error in recording or administration. There were records of medicines returned to the pharmacy. Most medicines that were not in the monitored dose system were dated on opening so that checks could be made of medicines carried forward to the next month. Most medication administration record (MAR) charts were complete and showed that the majority of people received their medication as it was prescribed. However, there were a few inaccuracies. For example, the MAR chart for one person indicated that they had completed a course of antibiotics but they had not all been signed for. One person had been prescribed medication that had not been added to their MAR chart. The medication was to be given ‘when required’. The lack of records could result in some staff not being aware that the medication had been prescribed. There was evidence that three residents were ‘sharing’ a bottle of Lactulose. The MAR chart for one of the people instructed them to take the medicine ‘as directed’. As this person did not have their own bottle with directions, it was not clear how much the staff were administering and whether they were giving the dose that had been prescribed. There were no controlled drugs at time of the visit. However, it was discussed with the registered manager that the proposed container to store controlled medication might not meet the required specifications. At the time of the visit the manager discussed the action she was going to take to improve the management of medicines. She said she would arrange for update training for staff and she plans to carry out regular audits to ensure there are improvements. All staff received training in core values during their induction and NVQ training. Staff talked about helping people to maintain their independence and self-esteem. A member of staff wrote on their survey, “Confidentiality and privacy are important issues in the home.” Residents confirmed that staff respected their privacy and dignity. One said, “I can be private in my room and when my daughter comes we go in there.” Another commented, “I don’t need a lot of help, staff let me do my own thing and it keeps me independent.” A relative said, “Staff are respectful and they deal well with anyone who is awkward, no arrogance.” Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Daily routines suited the majority of people living at the home. Most people were assisted to meet their social and recreational needs. EVIDENCE: People who were case tracked had care plans to address their social care needs. The plans listed the resident’s likes, dislikes and abilities with regard to activities and social interaction but there were no directions for staff as to how they could help the resident to meet their needs. A number of residents said that they were able to occupy themselves. There were also some activities arranged by the part-time activities co-ordinator, such as quizzes, dominoes and other games. A number of people said there were more trips out, which they liked. Everyone who was asked said there were sufficient activities to suit him or her. People who preferred to spend time in their bedrooms said that staff came in for a chat if they were not too Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 17 busy. One person said, “it’s been better since the activity person comes in for a game of dominoes, I enjoy that.” Profiles contained information about people’s likes, dislikes and routines. For example, times they liked to get up and go to bed. The manager said residents were assisted, wherever possible, to make their own choices and decisions. A member of staff who completed a survey wrote, “All the staff treat the residents as individuals and respect their wishes.” Residents confirmed that they had some choice and autonomy in their daily lives. One person said, “There are no restrictions, I like to get up early and staff provide help when I want it.” Another said, “Staff are not always telling us what we can and can’t do.” Relatives confirmed that residents were given choices about where they wanted to have their meals and where they wanted to spend their time. There was also information on profiles about needs relating to culture and religion. There were regular visitors from local churches. Staff had also helped to arrange assistance for two people who had special needs relating to their religious beliefs. There was open visiting. A member of staff wrote, “We welcome all families and try to make them feel at home.” A relative said that the staff always made them welcome and offered refreshments. Residents who returned surveys had mixed views on whether they always, usually or sometimes enjoyed the meals. People spoken with during the visit all said they enjoyed the food. There was a set meal at lunchtime. People were told in the morning what was for lunch and they could request an alternative if they wished. There were no records to show when anyone had anything different to the set meal. There were several choices at breakfast and teatime. The home did not have a rotating menu. Records showed very little variety, with some main meals appearing on the menu every week. A few months ago the same dish was served for two days running. When asked about this one resident said, “I am happy enough with the variety of meals. They’ll always give you something different if you ask.” Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service were protected by the complaints and safeguarding procedures followed by staff. EVIDENCE: There was a clear complaints procedure on display in the home. Most residents who returned surveys indicated that they knew who to speak to if they were not happy and they knew how to make a complaint. Relatives also said they knew how to make a complaint. One had raised a concern some time ago and they said that they had been listened to and it had been sorted out. Staff who returned surveys indicated that they were aware of how to respond to a complaint or concern. The home had received one verbal complaint since the last inspection. Records showed that it was investigated and responded to in accordance with the procedure. Staff had written guidance on safeguarding procedures. There was a copy of the local authority procedure but this may not have been the most up to date guidance available. There was also a policy specific to the home. Most staff had received training in safeguarding when doing their induction and NVQ but there were no recent updates. Despite this, all staff spoken with, and those Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 19 who returned surveys, were aware of the indicators of abuse and knew how to report inside and outside the home. Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean and well maintained and provided people with a comfortable and homely place to live. EVIDENCE: At the time of the visit all rooms were used for single occupancy. There was an ongoing programme of redecoration and refurbishment and the home was generally well maintained. During a tour of the building a few areas that were in need of attention were identified and discussed with the manager. For example the dining room carpet, although recently cleaned, was still heavily stained and looked unsightly. A member of staff who completed a survey commented that the home could do with new furnishings in the lounges and bedrooms. The annual quality assurance assessment (AQAA) indicated that new lounge chairs were planned in the next year. Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 21 Many residents had personalised their rooms with small pieces of furniture, ornaments and photos. Those who were asked said they were happy with their rooms. One person said their room was a bit small but they managed to fit everything in. Another said, “My room’s comfortable enough and always kept clean.” A number of radiators were unguarded. Risk assessments for these had been reviewed as recommended at the last inspection, and at least one guard had been put on because of the increased level of risk. However, furniture in one bedroom, whose occupant was at risk of falling, had been moved around, which left the radiator exposed. This increased the risk of injury should the resident fall against the radiator. The home was clean and most areas were free from offensive odours. The manager was aware that a small number of bedrooms were in need of further odour control and was working towards this. Residents who returned surveys indicated that the home was always or usually fresh and clean. The AQAA indicated that the manager had carried out an infection control audit and there were no outstanding actions to be taken to improve infection control practices. All staff had received, or were booked on, infection control training. However, there were no disposable gloves in the laundry or in bathrooms and non-disposable hand towels were used in communal bathrooms and toilets. Although these were changed regularly they could increase the risk of the spread of infection. A family carer also commented on the use of cloth towels. Care staff undertook all laundry duties. The laundry was adequately equipped for the size of the home. There were no complaints from residents about the laundry service. Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home were safeguarded by the recruitment practices. There were sufficient staff, with appropriate training, to meet the needs of the residents. EVIDENCE: The duty roster showed who was on duty at any given time. The manager and staff said there were enough staff to meet the current needs of the residents. One staff wrote, “I think we have enough staff to meet all the clients needs,” and another commented, “There is always the full amount of staff on duty.” Most residents who completed surveys indicated that staff were always available when they needed them. One wrote, “When I use the nurses call system staff always come to see what I want.” The manager said she had the flexibility to increase the number of staff should the residents’ dependency levels change. Some people commented about their good relationships with the staff. One said, “The staff are a nice group of women, I like them all.” Another said, “The staff are marvellous. All kind, considerate, obliging and efficient.” A family carer described the staff as, “brilliant.” Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 23 The files of two new staff were seen. The files included all the necessary information and documents to show that the required pre-employment checks had been carried out. All employees received a contract of employment. All staff who completed surveys confirmed that they had to have pre-employment checks. One wrote that they could not start work until all these had been done. Discussions took place with the registered manager about obtaining references for applicants who had not been in employment for some time. The manager currently accepted references from friends, who may not be impartial. New staff went through an induction programme. There was an initial introduction to the home and the residents. Staff then went on to complete a workbook that covered the common induction standards. During the induction programme the manager assessed the new staff to ensure that they understood the training and were competent to put it into practice. The staff surveys showed that recent employees were happy with the programme. Several wrote that they had weekly sessions with the manager during this period. One wrote, “I was very happy about my induction, if there was something I was not sure about I could go back to the manager for advice.” There had been improvements in the level of training. Records showed that most staff had received refresher training in the safe working practice topics. Those who had not were booked on courses. Several staff had also completed a short course in dementia care. Most staff who completed surveys indicated that they received sufficient training; two said they would like more but they did not specify what. Information on the AQAA showed that over 50 of staff were qualified to NVQ level 2. Other staff were enrolled, some on L3 or 4 courses. Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was run in the best interests of residents and in a way that protected the health and safety of both residents and staff. EVIDENCE: The home had a stable management team. One of the registered managers has many years experience of managing care services for older people. She has care and management qualifications and regularly attends courses to keep up to date with current practice. The other registered manager, who takes on the role of deputy, was undertaking NVQ level 4 in management. At the time of the visit one of the residents said the home was “well run.” Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 25 A number of staff who returned surveys commented that they were very well supported by manager and deputy. Several confirmed that they had regular supervision, staff meetings and appraisals. One member of staff wrote, “The manager comes into work at night to do supervisions for night staff and pass on any important information.” Another commented, “I feel the home is very well run.” The service held the Blackburn with Darwen Quality Assurance Scheme award. Residents had an opportunity to express their views of the home on the annual quality survey. The results were published in the service user’s guide. There had only been one suggestion for improvement and this had been actioned. Residents were also able to put suggestions forward during three monthly meetings. Minutes showed that residents were consulted about issues that affected them on a day-to-day basis, such as activities, meals and improvements to the environment. A relative said they had attended a few meetings and were kept informed about issues in the home. For example residents and relatives were asked what they would like to have planted in the garden. The service had returned the AQAA by the due date but the information contained in it was particularly brief. For example, the AQAA stated that there was always room for improvement but there was a lack of specific information about what the service could do better and plans for improvements over the next 12 months. The managers did not act as agent or appointee for anyone living at the home. Family carers managed finances for most people. Records were kept of any money or valuables handed over for safekeeping and receipts were kept when any money was paid out on someone’s behalf. The records were audited every month. The service had an up to date fire risk assessment. A fire safety officer had carried out a full audit earlier in the year and found all fire safety to be satisfactory. Following a previous requirement all staff had received fire training. The manager also carried out practice drills every month. Servicing and tests of fire safety systems and equipment were up to date. The AQAA showed that all other maintenance was up to date. The electrical installation was tested on the day of the visit and the manager took immediate steps to arrange for required work to be carried out. The manager had reviewed and brought up to date a number of environmental and safe working practice risk assessments. Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 4 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 Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement In order to ensure that everyone receives their medication as it is prescribed, they must all have their own supply of medicine and MAR charts must indicate the dose and frequency of the medicine to be administered. In order to protect the health and safety of people using the service and to provide a thorough audit trail, accurate records must be kept of medicines received into the home and medicines administered. Timescale for action 30/09/08 2. OP9 13(2) 30/09/08 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 Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 28 1. OP7 Care plans should clearly identify the needs of people who are confused and have memory loss. There should be clear directions for staff so that they know how to help to meet those needs. Following consultation with residents the manager should review the menus to ensure that there is a greater variety of main meals. In order to give people a choice an alternative meal should be offered at lunchtime. 2. OP15 3. OP19 The risk assessments for unguarded radiators should be reviewed as soon as there are any changes in occupancy or current control measures. Radiators that are considered to create a high risk of injury should be covered. The registered person should consider the use of disposable towels in bathrooms and toilets. In order to protect people living at the home character references for new staff should be obtained from impartial sources. 4. 5. OP26 OP29 Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Heslam Homes Limited DS0000005825.V370386.R01.S.doc Version 5.2 Page 30 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!