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Inspection on 22/05/07 for Heston House Care Home

Also see our care home review for Heston House Care Home for more information

This inspection was carried out on 22nd May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a diverse service makes sure that the separate social, cultural, religious and language needs of all the people who use the service are met appropriately. Residents were observed being suitably dressed and appeared comfortable and content. Those who were spoken with reported being generally happy with the standard of care they received. In particular, all were complimentary about the quality of quantity of meals provided. Most of the care staff that were on duty during the inspection appeared caring, competent and attentive in meeting the needs of the people who use the service. All care plans viewed were satisfactoryand indicated that residents` participation was sought in identifying individual needs and ensuring that their best interests were being safeguarded. The atmosphere was calm, pleasant and homely.

What has improved since the last inspection?

Requirements relating to issues regarding the laundry and separate risk assessments had been complied with.

What the care home could do better:

Requirements that were identified at this inspection related to medication, personal care, the environment and staff training. The home must ensure that prescribed medication is at all times administered appropriately.

CARE HOMES FOR OLDER PEOPLE Heston House Care Home 201-209 Vicarage Farm Road Heston Middlesex TW5 0AH Lead Inspector Ms Jean Bovell Unannounced Inspection 22nd May 2007 11:00 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 Heston House Care Home DS0000032606.V334607.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. Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heston House Care Home Address 201-209 Vicarage Farm Road Heston Middlesex TW5 0AH 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) 020 8570 3040 020 8570 6099 London Borough of Hounslow Mrs Belinda Jane Calen Care Home 60 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (46), of places Physical disability (6) Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Any proposed reduction in staffing levels must be discussed with the allocated inspector and agreement given prior to any such proposed reduction being made. 16th November 2006 Date of last inspection Brief Description of the Service: Heston House is owned and managed by the London Borough of Hounslow. This very large home is sub divided into eight smaller units. Each unit has a dedicated kitchenette, dining area and lounge. Three units are dedicated to Asian Elders. The home has an intermediate care unit, which provides a rehabilitation service for up to six service users. There is also an eight bed dementia unit on the ground floor which has a secure garden. All meals are served from the main kitchen. The Registered Manager has demonstrable experience in working with older people. Diversity is recognised when recruiting staff. Heston House is set back slightly from Vicarage Farm Road which runs through Heston. The home is conveniently located for local amenities and bus routes. Heston House is situated in a large plot of land, most of which is lawned. The home provides a service for elderly frail people, who for what ever reason, can no longer live at home with support. The home aims to support service users in maintaining their independence for as long as possible. Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out between 11:00am and 6:30pm on 22nd May 2007. The Registered Manager, three senior care staff and 37 residents were at the home. The Inspector was informed by the Registered Manager that 10 residents were at the day centre. The rota indicated that a total of 11 care assistants were covering duty over all units at the time of the inspection. During the course of the inspection, records, documents, policies and procedures were examined. Observations were made and a tour to the building was undertaken. Three senior care staff, five care assistants and seven residents were spoken with. The requirements that were made at the last inspection and all key Standards were examined. The Registered Manager was co-operative and provided appropriate assistance throughout the inspection. What the service does well: The home provides a diverse service makes sure that the separate social, cultural, religious and language needs of all the people who use the service are met appropriately. Residents were observed being suitably dressed and appeared comfortable and content. Those who were spoken with reported being generally happy with the standard of care they received. In particular, all were complimentary about the quality of quantity of meals provided. Most of the care staff that were on duty during the inspection appeared caring, competent and attentive in meeting the needs of the people who use the service. All care plans viewed were satisfactoryand indicated that residents’ participation was sought in identifying individual needs and ensuring that their best interests were being safeguarded. The atmosphere was calm, pleasant and homely. Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 7 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 Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 8 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. Initial written needs led assessments regarding prospective service users that had been carried out by placing authorities and subsequently by the home were viewed and found to be satisfactory. The home does not provide intermediate care. EVIDENCE: The Registered Manager confirmed that referrals to the home were usually made by Care Managers based in locality social services teams or local hospitals. Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 9 A number of residents files were viewed at random. All contained copies of separate background information and written needs led assessments that had been carried out by placing authorities at the point of referral. Copies of subsequent written assessments that had been carried out by the home in relation to prospective service users were also on file. It was indicated that relatives, previous carers, care managers and health care professionals, where appropriate, were involved in the process of determining the suitablity of the home in meeting specific identified needs. Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A number of care plans were viewed and all were found to be satisfactory. However, a number of people who use the service expressed dis-satisfaction with the standard of personal care they received. The records indicated that the health care needs of the people who use the service were being appropriately met but it was also reflected that medicines were not, in every case, accurately administered or recorded. Residents confirmed that their privacy and dignity were being respected. Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 11 EVIDENCE: The care plans regarding seven resident were examined. It was reflected that the people who use the service participated in identifying their separate personal, social, emotional, cultural, mobility and health care needs and with putting into place ‘aims’ and ‘actions’. All care plans viewed were signed by a particular resident and his/her key worker. Risk assessments relating to specific activities identified within care plans such as moving and handling, smoking, threats of self-harm, angry/aggressive behaviour and leaving the premises unescorted, had been carried carried out and were clearly detailed. It was evidenced that care plans and risk assessments were regularly reviewed. Residents who were spoken with expressed general satisfaction with the care they received at the home but complained that that they were not always thoroughly washed and that regular baths were not provided, unless requested. The records indicated that the people who use the service were registered with separate general practitioners and that they received access to health care services as required. A senior worker holds overall responsibility for the monitoring of medication at the home and records of medicines collected from and returned to the pharmacist were satisfactorily documented. The records were indicative of regular medication training and refreshers being delivered to all care staff. The medication administration sheets were inspected and the majoirty were satisfactory. In one case, however, prescribed medicines had not been administered at appropriate intervals at the time of inspection. Reasons why and actual times that medicines were administered were not recorded. This was considered a potential risk to a resident and was discussed with the Registered Manager and a Senior care worker. A resident who was spoken with confirmed that there was an approximate gap of only two hours between being administered separate morning and afternoon doses of prescribed medication. Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 12 Although some of the people who use the service indicated awareness of their specificd prescribed medicines, none were self-administering their medication at the time of the inspection. Residents who were spoken with expressed general satisfaction with the care they received at the home and reported that their privacy and dignity were being respected. However, there were allegations of strip washes not being thorough and baths being infrequently delivered, unless requested. Care staff were observed being friendly and respectful in their interactions with residents. Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. The separate social, cultural and religious needs of the people who use the service are identified within their separate care plans and are being met satisfactorily. The people who use the service are able to maintain contact with relatives and/or friends and receive choice in relation to their daily living routines. Varied and nutrtitional meals are being provided to the people who use the service. Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 14 EVIDENCE: Separate cultural, religious, language and social needs were identfied within care plans and a diverse service is provided by the home. The Inspector was informed by the Registered Manager that ten people who use the service were attending the day centre at the time of the inspection. The Activities Co-ordinator confirmed that residents were able to participate in organised activities such as bingo, music and movement and craft. Tea dances and club nights were regularly held and birthdays and religious festivals were celebrated. Holy Communion is provided by a Roman Catholic Cleric each week. People who use the service were observed singing along and tapping their feet during a musical activity that was being presented in the lounge within an Asian unit. The Activities Co-ordinator reported that the residents had previously joined together in prayer and that an exercise session had been held. Residents were also observed participating in ball games in the garden with the Activities Co-ordinator. Others were escorted by key workers to separate activities in the local community An open visiting policy is place and contact with relatives and/or friends is encouraged and facilitated. Several residents told the Inspector that they regularly received visits from their respective relatives. The people who use the service are able to have choice in relation to their daily living routines such as meals, activities and what they wear each day. Residents were observed moving freely and comfortably around the home. Some chose to rest, read or watch television in their separate bedroom. Others sat in the various lounges and/or joined in shared activities. Three cooks and one kitchen assistant are employed at the home and meals are prepared in the main kitchen. The menus were reflective of varied and wholesome meals and nutritional and appealing lunch options which included cultural preferences were provided at the time of the inspection. Residents who were spoken with reported being happy with the quantity and quality of food they received. Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure is satisfactory and accessible. Policies and procedures on the protection of vulnerable adults were in place but there was no recorded evidence that up-to-date staff training on POVA had been delivered. EVIDENCE: The complaints procedure was in place and accessible to the people who use the service and their relatives. The complaints book was not available for viewing at the time of the inspection. The London Borough of Houslow policies and procedures were in place and an ‘At a Glance’ flow chart detailing POVA procedures was on display. There was, however, no Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 16 indicators that care staff had received accredited training on the Protection of Vulnerable Adults. Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is Adequate. This judgement has been made using available evidence including a visit to this service. Although the home is essentially adequately maintained, attention is required in ensuring that general repairs are carried out, all areas in the kitchen are kept clean, waste bins in bathrooms are regularly emptied and soap containers in handwashing facilities are regularly filled. The overall environment of the home is calm and homely. Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 18 EVIDENCE: There is a homely atmosphere within each separate unit at the home and all are adequately spacious, comfortably furnished and suitable for shared or individual activitity. The surrounding gardens are adequately maintained and accessible to wheelchair users. Specific areas within the environment were not being satisfactorily maintained. Windows and tiled sills in the main kitchen needed to be cleaned. There was no soap in a toilet/handwashing facility on the ground floor. Bins were overflowing with used pads and floors were strewn with toilet paper in en suite/shower rooms. A lock on the door of a staff meeting room was completely dislodged. No issues were identified in relation to the laundry. The home’s refurbishment programme was in place. Decorative work had been undertakn in hallways and carpets had been replaced. The overall atmosphere at the home was calm, pleasant and homely. Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 19 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. Observations were carried out within the various units and staffing levels in relation to people who use the service were found to be adequate. Records and documents were viewed and it was reflected that care staff had been appropriately trained for meeting the needs of the service users. However, it was not evidenced that POVA training had been delivered to care workers. It was indicated on a sample of viewed personnel records that the home’s recruitment procedures were satisfactory. Care staff were observed being competent in meeting the needs of the people who use the service. Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 20 EVIDENCE: The ratio of staff in relation to people who use the service was appropriate at the time of the inspection and care staff were observed being attentive and competent in responding to the needs of residents. Training programmes were in place and it was indicated that 65 of care staff had received National Vocational Training. Staff training delivered to care workers during 2006/7 included Moving and Handling, Food Hygiene, First Aid, Infection control, dementia and medication. However, training on the Protection of Vulnerable Adults was not reflected. A number of recruitment files were viewed at random and contained all required documents. Care staff were observed being sensitive and competent in meeting the needs of the people who use the service. Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 21 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 records are reflective of the Registered Manager being appropriately trained and qualified for carrying out her full responsibilities. Systems for carrying out effective qualifty assurance are in place. The financial records relating to the personal allowances of residents are satisfactory. Health and safety checks are being regularly undertaken but records of completed environmental risk assessments were not in place at the time of the inspection. Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 22 EVIDENCE: The records indicated that the Registered Manager had received recent appropriate training such as The Role of the Manager in Adult Protection, Recruitment and Selection Skills and Financial Management. Members of the care support staff team that were spoken with reported that the Registered Manager was open and approachable. There was documented evidence that effective quality assuraance had been undertaken in 2006 and outcomes published. Systems were in place and quality assurance processes had been initiated for carrying out quality assurance during 2007. The Inspector was informed by the Registered Manager that the home was not responsible for the overall financial affairs of the people who use the office. However, the personal allowances of four residents were safeguarded at the home. The financial records relating to the personal allowances of four residents were viewed and no discrepancies were identified. The records were indicative of fire drills being undertaken and health and safety checks such as fire alarms, portable appliances, water temperature and gas appliances being up to date. Tests for legionella had also been carried out. Environmental risk assessments were not available for viewing at the time of the inspection. Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 23 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 3 X X 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 24 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 OP7 Regulation 12(1)(b) (3) Requirement The Registered Person must make sure that strip washes are thoroughly undertaken and that the people who use the service receive regular baths to ensure that personal hygiene and cleanliness are properly maintained. The Registered Person must make sure that prescribed medicines are accurately administered and recorded to ensure that the health and welfare of the people who use the service are at all times safeguarded. The Registered Person must ensure that bins containing used pads within bathrooms are regularly emptied to minimise risks to health and safety. The Registered Person must make that a broken lock on a staff room door on the first floor is repaired to ensure that all parts of the care home are kept DS0000032606.V334607.R01.S.doc Timescale for action 08/06/07 2. OP9 13(2) 08/06/07 3. OP26 16(2)(k) 08/06/07 4. OP26 23(2)(b) 15/06/07 Heston House Care Home Version 5.2 Page 25 5. OP26 13(4)(c) in a good state of repair. The Regostered Person must ensure that that soap containers in toilet/handwashing facilities are at all times filled to eliminate risks to health and safety. 08/06/07 6. OP26 17(3)(b) 7. OP30 18(1)(c) (i) The Registered Person must 22/06/07 ensure that records relating to environmental risk assessments are available for viewing as it must be evidenced that they are being appropriately carried out. The Registered Person must 30/09/07 ensure that POVA training is delivered to all members of the care staff to make sure that the needs of all the people who use the service are met satisfactorily. 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 Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Heston House Care Home DS0000032606.V334607.R01.S.doc Version 5.2 Page 27 - 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!