Inspection on 01/02/08 for Heywood Court Care Centre

This inspection was carried out on 1st February 2008.

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

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

Other inspections for this house

Heywood Court Care Centre 29/07/08

Heywood Court Care Centre 11/07/07

Heywood Court Care Centre 22/05/06

Heywood Court Care Centre 23/01/06

Heywood Court Care Centre 23/08/05

Heywood Court Care Centre 12/02/05

Heywood Court Care Centre 21/09/04

Heywood Court Care Centre 16/03/04

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

CARE HOMES FOR OLDER PEOPLE Heywood Court Care Centre Green Lane Heywood Rochdale Lancs OL10 1NQ Lead Inspector Jenny Andrew Unannounced Inspection 1st & 4th February 2008 1:30pm 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 Heywood Court Care Centre DS0000049296.V358879.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. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heywood Court Care Centre Address Green Lane Heywood Rochdale Lancs OL10 1NQ 01706 361900 01706 361944 heywoodcourt@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Care Homes No 2 Limited 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) vacant post Care Home 45 Category(ies) of Dementia - over 65 years of age (45) registration, with number of places Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 45 service users to include: *up to 45 service users in the category of DE(E) (Dementia, over 65 years of age) 5th November 2007 Date of last inspection Brief Description of the Service: Heywood Court is a dementia care residential unit, owned by Southern Cross Healthcare. It can accommodate up to 45 elderly service users on both a permanent or respite stay basis. With the exception of one double bedroom, all others are single and all rooms are equipped with en-suite toilets and wash hand basins. Bedrooms are situated on the ground, first and second floors of the home although at the time of this visit the second floor was unoccupied. A passenger lift is provided to all floors. The home has disabled access and two safe enclosed patio garden areas are provided to the front and rear of the home. The home is well maintained both internally and externally and a large car park is provided. Public transport passes the home and the motorway network is also nearby. The weekly charges, as at February 2008 are as follows: if the Local Authority funds the person, the charge is £365.00 with a top-up fee of between £10-£15, which has to be paid by the resident or their relative. For those people who are paying for themselves, the weekly charge is £468.00. Additional charges are made for private chiropody treatment, toiletries, newspapers, hairdressing and physiotherapy. The provider makes information about the service available upon request, in the form of a Service User Guide and Statement of Purpose, which are given, upon admission, to each new resident and/or their relative. A copy of the most recent Commission for Social Care (CSCI) inspection report is displayed in the entrance hall. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A key inspection of the home was done in July 2007 with a follow-up random visit taking place in November 2007. In addition, the pharmacy inspector carried out two random inspections on 2nd October and 26th November 2007. The November visit showed many areas of concern in the way the medication was being handled and an enforcement notice was sent to the home saying they had to put things right quickly or court proceedings would be started. This second key inspection was done to check whether the level of care being given to residents had improved since the previous visits and also to see if the home had done everything set out in the enforcement notice in respect of medication. Everything in the notice had been put right and there were no longer concerns about the way medication was being given out and handled. This unannounced inspection took place over two days. The pharmacy inspector spent two hours on the first day looking at the way medication was stored, recorded, given out and kept. On the second day two inspectors spent eight hours in the home looking around parts of the building, checking the records kept on residents, to make sure they were being looked after properly (care plans), as well as looking at staff files and training records. Some of the inspection was spent watching how the staff looked after the residents. Elements of complaint issues were also looked at during the visit. In order to find out what it was like to live at Heywood Court, six residents were spoken to as well as the project manager, acting manager, three care assistants, the chef, domestic, three visitors and the district nurse. No comment cards had been received at the Commission for Social Care (CSCI) Office from relatives or other visitors to the home. Since the last inspection the manager had left and there was another acting manager in post who was going to apply for the permanent job. If she is successful, an application to be registered will be submitted. Since the last key inspection in July 2007, we have received two complaints about the home and these have been addressed in the complaints section below. Four safeguarding referrals have been received which were all thoroughly investigated in partnership with the home, the Local Authority and ourselves. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The management team have been making sure that the requirements made at the last inspection have been met. Care plans and risk assessments were more detailed and up to date, so that the staff would know how each person needed to be cared for. Residents were now being given their medicines as prescribed and any variations, omission and errors were well documented. All medication could be accounted for and could not be misused and residents’ health was no longer at risk. The home was being re-decorated and new furniture bought so that it would be a nicer place for people to live in. Also, changes in the way the rooms were set out had been made so there were more choices of where to eat and sit. All but the very newest staff had done training in what to do if they suspected people were not being treated properly (protection of vulnerable adult training). Arrangements had been made to make sure enough domestic staff were available to provide cover if people were off sick or on holiday. The laundry door was being kept shut when staff were not using it, so that residents would not wander in and harm themselves. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 7 What they could do better: Before people come to live at the home, a full assessment of their needs should be done to make sure that the home is able to meet those needs. So that the staff will have the knowledge they need to care and support residents, they need to do dementia awareness training. There were very few social activities or trips out being organised and staff were not spending enough one to one time with the residents. As a result, the residents were bored, falling asleep or just sitting staring around the rooms they were in. There was a malodour in some areas of the home and whilst new carpets were going to be fitted when the re-decoration work was completed, something needed to be done in the shorter term to make the environment a more pleasant place for people to live and work in. There was nothing on the staff files to show that they had completed training when they had first started work, so that they would know how to do their jobs safely and support residents in the correct way. Before staff start work at the home, the manager must make sure all the right checks are made, photographs for identity purposes are in place and that application forms record full employment history. This will help to ensure that the right people are employed to care for the vulnerable people living at Heywood Court. Whilst many people had already done all their health and safety training so they would have the skills they needed, some people still needed to do this training. The home had, however, already made arrangements for this to happen. There was no manager currently registered with us (The Commission for Social Care Inspection), and the organisation needed to make sure an application was completed and sent in quickly. In order to make sure money held on behalf of residents was correct, an audit of the accounts should be done. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 8 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. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 9 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 Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 10 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 adequate. This judgement has been made using available evidence, including a visit to this service. Residents were not always assessed before coming to live at the home, to ensure their needs would be able to be fully met and that they would receive the right type of care. Standard 6 was not assessed, as the home did not accommodate intermediate care residents. EVIDENCE: Assessments for two people admitted within the last nine months were checked. One file contained a Local Authority assessment that had been fully completed and showed what the person’s needs were. The other person had been transferred from one of Southern Cross’s other homes and only her original care management assessment when she had first gone to live at that home was in place. As this person was moving from a residential care unit to a home providing dementia care, a new assessment should have been done. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 11 Before any new residents are admitted, whether they are local authority or privately funding, they must be assessed to ensure the home can meet their needs. Care managers had recently re-assessed all residents living at the home and several people had been assessed as needing different placements, as their needs had changed. Care managers were currently arranging this in consultation with all the people concerned. The home specialises in offering care to people with dementia. However, out of a team of 21 support staff, only six people had received any dementia awareness training. One of the visitors spoken to said the staff had commented to her that they knew nothing about Alzheimer’s. The manager said this was because a lot of the original trained staff had left. At previous inspections, staff training records had showed that more people had received the training. Given the specialist nature of the unit, part of each person’s induction training should be about how to care for people with dementia and action must now be taken to ensure that all staff receive this training. The Yesterday, Today and Tomorrow dementia training, which is done over eight sessions is extremely thorough and all staff would benefit from this course, especially those in a senior position. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Residents’ health and personal care needs were clearly set out in detailed care plans that the staff were following. EVIDENCE: At the last key inspection, two requirements had been made in respect of care plans and support. Both of these had been met and it was clear that people were now receiving a much better standard of care than previously. Care plans were in place for all the residents currently being accommodated. Three residents’ files and care plans were checked. One care plan was for someone whom the district nurse was visiting, one was for a resident at risk of malnutrition and one was for someone who relied upon the staff to help with all her personal care needs. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 13 All three plans were detailed, showing exactly what care and support each person needed. Where people had been assessed as being at high risk after a nutritional assessment, the care plan recorded exactly what action needed to be taken to reduce the risk. Advice of dieticians was being taken as and when needed. Due to the number of people who were assessed at medium and high risk of malnutrition, the manager had instructed staff to weigh everyone on a weekly basis and where weight loss was identified, action was being taken to address this. Two care plans showed the residents to have either maintained or gained weight. The third person had lost weight but the dietician had been consulted and an action plan was in place. Milky drinks were being offered throughout the day and full cream milk was being ordered. Fortified drinks prescribed by the GP’s were also being given and night staff were instructed to make sure suppers were offered to all residents, such as milky drinks, sandwiches, toast or cereals. One relative spoken to said that the person she was visiting had lost weight but was on supplement drinks four times a day. When checking dietary intake sheets, it was noted that they were vague and not recording exactly what had been served. The manager said she would address this with the staff team. One care plan recorded that a resident had pressure sores and that the district nurse was visiting. It was however, noted that the professional visitors sheets, held in the care plan file, did not record when the district nurse visits had taken place, nor were the visits recorded in the daily notes. This should be addressed, together with any changes in instructions she may give to the staff. The nurse was spoken to during our visit. She confirmed that the staff were supporting this resident in accordance with her instructions and that she was pleased with her patient’s progress. She also said that diet, fluid and turning charts were being kept up to date and that the sores were responding well. All three care plans had been regularly reviewed and updated. All residents had recently been reviewed by care managers. The project manager said that as soon as they received copy reviews, she instructed the deputy or team leader to implement the recommendations as speedily as possible. One of the reviewed person’s recommendations was followed up on this visit and seen to have been met. At the last two inspections, it was noted that care staff were not always completing the daily personal care sheets. There had been some improvement in this respect but staff were still forgetting to complete the forms after assisting people with baths and showers. Given the client group that the home accommodates, it is vital that staff can demonstrate that residents’ personal care needs have been fully met and they should ensure the personal daily records are kept up to date. The manager said she would be monitoring this and that staff now had to record all baths and showers on the staff handover sheets for early, late and night shifts. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 14 As the home catered for people with dementia, it was difficult to check with residents if they felt their needs were being met and whether their care plans were accurate. However, those people who could express their thoughts said they liked the staff and felt they were well cared for. Three relatives were spoken to during the visit. One person said they had seen some improvement in the way the person they visited was cared for. The other two felt the care was fairly good, although they did have issues about loss of personal items which were addressed during the visit. Ethnicity, culture and religion were included in the care plan files wherever pertinent. Risk assessments were undertaken as part of the admission process. All three files contained detailed up to date risk assessments for skin (Waterlows), moving and handling, dependency, nutrition, continence and falls. Where areas had been assessed as high or medium risk, as stated above, the care plans detailed the action which was needed to reduce the risks identified. Following a fall, a system had been implemented where staff had to closely monitor the person and complete a monitoring form, either hourly or two hourly. Two of the relatives spoken to said they were advised if the person they visited had had a fall or was ill. Other than the shortfall identified above in respect of district nurse visits, the care plans contained details of when professional visitors had visited, such as chiropodists, GP’s, etc. On the day of the inspection, one resident was quite poorly and the home had requested a GP to visit. This request had been refused and so the home had made an emergency call and the person was being admitted to hospital. This course of action was felt to be appropriate for the person. During this inspection the pharmacist inspector looked at records about medication, together with the medicines held in the home for residents. This was to make sure that the requirements made in the Statutory Requirement Notice, which was served on 9 January 2008, and the requirements made at the last inspection, in November 2007, had been met and that residents living here were safe. During the last inspection residents’ health was at potential high risk from harm because of poor medication practices. Since that inspection staff and managers have worked very hard to make sure residents’ health was not at risk. The standard of the records, seen during this inspection, about medication was good. The accurate records showed that residents were now being given their medicines as prescribed by the doctor. The staff also clearly recorded why sometimes residents did not take their medicines as prescribed. The records also showed that all medication could be accounted for. Ordering of medication has now been improved to make sure residents do not go without their prescribed medicines. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 15 All other aspects of medication handling looked at were good and staff who administered medication had all been assessed as competent to do so safely. During the inspection it was noticed that one resident, who had previously refused a lot of medication, had been encouraged to take the medicines more regularly which reduced the risk of harm to their health. The management has regularly checked how well medicines were being managed and have helped staff improve practices when needed, this makes sure that residents health is not at risk from harm. Observations made during the visit showed the staff encouraging and supporting people to be as independent as possible within individual capabilities and enabling them to follow their preferred routines. People were not being got up early in the morning and breakfast was being served up until about 10.00am. In the main, staff were making sure that residents were dressed properly, that toilet doors were closed behind them, that their clothes were clean and people looked tidy and cared for. Feedback from two relatives did, however, indicate that improvements still needed to be made in respect of making sure that residents wore their glasses and had their dentures in every day. The person they visited had had no dentures for several months, as they had been lost and the second pair of spectacles they had brought in were not being worn by the resident. The manager said the dentist had visited very recently and new dentures were to be obtained. One of the more recent complaints was in respect of privacy and dignity issues, when certain staff had been caring for someone who was very ill. The manager said the staff concerned would be receiving training in privacy and dignity. The home had two male care assistants, one working on nights and the other on days. This meant that male residents could choose to receive a bath or shower assisted by someone of their own gender. In order to uphold privacy, professional visitors to the home saw people in the privacy of their rooms and this was evidenced during the inspection when the district nurse visited. Heywood Court Care Centre DS0000049296.V358879.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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People were given choices in their daily routines, resulting in them being able to have some control over their preferred lifestyles. EVIDENCE: In many instances, due to mental frailty, staff did have to make choices on residents’ behalf. However, staff spoken to said they tried to offer them choices if at all possible. This was seen during the visit, one resident used the lift to access her first floor bedroom unaccompanied and clearly enjoyed walking around the home. Another person liked to get up late in a morning and anyone asleep was left to wake up on their own, unless there was a reason why they needed to be awakened. One resident liked to eat all her meals in her room. Staff gave people choices in what to wear, where to sit in the dining room and communal rooms and what to have for their meals. One resident carried her coat around the home for the whole inspection and as this gave her comfort, the staff did not intervene. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 17 Some of the bedrooms looked at had been personalised and it was evident that residents had been encouraged to bring ornaments and other personal possessions in with them to make their rooms more homely. The different coloured bedroom doors with nameplates or other personal effects hung on the doors, made them more easily recognisable for the individual. Also, large clear pictorial signs had been fitted to bathroom and toilet doors so that people could find them more easily, with staff assistance. A requirement was made at the key inspection in July 2007 for the manager to put into a place an activities programme, which would meet both individual and group needs. This requirement had been met for a short period of time only, when an experienced activity worker had been appointed and taken up post in November 2007. Excellent feedback was received from relatives and staff about the things she had organised for the residents over the Christmas period. They had made Christmas decorations, decorated the trees, baked, had external entertainers in and enjoyed Christmas parties and celebrations. Unfortunately, this person had now left on an extended holiday and the manager was currently advertising for a replacement. Since she had left however, social stimulation had again been lacking. During the visit, appropriate music was being played in the lounges and one television was switched on showing suitable programmes. However, interaction between the staff and the residents, at times, was poor. One of the visitors spoken to also commented about this. Whilst staff presence was now being maintained in each of the lounges, the level of interaction varied, dependent upon who was on duty. Two staff were observed just standing in two of the lounges watching over the residents. They were not spending time chatting to them or trying to engage them in any sort of activities. It was felt this may have been because they were unsure of how to do so, or even whether they knew enough about each person’s previous background so they could talk about things that interested them. Clearly, social stimulation should not just be about one person (e.g., social activity worker), organising games and activities. It should be about all staff engaging people in conversations that might be of interest to them or simply sitting down next to them, offering comfort and care. The manager should ensure staff receive the training they need in this respect and also check that social profiles in care plan files are fully completed so that staff will have the information they need to try and gain some insight into what has interested each person in their past lifestyles. Observations of good practice included a domestic encouraging a resident to assist with the dusting and providing her with a duster. Another care assistant put on some dance music and tried to get people to dance. One person spoken to was smiling and relaxed. She said “I like this place, I like to keep it nice and the curtains are lovely”. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 18 Residents’ religious needs were addressed as part of the admission procedure and recorded on each resident’s social history sheet. At the time of the last random inspection in November, 2007 the manager had arranged visits from the local clergy. Only one visit took place and the home should now check out whether any other local church reprentatives would be able to visit. One person went out to church every week with her visitor. During the inspection, three relatives were spoken with. They confirmed they could visit whenever they wanted and that they were made welcome. One said, “I can come and go as I like”. They all felt that care had improved but felt that staff needed to be more vigilent in respect of making sure the residents wore glasses and had their teeth in every day. Four weekly menus were being followed, although these were due to be changed very shortly to new ones that were more nutritionally balanced and called “nutmeg menus”. The Chef and manager confirmed they could be adapted to include food people liked but that the outcome for people would be they would have reduced salt and other unhealthy foods in far lesser amounts. The current menus included a good range of meats and fish and many of the desserts were milk and fruit based, such as sponge and custard, milk puddings, apple pie, pineapple upside down cake and fruit crumble. The chef said that some meals were fortified with cream and milk in order to increase people’s calorie intake. On the day of the inspection the lunch meal was scotch broth soup, meatballs and vegetables or an assortment of sandwiches with chips. All the food was home made. The main evening meal was a choice of chicken casserole or fish morney. People were seen to enjoy their lunch time meal and it smelled tasty. Residents were encouraged to have suppers which included biscuits, sandwiches, toast and milky drinks. One resident said, “The food is very good” and another said, “I like everything they give me”. Another resident, when asked if they liked living at the home, replied, “Yes, its alright, we get cooked dinners and fish and chips on a Friday”. A good practice observation was seen where a resident was given a plate of sandwiches as he continually walked around the home and refused to sit down anywhere. Another person chose to eat all her meals in her bedroom and this was not a problem. One area of practice that needed to be improved upon was for residents not to be assisted to the dining rooms until their meals were ready to be served. In one conservatory, residents were sitting down at tables at about 12.30 and were not given their meals until after 13.00. They became restless and two people got up and down several times. The staff should be instructed to make sure this does not happen in the future. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 19 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 adequate. This judgement has been made using available evidence, including a visit to this service. Care staff did not always listen to people’s complaints and concerns, resulting in issues not being properly investigated in line with the home’s policies. EVIDENCE: The complaints procedure was in the service user guide, which was given to new residents and/or their relatives as part of the admission procedure. Since the last key inspection in July 2007, the Commission for Social Care Inspection had received two complaints, one in respect of poor medication practice and the other about continence pads running out and other care issues. The manager at that time had investigated the care issues complaint and action had been taken to resolve the problems. The pharmacy inspector had investigated the medication complaint on one of the random visits made in November 2007. It was felt that if staff employed at that time had communicated better with their manager, some of the problems could have been dealt with before they became full blown complaints. Also, if staff had been more vigilant and received the right training to do their jobs properly, they would have known how to report and follow up concerns from relatives and other people visiting the home. In September 2007, the training matrix showed that four care assistants had received customer care training. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 20 The logging of complaints had since improved and now concerns were also being logged in the same way as complaints. Since the random inspection, two concerns and one complaint had been logged. The complaint was in respect of privacy/dignity of a person who was ill. The project manager had almost concluded her investigation and felt that elements of the complaint were upheld. As a result of her findings, more training in privacy/dignity was to be obtained for the staff involved. One relative spoken to said, “If there’s a problem staff do deal with it. I have made a complaint and feel that I was listened to. We had a big meeting and the problem was resolved but the top floor was closed”. Four safeguarding alerts had been made, three of which had been thoroughly investigated in line with the Local Authority’s safeguarding policy/procedures. One was ongoing and was in respect of poor practice by two agency staff and the agency concerned were responsible for this investigation. The police involved had expressed that they did not feel abuse had taken place, but that the agency staff needed to do further moving/handling training. Poor practice in respect of not giving someone medication for two weeks was upheld and appropriate action was taken to dismiss the staff concerned and submit to the Department of Health a referral for the person to be included on the protection of vulnerable adult list. The other allegation did not involve staff and Social Services staff took appropriate action to safeguard the people involved. A requirement had been made at the random inspection in November 2007, for all staff to do protection training. From checking the training matrix, it was noted that all but the very newest staff had now done this training. This included the administrator, laundry assistant and some other ancillary staff. The project manager said the few who still needed to do the training will receive it over the next few weeks. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 21 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 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The environment was being upgraded but the malodour which was still apparent in certain areas of the home needed to be dealt with so the home would be a pleasant place for people to live. EVIDENCE: At the front of the home was a safe courtyard area, which residents could use in the warmer weather as seating was provided. One CCTV camera was in place to view the courtyard area but this was for safety purposes and was positioned so that staff could see who was arriving and wanting access to the home. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 22 As soon as we walked into the home, there was evidence of malodour, although it was significantly improved from the last visit. The project manager advised us that as soon as the re-decoration work was completed, all corridor and communal area carpets were to be replaced, following the floorboards being treated, in order to totally remove the smell. Several changes had been made in the home to make it a more homely and pleasant place for the people living there. A dividing wall had been built, making a separate entrance hall that visitors or residents could use as an alternative sitting area. Visiting social workers used this room during our visit. In addition, the main dining room had been made into a lounge/dining area and a conservatory changed into a second dining room. This gave people more choice in where to eat and whether to sit in a quieter part of the home. Throughout the visit, the atmosphere within the home was more peaceful and residents seemed more settled and did not wander around as much. Since the last inspection, the top floor unit had been closed and the residents moved into rooms on the ground or first floor levels. This decision had been made in full consultation with the residents and/or their relatives. The operations manager said the future of the unit would be reviewed at a later date when the refurbishment and redecoration of the home were completed. The decorators had started work painting the ground floor corridors and they said they would be painting all corridors and communal areas on all levels of the home. They said the work would probably take them about 8–10 weeks to complete. Following this work, the project manager said new blinds and curtains were to be fitted in the lounges and conservatories. Quotes were being obtained for some new easy chairs and dining room chairs. At the last visit, the smoking lounge was very cold and not suitable for people to sit in. A new wall mounted heater had been fitted. Upon our arrival however, the night staff had failed to switch it on before going off duty and it was freezing cold. A member of staff switched it on and within half an hour it was nice and warm and a resident was making use of it. The manager said she would speak to all night staff to remind them this was one of their tasks before going off shift. Some bedrooms were randomly checked and they were in good decorative order and well furnished. Large en-suite toilets were adapted for people with physical disabilities. There was a malodour apparent in one room only and the manager said they were to discuss this with the resident’s relative and suggest flooring that could be more easily cleaned. Residents were observed moving around the home fairly easily and appropriate aids and adaptations were fitted in bathrooms, toilets and corridors so that residents could remain as independent as possible. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 23 One of the first floor bathrooms, across from the medication room, was cold and the radiator was not working properly. Also when the fan started to work, it made an extremely loud screeching sound. The project manager said this had already been reported to the handyman but that an out of service notice would be put up so that residents would not be disturbed with the noise during the night. The radiator was reported to the handyman on the day of the visit and the manager said she would monitor this was dealt with quickly. One of the domestics was spoken to. She said they had sufficient staff to keep the home clean and that if staff were off sick or on holiday, proper arrangements were made to provide the right cover. She said they now felt they could keep on top of cleaning the building. All areas in the home that were checked were clean. Upon checking resident toilets, it was noted that whilst they were equipped with paper towels and liquid soaps, there were no bins provided for putting paper towels in. One of the staff said they had been told to remove all bins from the toilets and that they had to walk to the nearest sluice to dispose of any paper towels used by the residents. This was poor practice in respect of infection control measures and the lack of bin provision could have stopped residents from washing their hands after using the toilets. The project manager said they had misunderstood the directive as it was yellow bins she had requested be removed. Replacement bins were taken from the top floor, which was not currently being used and put into the ground floor toilets during our visit. Good infection control practice was noted at meal times when staff changed into blue disposable aprons. They wore white disposable ones when assisting with personal care tasks. The staff said there were always plenty of disposable gloves and that liquid soap and paper towels were supplied in all bedrooms, bathrooms and toilets. Evidence of this was seen during the visit. Good laundry facilities were in place and individual baskets supplied for each person’s clothes. The laundry was tidy and clean. Appropriate colour coded laundry bags and protective clothing were in use for this service. When unoccupied, the laundry door was kept locked to prevent residents from going in and harming themselves. One relative spoken to said that many problems had been identified in the past in respect of lost items of clothing. She felt this was now improving. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home was adequately staffed to meet the health and personal care needs of the people living there. EVIDENCE: The present resident group were all white, as were the majority of the team, although some carers were from other ethnic backgrounds. The organisation had equal opportunity and equality/diversity policy procedures in place. The new management team had been closely monitoring and supervising the staff to try and make sure they were working safely and caring for the residents so that their identified needs would be met. The project manager, with support from the operations manager had taken a strict approach to poor practice within the home, resulting in some staff receiving disciplinary warnings or being dismissed. The staff felt they were now working better as a team, were being given proper guidance and support, resulting in staff morale improving. As highlighted in the complaints section above, it was felt improvements could be made in respect of staff communicating better as a team and making sure that important information was passed from one shift to the next. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 25 Satisfactory staffing levels were being maintained for the number of people presently living at Heywood Court. This was seen from checking rotas, and speaking to care assistants. Five residents had recently been re-assessed and were due to go to other placements over the next few days. The project manager said present staffing levels would be maintained in the short-term so that the deputy, team leader and other senior staff would have sufficient time to continue to monitor care practice and keep residents’ records accurate and up to date. As a result of several staff either choosing to leave or being dismissed, the manager was advertising for more care assistants. Until posts were filled, the manager was still using agency staff. She said she requested the same staff whenever this was possible so that they would know the residents for whom they were caring. Of the 21 care staff currently working at the home ten had completed NVQ level 2 training or above making 48 of qualified staff. This level of trained staff had improved since the last inspection. The deputy manager had done her NVQ level 3 training as had three senior care assistants. Seniors were not employed unless they had achieved at least a level 2 qualification. The names of a further six staff had been put forward to be enrolled onto NVQ level 2 training but dates for the training to be started had not yet been agreed. When checking staff training files, it was noted that copy NVQ documentation was not always in the files. Copies of all training certificates should be held on files. Three staff files were checked. Some shortfalls were noted in respect of not having staff photographs for identification purposes, employment records not always showing full employment histories and one file not having evidence of receipt of a Criminal Record Bureau (CRB) check. The manager telephoned us after the inspection to say she had checked this out and the CRB had advised the delay was because of errors in postcode and former addresses. A Pova First had been done before the person had started work. The manager was reminded that this person should not be working unsupervised until a satisfactory CRB check had been obtained and that in future a track of progress of requested CRBs should be maintained. Also, on occasions, references were being obtained from colleagues rather than management and the manager should be obtaining references from previous employers, even if this means ringing up and asking for the information, when references have not been returned. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 26 Regional two-day induction training courses had been set up for new staff and some of the staff at the home had attended the first lot of training. The project manager said they were addressing the Skills for Care units, but evidence of this was not available at the time of the inspection. All the mandatory training was to be completed within the first 12 weeks of employment, but again, there was no evidence in files to substantiate this. From checking the training matrix, improvements were noted in the number of staff who had now attended training in fire safety, moving/handling and food hygiene but due to the numbers of staff who had left and those who had since joined the team, there were still some gaps. Additional sessions were to be arranged to ensure that all the staff received the necessary training and dates had already been arranged in March for food hygiene training. Although a requirement had been made for all staff to do infection control training, this had not been done. During the visit however, the project manager obtained a training date of 22 February when two half day sessions would be carried out so that all staff could attend. There was nothing recorded on the training matrix in respect of staff who had done first aid training. The manager said six staff had recently done this training and the training matrix would be updated accordingly. It was also noted that some of the current staff team had not been included on the training matrix. The manager confirmed this list would be updated immediately and their training recorded on it. The deputy manager and a team leader were booked to attend a three-day training course in moving/handling which would then allow them to do this training in-house with the two care staff who still needed to do this training. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Changes in the way the home was being managed have resulted in improvements being made for the people living there. EVIDENCE: The home has been without a registered manager over the past 18 months. Although managers have been appointed, they have left either before their application to be registered has been submitted or prior to their application being processed and approved by us. This lack of continuity has had an adverse affect on both staff and residents resulting in a significant number of concerns, complaints and safeguarding alerts being made. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 28 Since the random inspection in November 2007, the management of the home has improved, although the manager working at the home at the time of that inspection had moved to another home within the company. The operational manager, supported by the responsible individual has taken positive efforts to address the problems by allocating an experienced project manager to manage the home on a temporary basis until a permanent manager has been appointed. In addition, over the past five weeks, a manager with a nursing qualification, from another home, has been working alongside the project manager. As a result of their experience, many improvements have been made, although only time will tell whether these improvements will be sustained. Staff were now receiving regular supervision, staff meetings were being held, more staff training courses had been arranged, staff had daily designated duties resulting in residents being monitored in the lounges, staffing levels were being maintained and the manager was spending time on the floor observing staff practice and making sure residents were clean and cared for. In addition, arrangements had been made for the home to be re-decorated, and the top floor unit had been temporarily closed with all residents now being accommodated on the ground and first floor levels only. Both the operations manager and the responsible individual had been regularly calling at the home to monitor that the improvements were continuing. The new manager said she had applied to become the permanent manager of the home and would be submitting her application to be registered very shortly. Whilst she has a nursing qualification, she has not got a background in dementia care. The operations manager confirmed that she would be enrolling on a 16 week university dementia care training course which involved one day per week training. Staff feedback about the new manager was positive. They said she spent time on the floor and was not always shut away in the office. They commented, “she’s very fair and treats everyone the same”, “strict but approachable” and “knows her job”. Even though she had not been at the home very long, observations made showed her to know residents by their names and she had a calm and kindly manner when speaking to people. A corporate quality monitoring and assurance system was in place and the audit tools were being used. The manager did a monthly audit that was validated by the operations manager. Due to the many problems that had been identified in the past in respect of medication, weekly audits were continuing. In addition, pressure sore, weight loss and falls audits were being done monthly. Action plans were completed where shortfalls were identified. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 29 Questionnaires to relatives were sent out twice yearly and the next batch were due to be sent out very shortly. These were then returned to the regional office so that responses could be collated before they were returned to the home. When results of the feedback are available, a copy should be forwarded to the CSCI office so that we can monitor that improvements are being maintained. Since the random inspection in November 2007, the manager had held one relative meeting and another one was due the week following the inspection. The minutes of the relative meeting were seen. Many problems had been raised by them. Notes made on the minutes sheet showed that the majority of the criticisms had already been addressed. The late night weekly surgery held by the manager was being continued and this enabled relatives to call in for informal chats or to raise any concerns they had. As previously stated, the operations manager was closely monitoring the home’s performance and Regulation 26 visit sheets were seen on site. In order for us to monitor that the present improvements are maintained, copies of the Regulation 26 visits must be sent to us until further notice. Where the home held any money for the residents, all income and outgoings were listed on the computer and print-outs were given to residents and/or relatives upon request. Due to the mental capacity of the residents, their relatives or advocates managed their financial affairs and regularly liaised with the administrator to check that sufficient money was held at the home to pay for hair, chiropody, etc. The financial records of three residents were looked at. Two were satisfactory but one of them was inaccurate, with two entries being made in error. The administrator could not remember why the errors identified had been made or what they were. The manager was to investigate this further. The organisation had detailed health and safety policies and procedures in place which were reviewed and updated as needed. Information contained on the Annual Quality Assurance Assessment (AQAA), returned to us in July 2007, showed that the required maintenance checks had been carried out. A random sample of fire records and lift servicing showed these to be in order. As highlighted in the staffing section above, some health and safety training was still outstanding for some of the staff team but arrangements had already been made to address this training shortfall. Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 30 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X X 2 Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement Before residents come to live at the home, they must be assessed to make sure the home can meet their identified needs. In order to be able to meet the needs of people with dementia, the staff must receive dementia awareness training so they will know how to look after the people in their care. An activity programme must be implemented which meets the differing needs of the people living at the home, so they will not be bored and unfulfilled. The smell of urine in some areas of the home must be addressed so that the home will be a more pleasant place for people to live in and visit. So that residents are encouraged to wash their hands after going to the toilet, paper towel bins must be supplied in all bathrooms and toilets. Before staff start to work at the home, all the right checks and information about them must be in place to ensure they are DS0000049296.V358879.R01.S.doc Timescale for action 29/02/08 2 OP3 18(1)(c) (i) 31/03/08 3 OP12 16(2)(n) 29/02/08 4 OP19 16(2)(k) 29/02/08 5 OP26 16(2)(j) 29/02/08 6 OP29 7, 9, 19 29/02/08 Heywood Court Care Centre Version 5.2 Page 32 7 OP30 1818(1) (c)(i) 8 OP33 26 9 OP35 17(2) 10 OP38 8 suitable to work with vulnerable people. All new staff must undertake induction training within 12 weeks of starting work, which must include all Skills for Care Common Induction Standard units. When the operations manager has done his monthly Regulation 26 visit, the report must be forwarded to the CSCI so that we can monitor that the improvements to the service are being sustained. An audit of residents’ monies held on their behalf must be done to make sure that the accounts are correct. A permanent manager must be appointed to manage the home so that it runs smoothly and an application to register this person must be sent to the CSCI so they can arrange a fit person interview. (Previous timescale of 30/11/07 not met). 31/03/08 29/02/08 31/03/08 31/03/08 Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Residents’ individual daily personal care sheets should be completed when baths/showers are given so that management can monitor these are taking place. (Outstanding from the last inspection.) When district nurses or other professionals visit the home, the visit should be logged on the person’s file, together with outcomes of the visit. Staff should receive training in privacy and dignity to ensure they have the knowledge to care for people in the right way. Staff files should contain individual training profiles with copy certificates so that the manager can easily see who needs training or refresher training. The staff training matrix should be updated to show all the staff employed and when they have completed training courses. 2 3 4 5 OP8 OP10 OP30 OP30 Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Manchester Local Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Heywood Court Care Centre DS0000049296.V358879.R01.S.doc Version 5.2 Page 35 - 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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