Inspection on 11/07/07 for Heywood Court Care Centre

This inspection was carried out on 11th July 2007.

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

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

Other inspections for this house

Heywood Court Care Centre 29/07/08

Heywood Court Care Centre 01/02/08

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 11th July 2007 08.00 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 Heywood Court Care Centre DS0000049296.V343910.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.V343910.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 Care Home 45 Category(ies) of Dementia - over 65 years of age (45) registration, with number of places Heywood Court Care Centre DS0000049296.V343910.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) 9th January 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. 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 July 2007, are as follows: If the Local Authority fund 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.V343910.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over ten and three quarter hours, the inspector arriving at 08:00 and leaving at 18:45. In order to find out what it was like to live at Heywood Court, eight residents were spoken to as well as the acting manager, operations director, operations manager, three care assistants, the chef, laundry worker, the visiting district nurse and four visitors to the home. No comment cards had been received at the Commission for Social Care (CSCI) Office, from relatives or other visitors to the home. The inspector also looked around parts of the building, checked the records kept on residents, to make sure they were being looked after properly (care plans) as well as looking at how medication was given out. A large part of the inspection was spent watching how the staff looked after the residents. Since the last inspection the manager had left and there was an acting manager in post who had applied for the permanent job. If she is successful, an application to be registered will be submitted. A random inspection had taken place in January 2007. This had been carried out to follow up two complaints that the manager had investigated and also to check that the manager was putting right all the things that had been written in the last inspection report. Since January 2007, the Commission for Social Care Inspection had received another complaint in respect of insufficient staffing levels and the lift having been out of order for a considerable time. These are addressed in detail under the complaints and staffing headings in the report. What the service does well: The staff had good relationships with the residents and if someone became upset or distressed, the staff knew the best way to handle the situation in order to calm the person down. The new acting manager was committed to ensuring that new residents were thoroughly assessed before coming to live at the home, in order to ensure their needs could be met. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 6 Although there had been occasions when the home was short staffed due to someone ringing in sick at the last minute, the management team were trying to make sure that enough staff were on duty both during the day and night time to meet the needs of the residents. The chef was good at his job and the menus were varied and nutritious. He knew the importance of making sure that people had choices at each meal and residents’ special dietary needs were well catered for. The new acting manager had made a good start at looking where the home needed to improve and with the support of the operations manager had already written action plans so that staff knew exactly what needed to be done. What has improved since the last inspection? What they could do better: The care staff needed to read and follow the care plans to make sure they were giving the right care to each person. The care plans were not always recording the up to date needs of each resident so that their assessed needs were being met. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 7 There were very few social activities or trips out being organised and, as a result, the residents were bored, falling asleep or just sitting staring around the rooms they were in. New staff were not getting thorough training when they first started work or being properly supervised by an experienced worker, so they would know how to do their jobs well. Since the last inspection, more staff had received training in food hygiene, infection control and fire but there were still many staff who needed to do this training so they would know how to ensure the safety of residents and themselves. 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.V343910.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents were assessed before coming into the home to ensure their needs could be satisfactorily met. Standard 6 was not assessed as the home did not accommodate intermediate care residents. EVIDENCE: Assessments for three residents were checked. One file contained a Local Authority service delivery agreement, as well as the home’s assessment document, which had been fully completed. In the second file, the home’s assessment was missing. The manager said the team leader had been out to assess this person, but the assessment document could not be found. However, Local Authority documentation was seen. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 10 The acting manager had been out to assess the third person herself before they were admitted to the home. The assessment document was detailed and gave a comprehensive picture of the person’s needs and abilities. The manager said she had spent some time speaking to the resident’s husband in order to get as wide a picture as possible about her preferred routines and lifestyle. The acting manager demonstrated her knowledge and awareness of the importance of the assessment process. She said that admissions to the home only took place if she was confident the home could meet their needs. The home had two designated respite stay beds which, on occasion, were needed on an emergency basis. When this happened, the resident was assessed within the first day or two of admission. From the assessment an initial care plan was drawn up with a more detailed plan being done at a later stage. These plans were seen on the files inspected. Whilst checking the files, it was noted that contracts had not been issued for two of the residents. The administrator said she was aware of this and had got behind in her work. She said she would ensure this was immediately addressed. At the last key inspection in May 2006, a requirement was made for all staff to receive dementia care training. Since this time, a further eight staff had attended dementia care training. The deputy manager, team leader and one senior had also been booked on a two-day dementia care course, which was to be held the day following the visit. A telephone call received following the inspection identified the deputy had not attended. The acting manager had done a facilitator’s course in dementia care entitled “Yesterday, Today and Tomorrow”. She had now planned dates in July and August so that all staff would be able to receive this training in order to ensure they had a better understanding of how to meet the needs of the people in their care. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Staff were not always following the care plans, which could result in the residents’ personal care needs not being fully met. EVIDENCE: Care plans were in place for all the residents currently being accommodated. Three residents’ files and care plans were checked. Two care plans were for fairly new residents and one was for a resident with more complex needs who had lived at Heywood Court since April 2005. The care plans for the two most recently admitted people were up to date and identified their needs and choices with regard to daily lifestyles and routines. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 12 The other resident had recently suffered from ill health, resulting in admission to hospital. The care being given to her, both pre and post admission was not as recorded on her plan. The care plan stated that she should be weighed weekly and that turning and fluid intake charts should be in place. Only two fluid charts could be found by the staff on duty. She had last been weighed on 15 May 2007 and had not been re-weighed since returning from hospital. The professional visitor sheets had not been updated to reflect visits from the district nurses who were coming in to do dressings. No turning charts were in place. One of the care assistants who was on duty on the unit said she was unaware that the care plan recorded that fluid intake should be recorded. In addition, the care plan evaluation sheets had not been updated since 16th May 2007. The malnutrition risk assessment for the person recently returned from hospital was inaccurate and had not been updated to reflect her present condition. The shortfalls in this care plan must be addressed. 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, all residents spoken with said they liked the staff and they felt they were well cared for. Four relatives were spoken to during the visit, three of whom said they were satisfied with the care the home was providing. One person was dissatisfied and was waiting for a response to a complaint she had recently made. Ethnicity, culture and religion were included in the care plan files wherever pertinent. The previous manager had implemented a six monthly reviewing system and the acting manager said she would be continuing this system. At the last inspection, it was noted that care staff were not always completing the daily personal care sheets and there had been no improvement in this respect. The July personal care sheets were looked at and out of 11 days, only five days had been completed. It could not therefore be determined, from checking the records, when residents had been assisted to take baths or showers or other personal care tasks. 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. One care plan file did not contain a belongings/clothing inventory. Given the problems that can occur with regard to clothing going missing, it is essential that upon admission, a full inventory be completed. Where challenging behaviour was identified, the appropriate forms were completed with action plans detailing how staff should address any problems. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 13 Risk assessments were undertaken as part of the admission process. All three files contained detailed risk assessments for skin (Waterlows), moving and handling, dependency, nutrition, continence and falls. Where areas had been assessed as high or medium risk, the care plans detailed the action which was needed to reduce the risks identified. As identified above, one of the nutritional assessments did not accurately reflect the present condition of one of the residents. Action taken by the staff, following a resident falling had improved. The operations manager was monitoring falls by way of a daily report which she had faxed by one of the management team. In addition, the acting manager had implemented a system whereby anyone having a fall would be closely monitored for the following 24 hours. Relatives spoken to said they were always advised if the person they visited had had a fall or was ill. After having read clinical guidelines about the benefits of older people being prescribed vitamin D3 to reduce the risk of falls, the acting manager had written to all GP surgeries requesting they consider prescribing the vitamin for those who would most benefit. At the time of the visit, none of the surgeries had responded. Other than the shortfall identified above, the care plans contained professional visitors sheets which identified visits made to the home by chiropodists, dentists, district nurses, GP’s, community psychiatric nurses and opticians. From speaking to the manager, staff, visiting district nurse and relatives, it was clear that whenever residents were ill, staff would request a visit from a doctor or a nurse. The visiting district nurse confirmed that the working relationships between nursing and care home staff had significantly improved and she felt the needs of the residents were being met. It was pleasing to note that the anomalies in care plans, identified above, had already been highlighted by the new acting manager who had discussed the shortfalls with the operations manager. She had written an action plan addressing the shortfalls in the care planning system. This clearly addressed the action required, who was responsible and a timescale for completion. She had also arranged care plan training for the deputy, team leader and seniors and said she would be emphasising the importance of a person centred approach. In addition, the operations manager had drawn up a regional monthly weight loss monitoring report which the manager had acted upon. She had implemented a weight loss plan for seven residents and the chef had a copy of this plan in the kitchen. Upon interview, he was clear about the need to increase the calorific intake for these residents and said he was adding cream to many of the dishes, ensuring milky puddings were served frequently and was baking more cakes which the residents liked. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 14 Milky drinks were being offered throughout the day and full cream milk was being ordered. Fortified drinks prescribed by the GPs’ were also being given and the plan instructed night staff to ensure that suppers were offered to all residents such as milky drinks, soup, sandwiches, toast or cereals. Detailed medication policy and procedures were in place and a monitored dosage system was in use. In the medication room, it was noted that medication for June had not been returned to the pharmacy and some blister packs had not been recorded on the returns sheet. This should be addressed. In addition, there was a large crate of Fortisips and Fresubin (build-up drinks for people without an appetite) for one resident, stored in the room. Clearly, the repeat prescriptions were being delivered when the home had already stockpiled the drinks. The manager said she would ensure this was addressed. Staff responsible for giving out medication wore red tabards with “Do not disturb” printed on them. They said these had been introduced so that they were able to do the medication rounds without interruption. From observations of two medication rounds, it was seen that staff were correctly signing the medication sheets after medication had been given to the residents. One or two gaps on the medication adminstration records were seen but the manager had already identified this. A monthly medication audit was being done and the last audit was seen. Following the audit, the acting manager had drawn up an action plan which the deputy manager was responsible for implementing. Both the acting manager and operations manager were monitoring progress. The arrangements in place for controlled drugs were in order and staff were following the procedures. None of the present resident group were self medicating but if a resident did wish to self-medicate, then a risk assessment would be done. Given the residents placed at Heywood Court have differing degrees of dementia, it is not expected they would be able to manage their own medication safely. Lockable space was fitted in each of the bedrooms where medication could be locked away. A lockable fridge was being used and the fridge temperature was being monitored daily. The training matrix showed that all but one senior care assistant had completed appropriate medication training. The senior who had not was said to have a nursing qualification but no evidence of this was on file. She had however, done some medication training as there was a certificate in her file. The certificate did however specify that it did not mean that because she had done the training that she was necessarily qualified to dispense medication. The acting manager agreed to put her on a medication training as soon as possible. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 15 The home’s philosophy of care contained reference to core values, such as privacy, dignity and independence, and relative/resident feedback was good with regard to how staff treated them. In order to uphold privacy, the district nurse saw residents in private and this was evidenced during the inspection. Observation of care plans and information provided by the staff indicated that residents were being encouraged and supported to be as independent as possible within individual capabilities and enabled to follow their preferred routines. Good examples of staff being sensitive to residents’ privacy and dignity were seen during the inspection. Staff searched for missing shoes/ slippers and ensured that residents were appropriately dressed. They also asked residents discreetly if they wanted the toilet. On one care plan, reference was made to ensuring the resident was asked about what jewellery she wished to wear. Heywood Court Care Centre DS0000049296.V343910.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 adequate. This judgement has been made using available evidence, including a visit to this service. Residents were encouraged and supported to exercise choice in their daily routines in relation to lifestyle and to maintain contact with their relatives but social stimulation was lacking and resulted in residents feeling bored and unfulfilled. EVIDENCE: Staff were able to give examples of what choices they offered to residents on a daily basis. One resident liked to spend some time in their room and this was respected. Staff said they gave choices in what to wear, where to sit in the dining room and communal rooms, when to get up and go to bed and what to have for their meals. In many instances, due to mental frailty, staff did have to make choices on residents’ behalf. Bedrooms 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. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 17 The home had previously been found lacking in respect of the provision of social activities and stimulation. This had continued and the activitity worker had been off sick for some considerable time. Whilst the staff tried to spend some one to one time with individual residents, this depended upon what other tasks needed to be done. During the inspection one carer spent some time in one of the ground floor lounges, playing skittles with a few residents, but on the visits made to the second floor unit, only nail care was being done. There was no activity programme displayed within the home and the relatives spoken to also said this was an area which they felt the home needed to improve upon. Many of the residents spent the whole day, other than meal times, sitting in their lounges, staring at television programmes which they did not fully understand. In one lounge, a video of country music was being listened to and two or three of the residents were enjoying this. One resident was able to express his frustration about the lack of things he could do and how the time seemed to drag. Other residents were wandering around the home and instead of staff spending time trying to find something different to occupy them, they were simply escorting people back to a chair in one of the lounges. One staff did however, offer one resident a duster so that she could help the domestic clean one of the communal areas. In each person’s care plan file, there was an activity sheet but many of these were blank, confirming that social activities and stimulation were lacking. The home’s development plan, dated 11 June 2007, was seen. This addressed the shortfalls from this inspection and action required to address these was as follows: staff to document all interventions on activity sheets daily; in the absence of an activity worker a member of staff on each shift to be identified to carry out activities; minimum of monthly external entertainer to visit the home; minimum of monthly trip into the community; seasonal events such as fete, barbecue to be organised; relative meetings to have activities as an item on the agenda; activities to be advertised on the notice board and residents asked what they would like to see organised. The acting manager was mindful of the current shortfall and said this would be an area she would be prioritising. More trips out could be arranged as the home had the use of a mini bus, equipped with a tailgate lift, so that those service users reliant upon wheelchairs were not excluded from going out on trips. Heywood Court Care Centre DS0000049296.V343910.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 inspection however, representatives from the two churches who had previously visited had ceased and the manager was unaware of why. She said she would make enquiries and try to arrange visits for those residents who wished to have communion. During the inspection, four relatives were spoken with. They confirmed they could visit whenever they wanted and that they were made welcome. Three were satisfied with the care the person they visited was receiving. One person felt the care could be improved. Four-weekly rotational menus were seen and they provided a good choice of meat, fish, vegetables and fruit. Residents’ individual dietary needs were being well catered for. The chef on duty on the day of inspection was keeping to the menus as far as possible, the only exceptions being if orders had not arrived on time. On the day of inspection at lunch time, residents had homemade cream of vegetable soup followed by either sandwiches or corned beef hash, followed by chocolate sponge and mint custard. For the evening meal, the chef had made home-made pork casserole or mild beef chilli followed by stewed fruit and custard. The inspector sampled the choices at lunch. The soup was hot and creamy and the corned beef hash was tasty with carrots being added. The chocolate sponge with mint custard was delicious. The chef clearly enjoyed his job and had worked at the home for quite some time. He had got to know the residents well and tried to ensure that the residents had a good diet. The manager’s dietary action plan was pinned up on the kitchen wall and he was knowledgeable about what food the people on the list needed to have. He said he tried to increase calorific content to many meals by adding cream, offering fruit smoothies, milk shakes, milky drinks throughout the day, the use of milk puddings and by baking cakes and buns which the residents enjoyed. The sandwiches he was preparing for lunch had plenty of filling, especially those with cheese in. The chef was knowledgeable about which residents had to have special diets and demonstrated the choices he was able to give them. Meal times were observed and the improvements made at the random inspection, undertaken in January had been sustained. There was a more relaxed atmosphere within the ground floor dining room and residents were able to come into the dining room when they were ready to. The residents who needed assistance with their meals were given it sensitively. However, observations were made where two of the physically frail residents had refused to eat their meals and had declined any help. The meals were removed without giving the people anything else although a carer said she had already given one of the residents a sandwich, which she had refused. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 19 A good practice observation was seen where a resident was given hot finger food to eat at teatime, which she clearly enjoyed. Another resident refused to come into the dining room to eat his meal and the care assistant said he would be given it later when he was ready to eat. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 20 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 & 17 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. An effective complaints system was in place which relatives and residents were familiar with and staff training and good recruitment practices ensured that residents were protected, as far as possible, from abuse. EVIDENCE: A copy of the service user guide was in the rooms which were checked. addition, a copy of the complaints procedure is displayed within the home. In Since the random inspection in January 2007, the Commission for Social Care Inspection had received two anonymous complaints in respect of staff shortages and the lift breaking down and how this had affected the residents. The manager had been asked to investigate the lift complaint and the staffing one was looked at on this visit. The operations manager had responded to the complaint about the lift within the home’s 28 day timescale but the Commission for Social Care Inspection (CSCI) had not yet received the response, although it had been posted. The manager gave the inspector a copy report during the visit. The response was satisfactory and it was felt that everything possible had been done to reduce the distress and upheaval the residents had experienced. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 21 In respect of staffing levels, other than an odd occasion when staff had rung in sick at the last minute, staffing levels to meet the needs and numbers of residents living at the home had been sustained. The home’s complaints book had gone missing and a new book had been ordered. However, the complaints file was seen which contained responses to any complaints made by social workers, CSCI or relatives. It was clear that complaints were taken seriously and thorough investigations were undertaken. The operations manager was currently investigating a complaint made by three relatives, one of whom was spoken to during the inspection. She had only recently received the complaint and was well within the response time. No protection of vulnerable adult (POVA) investigations had taken place since the last inspection. A procedure for responding to allegations of abuse was available, as was an inter-agency procedure. Of 26 care staff currently employed, the training matrix showed that 14 had undertaken POVA training. The manager was aware that the remaining staff needed to undertake some training and she agreed she would ensure this was done. Three staff had done NVQ Level 3 training where protection training is thoroughly covered. The staff files inspected showed that Criminal Record Bureau and POVA first checks were being done to ensure that the staff were suitable to work with vulnerable people. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 22 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 home was adequately decorated and furnished throughout but some areas of the home were unclean and there were still some malodours in some communal areas and corridors. EVIDENCE: There was a maintenance plan in place, dated June 2007, that identified areas in the home which needed attention, together with timescales for the work to be completed, such as re-decoration work, dementia signposting, new furniture, improved lighting in the dining room and the fitting of nurse call sounder in this room. New bedroom carpets had been fitted in four or five bedrooms. Some of the work was ongoing, such as redecoration and painting bedroom doors different colours so that residents’ would be able to recognise their own rooms, fitting numbers, letter-boxes and door knockers, etc. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 23 One major improvement was identified in the building, which was the installation of two air conditioning units. One had been fitted in the reception office and the other on the second floor dementia unit. Staff will now be able to regulate the temperature of these rooms during warm weather, which will benefit both residents and staff. 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 were no odours apparent in any of these rooms. However, upon entering the home and in some communal areas and corridors on the ground floor, there was a sickly odour of cleaning products mixed with an existing malodour. This was however, a considerable improvement from that experienced at the last inspection but the odour problem was still an ongoing issue. The acting manager had discussed this with the operations manager who stated that new communal and corridor carpets were to be fitted as part of the maintenance programme. A smoking room was designated for residents and this was in one of the conservatories. One resident used this during the inspection, accompanied by a staff member. All the windows could be opened to allow the room to be aired. Staff were not allowed to smoke in the building. 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. The front courtyard area was well used by the residents when it was fine and this enabled them to move freely around. Seating was provided and it was attractively presented with pots and hanging baskets. The acting manager said plans were already in place for the outside areas, accessed via the conservatories, to be made into more pleasant areas for residents to spend time. 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. Infection control policies/procedures were in place. At lunch time, staff were seen to change protective aprons to blue ones for serving food. Liquid soap and paper towels were supplied in bedrooms, toilets and bathrooms to try and prevent the spread of infection. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 24 Two part-time laundry assistants were employed, covering for each other for annual leave and sickness. Good laundry facilities were in place and individual baskets supplied for each resident’s clothes. The laundry was tidy and clean. Appropriate colour coded laundry bags and protective clothing were in use for this service. The laundry person spoken to said that missing clothing was not a big problem and she only had one unmarked item which needed returning to a resident. She did comment there were occasions when night staff discarded used disposable gloves and aprons into the dirty linen baskets and that she then had to sort through the basket before putting the washing in. She had not however, addressed this with the acting manager. The manager spoke to her following the visit and advised the inspector that she would address this with the night staff. She had asked the laundry assistant to record any future bad practice and to bring it to her attention. Whilst the majority of the home was clean, there were areas that were not. The first floor kitchen was dirty and staff said it was not used. Given that staff were constantly having to go down to the ground floor when residents needed hot drinks, snacks, etc., it is recommended this room is brought back into use. The kitchen was thoroughly cleaned during the visit. The medication room needed cleaning and tidying and the waste basket was overflowing with waste items. The lift floor needed a thorough cleaning as it felt sticky. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 25 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 but training for new and existing staff needed to be improved to ensure they worked in a safe and competent way. EVIDENCE: Adequate staffing levels were being maintained for the number of people presently living at Heywood Court. This was evidenced by checking rotas, timesheets and speaking to care assistants. One carer felt there were often times when they were short-staffed, but rotas showed otherwise. It was noted that, on occasions, rotas did not reflect the actual hours or shifts worked and this was pointed out upon the visit. In these instances, the timesheets completed by the care staff were checked so that an accurate picture could be obtained. The acting manager said that in the future, she would ensure the rotas included agency staff hours and actual shifts that staff had done. She said that some of the staff did not take into account that staffing levels were reduced when resident numbers dropped, as had happened over the past few weeks. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 26 The present resident group were all white as were the majority of the team although some carers were from other ethnic backgrounds. All could speak English and be understood by the residents. The organisation had equal opportunity and equality/diversity policy procedures in place. Of the 26 staff currently working at the home nine care staff had completed NVQ level 2 training or above making 35 of qualified staff. In addition, two carers were due to complete by the end of July, bringing the figure up to 42 . The names of a further 11 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. The acting manager had also requested NVQ level 2 training for the administrator, kitchen assistant and five domestics. Whilst copy certificates were in place where staff had undertaken training, individual staff training profiles were not and this should be addressed. Inspection of three staff files showed that the home’s recruitment and selection procedures were being followed. Each file contained application forms, two satisfactory written references and Criminal Record Bureau checks. A supply of General Social Care Council “Code of Practice” booklets were kept in the office and said to be given to each new employee together with the staff handbook. In the files, staff had signed to say they had received a copy hand book. Skills for Care training for new employees had been commenced. However, upon checking the files for three care assistants who had started work in March 2007, it was noted that the training was being completed in one day. The sheets were being ticked and signed off by the assessor with nothing recorded about how the carers’ competence had been assessed. Clearly, induction training that is expected to take up to 12 weeks to complete and includes moving/handling, infection control, first aid, fire and food hygiene, cannot be done in one day. One of the newer care assistants was on duty at the time of the visit. She confirmed that her induction had consisted of being asked whether she knew about the topics and had taken about one hour to complete. Whilst she had done a health and social care course at college, she had never worked in a care home previously and had not done any mandatory training. When asked about how she had learned the job, she said she had worked alongside another carer for a day and had then been expected to work unsupervised. Discussion took place with the acting manager about the importance of new staff receiving thorough induction training and for them to work on a supernumerary basis until they were familiar with the residents. The manager said this would be her usual practice should any new staff start work at the home. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 27 From checking the training matrix, it was identified that almost the whole staff team had now completed moving/handling training. Since the last inspection more staff had completed training in fire protection and dementia but not much progress had been made in respect of food hygiene and infection control. A requirement had been made at the last inspection in respect of infection control training. The manager gave an undertaking that she would undertake training with those staff who had not yet done it and it would be completed by the end of July 2007. Six staff had completed first aid training, but the manager should be mindful that someone trained in first aid must be on duty at all times and more staff may need to take this training to ensure adequate cover. The manager had already identified these training shortfalls and had obtained a list of future mandatory training dates when training courses were planned at other homes. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 28 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. The acting manager had a clear development plan and vision of what needed to be improved in the home in order to ensure the residents received consistently good care. EVIDENCE: At the time of the inspection, there was no registered manager in post, the previous manager having left in May 2007. The acting manager had commenced working at Heywood Court just before the registered manager had left but had only spent two days with her before she left. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 29 She was on a secondment from her previous job, which was at another Southern Cross Healthcare home, that provided care to people with dementia. Her role had been as unit manager, and she had done the job for about two years, although she had been in the caring profession for eight years. The registered manager’s post at Heywood Court was currently being advertised and interviews for the job were planned in two weeks’ time. She had applied for the permanent post. She had recently successfully completed her NVQ Level 3 qualification and was awaiting her certificate. She was aware that she now needed to enrol for the Registered Manager’s Award so that if she were appointed as manager, she would be ready to commence the appropriate training. Throughout the inspection, the acting manager demonstrated her experience and knowledge in all aspects of management of a residential home. She had, with the operational manager’s support, already identified the areas of weakness, which had been identified on this inspection. Action plans to address these areas had been written and were in the process of being implemented. She had commenced supervision for the deputy and senior staff and had undertaken care plan training with them. In addition, staff appraisals were almost ready to be started. One night a staff meeting had taken place and another was planned. In addition, dates for a kitchen staff meeting, general staff meeting and another night staff meeting were in place. As already highlighted in the report she had also put into place ways of monitoring how care was being delivered, including medication and falls and was now addressing the shortfalls in the care planning system. Several weeks before this inspection, the Annual Quality Assurance Assessment (AQAA) form had been sent to the home for completion and return to the CSCI. This had not been returned within the timescale and three phone calls to the home had had to be made before the form was received. The reason given for the delay was that the previous manager had not advised the new manager the form had been sent electronically and was awaiting completion. The new manager had then taken two weeks’ leave. Following a phone call to the operations manager, the form was returned but it had not been fully completed. The importance of completing the form fully and returning it on time was emphasised on this visit. Staff feedback about the manager was positive. They described her as “knowledgeable”, “approachable” and “seems fair”. One person said they had not really got to know her very well yet, as she had been spending a lot of time in the office putting things in order. Discussion took place during the inspection, of balancing her time spent in the office, with that on the floor, in order to get to know the residents and staff better. She was aware of this but with the volume of management issues she was dealing with, said this area of her work would be her next priority. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 30 A corporate quality monitoring and assurance system was in place and the audit tools were being utilised. The manager was undertaking a daily walk around the home, including the random sampling of bedrooms, to ensure that everything was in order. Action plans were completed where shortfalls were identified. External audits were also being done. In order to support the acting manager, the operations manager was spending quite a lot of time at the home and following up on action plans she had requested. Questionnaires to relatives were sent out twice yearly and the next batch was due out in August 2007. 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. The acting manager had held one relative meeting since her appointment but minutes were unavailable. The operations manager confirmed the meeting had taken place and said that minutes would be done in future. The late night weekly surgery held by the previous manager was being continued and this enabled relatives to call in for informal chats or to raise any concerns they had. Senior managers were making regular visits to the home and the Regulation 26 visit sheets were being sent to the CSCI. The financial records of three residents were looked at, all of which were in order. 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 previous system, whereby there was a pooled residents account, had been discontinued and residents now had their own savings accounts which accrued interest. The organisation had detailed health and safety policies and procedures in place which were reviewed and updated as needed. Information contained on the AQAA form showed that the required maintenance checks had been carried out. A random sample of maintenance checks was not made on this occasion as the handyman, who was responsible for arranging these, had finished work. As highlighted above, many of the staff still needed to undertake mandatory health and safety training courses. Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 32 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 OP7 Regulation 12 Requirement The personal care needs of the residents must be as set out in the care plan in order they receive the care they had been assessed as needing. The care plans and associated assessments must be accurate and kept up to date in order to ensure the right care is given to the residents. Staff who give out medication must receive training to make sure they know how to do it safely. There must be an activities programme in place, which meets the needs of both individuals and groups so that residents have social stimulation to prevent boredom and restlessness. The areas of the home identified in the report must be thoroughly cleaned to prevent the spread of infection. Timescale for action 27/07/07 2 OP7 15 31/08/07 3 OP9 18(1)(c) (i) 16(2)(m) 31/08/07 4 OP12 31/08/07 5 OP26 23(2)(d) 31/08/07 Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 33 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. 6 Standard OP30 Regulation 18(1)(c) Requirement New staff must receive thorough induction training and must be supervised by a member of staff who is appropriately qualified and experienced in order they learn how to do their job properly. All staff must receive training in food hygiene, infection control, fire and moving/handling in order to ensure the safety of the residents and themselves. (The previous timescale of 30/09/06 has not been met). A permanent manager must be appointed to manage the home and an application to register this person must be sent to the CSCI so they can arrange a fit person interview. Timescale for action 31/08/07 7 OP38 18(1)(c) (i) 31/10/07 8 OP38 8 31/08/07 Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 34 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP7 OP9 OP9 OP12 OP15 Good Practice Recommendations Residents’ individual daily personal care sheets should be completed when baths/showers are given. (Outstanding from the last inspection.) Unused medication should be returned to the pharmacy at least monthly so that stocks of medication do not build up. Repeat prescriptions should be ceased when the home has a build up of stocks. Social activity sheets should record any activities and outings that residents have enjoyed. If residents refuse their meals, other food should be offered and carers need to spend time tempting people to eat. Where residents continually refuse their meal this information should be recorded and passed onto the next shift in order they can offer food to them at a later time. The manager should ensure that all staff have undertaken protection of vulnerable adult training. More staff need to undertake NVQ level 2 training in order for the home to achieve at least 50 of trained staff. The Skills for Care training records should demonstrate how competencies have been assessed and not just be a record sheet with signatures. 6 7 8 OP18 OP28 OP30 Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Heywood Court Care Centre DS0000049296.V343910.R01.S.doc Version 5.2 Page 36 - 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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