Inspection on 22/05/06 for Heywood Court Care Centre

This inspection was carried out on 22nd May 2006.

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 11/07/07

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 22nd May 2006 08.15 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.V291215.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.V291215.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 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) Southern Cross Care Homes No 2 Limited Vacant Care Home 45 Category(ies) of Dementia - over 65 years of age (45) registration, with number of places Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 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) The service should employ a suitably qualified and experienced Manager who is registered by the Commission for Social Care Inspection. The Registered Person must ensure that all staff working in the home have dementia awareness and dementia care training, which equips them to meet the assessed needs of the service users accommodated, as defined in the individual plan of care. The service should at all times employ suitably qualified and experienced members of staff, in sufficient numbers, to meet the assessed needs of the service users with dementia. 23rd January 2006 4. Date of last inspection Brief Description of the Service: Heywood Court is a dementia care residential unit, owned by the Southern Cross Group that 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 range between £360 - £420 as at 22 May 2006. Additional charges are made for private chiropody treatment, toiletries, 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 is 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.V291215.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 one full day, the inspector arriving at 08.15 and leaving at 16.45. A lot of time was spent watching how staff spoke to and looked after the residents. In order to find out what it was like to live at Heywood Court, 7 residents were spoken to as well as the manager, operations manager, team leader, 2 care assistants, the chef, maintenance worker, 1 visiting care manager and 3 visitors to the home. No comment cards had been received at the Commission for Social Care (CSCI) Office, from relatives, staff 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. The new manager had not yet been approved by the Commission for Social Care Inspection but this was being arranged. The new manager had continued to make a lot of improvements in the way the home was being run. There had been no complaints received about the home since the last inspection in January 2006. What the service does well: What has improved since the last inspection? Of the 12 requirements made at the last inspection, 9 had been put into practice. Those that had not were to do with staff training although there had been a great improvement in this area. Care plans were much more detailed and gave a clear picture of what each person needed help and assistance with which made sure all the staff were caring in the same way for each resident. Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 6 There was a calmer atmosphere within the home and staff were spending more one to one time with the residents. Although the new activity worker had only been employed for about 4 weeks, she had already organised more activities and outings to keep the residents occupied. Nearly half of the care staff had successfully completed their NVQ level 2 training, which had equipped them to understand more about their jobs and how to care well for the residents. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Heywood Court Care Centre DS0000049296.V291215.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.V291215.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The Service User Guide and Statement of Purpose were detailed and would enable prospective residents and/or their representatives to make an informed choice about whether they felt the home would be suitable for them. Residents were assessed before coming into the home to ensure their needs could be satisfactorily met. EVIDENCE: The Statement of Purpose and Service User Guide had recently been reviewed and updated to reflect the home’s change of provider to Southern Cross Healthcare. It was noted that the Service User Guide did not include a copy of the summary from the Commission for Social Care’s (CSCI) last inspection report, together with the home’s action plan to address the requirements. This good practice had been implemented in a sister home and the manager should consider following this practice. Copies of the Service User Guide, Statement of Purpose and full inspection report were displayed in the entrance hall. New residents and/or their representatives were said to be given an admission pack containing all relevant information. One relative who was spoken to said he Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 10 had received this information when they had decided to place their relative there. The manager undertook pre-admission assessments for all new residents, visiting them either in their own home or at hospital. If there is social work involvement, a care manager assessment is also received. Two files were looked at, for two recently admitted residents and both contained detailed assessments, which had been done by the manager. From the assessment an initial care plan is drawn up with a more detailed plan being done at a later stage. The manager demonstrated her competence in the assessment process. She said that admissions to the home only took place if she was confident the home could meet their needs. When emergency admissions happen, the resident is assessed within the first day or two of admission. During the inspection, a review meeting was taking place at the home for a resident currently on a respite stay. The visiting care manager and a relative were spoken to. They said the resident had been admitted on an emergency basis and that they were very pleased with how the staff had helped her settle in and with the whole admission process, including the care she had continued to receive. Heywood Court Care Centre DS0000049296.V291215.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 10 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The individual health and personal care needs of residents were being met except for some shortfalls identified with regard to medication which could impact on residents’ health care. Personal care and support was given in such a way as to promote and protect residents’ privacy and dignity. 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. Their care plans were detailed, easy to understand and identified their needs and choices with regard to daily lifestyles and routines. One resident had recently suffered from ill health. The care plan showed the problems being experienced and how staff were to address them. As the home caters for people with dementia, it was difficult to check with residents if they felt their needs were being met and whether their care plans Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 12 were accurate. However, all residents spoken with said they liked the staff and that they were well cared for. One relative spoken to said a senior care assistant had gone through his mother’s care plan with him, within the first few days of her admission and that he had been fully consulted about her needs. He said the plan was detailed and contained all the necessary information for staff to care for her as she would have wanted. Another relative said the care given by the staff team was “second to none”. Ethnicity, culture and religion were included in the care plan files wherever pertinent. The plans were being reviewed and updated monthly. Whilst 6 monthly reviews were not yet taking place, the manager was planning to introduce this system within the next few weeks. It was noted that care staff were not always completing the daily personal care sheets. 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. One care plan recorded the resident wished for a daily shower but the lack of recorded evidence meant this outcome could not be measured. 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. Two care plan files for the most recently admitted residents 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. Missing laundry was an issue raised at the last relative meeting and the manager should ensure that all staff involved in resident admissions are instructed to follow the correct procedure. Where challenging behaviour was identified, the appropriate forms were completed with action plans detailing how staff should address any problems. 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. All had been regularly updated. Where areas had been assessed as high or medium risk, the care plans detailed the action which was needed to reduce the risks identified. From checking bedrooms, it was observed that where residents had been assessed as at high risk of injuring themselves by getting up during the night and falling, large cushioned mats had been placed at the side of their beds, as recorded in their care plans. Residents health care needs were well recorded. The care plans contained professional visitors sheets which identified visits made to the home by chiropodists, dentists, district nurses, GPs, community psychiatric nurses and opticians. From speaking to the manager, staff and relatives, it was clear that whenever residents were ill, staff would request a visit from a doctor. Entries seen in the diary also confirmed this. An optician and district nurse were Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 13 visiting the home during the inspection. The manager’s previous background was nursing and this enabled her to watch for signs that residents were becoming unwell so that action could be taken before the situation became serious. Nutritional screening was undertaken upon admission and residents weight was recorded on their care plan. On one of the care plans it was identified that where a resident had lost quite a significant amount of weight, over a 4 month period, this had not been addressed in the care plan. In line with the nutritional training recently done by the manager, this must be addressed. The home had recently changed to the Boots monitored dosage system. Detailed medication policy and procedures were in place and from observations of 2 medication rounds, it was seen that staff were correctly signing the medication sheets after medication had been given to the residents. The manager was also regularly auditing that policies were being adhered to. Staff interviewed were able to say how they dealt with medication from it being delivered until collected from the home. It was however, identified that 1 resident had been without painkillers for several days due to medication running out and a new prescription not being delivered. This was being addressed. During the morning round, the staff giving out medication had to wash out the medication pots as there were insufficient to accommodate the number of residents. The manager said she would purchase further pots. Due to residents arising and coming into breakfast at different times, it took staff a considerable amount of time to give out the medication. However, timings of medication were adjusted as necessary throughout the rest of the day. The good practice of returning to residents who had first refused their medication was seen. However, in one instance, one resident had finished her breakfast by the time her tablets were offered to her and she refused to take them. Clearly, medication should be given out whilst residents are having breakfast so they do not become agitated and wish to leave before receiving their medication. Storage of drugs was satisfactory. However, loose tablets, waiting to be returned to Boots were not recorded on the relevant returns sheet and this is unsafe practice. A care assistant was in the process of logging all returns to Boots during the visit and the Boots representative called to collect the drug returns. There was no excessive stock of medication being held. 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 Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 14 own medication safely. Lockable space was fitted in each of the bedrooms where medication could be locked away. A lockable fridge was being used but temperature recordings had not been done since 17 April 2006. 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 their own bedrooms 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 was seen during the inspection. Staff searched for missing shoes/slippers and ensured that residents were appropriately dressed. On one care plan, reference was made to ensuring the resident “ be dressed smartly and casually” and he certainly was. It was clear that this was very important to him. One of the senior carers interviewed was able to give very good examples of how she would promote privacy and dignity when assisting residents with personal care tasks. Another care assistant was not able to give as many examples but was about to commence her NVQ level 2 training, which would ensure her knowledge increased in this area. In order to make sure that all staff have basic knowledge and awareness in this area, the home’s induction programme should target this area within the first weeks of starting work. Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area was good. This judgment 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 activities and to maintain contact with their relatives. Whilst the dietery needs of residents were well catered for, the organisation at breakfast needed improving so that residents did not become restless and distressed. 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, what to have for their meals, whether or not to join in with activities and when to go to bed. The manager was looking at providing a seating area on the middle floor so that residents walking around the corridors could stop and enjoy some quiet time in a comfortable seat. Weekly visits to the home were made by a Roman Catholic priest and a relative would sometimes say prayers with some of the residents. Their religious preferences were recorded on care plans. Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 16 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. A new activity worker was in post but had only been working at the home for about 4 weeks. It was therefore difficult to make a judgment in this area, but it was clear that the provision of social activities had improved. It is now important that they are sustained. She could not be interviewed as she was on a weeks holiday. She had written an activity programme which was displayed in the foyer of the home together with photographs of residents enjoying some of the activities she had done with them. Weekly activities included reminiscence (using memory boxes loaned from the library), pampering sessions, floor games, music and baking sessions. The staff were also thinking of putting on a concert for the residents in aid of Comic Relief. At the last relatives meeting, held on 3 May 2006, of which the minutes were seen, discussion took place about what other activities could be offered. Concerns were expressed that residents on the top floor unit could be missing out on activities and the manager had already addressed this and was making sure that those who wanted to join in were encouraged to do so. The activity worker had started taking residents out on an individual or small group basis to the shops, supermarket and park and was planning a trip to a local steam train 1940’s day. A trip to a concert had been organised two weeks before the inspection. In order to ensure that the men also had appropriate activities, the home had signed up to the organisations inter-home darts league and it was hoped that a team from the home could be formed. A relative had also suggested that some of the residents may wish to do crown green bowling as they had access to a bowling green. 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. Residents religious needs were addressed as part of the admission procedure and recorded on each residents social history sheet. At the time of the inspection, a Roman Catholic Priest was visiting the home weekly and a relative was coming into the home to say prayers with some of the residents. Staff said they seemed to enjoy this. During the inspection, 3 relatives were spoken with. All felt the standard of care offered was good. They confirmed they could visit whenever they wanted and that they were made welcome. One cook and 2 chefs are employed to work at the home in order to provide the necessary cover. One person is on duty each day and in addition, a parttime kitchen assistant is employed. The manager had recently made a decision to change the main meal of the day from lunch to evening, on a trial period, to Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 17 see if the change had any positive effects on the residents. The team felt the change had already seen some improvements in the behaviour and sleeping patterns of some of the residents. The manager was to continue monitoring this with a view to making it permanent. 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 not keeping to the menus as he was trying out new food to see what changes could be made when the menus were reviewed. The other chef and cook were said to be sticking to the set menus. On the day of inspection at lunch time, residents had soup followed by either sandwiches or a beefburger and a dessert of cherry sponge and custard. For the evening meal, the chef had made individual chicken breasts, wrapped in bacon and topped with cheese, sauteed or mashed potatoes and carrots followed by semolina pudding or yoghurts. From speaking to the chef, it was clear he enjoyed his job as he was very enthusiastic and willing to try and ensure that the residents had a good diet. However, when menus are not being followed, the substitute meals must be recorded in order that judgments can be made as to whether the meals are varied and nutritious. The manager must ensure that in the next few weeks, the 4 weekly menus are reviewed and implemented and that all the catering staff adhere to them. The chef was knowledgeable about which residents had to have special diets and demonstrated the choices he was able to give them. Breakfast and lunch were observed. The good practice of residents being able to get up when they were ready was noted. However, as residents were being escorted into the dining room at different times, organisation was lacking. Some residents were seen to enter the dining room at 9.00 and not be given their breakfast until 9.35, followed by toast at 10.00. This is a long time to wait for those people who are restless and several times people got up from the table to leave the dining room. Other residents were served immediately they sat down at a table and this was clearly distressing some of the people who had been waiting a long time. Toast was served without jam or marmalade and by the time it was served, it was going cold and soggy. Staff did not put on protective aprons to prevent cross infection until breakfast had almost finished. Whilst a menu board was on the dining room wall, the daily menu had not been recorded for 5 days. The clock in the dining room had also stopped at 06.45 which could create further confusion for the residents. The handyman was requested to attend to this. Good practice was seen when one resident repeatedly asked to go to the toilet. On 3 occasions staff assisted him and gave him fresh porridge each time. One resident needed assistance to eat his breakfast and a carer sat with him until he had finished. She then asked if he would like more and stayed with him until he had had sufficient. On the top floor, one resident was being coaxed to Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 18 eat more lunch by mixing bread into her soup and being assisted to eat it. A plentiful supply of drinks were seen to be offered to residents throughout the day. A relative was sitting with the person he was visiting at lunch time. He commented that he visited daily and that the food served was good. He said “it’s better food than I make myself at home”. Heywood Court Care Centre DS0000049296.V291215.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. An effective complaints system was in place which relatives/visitors were familiar with. Adult protection training had improved since the last inspection and there was clear evidence that residents were being protected from abuse. EVIDENCE: The home had an easily understandable complaints procedure which was contained in the service user guide and statement of purpose, both of which were displayed in the entrance hall. The complaints record showed the manager responded to issues raised and carried out investigations in a thorough manner. Since the last inspection in January 2006, 8 complaints had been logged, 7 of which had been appropriately addressed. One was still being investigated and letters from the manager to the complainant, keeping them advised of the process, were seen. Since the present manager had been working at the home, the Commission for Social Care Inspection (CSCI) have not had cause to undertake any complaint investigations. The manager has a late evening surgery once a week and felt this was a useful forum for relatives if they had any concerns or grumbles. Eleven staff had done in-house protection of vulnerable adult (POVA) and whistle blowing training which had been facilitated by the manager. The manager is to provide further training sessions to those who have not yet completed it. In addition, 2 staff are to undertake Rochdale MBC’s POVA Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 20 training in the next few weeks. Staff files showed POVA first checks had been obtained prior to new staff starting work and Criminal Record Bureau (CRB) checks had been either obtained or applied for. Two files inspected were awaiting results of CRB’s but these staff were working alongside a more experienced care assistant. This was evidenced during the inspection. Heywood Court Care Centre DS0000049296.V291215.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The home was clean and well maintained and provided a comfortable and safe environment for the residents but some areas of the home had an unpleasant malodour, which was being addressed. EVIDENCE: The home was in good decorative order throughout and fitted with appropriate aids and adaptations so that residents were able to be as independent as possible. Close circuit television cameras (CCTVs) were in use but only on the entrance area for security purposes. A maintenance programme was in place, which was being implemented by the maintenance worker. As bedrooms became empty, they were re-decorated before a new resident moved in. Handwritten signs were displayed on toilets and bathrooms. The operations manager had purchased more meaningful signage, which had not yet been fitted. Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 22 Inspections had been undertaken over the last 12 - 18 months by the Greater Manchester Fire Department and the Environmental Health Officer. Requirements made had been implemented. The home was clean throughout. It was however, noted that a strong malodour was present in one section of the home. The reason was said to be that over the weekend a resident had flooded her bedroom and corridor, by leaving the wash hand basin taps running and this had resulted in a sour, damp odour permeating the ground floor area. From reading the minutes of the last relatives meeting, held on 3 May, 2006, it was recorded “there is a strong malodour within the home” so this had been an ongoing problem for at least 3 weeks. The handyman had been instructed to purchase and fit press down taps to the bedroom wash hand basin. In addition, corridor and bedroom carpets had been cleaned and would be re-done as soon as the new industrial carpet cleaner was delivered. Three bedrooms were randomly checked and were roomy, clean, personalised and in good decorative order. En-suite toilets were also large and adapted as necessary for those people with disabilities. Two separate safe outdoor garden/patio areas were provided for the residents, one accessed via the conservatory doors and the other from the front door. This meant that when the weather was good, residents could wander freely outside, independent of staff. The manager said she would ensure that the residents from the top floor unit were enabled to use the outdoor facilities during the summer months. The manager’s office was situated behind the office the administrator occupied. There was no natural light or ventilation in her office, which was extremely cramped. Discussion took place about the possibility of transferring her office to a room on the first floor of the home. This room was furnished with comfortable seating and was used to hold review meetings. It was however, said to be seldom used. Provided the room, which is a reasonable size, is furnished so that meetings may continue to be held there, there is no reason why this change cannot take place. Laundry facilities were sited away from bedrooms and 2 industrial washers and 2 dryers were provided. The washing machines had a sluice programme. The laundry personnel were responsible for collecting, washing and re-distributing all laundry. Appropriate colour coded laundry bags and protective clothing were in use for this service. Liquid soap and paper towels were supplied in bathrooms/toilets and bedrooms for staff to use. However, it was noted that after having got residents up and dressed in the morning, staff did not put on blue disposable aprons until breakfast was almost finished. The manager said this was an oversight, due to supplies running out in the dining room. Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. The staff team had stabilised, staff morale had risen and staffing levels ensured the needs of residents were being met. Whilst training opportunities for staff had improved and resident care had benefited from this, further training was still needed by some staff with regard to health and safety and dementia care. EVIDENCE: Whilst there had been some turnover of staff, which is usual when a new manager takes over the running of a home, this had now stabilised. Both the manager and the staff spoken with felt the team was now running much better and that morale had greatly improved. Since a complaint investigation in December 2005, when it was identified insufficient staff were on duty to meet the needs of the residents, the CSCI have been monitoring staffing levels at the home. Staff rotas have been faxed weekly to the CSCI office and the required number of staff on each shift, both during the day and at night, had been maintained. The use of agency staff had almost ceased, with such staff only being used for real emergency situations. This meant that residents were now being cared for by a group of staff who knew their individual routines. Staff interviewed confirmed staffing levels now enabled them to spend some quality one to one time with the residents and this was seen during the inspection. Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 24 Sufficient ancillary staff were employed e.g. cook, chefs, kitchen assistant, domestics and laundry assistant. The present resident group were all white as were the majority of the team although 5 carers were from other ethnic backgrounds. All could speak English and be understood by the residents. Whilst many of the residents were male, only 1 member of the team was of the same gender. The manager said she would like more male carers but they did not get many applicants. Residents were able to have a choice of male/female staff to assist with personal care tasks, but at the present time, both male and female residents were said not to have any preferences. If this changes, the care plan would record individual preferences. The organisation had equal opportunity and equality/diversity policy procedures in place. An external body was supporting one employee, with a mild disability, in order to ensure they could fulfil their role satisfactorily. The home had almost achieved the CSCI’s target that at least 50 of care staff must achieve NVQ level 2 training. At the time of the inspection 11 carers had successfully completed NVQ level 2 training although only 3 had yet received their certificates. The manager was following this up. A further 5 staff had recently enrolled to undertake NVQ level 2 training which was due to commence in about 4 weeks time. When these staff have completed their training the home will have achieved the required target and further staff will continue to be enrolled. It is a condition of the home’s registration that all staff receive training in dementia care. To date only 7 staff had done any such training. A requirement regarding this was made at the last inspection, but had not been implemented. The manager said that she had assessed care-planning training to be the main priority from the last inspection, but that dementia care training was now to be offered. An appropriate course had been identified entitled “Yesterday, Today and Tomorrow” which was done by the Alzheimers Disease Society. It consisted of 8 one hour sessions, with study and write ups following each session. The manager was unclear as to when this training was to begin. Clearly, given the home specialises in providing care for people with dementia, this must now be offered to all relevant staff without further delay. From checking the training matrix, it was identified that health and safety training had also improved e.g. fire, moving/handling, food hygiene and infection control. For those staff who had not yet done moving/handling, another course had been arranged, in house, for 24 May 2006 and a further 4 staff were booked on a Rochdale MBC infection control training course. The manager was clearly committed to ensuring she had a fully trained staff group, and whilst there were still some training gaps, continuing training courses will ensure that all staff will receive the necessary training. Shortfalls were identified in relation to first aid. It is expected that at least one person on Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 25 each shift must have undertaken the relevant training. The manager is to address this shortfall. The staff spoken with said that training opportunities had significantly improved since the new manager came into post. They said that almost on a weekly basis, staff were going on different courses. One of the newer staff said she was pleased that she had been able to enrol on the NVQ level 2 training course. Robust recruitment and selection policy and procedures were in place which were being followed. Three staff personnel files were checked, two for relatively new staff and one for someone who had worked at the home for sometime. All three files contained completed application forms, health declaration statements and proof that either Pova First or full Criminal Record Bureau checks had been done before staff started work. Two of the files contained 2 satisfactory references, 1 file only contained 1 but both the manager and administrator confirmed that a second reference had been received but had been mislaid. Whilst copy certificates were in place where staff had undertaken training, individual staff training profiles were not and this should be addressed. A supply of the General Social Care Council’s “Code of Practice” were kept in the office and said to be given to each new employee together with the staff handbook. When new staff begin work, they must undertake induction and foundation training which is to the Skills for Care specification. Other than a first day training record, which included many administrative tasks, the two files for new employees did not contain any evidence that the workers had received any form of induction training. From speaking to a carer who had worked at the home for approximately 6 weeks, it was established that she had not yet started her Skills for Care induction training. She said she was learning the job by watching a more experienced carer and asking for advice when she needed it. She did say that she had had a chat with the manager about her progress. One file did contain evidence that “Skills for Care” induction training was being done, but other than the manager’s signature against each unit, there was no evidence of how this had been demonstrated. Discussion with the manager took place about this shortfall and she is to address the way induction training is addressed in the future. From September 2006, all new staff must complete their induction and foundation training within 12 weeks of starting work. Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 26 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home was being well run by an experienced, qualified manager who had a clear understanding of the areas that still needed improving for the benefit of the residents. EVIDENCE: The manager had previously worked as a State Registered Nurse and more recently had deputised in another home for older people. She clearly had the knowledge and experience necessary for running a residential home. She was currently undertaking her Registered Managers Award and was expecting to complete the units by August this year. She had also previously done dementia care training and had a certificate to confirm this. Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 27 Discussion took place about progress made towards submitting her application to become the registered manager of the home. She was still awaiting her Criminal Record Bureau check being returned. During her time in post, she has made many improvements which have benefited the care residents are now receiving. Areas she had worked on included: more detailed and updated care plans, maintaining correct staffing levels, improving the quality assurance and monitoring systems and facilitating more staff training. Feedback from the staff about the manager was good. They felt team morale had improved, that they were given good support and that with her experience and training she was able to give them advice when needed. The majority of shortfalls identified on this inspection, had already been highlighted by either the manager or the operations manager who were taking steps to put matters right. A staff supervision system had been introduced and whilst not all staff had yet received supervision, records showed that many had, dependent upon their roles and experience. One file showed the employee had received supervision on 3 separate occasions. Team meetings were also now taking place on a more regular basis and minutes of the last meeting were seen. 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. A manager from another home was visiting regularly to random sample care plans. The manager was also checking care plans to ensure they reflected the needs of the individuals and that they were up to date. Questionnaires had been sent out to relatives but these were 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. Relative meetings were being held monthly and minutes of the last 3 meetings were seen. Any concerns raised were being addressed and suggestions were implemented wherever possible. As previously stated, the late night surgery held by the manager, 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 home’s administrator had worked at the home since it first opened three years ago and knew each individual resident well. Whenever she left her Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 28 office, she would stop for a chat with residents, make them a cup of tea or show them to a chair or to the toilet. The financial records of 3 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 Service User Guide states clearly that there is a pooled account where money can be placed but that no interest is given. The organisation had detailed health and safety policies and procedures in place which were reviewed and updated as needed. Information contained on the pre-inspection questionnaire showed that all but one of the required maintenance checks had been carried out. The fixed and mobile hoists situated around the home were due for servicing as they had not been checked since 17 October 2005. It is required that all lifts and hoists are checked as a minimum, 6 monthly. The manager said she would immediately arrange for the hoists to be serviced. The fire and accident books were randomly sampled and in the main were in order. The accidents which had been noted from individual residents care plans had all been entered in the accident book. One section of the fire book relating to fire door exits had not been completed, although they were included in other sections of the book. The maintenance man said he would ensure that in future, this section would be fully completed. Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 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 3 X 3 3 X X X 2 Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 30 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 13 Requirement Where risk assessments and weight charts show that residents are at nutritional risk, a care plan addressing the risk must be drawn up and implemented. Staff must ensure that supplies of medication are monitored to ensure stock does not run out. All medication awaiting return to the pharmacy, must be recorded on the returns sheet immediately it is no longer required. When menus are not adhered to, records must be kept of the meals served in order that judgements can be made about the nutritious content. Action must be taken to address the malodour permeating around the home. Staff must wear protective aprons when serving food to residents. All staff must receive dementia care and awareness training.(Previous timescale of 31/03/06 not met). Timescale for action 30/06/06 2. 3. OP9 OP9 13 13 30/06/06 30/06/06 4. OP15 16 30/06/06 5. 6. 7. OP26 OP26 OP4 23 13 18 30/06/06 30/06/06 30/06/06 Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 31 8. OP30 18 All staff must undertake all identified health and safety training i.e. moving/handling, fire, first aid, infection control and food hygiene. (Previous timescale of 31.03.06 not met). Induction and foundation training to the TOPSS/Skills for Care specification must be undertaken by all new staff, including those who have recently started. (Previous timescales of 31.10.05 and 31/03/06 not met). 30/09/06 9. OP30 18 31/08/06 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. Refer to Standard OP1 OP7 OP7 Good Practice Recommendations A summary of the most recent CSCI report together with the home’s action plan should be included in the Service User Guide. Residents’ individual daily personal care sheets should be completed. Care plans should be agreed and signed by the resident and/or relative. (This recommendation is outstanding from the last inspection). Upon admission a full inventory of residents clothing and other belongings should be done. More medication pots should be purchased in order that staff do not have to break off the medication round to wash out used pots. Breakfast times should be better organised so that residents are served as soon as they come into the dining room, rather than waiting an excessive time. Meals should be recorded on the menu board and the clock in the dining room should record the correct time. DS0000049296.V291215.R01.S.doc Version 5.2 Page 32 4. 6. 7. 8. OP7 OP9 OP15 OP15 Heywood Court Care Centre 9. OP30 All staff should receive a minimum of 3 days training (prorata) per year (this recommendation was outstanding from the last inspection). Heywood Court Care Centre DS0000049296.V291215.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 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.V291215.R01.S.doc Version 5.2 Page 34 - 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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