Inspection on 29/07/08 for Heywood Court Care Centre

This inspection was carried out on 29th July 2008.

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

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

Other inspections for this house

Heywood Court Care Centre 01/02/08

Heywood Court Care Centre 11/07/07

Heywood Court Care Centre 22/05/06

Heywood Court Care Centre 23/01/06

Heywood Court Care Centre 23/08/05

Heywood Court Care Centre 12/02/05

Heywood Court Care Centre 21/09/04

Heywood Court Care Centre 16/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Heywood Court Care Centre Green Lane Heywood Rochdale Lancs OL10 1NQ Lead Inspector Michelle Haller Unannounced Inspection 29th July 2008 09:00 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.V367303.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.V367303.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) Manager post vacant Care Home 45 Category(ies) of Dementia (45) registration, with number of places Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either; whose primary care needs on admission to the home are within the following categories: Dementia - Code DE. The maximum number of service users who can be accommodated is: 45. 1st February 2008 Date of last inspection Brief Description of the Service: Heywood Court is a dementia care residential unit, owned by Southern Cross Healthcare. It can accommodate up to 45 elderly service users on both a permanent or respite stay basis. With the exception of one double bedroom, all others are single and all rooms are equipped with en-suite toilets and wash hand basins. Bedrooms are situated on the ground, first and second floors of the home although at the time of this visit the second floor was unoccupied. A passenger lift is provided to all floors. The home has disabled access and two safe enclosed patio garden areas are provided to the front and rear of the home. The home is well maintained both internally and externally and a large car park is provided. Public transport passes the home and the motorway network is also nearby. The weekly charges, as at August 2008 are as follows: £371.12 to £492. 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.V367303.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a key inspection that included an unannounced visit to the service. This means the manager did not know in advance that we were coming to do an inspection. During the visits we looked around the building, talked to residents, relatives and staff, including the deputy manager and registered provider. We observed the interactions between people living at Heywood Court and staff. Owing to their dementia, the majority of the people living at Heywood Court were unable to communicate with us and tell us what they thought of the care they received. So we relied on what we saw to make our judgements and from speaking to the manager, staff and comments sent to us in the surveys. We examined care plans, files and other records concerned with the care and support provided to people in the home. We also looked at all the information that we have received or asked for since the last inspection. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Information we have about how the manager has managed any complaints and any adult protection issues that may have arisen. What the manager has told us about things that have happened in the home through ‘notifications.’ We also sent out surveys. We received seven back from people with an interest in the service, such as staff and relatives. An expert-by-experience also assisted with this inspection. An ‘expert by experience’ is a person who has used and accessed services that are regulated by the Commission. We consider these people to be experts because they have used/or accessed services. Comments from the expert by experience have been included in the body of this report. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 6 There are currently two adult protection investigations concerning the alleged conduct of staff in the home. The outcomes are not yet concluded, however records confirmed that, in both cases, the manager has taken action in keeping with the local authority’s adult protection protocol. There have been no other new safeguarding issues raised since the previous key inspection. What the service does well: The management team have ensured that enough staff are on duty to be able to meet the needs of the people presently living at the home. Out of a team of 19 staff, nine had successfully completed a recognised training course (NVQ) either at level 2 or 3 and four more staff were part way through the course. This training included health and safety elements so they would know how to do their jobs safely, both for themselves and for the people they were supporting. The management team have put systems in place to meet the requirements made at the last inspection. Care plans and risk assessments were more detailed and up to date, so that the staff knew how each person needed to be cared for. Residents were now being given their medicines as prescribed and any variations, omission and errors were well documented. The home has been re-decorated and new furniture bought so that it is now a pleasant place for people to live in. The layout of the home has also been changed so that there are more choices of where to eat and sit. The management team continues to work hard to try and raise the standard of care at Heywood Court. All but the very newest staff had done training in what to do if they suspected people were not being treated properly (protection of vulnerable adult training). Staff felt that people living at Heywood Court experience ‘A friendly home from home environment were service users feel safe and happy.’ The relative who returned a survey assessed that ‘The home is clean, the food is reasonable and there has been an improvement with new chairs and flooring.’ Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The manager needs to continue to make improvements and to make sure that the improvements are kept up. Care plans must be further developed to include specific health care or communication needs. It is also important that the effectiveness of care plans is monitored to make sure that best practice is achieved in areas of identified need, so that, for example, people receive plenty to drink. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 8 The manager must take steps to make sure that pressure area care is more effective so that skin damaged is noticed sooner and treated before it gets to a serious stage. The manager must make sure that people are offered at least two litres of fluid a day; this may help to reduce the risk of urinary tract infections for people living at Heywood Court. The manager needs to make sure that when the activities co-ordinator is unavailable people still have the opportunity to join in with social activities and trips out. This will help to give people more choice than falling asleep, listening to the same music for most of the day or staring around the rooms they are in. The manager must make sure that people have baths, washes or showers with enough frequency to make sure that they are clean and free from unpleasant odours. Staff need better direction in this area. The manager must make sure that all visitors to Heywood Court are able to enter without having to wait outside for a long time. Communication needs must be better managed so that staff return people’s glasses when they are left around the home and people are assessed and treated for hearing loss through the relevant primary care trust (National Health) department. Staff would benefit from deaf awareness and other communication training so that they can communicate better with people who have a sensory loss. The registered person must send in copies of Regulation 26 visits that are completed so that we can monitor progress in the service and confirm that it is been sustained. The menus should be produced in bigger print and be made more accessible to the residents. 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.V367303.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (standard 6 is not applicable) Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. New admissions to Heywood Court have their needs fully assessed so that they (service users) can be sure that these needs can be met by the service available. EVIDENCE: The manager stated that since the last inspection there have been no new admissions. The manager stated that it is company policy that senior staff visit the prospective resident. A completed pre-admission assessment was looked at, this held information that included personal care; physical wellbeing; mental state; mobility; diet, sight; hearing; continence; sleep; social history; sexuality; personal safety; skin care and family involvement. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 11 The manager confirmed in the AQAA that: ‘To ease the pre-admission assessment process a pre-admission draft care plan and new admission checklist have also been added to ensure everything is in place and all departments within the Care Centre have been notified.’ If this procedure is used then the information gathered by the pre-admission assessment will determine whether people’s needs can be met at Heywood Court. No-one visiting Heywood Court, on the day of the inspection, had any comments about the admission process. All staff who returned surveys felt that they received enough information about newly admitted residents. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. People’s general health needs are mostly provided for, however some aspects of personal care are of an inadequate standard. EVIDENCE: At the last key inspection, one requirement was made in respect of dementia care training for staff. The manager stated that since then all staff have received specialist training called ‘Yesterday, today and tomorrow‘(YTT) which is a three-day course about understanding and dealing with different aspects of the effects of dementia. Four residents’ files and care plans were examined in full and these included people who were receiving treatment from the district nurse service and/or who had additional health needs, such as diabetes. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 13 Each plan was detailed and showed what care and support each person needed. The assessment document involved scoring the outcome of the assessment, and this score then determined the complexity of the care plan required and also prompted staff to complete additional risk assessments or to make referrals to health care specialists, such as dieticians or the continence service. The record of professional contact and daily records did confirm that emergency and routine medical and health care was provided to people living at Heywood Court, this included: general practitioner consultations, district nurse input, podiatry, dental care and opticians. People were seen wearing glasses but it was also noted that quite a few pairs were left around the home. The manager said that these were all labelled so that they could be returned, the manager should make sure that staff actually carry out this task. The care plans and senior staff had reviewed assessments and the manager has also audited the quality of a number of care plans and identified where, for example, social histories had not been completed. Where people had been assessed as being at high risk after a nutritional assessment, the care plan recorded exactly what action needed to be taken to reduce the risk. Advice of dieticians was been taken as and when needed. Three of the people whose care files were examined had gained weight during their time Heywood Court and the dietician was involved with the person whose weight was on a slow decline. People had been prescribed fortified drinks and it was observed that these were given at teatime. Each file we examined showed us that the person had experienced urinary tract infections. The fluid intake chart was checked and it was noted that people were generally offered less than 2000mls of fluid each day. People may benefit if staff were required to do this. Staff are now routinely completing daily records, these varied in respect of how much they related to the care plans or provide a picture of type of day each person may have had. In the main, the comments were written with respect but they tended to be repetitive from day to day. However, key events were documented, these included when staff interacted with families, falls, health care and events concerned with the choices people have made. Some files also contained weekly updates; the information was useful in providing over all progress for people whose needs are less stable. Assessments and care plans had been reviewed with the involvement of relatives and social workers on a yearly basis. It was also clear from the records that relatives were listened if they had any concerns regarding health Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 14 Staff spoke to people in kindly manner and, for the most part, explained what they were doing. Staff were also consistent in their dealings with people who approached them. Following a fall, a system had been implemented where staff had to closely monitor the person and complete a monitoring form, either hourly or two hourly and this is proven to have been effective in finding the best solution for reducing the risk, such as application of a pressure pad alarm. Records also demonstrated that night staff would stay with a person all night if they were agitated in order to prevent them coming to harm. The medication record sheets were examined and storage and administration of medication was checked. There were no unaccounted for gaps in the MARS that were looked at. All medication had been counted into the home. The sample signatures of staff with a responsibility to administer medication were in the front of each medication file. The training calendar confirmed that staff who had a responsibility to administer medication had received accredited training from Boots the Chemist. The manager also said that she was going to cascade medication training to junior staff so that they could begin to gain an understanding of the responsibilities concerned with medication administration and monitoring of effects. A picture of each resident was also in the medication file to assist with identifying that the medication was been offered to the correct person. The effect of medication was also monitored and the general practitioner approached if it was thought the medication was not having an acceptable effect, for example, if the person was over-sedated. Medication care plans for short term drugs, such as antibiotics, are also put in place. The controlled medication storage and recording systems were also checked and were found to be in order. The manager stated that a local pharmacist had verified that the controlled medication cabinet met current pharmaceutical guidelines in relation to security. The manager also stated that she had a responsibility to adult the medication administration in the home to ensure that staff were adhering to the organisation’s guidelines and expectations relating to best practice in this area. At this inspection there was no indication that people’s health was at risk due to poor medication practice. Ordering of medication continues to make sure residents do not go without their prescribed medicines. All other aspects of medication handling looked at were satisfactory and staff who administered medication had all been assessed as competent to do so safely. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 15 In order to uphold privacy, professional visitors to the home saw people in the privacy of their rooms and this was evidenced during the inspection when the district nurse and general practitioner visited. Despite some clear improvements in the health care and support provided ay Heywood Court there are still some fundamental problems in the provision of care; these are outlined below. There were times when staff spoke loudly to a resident; when we enquired why this was, we were told that the person couldn’t hear very well. Although this was recognised as an issue, there was no evidence that best practice guidelines had been followed, for example, referral via the general practitioner to an audiologist in the local Primary Care Trust. Staff would also benefit from deaf awareness training because speaking loudly is not always the best way to communicate when people have a hearing loss. It was also noted that residents left their glasses around the home and staff did not return them directly to the service user, even though the manager stated that each was labelled with the owner’s name. Care plans clearly identified when people were vulnerable to skin damage and guidelines were in place to prevent these occurring and ensure that skin problems are recognised. Instructions included observing pressure areas for signs of tissue damage and reporting changes quickly. The training matrix also confirmed that staff had received tissue viability training. Despite this, we evidenced that there have been recent occasions when skin damage pressure sores have become quite advanced before they have been dealt with. The effectiveness and diligence of staff in relation to pressure area care provided to residents was discussed with the manager. Another area of concern was the low standard in personal care and hygiene that people were been supported to achieve. Although people’s clothes were clean, it became evident that a significant number of residents smelled strongly of urine. A contributing factor to the bad odour coming from the residents was the lack of good personal hygiene. People’s hair was also very unkempt. The expert by experience’s comments about health and personal care included: ‘The first impression on entering the building was the smell. It was in most places. Eventually, we agreed that it was the residents themselves. Each person’s hair appeared as if it had not seen a brush or comb. Some residents’ hair looked and smelled greasy. The hairdresser had cancelled the visit this week, but surely residents don’t wait a week or two weeks for hair washing? There was a similar status with fingernails. Some residents’ nails appeared broken and dirty, also it was noticeable that old nail polish had been scraped off. The reason given for this was because the activities co-ordinator was off sick.’ Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 16 Further comments from the expert by experience about hygiene included: ‘It was noticeable that only one resident was taken to the bathroom to change his incontinent pad during my visit. As I was leaving, a doctor arrived, apparently, to see the resident the staff had changed. I had recognised the resident’s name.’ The bathing record showed that most of the time people were receiving a full immersion bath or shower about once every seven to ten days. Discussion with the management team confirmed that the majority of people living at Heywood Court required support in relation to continence needs. In light of this, weekly baths or showers are inadequate as it does not meet personal hygiene requirements, but also it raises the risk of developing pressure areas and other skin problems. Furthermore, having a bad body odour does not help to maintain people’s dignity and feeling of self worth and wellbeing. Cross-referencing assessments with the care plans that had been developed it was found that, on occasion, not all aspects of assessed needs had been planned for fully. This was particularly the case in respect to diabetes care. It is essential that diabetic care plans make it plain to staff how the effect of the diabetes is to be monitored and the steps that are necessary to prevent or deal with emergency situations that may arise. The relatives for four people were approached to comment about care provided in the home and no-one wanted to speak to the inspector except to say, in general terms, that they were content with the care provided and had no complaints. The one person who returned a relative survey said that care in Heywood Court had improved recently: ‘‘It is better now than in the past - still some improvement needed.’’ Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. People at Heywood Court do not have consistent opportunities to experience a stimulating lifestyle through access to a variety of activities and events that they enjoy. EVIDENCE: In many instances, due to mental frailty, staff have to make choices on residents’ behalf. However, choice was highlighted as an important aspect of care in assessment and care planning. For example, in one case it was identified that a person must be supported in choosing the clothes they wore. Clothes in wardrobes that were checked were correctly labelled, so people were wearing their own belongings. Records of staff meetings also identified that the manager had attempted to introduce strategies that may help people make a more valid choice about meals, this included informing people of the meal choice on the day. Although other steps could be taken, this is a step in the right direction. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 18 People were enjoying walking around the home, and people were at different stages of having breakfast at the beginning of the inspection. People were given a choice about where they sat during the day. An experienced activity worker had been appointed and taken up post in November 2007. Unfortunately, at the time of the inspection, no-one had been active in this role for approximately six weeks. The activities calendar and other records concerning leisure and activities were examined. These records demonstrated that a good programme of activities had been introduced into the home, and that these were varied enough for most people to have an opportunity to participate if they wished. These activities included arts and crafts, outings, gardening, different style concerts, games and quizzes. There was artwork displayed in the home to which the majority of residents had contributed. Pictures also showed that a non-cook ‘baking’ session had been organised. It is regrettable, however, that the employment of an activities co-ordinator has not been combined with educating and enabling all care staff in respect of offering regular activities that will provide stimulation to the residents in the absence of the co-ordinator. Staff who were spoken to praised the work of the activities co-ordinator, and acknowledged that her absence had meant a significant decrease in activities. They were vague about what they could do, one person did say that they could talk to people on a one-to-one basis more regularly. The activities record kept for each person showed that men and women were given equal access to activities that did occur. According to this the main activities for June and July 2008 have been chats, watching television, nail care and the hairdresser attending to people each week. The hairdresser was due on the day of inspection but had cancelled. On the day of inspection people were encouraged to spend time with staff in the garden. At the previous inspection, in February 2008, the importance of ensuring that all staff are given responsibility and skills to facilitate and organise activities in the absence of a ‘co-ordinator’ was highlighted. The actions and knowledge of staff working on the day of the inspection confirmed that this area has not been addressed. The expert by experience observed interaction and activities during the morning of the inspection. All systems in Heywood Court, including the provision of meaningful and varied activities and pastimes, must be sustainable and not dependent on the presence of one individual. This issue was discussed with members of the management team on the day of the inspection. They agreed to develop strategies to deal with this issue. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 19 Interaction between staff and residents when tasks were been completed was satisfactory however the expert by experience observed that, at times, staff spent time standing around and not engaging with the residents. She felt that their actions lacked direction, for example, when the music finished playing a member of staff restarted the same CD, but no-one sat and with people encouraging them to sing along or take notice of what was going on. In another lounge the same CD was played throughout the day. The expert by experience commented in her report that: ‘There did not appear to be any activities organised for the morning. Carers said they took place in the afternoon. Currently, the Activities Co-ordinator was off sick. A couple of CD’s with old war songs were played constantly. I sang along with a couple of residents and I was told that I had livened the place up. One carer did dance a little with one resident, but this was a short time before lunch’. ‘There is no indication of organised visits by any religious sects. A carer advised that she was not aware of any visitors coming from any church. There was no indication of a programme for residents going to a church service or a programme for residents receiving holy-communion in their rooms if they wished. There was no indication of any links with the local community, with the exception of a resident’s husband who played the piano twice per week on his visits to see his wife’. It was noted that many social profiles in care plan files had been completed. This information must included in the care plans so that staff can use the information to gain insight into what has interested each person in their past lifestyles and what activities they may now enjoy. The expert by experience observed a care assistant attempting to encourage people to dance. Residents’ religious needs were addressed as part of the admission procedure and recorded on residents’ social history sheet. The manager stated that she is still trying to arrange for religious services and communion to be conducted at Heywood Court. During the inspection it was observed that people could visit whenever they wanted and that they were made welcome. Visitors who made comments were positive about the arrangements for visiting; one person said: ‘I come every day.’ And it was noted that at teatime three visitors sat and assisted their relatives with their meal. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 20 Four-weekly menus were being followed and were nutritionally balanced through a programme called “nutmeg menus”. The menus included a good range of meats and fish and many of the desserts were milk and fruit based, such as sponge and custard, milk puddings, apple pie, pineapple upside down cake and fruit crumble. The manager confirmed that some meals continue to be fortified with cream and milk in order to increase people’s calorie intake. On the day of the inspection the lunch meal was chicken stew and mashed potatoes or fish cakes with parsley sauce. All the food was home made. The main evening meal was a choice of quiche or cauliflower cheese. People were seen to enjoy their lunchtime meal. It was observed that people were seated at the dining tables in preparation for lunch at between 12:15 and 12:30 yet this was not served until about 13:00 (1pm). During this time, people were left mostly to themselves and staff brought people to the table and didn’t spend time sitting or conversing. Staff did sit, however, and spend time encouraging people to eat their meals. One glass of water was served at lunchtime, and people were not offered the option of an additional or alternative drink such as squash, tea or coffee. The expert by experiences reported that: ‘I was told that lunch was at 12.30pm and I was going to have lunch with the residents. However, at 1pm, I decided that there would be insufficient time for me to wait for lunch. I could only see the two menus, covering a period of time, on the wall in the hall where residents were unable to access. Also the writing was in small print.’ The expert by experience also felt that: ‘If relatives were able to see the menus and read them as well as the residents, this would create a varying point of conversation between everyone.’ Weight charts confirmed that people generally put on weight when they move into the home. People who were observed ate all their meals and relatives who commented said the food was good. ‘Yes the food is very good I sometimes have a meal.’ Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. There are effective complaints and adult protection procedures in use at Heywood Court so that people feel listened to and their views taken seriously. EVIDENCE: The manager stated in the information provided that the complaints procedure is clearly displayed in the reception area. This was the case on the day of inspection. Since the last key inspection in February 2008, the Commission for Social Care Inspection had received two safeguarding alerts concerning people living in the home. These are currently under investigation by Rochdale Metropolitan Borough Council and the Police. The manager’s initial actions have demonstrated that the safeguarding policy has been used to deal with these disclosures openly, effectively and to protect people from further harm. The logging of complaints continues to be satisfactory. The records indicated complaints received had been logged and responded to in writing. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 22 A requirement had been made at the random inspection in November 2007, for all staff to do protection training. From checking the training matrix, it was noted that all but the very newest staff had now done this training. This included the administrator, laundry assistant and some other ancillary staff. The project manager said the few who still needed to do the training would receive it over the next few weeks. The manager stated and training records confirmed that adult protection training is provided on a rolling programme. Staff who were interviewed were clear and confident about their responsibility in protecting residents from harm. Those working in the home had used the protected disclosure (whistle-blowing) policy effectively, and were pleased with the response from the manager and RMBC in dealing with their concerns. Comments from staff included: ‘We have received training and a booklet about protecting people.’ Staff comments also included: ‘There is an internal and external (if needed) complaints procedure to follow.’ Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The environment at Heywood Court accommodation to the people living there. provided comfortable and safe EVIDENCE: Access to the home is via a gated courtyard. On the day of inspection the entrance bell was broken and we found access to Heywood Court difficult. Despite there been a CCTV camera trained on the area, so that staff could see who was arriving and wanting access to the home, it took us approximately 15 minutes before someone came to open the gate. The district-nursing sister also said this was a problem encountered by nurses visiting the home. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 24 Some people, such as regular visitors, are provided with the code to open the door. However, for people who are not regular visitors (such as us) it was a problem and is not a positive welcome to the home. There were no instructions about getting attention if the bell was not working for those without the access code. The expert by experience reported ‘It was difficult to get into the building, having to pass through two doors which opened by keypad and it was even more difficult to get out. The activating numbers did not seem to work efficiently. There was no obvious instructions on the wall outside on how to get in. This detracted from staff being able to give a warm welcome to anyone.’ At the front of the home was a safe courtyard area, which residents could use in the warmer weather as seating was provided. We had a look round the home. All communal areas were looked at and a number of bedrooms were also inspected. On entering the home there was still evidence of malodour. This was despite of the home been newly decorated and extensively refurbished. One area has been enclosed and this may be preventing air circulation in the lobby area. The windows and doors were opened to allow air to pass through rooms. Air sanitising equipment was also discussed with the management team because there was no obvious reason, in relation to the environment, for the malodours that were noted in different areas of the home. The manager also stated that staff cleaned the carpets immediately after any spillage. All areas of the home looked clean. Furniture was new and clean and carpets also looked clean. The corridors are decorated in different colours so that people could recognise which one they were on. The expert by experience report said: ‘Inside the building, the décor was beautiful. Considerable thought had been given to corridors. Each corridor was identifiable by its specific colour combination. Carpets appeared new. A life-size painting on the wall of an old-fashioned red telephone box identified the placement of a telephone. Similar wall murals depicting plants in a conservatory and another showing shelves of fruit. These were wonderful enhancements for people suffering from dementia.’ A number of 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. Specialist flooring had been installed in the rooms where it was assessed that this would meet people’s hygiene needs better. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 25 The bedroom doors were different colours with nameplates or other personal effects hung outside doors. This made them more easily recognisable for the individual. The manager has begun the process of staff putting pictures of the resident on their room doors. Many of these pictures are of people in their younger days - this is because some people no longer recognise their older selves. Many of the bedrooms has been personalised with family photographs, ornaments and their own furniture. A number also had televisions and radios. The bedrooms that were entered did not smell unpleasant. The expert by experience report stated: ’Residents’ rooms were all with an ensuite. Some rooms had the residents’ own favourites decorating walls and dressing tables. Each room was identifiable not only by the number on the outside but also an addition of a photograph of the resident themselves. Very helpful for people with dementia problems.’ Also, large clear pictorial signs had been fitted to bathroom and toilet doors so that people could find them more easily, without staff assistance. The environment was homely and provides sufficient spaces so that people can have different degrees of privacy. There is a dividing wall at the entrance making a separate entrance hall that visitors or residents can use as an alternative sitting area. There are a number of lounge/dining areas. Throughout the visit, the atmosphere within the home was generally peaceful and only two residents walked around asking for assistance. The top floor unit remains closed and the residents moved into rooms on the ground or first floor levels. All areas of the home were comfortable to use and decorated in a way that would prompt people to recognise the purpose of the area. For example, by the telephone is a mural of a red telephone box; and at the entrance to another area there is a mural of a dresser containing plates and other food related items. 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. All bathrooms that were entered during the inspection were clean and warm. Good infection control practice was noted at meal times when staff changed into blue disposable aprons. They wore white disposable ones when assisting with personal care tasks. The store cupboard held a good stock of disposable gloves, and liquid soap and paper towels were seen in the bedrooms entered. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 26 Good laundry facilities were in place and individual baskets supplied for each person’s clothes. The laundry was tidy and clean. Appropriate colour coded laundry bags and protective clothing were in use for this service. When unoccupied, the laundry door was kept locked to prevent residents from going in and harming themselves. The dining rooms had non-slip easily cleanable floors. There was an enclosed garden, but the furniture appeared very worn by the weather. Overall, the environment was a lovely place to be.’ The relative who returned the survey confirmed that in their opinion the Heywood Court was always clean. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 27 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): Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The staff at Heywood Court have access to a comprehensive training programme and are employed in sufficient numbers to meet residents’ needs. EVIDENCE: On the day of inspection the manager said that there were 23 residents living at Heywood Court. Staff on duty during the day consisted of the manager, six care staff, two domestics, one laundry assistant, a chef, and maintenance and administration staff. The training matrix showed that staff training provided since the previous inspection in February 2008 has included: fire safety; food hygiene; moving and handling; control of substances hazardous to health (COSHH); protection of vulnerable adults; infection control; nutrition; safe handling of medication; continence care; mental capacity act 2005; care planning; use of bedrails and specialist dementia care training called ‘Yesterday Today and Tomorrow. Staff who where interviewed confirmed that they liked working at Heywood Court saying ‘I like working here’ and ‘It’s smashing.’ These people also went on to describe the training and supervision they had received and were positive about the experiences. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 28 A recent recruit confirmed that she had completed an induction workbook. This was seen on file and showed that areas covered at induction were in keeping with the Skills for Care guidance on induction into social care. Topics covered included: introduction to home; principles of care; organisational responsibilities; expectations in relation to the General Social Care Council code conduct; health and safety issues; communication; adult protection; firesafety and personal development. This person had a certificate that confirmed that she had completed an apprenticeship in health and social care. All staff who returned surveys felt that they were provided enough training to carry out their jobs, deal with equality and diversity issues and remain up to date in their practice. Comments included: ‘I recently attended a dementia course set by the Alzheimer’s society which taught me a lot of new things’ and ‘The deputy and home manager went through a very thorough induction process.’ Staff files were examined and each contained a copy of the application form, two references that had been followed up with phone calls when needed and evidence that protection of vulnerable adult (POVA) and Criminal record (CRB) checks had been completed before people worked in the home. All the staff who returned surveys confirmed that they were unable to take up their post until the vetting process had been completed - one person commented: ‘My actual start date was confirmed as my second reference was received.’ Although staff records confirmed that the quality of the work they completed was discussed, the standard of personal hygiene staff supported people to achieve, indicated that additional supervision and instruction in this area was needed. The training calendar also needs to be expanded to include, amongst other topics, information about working with people with sensory loss and how to provide activities in a residential setting. In the information returned the manager calculated that 50 of staff have achieved National Vocational Qualification (NVQ) in Care level 2 or above. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The management of Heywood Court aims to be open and accessible, a quality assurance system is in place and people living at the home make a contribution and their views influence how the home is run. EVIDENCE: The home has been without a registered manager over the past 18 months. The lack of a registered manager has impacted on the outcomes for people living at the home and we have commented on this in our last inspection report. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 30 Since the last inspection Southern Cross has recruited a new manager and is currently going through the registration process with us. The current person managing the home has achieved a level of stability and has worked hard to raise the standards in all areas of support provided at Heywood Court. We have evidenced lots of improvements within the service, but we still feel that there is much to do, particularly around aspects of personal care and activities for people. The operational manager, supported by the responsible individual, also monitors the progress made in relation to the environment, staff conduct and training and customer satisfaction. Staff were now receiving regular supervision, staff meetings were being held, more staff training courses had been arranged. Both the operations manager and the responsible individual continue to regularly call at the home to monitor that the improvements are continuing. Whilst the current manager has a nursing qualification, she has not got a background in dementia care, however since the previous inspection she has completed a specialist dementia care course ‘Yesterday, today and tomorrow’, targeted at managers of services. Staff feedback about the management of the service was positive. They confirmed that staff meetings were regularly, at least once every six weeks, and topics discussed included: the care of the residents such as concerns with management and care, and suggestions for future activities. One carer said ‘I feel the management and the senior staff are very very approachable.’ The manager continues to work along staff and observations confirmed that she continues to get to know residents by their names. A corporate quality monitoring and assurance system is in place and the audit tools were being used. The manager did a monthly audit that was validated by the operations manager. Medication audits continue to be completed and any issues discussed and, when necessary, the manager has informed the Commission for Social Care Inspection. Discussions with members of the management confirmed that they would initiate action plans to deal with any problem areas identified through the inspection process or as a result of the company’s own auditing process. Action plans were completed where shortfalls were identified. The increase in checks following a fall was a part of this process. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 31 The manager stated that questionnaires to relatives had been distributed in June 2008 but none had been returned to the regional office for collation. This is in keeping with the response to the surveys distributed by the manager on behalf of CSCI, as relatives had returned only one. The manager should also give health, social care and other professionals and visitors the home the opportunity to comment about their experiences of dealing with Heywood Court. Regular relatives meeting are organised and one was due to be held on the day of this inspection. The manager said that the previous meeting had been cancelled as no-one attended. The manager confirmed that she continued to hold ‘open surgeries’ where relatives and residents could talk to her about problems or concerns. The operations manager stated that Regulation 26 visit sheets were been completed. In order for us to monitor how well improvements were been sustained, copies of the Regulation 26 visits should be sent to us until further notice. The service holds small mounts of cash; money is spent as required and receipts are then submitted so that the company is reimbursed from the resident’s bank account. A running total of the amount that is banked for each person is available. 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 organisation had detailed health and safety policies and procedures in place which are reviewed and updated as needed. Information contained on the Annual Quality Assurance Assessment (AQAA), returned to us in July 2008, showed that the required maintenance checks had been carried out. The sticker on the movable hoist confirmed that this had been checked by a specialist company and was due to be mainitned in August 2008. Staff training in most areas of health and safety has been adressed although actual ‘Health and Safety’ training did not seem to have been provided to staff. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 32 Training records indicated that fire-safety training and fire drills had been conducted at least four times in since the previous inspection in February 2008. The manager described the training as practical and involved staff walking through the evacuton procedure, identifying where the fire was situated and making people in the area as safe as possible. The manager also stated that the trinaing was different for staff who worked nights, in keeping with the number of staff available and where most residents would be situated. The management team has achieved a good deal of improvement in relation to the records kept, the living environment and the safety of the residents, however more effective management and improved outcomes must be achieved in respect of health and personal care and lifestyle for people living at Heywood Court. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 33 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 3 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13 Requirement Timescale for action 01/11/08 2 OP8 13 (3) 3 OP8 13 (c) 4 OP8 13 (b) The registered person must ensure that care plans are developed for specific health conditions that are managed at Heywood Court, for example, diabetes care; this is so staff know how the illness may progress and what to do if a person’s condition gets worse. The registered person must 01/10/08 make sure that people have baths, washes or showers with enough frequency to make sure that they are clean and free from unpleasant odours. The registered person must 01/10/08 ensure that steps are taken to make the pressure area care at Heywood Court is more effective and identified in a timely manner. The registered person must 01/11/08 ensure that appointments are arranged for people to have access to hearing tests and appropriate aids according to their need. Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 35 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. 5 Standard OP12 Regulation 16(2)(n) Requirement The registered person must ensure that a permanent activity programme is implemented which meets the differing needs, including spiritual, of the people living at the home, so they will remain motivated and fulfilled. Timescale for action 01/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP8 Good Practice Recommendations The registered person should ensure that people are offered at least two litres of fluid to drink each day, so that they remain hydrated and reduce the risk of urinary tract infections. The manager should make sure that all visitors to Heywood Court are able to enter without undue hindrance. Staff would benefit from deaf awareness and other sensory training so that they can communicate better with people who have a sensory loss. The registered person should ensure that when the operations manager has done their monthly Regulation 26 visit, the report is forwarded to the CSCI so that we can monitor that the improvements to the service are being sustained. 2 3 4 OP19 OP30 OP33 Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Manchester Area Office Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Heywood Court Care Centre DS0000049296.V367303.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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