Inspection on 25/09/07 for Little Heaton Care Home

This inspection was carried out on 25th September 2007.

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

The inspector 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

Little Heaton Care Home 18/07/06

Little Heaton Care Home 30/01/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Little Heaton Care Home Little Heaton Walker Street Middleton Manchester Greater Manchester M24 4QF Lead Inspector Jenny Andrew Unannounced Inspection 25th September 2007 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 Little Heaton Care Home DS0000064013.V351194.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. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Little Heaton Care Home Address Little Heaton Walker Street Middleton Manchester Greater Manchester M24 4QF 0161 655 4223 0161 654 0200 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) Little Heaton Care Limited Sandra Beatrice James Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25), Physical disability (2) of places Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 25 service users to include: up to 25 service users in the category of OP (Older People); up to 1 male service user in the category of (PD) Physical disabilities under 65 years of age). The service should employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. The home’s manager must be supernumerary to the rota for at least 20 hours per week in a management capacity. The home is registered for a maximum of 25 service users to include for a 4 week period only, 1 female service user under 64 years of age in the category of (PD) Physical disabilities. 18th July 2006 2. 3. 4. Date of last inspection Brief Description of the Service: Little Heaton is a converted church building, situated in a quiet street off the main road into Middleton and Manchester. It is registered to provide personal care for up to 25 elderly persons in 21 single and two double bedrooms. The home is on a main bus route, with easy access to the motorway network. Local shops are situated close by. Disabled access is provided by ramps and a passenger lift. The home does not provide nursing care. There is one lounge/ dining area and a separate smoking lounge. Whilst there is no garden, residents can sit outside in the car parking area or in the church grounds. The weekly fee, as at September 2007, is £339.90 for bedroom without ensuite toilet and £349.90 for a room with en-suite facilities. Additional charges are made for private chiropody, hairdressing and newspapers. 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 to new residents. A copy of the most recent Commission for Social Care (CSCI) inspection report is held in the entrance hall. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, which included a site visit to the home. The staff at the home did not know this visit was going to take place. The visit lasted eight hours with the inspector arriving at 08:15 and leaving at 16:15 hours. We looked around parts of the building, checked the records kept on service users to make sure staff were looking after them properly, as well as looking at how the medication was given out. The files of three members of staff were also checked to make sure the home was doing all the right checks before they let the staff start work. In order to obtain as much information as possible about how well the home looks after the residents, the manager, deputy manager, eight residents, two carers, three relatives, the visiting district nurse and the cook were spoken with. Before the inspection, comment cards were sent out to residents and relatives asking what they thought about the care at the home. Five residents filled the cards in with the assistance of their relatives and returned them to the Commission for Social Care Inspection (CSCI). This information has also been used in the report. Before the inspection, we also asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. We felt this form was completed honestly and that a lot of time and effort had been given to filling it in accurately and in detail. The Commission for Social Care Inspection (CSCI) has not received any complaint about the home since the last key inspection. What the service does well: Residents spoken to and feedback from questionnaires indicated they liked the staff team. Comments about the staff included: “I get on well with the staff”, “they take good care of us”, “they are very good”, “staff are great”, “you can have a bit of fun with them”, “they’re fine”, “marvellous” and “the care couldn’t be better”. One person said, “You just ask and they’ll do anything for you, even when they are busy”. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 6 Before new service users came to live at the home, the manager made sure they had all the right details about them, so that they were clear that the home was the right place for them to live and that their needs would be met. The home was good at making sure residents’ health was well taken care of by sending for district nurses and other health care workers whenever they felt they were needed. Residents said they felt safe and cared for. The visiting district nurse said, “the residents always seem well cared for, the staff communicate well with us and follow our instructions”. The manager and staff team, including the cooks, were vigilant in trying to make sure that residents with weight loss were encouraged to eat the right foods and they had received training in how to do this. The manager knew how important it was for the staff to get the right kind of training and made sure they attended courses so they would be able to care for the residents safely. Almost half of the carers had now done training courses in how to look after the people in their care. These are called NVQ qualifications. The residents were being encouraged to have a real say in how the home was run, with regular monthly meetings being held and questionnaires being circulated to find out whether they were satisfied with the service they were receiving. The home was being well managed and staff were receiving the right kind of help and support so they could do their jobs well. What has improved since the last inspection? The care plans, which set out each person’s needs, were more detailed and where residents were thought to be at high or medium risk, the care plans showed what action staff should take to reduce the risk. A key worker system had been set up which will assist staff in getting to know their residents better, thus enabling them to include social histories in the care plan file. The way controlled drugs were given out and stored was now being done in line with the home’s policies, making it a safer system. Staff had been trying to spend more individual time with the residents and several had been escorted on shopping trips, to feed the ducks and on short local walks. More in-house activities to keep people occupied had also been done. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 7 The building of more single en-suite bedrooms meant that more people could have a single room with their own toilet, which had increased people’s privacy and dignity. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Little Heaton Care Home DS0000064013.V351194.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 Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The admission process was thorough with residents being assessed before coming into the home to ensure their needs could be satisfactorily met. EVIDENCE: The files for three of the most recently admitted residents were checked, including one for a resident who was in for a short stay. Each contained a full care management assessment. It is the usual practice of the home for the manager to go out and assess each new potential resident, either in their home or in hospital. The manager said she also encouraged relatives to be present, especially if the person was mentally frail. Two of the residents spoken to confirmed she had visited them before coming into the home. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 10 All three files contained pre-admission assessment forms. These were detailed and contained information that the staff would need to know in order to care for the person upon admission. Feedback from one returned resident questionnaire commented, “I had to be placed immediately as I was coming out of hospital and couldn’t visit the home. It was pure luck I ended up here as I believe it is the right place for me.” It was noted in one instance, that the social/spiritual needs and hobbies/ interests section of the assessment had not been completed and the manager should ensure such details are obtained. Once the resident had been in the home for a few days, another assessment was done which included a social history of that person. The care plans were then written using all the assessment information. Upon admission, a full inventory of each person’s clothes and belongings was not always being done. This should be addressed. The manager was good at making sure the home could meet the assessed needs of residents and when she felt they could not, she would not accept the person into the home. She also ensured that staff received the right training and records showed that eight staff had done training in dementia care, five had done Parkinsons disease and two had completed loss and bereavement training. Where residents had identified nursing needs, the district nurses were contacted and arrangements made for the individuals to be visited at the home. Feedback from one of the visiting district nurses indicated they were contacted as soon as any problems were identified and that the staff followed her instructions with regard to the residents’ care. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents’ health and personal care needs were being met by staff who respected their privacy/dignity needs. EVIDENCE: Three care plans were checked and improvements were noted since the last inspection when two requirements in relation to care plans and risk assessments were made. Whilst the plans continued to be the pre-printed type, with boxes to tick to indicate the persons’ needs, where individuals’ needs did not fit into a box, their care needs were recorded in full on a separate sheet. All residents spoken with felt they were being well cared for by the staff team and said their needs were being met. The three care plans had been signed by the individual residents and had been reviewed monthly. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 12 A key worker system had been recently introduced and two of the residents spoken to were able to confirm who their key worker was and the role of the key worker. Staff spoken to also felt positive about their new role and said they felt it was enabling them to build up closer relationships with their residents. Not all care plans contained full social histories, but the manager had already instructed key workers to address this shortfall. Residents’ bathing and foot care records were kept in a separate file but this process was now being discouraged, with key workers being requested to record on people’s individual care plans. Risk assessments were in place for nutrition, moving/handling, falls, general risks and skin care (Waterlows) and these were regularly updated. When the outcome of the assessment was found to be medium or high risk, the care plans recorded how the risks were to be managed. The manager and five care staff had received training in July 2006, by a dietician, in the use of the new Malnutrition Universal Screening Tool (MUST). All residents had now been assessed using this tool. Residents’ weights were being regularly checked and the home had the provision of sitting scales. The manager and staff team were vigilant in this area and had already had good results. One of the residents, whose care plan was checked, had been weighed upon admission in July 2006 when she was assessed at high risk of malnutrition. At the time of the inspection, she was medium risk with a significant weight gain of 8.4 kg. The relative of this resident was spoken to. She said she was really pleased with the progress her mother had made since coming into the home and that she looked so much better since she had put some weight on. All residents spoken with felt their health care needs were well met and said that if they felt ill, the staff would request a visit from their Doctor. They also confirmed that visits from the chiropodist and optician were arranged as needed and notes on the files confirmed this was so. The returned questionnaires were also positive with four people saying they always received the right care and one saying they usually did. The visiting District Nurse was spoken with. She said they did not visit the home regularly, as there was no cause to but that when there were any problems, they were contacted immediately. She said the manager and staff co-operated with her when she visited, followed any instructions given and cared for the residents well. She also said they were not treating any one for pressure sores. Visits by all health care professionals, together with the outcome of their visits, were recorded on the care plan files. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 13 The two requirements made at the last inspection in respect of administration and storage of controlled drugs had been met. The arrangements in place for the administration, storage and disposal of drugs were satisfactory. Controlled drugs for two residents were checked and found to be in order. A medication policy/procedure was in place and since the last inspection, a homely remedies policy had been written and implemented. The morning medication round, done by the deputy manager, was observed during the inspection. She administered the drugs in accordance with the home’s procedures. Where residents were being prescribed with nutritional supplement drinks, these were not being recorded on their medication administration records. This should be done in accordance with the GP’s instructions. All staff responsible for the administration of medication, had received training. The manager was aware that some staff were due for refresher training and she was looking for a training course to send them on. The aims and objectives of the home reinforced the importance of treating residents with respect and dignity. Residents interviewed were all complimentary about how staff assisted them with personal care tasks and felt their privacy and dignity were respected at all times. One resident was delighted with his new bedroom which had en-suite toilet facilities. He said he really valued having his own toilet. The staff interviewed were also able to give good practice examples of how they tried to ensure people’s privacy and dignity were upheld when assisting with personal care tasks. This was also observed during the inspection. Residents were taken to the toilet without having to wait, toilet doors were closed and staff knocked on bedroom doors before entering. One of the relatives spoken to said her mother was always treated with respect and dignity by the staff team. The returned relative/visitor questionnaires also confirmed satisfaction with the way the residents were looked after. One observation was made during the inspection, where a man was shaved, sat in the dining room, which was empty at the time. Residents should be encouraged to go to their rooms or a bathroom when needing to be so assisted. The induction training programme, which is now done by all new staff, included how to treat residents with respect and dignity. In addition, the Social Services training department were also offering privacy and dignity training and three of the staff had been on this course. The manager said she would be sending more when further courses were arranged. Residents were encouraged to remain as independent as possible and this was observed during the inspection. Residents who were becoming less mobile were being encouraged to continue to walk, with the aid of their zimmer frames or walking sticks. At mealtimes, whilst assistance was given where needed, residents were prompted by staff to continue to eat their meals themselves. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents were able to follow their chosen lifestyles both in and outside of the home and varied and nutritious meals were provided. EVIDENCE: Whilst there was no activity programme displayed in the home, the newsletter, which was available in the entrance hall, listed all the forthcoming events. There was a social activities file which recorded what daily activities had been offered to the residents and who had taken part. The staff said many of the residents were difficult to motivate and reluctant to take part in arranged activities but that they preferred one to one chats with the staff. Several of the residents living at Little Heaton were mentally frail but they were encouraged to join in with reminiscence chats, armchair exercises, music and simple ball games. An activities book was kept where staff recorded what activities had taken place. Examples were as follows: going out for walks, feeding the ducks, music, reminiscence, “play your cards right”, picture bingo, cards, newspaper discussion, music therapy, quiz, draughts and dominoes and crosswords. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 15 An outing to the theatre had been arranged and a trip to Blackpool illuminations was to take place the week following the inspection. Outside entertainers were regularly enjoyed and residents’ feedback was obtained about whom they liked. This had recently resulted in changes to which entertainers were booked. A clothing party had also been enjoyed by some of the residents. Birthdays were celebrated and significant days, such as St Patrick’s, St David’s, Easter, Halloween and bonfire night were social events. Feedback from four returned questionnaires confirmed activities always took place and one said they usually did. One person commented, “I really enjoy being taken out to feed the ducks in my wheelchair”. Residents’ meetings were arranged on a regular monthly basis. It was evident from the minutes that they were fully involved in the planning of the outings, entertainment and menus. No summer outings had been made this year, due to the bad weather. Residents’ religious needs were usually recorded on file although, as previously highlighted, one file did not contain this information. Three residents attended the local church on a weekly basis with staff accompanying and returning for them at the end of the service. One resident received monthly visits for communion and those spoken to said they were satisfied with the current arrangements in place. Feedback from the returned relative/visitor questionnaires indicated they were made welcome at the home at any time, were kept informed of important matters affecting their relative/friend and were satisfied with their overall care. The visitors spoken to during the inspection also confirmed this. Several residents had been taken out for short walks or to local shops when the weather was dry and they had enjoyed these community outings. Residents spoken to said they were able to make choices in their daily routines, such as times to get up and go to bed, what to wear, where to sit and use of their rooms. Residents’ finances were handled mainly by their relatives. However, money was held by the home for some of the residents who could request this money whenever they wanted to. Since the last inspection, changes had been made to the menus, incorporating the suggestions made by residents at the monthly meetings. A mid-week roast dinner had been put on the new menus and black pudding had also been tried but at the residents’ request, not put on regularly. The printed menus did not show a choice at lunch or tea but a large notice was displayed near to the serving hatch stating what standard alternatives were available daily upon request. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 16 From chatting with the residents, it was apparent they were not all aware that they could request something else if they did not like what was on the menu. The cook said she knew all their likes and dislikes and would make sure each person had something they enjoyed. A large wall mounted board, outside the kitchen, displayed the daily menus. The current menus were varied and offered a good selection of fish, meat, fresh and frozen vegetables and fruit, with desserts being offered at both lunch and tea. Feedback from the returned questionnaires and from those people spoken with all felt the meals were satisfactory. The following comments were made: “the meals have improved since ownership of the home changed”, “there will always be things I don’t like, you can’t please all of the people all of the time”, “the food is pretty much to my taste”, “the home knows my likes and dislikes” and, “the food is presented so that I can eat it, e.g., minced if necessary”. The inspector sampled the lunch-time meal of sausages, chips, peas and gravy. It was a tasty meal and the majority of residents seemed to enjoy it. Mashed potato was also offered to those who wanted it. An apple crumble and custard was the dessert offered. At teatime, the menus offered sandwiches or snack type meals but home baked cakes or a dessert were also offered at teatime. A substantial supper such as crackers, sandwiches, toast, biscuits or cake was available to residents, which many enjoyed. Hot milky drinks were also offered. Staff offered residents second helpings at lunchtime and also asked if they wanted more to drink. The special dietary needs of the residents were being met with soft/liquidised and high fibre food being given. Both the cooks had been on the Malnutrition Universal Screen Tool (MUST) training, which had raised their awareness of the importance of encouraging people to follow high calorific menus in order to help them to maintain or increase their weight. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. An effective complaints system was in place which residents and relatives were familiar with and staff training and good recruitment practices ensured that, as far as possible, residents were protected from abuse. EVIDENCE: The complaints procedure was included in the service user guide and statement of purpose. The manager had also put a copy of the procedure behind each resident’s bedroom door so they would not lose it. The manager said she also checked out at resident meetings whether anyone had any complaints and the minutes of the last meeting, held in September 2007 confirmed this. Residents had brought up a collective problem involving another resident. The manager and staff team were now working consistently to address the problem. A complaints file was in place and one complaint had been logged since the last inspection. The manager had investigated this thoroughly, setting out the outcome and responded appropriately to the complainant. The Commission for Social Care Inspection had not been involved in any complaint or protection of vulnerable adult investigations over the past year. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 18 Feedback, both from residents and from returned comment cards, indicated that the residents knew how to make a complaint and could speak to any of the staff if they had a problem. A copy of the Rochdale inter-agency protection procedure was in place, together with a whistle blowing procedure. Sixteen staff had attended Rochdale Social Services protection training, with only five still to do it. The manager was awaiting dates of the next courses. Staff files showed that Criminal Record Bureau checks were being undertaken and that if staff started work before these had been obtained, that Pova first checks were being done, with staff working under supervision until full checks were received. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. A clean and comfortable environment was provided for residents. EVIDENCE: Environmental Health and Fire Officer visits had been made since the last inspection. The manager confirmed that all the requirements made had been met within the specified timescales. She said the fire officer had returned in July to re-inspect the work completed. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 20 Information recorded on the returned Annual Quality Assurance Assessment (AQAA) form indicated that several changes had been made to the interior of the home. This was the first time the Commission for Social Care Inspection had been advised of the work. From walking around the home, it was observed that the laundry, which had previously been on the first floor, had been re-sited on the ground floor. Storage areas, the staff room and laundry space, together with existing loft space had enabled the owner to have six new en-suite bedrooms built. This did not, however, increase the number of people being accommodated; it simply reduced the number of double rooms to two, giving more single room provision. As part of the refurbishment programme, the central heating on the first floor had been converted to gas central heating instead of the existing storage radiators. The manager said the remainder of the home would be converted to gas central heating in due course. The Building Control and Fire Officers had been to inspect the work and had verbally confirmed to the manager it met their specifications. No documentation had however, been received by the owner or manager, confirming this. It is strongly recommended she pursue this with the enforcing authorities. The new rooms were light and bright and the en-suite facilities had been fitted with electric fans. New bedroom furniture had also been provided. It was noted that no lockable space had been provided in the new rooms. The manager said she would ensure this was done. The skylight windows had been fitted with net curtains but no blinds had been provided. The manager said the people already in the rooms had been asked about such provision but had declined, stating they preferred the natural light coming into their rooms at night, rather than using a bedside lamp. When the remaining bedrooms are occupied, each person should be asked their preference. Only one of the bedrooms had been finished, by having covers fitted on the radiator and exposed pipe work. This was of concern as residents could be at risk of scalding themselves should they fall against the uncovered radiators and piping. The owner was contacted by telephone and gave an undertaking that this work would be completed within the next seven working days. Before the end of the inspection, a delivery of radiator covers was made to the home. A stair lift had been fitted to the short flight of steps providing access to these rooms. It was safe for the residents to use independently if they so chose. One of the en-suite toilets had a frame fitted over the toilet to promote independence. The manager confirmed that each resident would be individually assessed and aids/adaptations provided as necessary. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 21 Redecoration work was in the process of being done in toilets and bathrooms and in bedrooms where storage heaters had been removed from walls. A parttime handyman was employed who was assisting with this work. The maintenance book showed that all outstanding work was completed as quickly as possible. Throughout all the alterations, residents and/or their relatives had been kept fully informed and this was evidenced from minutes of resident meetings. The owner was in the process of applying for a grant in order to improve other areas of the home. The residents had been consulted about what improvements they would like to see and several had suggested that existing communal areas be divided into smaller rooms. They had also suggested a safe sitting out area be provided at the rear of the home so they could enjoy some fresh air in the summer months. The manager had passed this information to the owner and quotes were in the process of being obtained. A smoking lounge was provided for the residents, which met the new government guidelines. Staff and visitors to the home could not smoke in the building. The new laundry was in full operation but there was still work outstanding that Building Control had said must be done. A new wall needed building so that the laundry and adjoining corridor were separate. The manager said they were waiting for a door to be made following which the work would be completed. The home was clean and odour free throughout and the resident and relative feedback about cleanliness was very positive. The visiting district nurse also said there were never any malodours evident. Infection control policies/ procedures were in place, which staff were following. The majority of the staff, including domestics, had received infection control training. Good infection control practices were observed and staff confirmed there was always a plentiful supply of disposable gloves and aprons. Liquid soap and paper towels were available in all bedrooms, bathrooms and toilets. Staff were seen to wear blue aprons when assisting residents with meals and white ones when assisting with personal care tasks. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Sufficient trained staff were on duty throughout the day and night to ensure the needs of the residents could be met. EVIDENCE: From checking staff rotas and speaking to care staff and residents, it was clear that sufficient staff were working on each shift. The home had 22 people living there, including three people on short stays. For this number of residents there were three staff covering the morning, afternoon and evening shifts and two night staff. This included someone in a senior position, other than the manager. The manager spent some time on the floor, as well as covering her management duties so that she could observe staff practice and keep herself updated with the care needs of the residents. This level of cover ensured the residents’ health and personal care needs could be met. The provision of ancillary staff was also satisfactory with cooks, domestics, handyman and housekeeper being employed. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 23 Due to the increase in resident numbers, additional staff had been recruited over the past eight months, but only two staff had left. There has always been a very low turnover at the home with many staff having worked there for many years. Other than two male night care assistant and the handyman, the staff team was all female. Two male day care assistants had left and had not been able to be replaced by male carers. The male residents spoken to did not see this as a problem. The ethnic makeup of the staff team was all white British, but this reflected the ethnicity of the resident group. Residents spoken to were all very complimentary about the staff team and felt they were well cared for, safe and secure. Staff feedback indicated they worked well together as a team and, as a result, they gave good consistent care to the residents. They confirmed they received regular one to one supervision with the manager and that staff meetings were held on a regular basis. From checking the staff meeting minutes, it was evident that all staff, irrespective of their roles, had regular meetings with the manager. Staff training was given a high profile, with the manager trying to make sure the staff were given opportunities to enable them to strengthen and develop their skills and knowledge. Seven of the 16 care staff had completed their NVQ level 2 training and four were in the process of undertaking it. One of the senior carers had recently completed her NVQ level 4 training. Whilst the home had not achieved 50 of trained staff, they were on track to do so shortly. They had previously exceeded the 50 before the two carers had left. In addition to the above, the majority of the team had received training in fire, infection control, moving/handling, food hygiene and first aid. Ten of the staff were due to attend health and safety training in the next few weeks and four were undertaking this training on the day of the inspection. The evidence of staff completing training was seen in their personnel files where all certificates were kept. The manager was in the process of identifying courses for the newer staff to undertake their mandatory training. According to the Annual Quality Assurance Assessment (AQAA) form, policies and procedures were in place for the recruitment and selections of staff. Three staff files were checked, two for the most recently recruited carers. The files were in order and contained all the required checks. Copies of the General Social Care Council, “Code of Practice” were given to new staff as part of their induction process. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 24 Since the last inspection, the manager had implemented the Skills for Care training for all new staff, as well as the in-house initial induction training. The manager had purchased a Skills for Care booklet entitled “The First 12 Weeks and Beyond”, which had sample questions to ask of new staff to assess their understanding and awareness. However, from records seen, it was identified that the training was not being completed within the expected 12 week period. The manager said the building work and problems experienced during this upheaval had meant certain timescales had had to be extended, including the Skills for Care training. She was also experiencing difficulties in finding mandatory training courses for the new staff in food hygiene, moving/handling and infection control within the three month period. She confirmed all staff received basic in-house training, delivered by herself, in health and safety until they went on full courses. The more experienced staff spoken to confirmed that new carers did not work unsupervised and were not expected to move and handles residents alone. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 25 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): 32, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The manager’s experience and qualifications enabled her to understand the importance of ensuring that current practices within the home promoted and safeguarded the health, safety and welfare of the people using the service. EVIDENCE: Since the last inspection, the manager had completed the Registered Manager’s award and her certificate confirming this was seen in her training file. Although it was identified at the last two inspections that the home did not have Internet facilities, the provider had not addressed this shortfall. In order to keep herself updated in contemporary care practice, the manager was having to use her own computer at home to access appropriate web sites including that for the Commission for Social Care Inspection (CSCI). The Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 26 provider should give serious consideration to providing Internet access at the home as it is becoming more and more vital that such provision is available for reference purposes during working hours. Residents knew who the manager was and felt they could speak to her if they had a problem. She sometimes covered a shift and worked alongside the staff, enabling her to monitor staff practice. Staff feedback indicated she was approachable, fair and had high standards in respect of how the residents were looked after. They also felt she was prepared to listen to their points of view. It was identified at the last inspection, that the quality monitoring system was in need of improvement. Since this time, the provider had purchased a quality monitoring package, which the manager was in the process of going through, before deciding how best the system could be implemented. Some formal quality assurance monitoring measures were already in place such as key worker system, monthly resident meetings, circulation of satisfaction questionnaires to residents and/or their relatives and regular separate staff meetings for the seniors, night, evening and ancillary staff. These were held at times convenient to the staff. A staff training matrix was in place so the manager could easily see which staff still needed to do training. Feedback from the in-house questionnaires was very positive but the manager had not collated it to include in the service user guide. This should be addressed. The systems in place for the recording of residents’ finances were in order with income and outgoings being recorded. Where residents received visits from the hairdresser or podiatrist, receipts showed which residents had received the services. Secure facilities were provided for the safe keeping of money and valuables and receipts retained for any purchases made on behalf of residents. Information received on the Annual Quality Assurance Assessment document confirmed that all the relevant maintenance health and safety checks had been carried out at the correct times. Fire equipment, gas and lift/hoist certification were randomly sampled and found to be up to date. As stated in the staffing section about, the majority of the staff team, including the ancillary staff, had attended the necessary health and safety training courses. The manager said she would send the new staff on the next available courses. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 27 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 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 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 Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 28 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 OP19 Regulation 13(4)(a) Requirement The newly fitted radiators and central heating piping must be covered so that residents are not at risk of scalding. A fax confirming this work has been completed must be sent to the CSCI office at West Point. Timescale for action 05/10/07 Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard OP3 OP9 OP19 OP19 OP30 OP31 Good Practice Recommendations Service users religious and cultural needs should be obtained during the assessment process. Where nutritional supplements are prescribed, they should be recorded on the medication administration records so that the manager can monitor they are being given. The manager should pursue Building Control and Fire in respect of written confirmation that the new building work meets their specifications. Each resident should have the provision of lockable space in their bedrooms and be asked whether they wish to have blinds in their new en-suite bedrooms. The Skills for Care training should be completed within the first 12 weeks of commencing work at the home so they will be able to undertake their jobs safely. Internet facilities and a printer should be available within the home. Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Manchester Local Office 11th Floor, West Point 501 Chester Road Old Trafford Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Little Heaton Care Home DS0000064013.V351194.R01.S.doc Version 5.2 Page 31 - 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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