Inspection on 02/10/09 for Scotia Heights

This inspection was carried out on 2nd October 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Scotia Heights 17/09/08

Scotia Heights 19/09/06

Similar services:

Aston Court Nursing Home

Breme

Ravenhurst

Westmead

Ashcroft Hollow Nursing Home

Bricklehampton Hall Nursing Home

Briar Hill House

Radbrook Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOME ADULTS 18-65 Scotia Heights Scotia Road Burslem Stoke on Trent Saffordshire ST6 4ET Lead Inspector Yvonne Allen Key Unannounced Inspection 2nd October 2009 09:00 Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Scotia Heights Address Scotia Road Burslem Stoke on Trent Saffordshire ST6 4ET 01782 829100 01782 829101 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) Email - scotia@exemplarhc.com Scotia Health Care Ltd Mr David Joseph Price Care Home 60 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (60), Physical disability (60) of places Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD) 60 Mental disorder, excluding learning disability or dementia (MD) 60 The maximum number of service users to be accommodated is: 60 2. Date of last inspection 17th September 2008 Brief Description of the Service: Scotia Heights is a purpose-built specialist nursing home providing 60 beds for young adults. The home provides holistic care for adult people aged between 18-65 years of age with a neurological diagnosis. The client group is people with a primary need of physical disability, with or without associated mental health problems. The environmental facilities are excellent. - All bedrooms are for single use, spacious, having en-suite facilities including shower and all bedrooms have TV and telephone points. There is ample room to negotiate moving equipment as required. There are 12 lounges and 6 dining areas providing high-quality accommodation furnished and equipped to the highest standards and allowing small group living areas. Corridors are wide and spacious with recessed seating areas and there are rooms for visitors and meetings. All facilities, including kitchen, laundry and office accommodation are spacious, bright, well equipped and pleasing in presentation. The home is located in a well-populated area in the northern part of Stoke on Trent. It is on a main bus route and easily accessible by car or public transport to the Potteries towns where all communal facilities can be accessed. The home is located next to a modern leisure centre offering excellent facilities. Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 5 At the date of this inspection, the fees charged by the home range from £1078.52 to £2588.93 per week. These should be discussed with the Registered Manager in the first instance, as fees are very much dependent on individual needs and available funding. Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that the people who use this service experience GOOD quality outcomes. The inspection process commenced several weeks prior to the visit. The visit to the home was carried out over two days by one inspector. Prior to the inspection visit the Providers had completed a self-assessment tool, which is known as the Annual Quality Assurance Assessment (AQAA). Completion of the AQAA is a legal requirement and it enables the service to under-take a self-assessment, which focuses on how well outcomes are met for people using the service. This AQAA was detailed and gave us good information about the services offered. During the course of the inspection it was identified that while most of this AQAA was accurate, some of the detail did not reflect current practice. All of the Key minimum standards were assessed and for each outcome a judgement has been made, based on the evidence gathered. These judgements tell us what it is like for the people who live in this home. The ways in which in we gathered evidence to make our judgements were as follows – We looked at any information we had received about the home since the last Key Inspection. This included any complaints and Safeguarding referrals we had received. We spoke with the people who live in the home including their representatives. We spoke with the staff who work at the home Discussions were held with the Responsible Individual, the Registered Manager and the Clinical Manager. We examined relevant paperwork and documentation at the home. We walked around the home. At the end of the inspection visit we discussed our findings with the Responsible Individual and Clinical Manager. The Registered Manager was not present during the second day of the inspection visit due to having to attend a pre-arranged meeting. Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 7 What the service does well: The home was registered in 2006 and purpose built. It is spacious, modern and adapted to meet the needs of people who live there. The home is divided into six separate units each accommodating up to ten people. This helps to ensure that the environment is more homely and that care is person centred. The small units also help to create a calmer atmosphere which is beneficial, and sometimes essential for many of the people who live there. People told us “The home runs like a home on the units to make people feel relaxed.” Personal, nursing and social care needs are delivered with a person centred approach. People who live in the home and their representatives are very pleased with the personal and nursing care they receive at the home – “Excellent standards of personal care. Staff are very respectful in the treatment of clients. There is good communication between staff and family” “The care my relative gets is excellent and the service that is offered to me on a personal level is above what they are obliged to give. I believe the people who care for my relative do care. They are first rate employees” “The standard of care is good in all ways. They provide a happy and home like environment” “Good quality of care on units” Staff told us that the home is good at “Meeting residents’ individual needs”. “Providing activity for staff”. “Good decorative homely environment” “Offers staff opportunities for training and development” Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 8 What has improved since the last inspection? What they could do better: Some people told us that they are concerned about the numbers of staff on duty at the home “The only improvement I could suggest is in staff rotation. Residents who are highly dependant do not like change and while a balanced skill mix is needed change is not always welcome by the most dependant”. “Being short staffed is a major problem and happens a lot. It is unfair on the staff on duty”. It was identified that, on one of the units, the provision of staff was insufficient to meet peoples’ needs. There are some very highly dependant people living on this unit and the numbers of staff provided on this unit on some days was insufficient to meet needs safely. We have made a requirement for the service to review the arrangements for staff provision in order to ensure that the needs of people are met on a continuous basis. Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 9 “Better induction programmes and training days organised better. More staff are needed to cover when training is on. More recognition is needed for staff with NVQ training”. “More support is needed for newly qualified staff and longer induction periods” The staff training and development programme should be stepped up in order to ensure that staff have the necessary skills to care for people. Staff told us that they did not receive regular formal supervision. This should be reviewed as staff should receive regular supervision so that they have the support they need to carry out their jobs. Care plans had not been reviewed monthly, some plans had been evaluated three monthly, some six monthly and some longer than this. Care plans should be evaluated more often in order to ensure that peoples’ changing needs are monitored and met. The Quality Assurance programme had not identified the problems with care plan reviews and this should be reviewed in order to make audits more effective in identifying areas in need of improvement. The service was in the process of meeting with the PCT to discuss GP service to the home. It was identified that, on some days, GP practices could receive several requests for visits from different units within the home. It is therefore recommended that the service review the arrangements for requesting GP visits with a view to co-ordinating the number of calls made to the GP practices. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People undergo a full assessment of their needs by a team of professionals before being offered a place at this home. The assessment process is thorough and comprehensive although, on occasions, this cannot always guarantee that peoples’ individual aspirations and needs can be met by the service. EVIDENCE: In their AQQA the Providers tell us – “We provide information to enable potential service users to make an informed choice about admission”. They tell us that they”Visit potential service users prior to admission wherever they are in the UK” and that “All potential service users and families are invited to visit prior to the planned stay”. They say that “During such visits, they are introduced to key members of staff to discuss individual needs and requests”. Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 12 Also – “Potential service users are invited to have a trial stay for a day and night and participate in meals and activities”. The Providers tell us of their “Comprehensive pre-admission assessment”. They also say that they “Decline to admit any service user where we feel unable to meet needs”. There are “Comprehensive care plans including choice of staff gender, time to get up/go to bed, choice of menus”. They say that “Potential service users are given the Statement of Purpose, Service User Guide and latest Inspection report”. The service holds a “Discussion with the service user about their preferred activities/lifestyle”. There is “Encouragement for all service users to maximize and maintain abilities”. We looked at the way in which the service assesses the needs of people before offering them a place at the home. We spoke with the Responsible Individual and the Registered Manager about the way assessments are carried out. They told us that the assessment process involves several staff members including the unit manager, clinical manager and physiotherapist. The assessment often includes other health care professionals involved in the care and management of the person. The assessment process is usually carried out over a period of time and involves visiting the person in their current care setting, sometimes several times. We spoke with the clinical manager, a unit manager and the physiotherapist and they all confirmed that they are involved in the assessment process. Also the person and/or their representatives are encouraged to come and view Scotia Heights and to stay for the day if they wish to. In this way they are able to meet other people who live in the home and to chat to staff. The assessment process ensures that only people whose needs can be fully met by the service are admitted to the home. Since the last Key Inspection the service has admitted two people whose needs they were unable to meet effectively. The manager told us that they had not been provided with all the necessary information about these people previous to their admission. It soon became evident that their mental health needs were too much for the service to meet. The people were found suitable placements at two of the other homes within the company. Meanwhile this caused general unrest on the units. Several Safeguarding referrals were made and some of the issues were raised as part of a letter of concerns sent to us. This “unsettled” period was referred to a few times during the inspection visit by some of the staff. One staff member told us that “things are much better now” and that “the home is back to normal.” Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 13 We looked at care plans and saw records of assessments of individual needs. These were very detailed and comprehensive and included a multi-disciplinary team input. Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 14 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home are given every opportunity to help to maximise their independence and to make decisions. People are supported to take risks in order to realise their aspirations and to achieve their goals. This outcome area could be improved by ensuring that individual care plans are updated more regularly in order to reflect the changing needs of people. EVIDENCE: Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 15 In their AQAA the Providers tell us – There are “Individual care plans with regular reviews”. They also told us that there are “Individual activity programmes”. They said that there is “Staff training and care planning to ensure that service users goals, lifestyle and aspirations are met within the confines of their abilities”. They told us that there is an “Assessment of ability to manage own medication”. Also there is an “Assessment of ability to manage own finance”. There is “Regular consultation with Nurse specialists to ensure best practice”. We looked at several individual Care Plans where we found that people and/or their representatives are involved in the planning of their care. Various risk assessments are in place which take into account the aspirations and abilities of the person. These risk assessments help to promote an independent lifestyle for people living in the home. Evaluations of these risk assessments in care plans had not taken place regularly and this has been outlined in detail in “Personal and healthcare support”. Family and friends were observed to be visiting at various times of the day and some are very actively involved in the care of their loved ones. We spoke to the relative of a person living in the home, whom we had met at the previous inspection. She confirmed that her relative’s care plan was devised with her and agreed by her and that she is kept informed of any changes. She is very involved in his care as she visits every day. We looked at this person’s care plan. There are many examples of risk taking and assessments. One example of this is that staff had enabled him to attend a wedding earlier on in the year. Staff had assessed the risk and taken action to help this person to attend the wedding. We spoke to a relative who runs the “relatives forum”. We had met this person at our last inspection. He told us that everything is very much the same, although meetings have not been as frequent due to a recent lack of interest. However he did say that relatives and people who live in the home are still involved in the running of the home. He said that suggestions and ideas are listened to and taken seriously. One of the people who lives in the home is still very much involved and produces a newsletter monthly. Communication is facilitated for people who have difficulties, including people with severe communication limitations. The person we met now uses a specialist communication computer and therapists have also helped to develop a quick reference board. Another person uses a similar type alphabet board in order to communicate. Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 16 Occupational therapists and physiotherapists are involved with people who live in the home to ensure that communication skills are developed and promoted. These are comments we received from some of the people who live in the home and their representatives – “I am looked after well” “I am able to do what I want” “I feel like I am treated as an individual and am always respected” Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 17 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: Standards 12, 13, 15, 16 and 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities of daily life are made flexible and varied and people are supported to engage in social activities designed to meet their needs. EVIDENCE: In their AQAA the Providers tell us that there is a “Supernumerary activities team” and an “Individual activities programme”. They tell us that they have their own “Mini-bus for trips and excursions”. There are “Internal activities - parties, barbecues, games, take-away nights, special events nights”. There are “Trips to local amenities - shops, pubs, cinema, bowling, theatre, Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 18 museum, art galleries”. The service also arranges “Excursions to coastal resorts, sailing, football, swimming and other outdoor activities”. Also “Attendance at local colleges for vocational and educational courses”. The service provides a “Smoke room and hairdressing salon”. There is a monthly “Newsletter”. People are supported to do maintain their interests and hobbies wherever possible. We noted that one young person is supported to maintain his interest in trains by being taken to look at them every morning at the local train station. This person also goes home one day each week. Another person was wearing his favourite football team shirt. His bedroom is decorated with pictures and memorabilia of this football team. This person, who has very restricted communication, was assisted to the lounge on the unit where he lives and he was asked what he would like to watch on the TV. He indicated that he wanted to watch one of his DVDs. This person’s relative told us that she takes him on trips out into the local town. There is a risk assessment in place for this and other activities. We were told that most of the issues of concern people raise at the “relatives forum” meetings are that their loved ones are bored and that there should be more organised activities. The service is also referred to as being “very quiet” and “more like a hospital environment”. It is identified; however, that most activities are 1:1 based and are planned exclusively for the individual because peoples’ needs are so different. We saw that people have their social and therapeutic needs assessed and activities are planned with them and/or their representative to help meet these needs. There is a person in charge of activities on each unit and this is directed by the unit manager. Trips out are organised by the service in their own minibus and there are many photographs displayed in the home of the various trips out which people have enjoyed. We saw the new games room which has been converted from the smoke room. There is a pool table, darts board and some board games and we were told that people use this. One of the people who live in the home told us “I like playing pool”. Another person told us “I am happy with the level of activities that I am offered”. Staff have re-structured the day for one of the people who lives in the home, as this person went through some very challenging behavioural episodes. As a result, staff have incorporated different activities into his day. Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 19 On one of the units we saw a person with his “activity buddy” who is privately funded. The “activity buddy” told me that the emphasis is on the person becoming as independent as possible. We noted that this person’s activities are specifically designed for his neurological needs. We met another person and his representative who was visiting him. The bedroom was personalised with walls covered in notes reminding staff of what to do and his likes and preferences. His relative is very involved in his direct care and spoke highly of the staff and care that her relative receives. As we walked around the units we observed good staff interaction with people and we noted the Clinical manager having a conversation with a person and his relative about planning an activity programme for him, as he had only recently been admitted to the home. There are activity boards placed on the walls in the units displaying the organised activities and a monthly newsletter is produced by one of the people who lives in the home. People who live in the home undergo an assessment of their dietary needs prior to and on admission to the home. Their specific dietary needs and preferences are then catered for. Regular meals and drinks are provided and people are able to take their meals and snacks at different times if they wish to. One person told us – “I am happy with the meals I receive and the choice of meals offered”. More comments included - “Good food” and “The food is good”. Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 20 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home receive personal support in the way they prefer and require. More regular evaluations of care plans will help to ensure that peoples’ changing physical and emotional health needs are monitored. EVIDENCE: In their AQAA the Providers tell us – That there are “Individual care plans are in place to provide staff with information required to meet service user’s individual preferences”. That – “High staffing levels of staff trained or willing to undertake NVQ 2”. Also there is a “Supernumerary activities team and a “Physiotherapy suite”. Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 21 We looked at personal care plans and noted that care is person centred and focussed on each person’s own likes, dislikes, preferences and choices. Life History is documented and personal preferences are promoted throughout the activities of daily living. Daily routines include personal preferences, such as, “prefers loose clothing” and “likes a bed bath between 6-6.30am.” People are assessed for their nursing needs and the nursing and health care support which people receive in the home is very good. There are several people living in the home with continuing care needs, some of whom have critical care needs and some needing 1:1 support. Nurses told us that they had received training in the use of ventilators and tracheotomy care. We saw that care plans contain specific instructions for nurses in the care of people with these specific needs. We saw that the staff who work at the home assess and manage peoples’ nutritional needs well. A number of people are fed enterally via a PEG. Staff work closely with dieticians and other health care professionals in order to ensure that these needs are met. People are risk assessed as to their likelihood of developing pressure ulcers and this is documented along with interventions and preventions. There is continuous monitoring of this and provisions of special mattresses and cushions to help in the prevention of pressure ulcers. Staff liaise with the Tissue Viability Nurse Specialist team as and when needed. As we looked though care plans it became apparent that these had not been evaluated monthly. Some examples were a “Nutritional score”, evaluated on 8/2/09 then not done again until 16/7/09. “Mobility” evaluated on 14/1/09 then not until 16/7/09. “Behavioural assessment” evaluated on 14/1/09 then not done again until 16/7/09 and yet the care plan states “does get verbally and physically aggressive.” “Risk of choking” was evaluated on 31/10/08 then not done again until 16/7/09. “Violence towards others” was considered a “substantial risk”. This was evaluated on 5/11/08 then not done again until 16/7/09. This was discussed with nursing staff and with the Providers at the end of the inspection. The Clinical Care Manager and the Responsible Individual were both surprised at these findings and had assumed that evaluations of care plans were being carried out monthly by staff. It is recommended that this practice is Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 22 reviewed and improved in order to ensure that peoples’ needs are monitored more frequently. We met with several of the people who live in the home and their representatives. All were happy with the personal, nursing and health care needs they receive at the home “I am happy with the care, I have no concerns” “Staff provide an excellent standard of care on a daily basis” “Because of attention to detail staff pick up on situations that may need action (for instance raised temperature) very quickly” “The staff, in particular registered nurses, are very good at communicating with family members and keep us fully informed” “Excellent standards of personal care. Staff are very respectful of clients” “The care my relative gets is excellent and the service which is offered to me on a personal level is above what they are obliged to give” “The standard of care is good in all ways. They provide a happy and home like environment” “The medical care is very good as is the general care” “The staff here are excellent” “my relative was really poorly a few months back and I did not want him to go to hospital so they let him stay here and looked after him” “The care they gave him over that period was excellent” “They were totally devoted to getting him well and he recovered thanks to them” The spokesperson for the relatives’ forum told us “I can’t find fault with the personal and nursing care and I know that this is the general view of many of the relatives” Two of the managers have just commenced the Palliative Care Gold Framework Standard award training. This will help to ensure that people who are terminally ill receive the best, up to date care. The staff provided at the home have mixed skills. There are Registered nurses and Learning Disability nurses and Registered Mental Nurses as well as staff Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 23 from other backgrounds. This helps to ensure that staff are trained to meet the diverse needs of people living in the home. The service provides two in-house physiotherapists and people told us that this is very beneficial for their relatives – “What’s good about this home is the in-house physiotherapy” We saw records in care plans demonstrating regular input by the physiotherapist. We also spoke with the physiotherapist on duty at the time and she explained how she works closely with people to help them to gain and maximise their independence. A nurse told us-“In general we have good medical support. We deal with specialist consultants and have close links with them” We saw that many professionals from health and social care are involved in the care and treatment of people living in the home. To name a few The The The The The Respiratory Nurse Consultant Neurosurgeon. Speech and Language Therapist Dietician Optician People receive visits from the General Practitioner (GP) as needed. The arrangements for GP support were being assessed and reviewed by the Primary Care Trust (PCT) at the time of the inspection visit. A meeting had been held involving the GPs, the PCT and the Providers. We looked at examples of the reasons for GP call out at the home and found that, on the whole, these were the norm for a nursing home service. There was nothing to suggest that GPs are being asked to carry out tasks which are not usual for this kind of service. However, as one of the nurses explained, the GP practice may receive several calls in a day from different units within the home. This was discussed with the Providers at the end of the inspection visit and it is recommended that the service review this with a view to co-ordinating the number of calls made to the GP practices. We observed staff interaction with people and it was evident that staff have the skills to be able to meet the needs of people living in the home. A example of this was a unit manager observed managing an emergency situation during our visit. He remained very calm and took immediate action to remedy the situation. Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 24 He confirmed to us that he went on a Tracheotomy care course on 6/8/09 and attended a critical care course 12 months ago. We looked at the arrangements for the receipt, storage, administration and disposal of medication in the home. We observed nurses administering medication; we spoke to them about this and looked at Medication Administration Record (MAR) charts. People are able to self medicate following a suitable risk assessment. We did not find any irregularities and found procedures and practice to be in keeping with the Care Standard Act Regulations for medication. Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 25 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home and their representatives can be assured that any concerns they may have will be listed to and taken seriously by the staff and managers. The systems adopted by the service help to ensure that people are kept safe from harm or abuse. EVIDENCE: In their AQAA the Providers tell us that – “Policies and procedures are in place to inform residents, relatives and visitors about procedures to follow in case of complaint”. They say that “The procedures are described throughout the building and in each service user’s guide”. Also “Staff receive training in whistleblowing”. Also staff are trained in “NAPPI training” in order to be able to manage people with challenging behaviours. Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 26 The service has a Complaints procedure in place on display in all of the units. This is clear and documents how complaints will be responded to by the service. This also contains the details of the CQC. We have received one letter containing several issues of concern about the service since the last Key Inspection. As a result of this we carried out a Random inspection on 14th April 2009. At this inspection we did not make any requirements but made some good practice recommendations in respect of Safeguarding referrals and staff training. People told us that they are happy to raise any concerns with any of the staff but particularly unit managers and/or the managers. The spokesperson for the relatives’ forum told us that concerns raised as a result of relatives’ forum meetings are taken to the manager David and are addressed by him. He said that “as long as David can see the reasoning behind it there is no problem and he will address/provide it”. People told us that they know who to go to should they have any concerns. There have been a few safeguarding referrals made by the service since the last Key Inspection. The service has reviewed its policy and procedures in respect of Safeguarding and staff we spoke to are aware of the policy and their role in the reporting of poor and abusive practice. Since the safeguarding procedure has been revised by the service there have been no more concerns raised about the way the service deals with safeguarding. On the second day of the inspection the Clinical Care Manager was attending a meeting with a representative from social services to discuss the provision of safeguarding training for staff. There is a robust staff recruitment process in place in which staff are carefully recruited to work at the care home. This includes obtaining satisfactory Criminal Records Bureau (CRB) and Protection Of Vulnerable Adult (POVA) checks. This helps to ensure that only suitable staff are employed to care for people and that people who live in the home are kept safe. Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 27 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in an environment which is completely adapted to meet their individual and collective needs. Continued improvements to infection control has helped to ensure the on going safety of the people who live there. EVIDENCE: In their AQAA the Providers tell us that they –“Provide a new building split into 6 units of 10 beds each” and “Provide several lounges and meeting rooms”. They tell us that “Each bedroom is designed for individual occupation, exceeds Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 28 national minimum standards and is en-suite”. Also “Each unit has its own satellite kitchen, assisted bathroom and dining room”. The Providers “Provide a bright, cheerful and airy environment”. The home is still quite new and is purpose built. As such it is completely adapted to meet the needs of people living there. Each bedroom is further adapted to individual needs with specialist equipment provided. We saw that bedrooms are very personalised and adapted to meet the needs and preferences of the individual person. The environment is clean and pleasant with no mal odours present. We spoke with the housekeeper who is very efficient pro active and she told us that she has carried out an infection control audit in this home as per the recommendations made by the PCT, Health Protection Agency. She has now installed hand gel in all rooms. The housekeeper and Responsible Individual have now done an action plan which has been sent back to the PCT. We were also shown the “decontamination room” which has been specifically adapted for decontamination of equipment, such as tracheotomy care equipment. In the Sluice the housekeeper has installed boxes for storage of supplies, gloves, bags and wipes. There are now always plentiful supplies of these. The housekeeper has completed an NVQ in Infection Control and is now helping to train all of the staff in this. People told us – “Nice shower in bedroom” “Everything is kept clean and tidy” “They provide a happy and home like environment” “Clients rooms are sometimes untidy. Not always cleaned to the same standard. Although this is not a major problem, generally a bit more efficiency would be appreciated” Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 29 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34 and 35. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that staff are carefully selected to work at the home and that they are protected by the home’s recruitment process. The staff training programme should be further developed and the provision of staff on units must be reviewed in order to ensure continuity of care. EVIDENCE: In their AQAA the Providers tell us that there is a “Robust recruitment system following company policies”. There are “Scored interviews to reduce the risk of bias and discrimination”. A “Job description is issued with an application form”. They say that “All staff receive induction training and regular updates thereafter”. Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 30 There is a “Registered nurse on duty at all times on each unit”. There are “High clinical staffing levels”. There is a “Supernumerary activities 8 strong team”. They say that “All clinical staff have or are undertaking NVQ courses” and “Domestic staff are on NVQ1 courses”. We looked at how the service recruits staff to work at the home. We examined three staff files of staff who had been recruited recently and found that the system is robust. All the required information and checks are carried out prior to staff being offered employment by the service. These checks include CRB and POVA checks. This ensures that staff are suitable to work at the home and that people who live there are safe. We spoke to all three of the staff about their recruitment and induction training. They all said that recruitment had been good but one person told us that “it’s a steep learning curve” comments received about how the home could improve include - “more support for newly employed qualified staff and longer induction periods.” Overall the new staff members were satisfied with their recruitment and induction. The service has recently employed a training manager. She told us that “each staff member has a training file and will have a personal development plan and supervision record” She told us that unit managers are responsible for their staff supervision and liaise with her about this. The training manager is in the process of updating the training matrix. She said that this process is identifying some gaps in training and that this is being addressed. The physiotherapists currently help to deliver the Manual handling training for all staff and the training manager wants to identify people who are interested in becoming a Manual handling trainer. Two people are trained to deliver fire safety training. The Housekeeper delivers COSHH and Infection Control training to staff. Other training sessions arranged include – Huntington’s disease, Tracheotomy care Stoma care, Supporting people with Mental Health and Learning Disabilities, Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 31 The NVQ ratio currently stands at 48 22 staff are due to start NVQ training and the aim is to get them through by the end of January. The training manager confirmed that she will be involved in recruitment and induction and will liaise with other homes within the company regarding arranging one induction day. As we spoke with the carers on duty on one of the units they told us that the “problem with the home is that there are sometimes just not enough staff on duty”. They said that over the recent weekend they had been very short staffed. We looked at the rota and on Saturday 3rd October there was 1 carer on duty with 2 new carers and a nurse from another unit. On Thursday 1/10/09 there were 3 care assistants plus 1 new starter plus a nurse during the afternoon. There are 4 people with tracheotomies and 3 people on ventilators on this unit. There are 9 people in total living on the unit and 1 person requiring several hours of 1:1 care. According to the staff on duty on the unit for care to be carried out effectively they require 4 carers on duty all day and 2 nurses. Staff were also unhappy about the lack of supervision sessions. One staff member said “I have not attended a staff meeting since I have been here, which is nearly 3 years and I have only had 1 supervision”. Another staff member said “I have been here one and a half years and have only had 2 supervisions”. We asked if they had raised their concerns at staff meetings, they said that “nobody listens to us.” Comments received from staff and people and relatives include – “More staff to cover when training is on” “More recognition for NVQ’s” “Better induction programmes and training days organised better” “The only improvement I could suggest is in staff rotation. Residents who are highly dependant do not like change and while a balanced skill mix is needed change is not always welcome by the most dependant.” “Being short staffed is a major problem and happens a lot. It is unfair on the staff that are on duty.” Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 32 “Provide more carers and individual unit manager.” “Yes, been trained in the aspects which involves in the care of the patient.” What the home could do better - “Regular clinical meetings, more training courses for all staff which is very essential for the whole care of the patient.” Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 33 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the best interests of the people who live there. The Quality Assurance system should be reviewed in order to ensure continuous improvement. EVIDENCE: In their AQAA the Providers tell us that the “Home Manager, Clinical Team Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 34 Manager and all Unit Managers are first level qualified nurses”. There are “Monthly Regulation 26 audits”. “Quality meetings involving all Heads of Departments” are held. There are “Regular Health and Safety meetings according to company strategy”. There is a “Relatives forum”. There are “Regular reviews of residents and an “open” culture in relationships with case Managers, Social Workers, PCT Commissioners and statutory bodies”. There are “Training and updates to all staff about reporting incidents”. During the inspection visit we met with the Registered Manager, the Responsible Individual and the Clinical Care Manager. Mr Price has been the manager here since the home opened and is qualified and competent to manage the service. There is a Quality Assurance programme in place. This includes a 12 monthly survey of the views of people who live in the home and/or their representatives. There is regular auditing of staff training, personnel, medication, care plans, hotel services and other services within the home. Regulation 26 reports are carried out monthly by the Providers. We were shown the Company “Health Care Clinical Stats and training report”. We were also shown the audits of falls, serious accidents/incidents and deaths. The quality assurance audits had failed to identify that evaluations in care plans had not been carried out monthly. Therefore the process for this should be reviewed to make audits more effective in identifying areas in need of improvement. The service has a Health and Safety Policy Statement in place. This includes servicing and maintenance of equipment. Fire alarms are tested regularly. Fire equipment is serviced along with passenger lifts and other equipment. We saw the maintenance manual relating to this. Risk assessments are carried out in order to minimise risk. These include both generic and individual risks. Staff have regular mandatory health and safety training updates. Some gaps were seen on the training Matrix but the new training manager intends to address this. Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 35 Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 36 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 4 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Version 5.3 Page 37 Scotia Heights DS0000064684.V377820.R01.S.doc 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 YA33 Regulation 18(1)(a) Requirement The Registered Person shall……. ensure that at all times suitably qualified……..persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. This means that the numbers of care and nursing staff provided must be reviewed by the service in order to ensure that the needs of people are met on a continuous basis. Also to ensure that people are kept safe. This was particularly in respect of Unit 4. Timescale for action 10/11/09 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 YA6 Good Practice Recommendations Care plans should be evaluated more often in order to ensure that peoples’ changing needs are monitored and DS0000064684.V377820.R01.S.doc Version 5.3 Page 38 Scotia Heights 2 3 4 5 YA35 YA36 YA39 YA19 met. The staff training and development programme should stepped up to ensure that staff have the necessary skills to care for people. Staff should receive regular supervision so that they have the support they need to carry out their jobs. The Quality Assurance programme should be reviewed to make audits more effective in identifying areas in need of improvement. It is recommended that the service review the arrangements for requesting GP visits with a view to coordinating the number of calls made to the GP practices. Scotia Heights DS0000064684.V377820.R01.S.doc Version 5.3 Page 39 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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