CARE HOMES FOR OLDER PEOPLE
The Heathers Nursing Home 50 Beccles Road Bradwell GreatYarmouth NR31 8DQ
Lead Inspector Susan Golphin Unannounced 13 April 2005 09:30 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 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. The Heathers Nursing Home Version 1.10 Page 3 SERVICE INFORMATION
Name of service The Heathers Nursing Home Address 50 Beccles Road Bradwell Great Yarmouth Norfolk NR31 8DQ 01493 652944 01493 652944 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Shereen Jesudason Miss Carol Preston Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places The Heathers Nursing Home Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1. From time to time a maximum of two (2) service users between the age of 50 and 65 years may be admitted to the home. 2. Forty-five (45) service users may be accommodated of either sex who are aged over 65 years. 3. The total number not to exceed 45. Date of last inspection 30 November 2005 Brief Description of the Service: The Heathers is a single storey extended property situated in the village of Bradwell, on the outskirts of Great Yarmouth. 45 older people can be accommodated in 21 double rooms (11 en-suite) and 3 single rooms (1 ensuite). Most of the bedrooms open out on to a patio area and gardens which is mainly laid to lawn with small flower beds and attractive containers arranged on the patios. In addition there are three communal rooms including a dining room which service users and their families can access. There is ample off street parking space to the front of the premises. The Heathers Nursing Home Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and not all the standards were inspected on this occasion. The inspection took place between 9.30am and 3.30pm. A brief tour of the premises was undertaken by the inspector whilst in contact with staff, visitors and service users. At the previous inspection carried out in November 2004 seven requirements were made . Part of this inspection was used to review progress of the homes’ own action plan to meet the requirements and monitor compliance. The registered provider Mrs Shereen Jesudason and the registered manager Ms Carol Preston were both present throughout the inspection. What the service does well: What has improved since the last inspection?
Since the last inspection the management and staff have made notable progress in meeting the requirements and recommendations and achieving compliance with the National Minimum Standards for older people and Care Home Regulations 2000. A further three staff are currently undertaking NVQ training ( level 2 and 4) and additional training places are being sought for later in the year The stability of the staff group has been maintained with staff in six months. a turnover of two The evaluation and audit processes in place are being developed and the views of those using the service are being sought and used to establish a QA system for the home. One of the service users and one visiting family stated that they have a good relationship with the staff find them helpful and
The Heathers Nursing Home Version 1.10 Page 6 informative. They also said that they are always made welcome in the home and know who to contact for care and nursing updates. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Heathers Nursing Home Version 1.10 Page 7 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 Standards Statutory Requirements Identified During the Inspection The Heathers Nursing Home Version 1.10 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 There is a satisfactory assessment process in place, that ensures the home can meet service users needs EVIDENCE: This standard was the subject of a requirement at the last inspection, and has now been met. The manager has instructed all trained staff responsible for the assessment / care planning process to pay equal attention to social and recreational needs of the service users and to ensure that their views and preferences are known and documented as part of the plan of care. Service users or their representatives are also signing up to care plan agreements, and three care plans were seen during the inspection and confirmed current practice The Heathers Nursing Home Version 1.10 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10 Minor improvements have been made to the care planning process and the health care needs of the service users are being met. The management also continue to promote and maintain good working relationships with other health care professionals EVIDENCE: Service users commented favourably about the care they receive, and examples were given of personal support and positive relationships between families, services users and staff. The manager has changed the way in which key staff monitor care plans which includes all staff maintaining a professional diary in which they are expected to plan all care reviews throughout the year to ensure individual care service is consistent. The Heathers Nursing Home Version 1.10 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 The meals provision in the home is good and offers a varied choice to meet individual dietary needs EVIDENCE: During the brief tour of the premises the inspector was able to observe staff serving the main meal of the day and where appropriate assisting staff with their meals. The manager and trained staff are continuing to monitor and supervise staff to ensure the feeding style and presentation is dignified and personal. Menus are reviewed regularly to reflect service users personal choices and the use of seasonal foodstuffs. The Heathers Nursing Home Version 1.10 Page 11 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home have a satisfactory complaints system. Service users can express their views, and concerns and complaints are acted upon. Staff training has improved knowledge and understanding about protecting vulnerable people from abuse, or risk of harm. EVIDENCE: The home has not received any formal complaints this year. Minor issues or concerns have been addressed directly by the management. Staff training opportunities are being offered to make sure that the staff know about adult protection procedures and protecting vulnerable people from abuse. Information about the complaints procedure is to be re-issued to service users and their representatives this year. During the discussions with a visiting family it was said that they were not familiar with the written complaints procedure for the home but were quite clear about who they would contact if there were any concerns. The Heathers Nursing Home Version 1.10 Page 12 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 25,26 The standard of décor and furnishings has improved over the year and standards are being maintained to provide a homely and comfortable environment EVIDENCE: The registered providers are continuing to improve the premises through an established programme of re placement and maintenance. There is also a building proposal in place to increase in the number of single rooms ( en-suite) and reduction in double rooms without increasing the overall occupancy level. During the brief tour of the premises the service users rooms were appropriately furnished and in good decorative order. The kitchen and laundry areas were also clean and tidy and well maintained. The staff work station has been re organised recently to provide a more stream lined work area for the staff. The Heathers Nursing Home Version 1.10 Page 13 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27-30 Increased staffing levels and reduced staff turnover have improved the care received by service users. EVIDENCE: Staffing levels have improved and the turnover of staff in the last six months has been two. On the day of the inspection there were sufficient numbers of trained nurses and care staff on duty to meet the healthcare needs of 21 service users with nursing needs and 14 with care needs. From the duty rota for the week it showed that there were -: two qualified nurses; six care staff; three domestic staff ;one laundry assistant ;one cook, and a kitchen assistant There is an ongoing review of the staff files which includes an update of staff details and documentation that confirms their identity. Most of this information is being obtained through the CRB procedure. Staff training and development files have also been revised and now have a front sheet with a document check list and training achievements and information.. A further three staff are undertaking NVQ training ( 2 at level 2 and one at level 4). A further three places are being sought for this year. The Heathers Nursing Home Version 1.10 Page 14 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,36 The arrangements for the induction and supervision of staff have improved in the last year. The current staff group have a mix of skills and expertise to meet service users needs. The process for seeking service users views and measuring the service provision is in place. The outcomes of surveys and questionnaires are published in the service users guide. EVIDENCE: The questionnaires to users of the service and other health care professionals will be issued in April 2005. The manager will be updating the format this year to include a wider range of questions and possibly larger response group. The manager is hoping to co-ordinate this year’s QA review of the home with some of the NVQ 4 assignment /course work relevant to Quality Assurance systems, and managerial responsibility.
The Heathers Nursing Home Version 1.10 Page 15 Staff supervision processes are in place and all the senior staff have been issued with diaries so that supervision agendas can be set and both informal and formal sessions noted and documented and recorded in individual staff files. The diaries are also used to plan teaching sessions, reviews, and staff meetings to promote a consistent overview of clinical practice and service delivery. They can also be made available during inspections providing easy reference to specific events. The Heathers Nursing Home Version 1.10 Page 16 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3
COMPLAINTS AND PROTECTION x x x x x x 3 3 STAFFING Standard No Score 27 x 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x x x x 2 x x 3 x x The Heathers Nursing Home Version 1.10 Page 17 yes Are there any outstanding requirements from the last inspection? 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 16 Regulation 22 Requirement The registered providers must ensure that service users and their representatives receive written information about how to complain. Details of the process should also be displayed in the home The registered providers must continue to provide training opportunities for staff to achieve NVQ qualifications The registered providers must complete the review and update of staff files and keep records relating to schedule 2 and 4 of the Care Homes Regulations. The registered providers must continue to implement and complete the quality assurance process for 2004/2005 in line with their own audit processes and review of services. The outcome of the reviews and surveys should be published and made available to the service users and their representatives Timescale for action immediate and by 31st October 2005 2. 28 18 .ongoin 3. 29 18 immediate and by 31st October 2005 immediate and by31st October 2005 4. 33 24 5. The Heathers Nursing Home Version 1.10 Page 18 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 29,36, Good Practice Recommendations It is recommended that the ongoing review of record keeping and staff file management be completed The Heathers Nursing Home Version 1.10 Page 19 Commission for Social Care Inspection 3rd Floor - Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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