Inspection on 06/02/08 for The Heathers Nursing Home

This inspection was carried out on 6th February 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

The Heathers Nursing Home 29/08/07

The Heathers Nursing Home 16/08/06

The Heathers Nursing Home 13/12/05

The Heathers Nursing Home 24/05/05

The Heathers Nursing Home 22/12/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Heathers Nursing Home Bowling Hill Chipping Sodbury South Glos BS37 6AX Lead Inspector Grace Agu Unannounced Inspection 6th February 2008 09:15 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 The Heathers Nursing Home DS0000062576.V359763.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. The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Heathers Nursing Home Address Bowling Hill Chipping Sodbury South Glos BS37 6AX 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) 01454 312726 01454 315614 theheathers@acaciacare.wanadoo.co.uk Mr Hitan A Patel Mr Roger Tippings Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. May accommodate up to 4 persons aged 50 years and over who are receiving nursing care May accommodate up to 3 persons (aged 65 years and over) who are receiving personal care Manager must be a RN on parts 1 or 12 of the NMC Register Staffing notice dated 10/06/99 applies. Date of last inspection 29th August 2007 Brief Description of the Service: The Heathers is a Grade II listed Georgian manor house situated in Chipping Sodbury close to the town centre of Yate. There is access to public transport for surrounding areas and the centre of Bristol and the home is close to the Avon Ring Road and motorway system. It is a care home with nursing and offers accommodation in single and shared rooms. The accommodation for residents is on two levels and there is a passenger lift between floors. There are several lounges and a small courtyard to the front of the building for use in good weather. The home operates a No Smoking Policy, staff and service users who smoke must do so outside of the building. Fees start from £505 per week. The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit that was undertaken by two inspectors over nine hours to review medication and other requirements made at the last inspection and also to review the care practice to ensure that it is in line with the legislation and that best practice is followed at the home. The pharmacy inspector reviewed the home’s medication and her report can be found in the body of the report under Standard 9. The visit also followed up complaints raised anonymously and by some staff members regarding some aspects of care provision and general management of the home. We met with the manager, deputy manager and the provider. A tour of the building was undertaken and a number of records were viewed. Ten service users, five staff members and one relative were spoken with on the day. What the service does well: Generally the home was found warm, clean, tidy and free from offensive odour. Individuals living in the home were found relaxed in their homely environment and looked well cared for. One comment card we received from a relative regarding her relative states, “My mother has been a resident at Heathers for over 2 years and I visit her frequently. I am always made very welcome by the staff and my mother always looks clean and tidy”. The home has a Statement of Purpose, which has information about the service provided, staff training as well as service user accommodation. There is a Service User Guide, which has information about the home; it’s aims, fees and services to enable a prospective service user to make an informed decision about the home. Good meals are provided for service users and staff ensure meals are not hurried and that people who are unable to feed themselves are assisted in a respectful and dignified manner. A complaint procedure is in place to enable service users, families, friends and advocates to complain if unsatisfied with the services provided by the organisation. The complaints procedure also gives them the option of how to The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 6 contact the Commission for Social Care Inspection it they were not satisfied with the way that their complaint was handled. There is an ongoing training course to enable staff to meet individuals’ needs and ensure that service users are protected from harm and abuse. The home follows thorough recruitment practices to ensure that appropriate staff are employed at the home. Aids and equipment are provided in sufficient quantity to assist care staff in meeting the needs of service users. The environment is well maintained, tidy and safe giving the service users a sense of homeliness and security. What has improved since the last inspection? What they could do better: People who use the service would be better protected and their needs met if their care plans are clearly written after assessment and in consultation with them and or their representatives. Whilst bedrails could be used to protect individuals’ safety, they must be applied with their consent or their relatives if they lack capacity and with appropriate risk assessment in order to promote freedom of choice. Controlled Drugs, which need increased security, must be stored in a cupboard that meets the requirements of the Misuse of Dugs Act (Safe Custody) regulations. Records must be kept of the receipt, administration and disposal of all medicines. This is so that there is a clear audit trail to show that medicines have been handled safely. Action should be taken to make sure that medicines supplied in standard packs could be audited. This is so that staff can check that medicines have been given as recorded. The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 7 Handwritten additions to the medicines administration record sheets should be signed and dated and checked by a second person. This is to reduce the risks of mistakes being made which could lead to medicines being given incorrectly. Identified staff members would be enabled to perform the duties effectively if regular formal documented supervision is provided. To ensure that the residents are adequately protected, the kitchen must be kept clean, specifically areas identified with built up grease. Complaints sent to the home must be recorded, including the outcome, to comply with the regulation. It was also recommended that the senior members of the management team undertake courses to enhance their people management skills. Staff would be better equipped to work as a team if they undertake courses on equality and diversity. 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. The Heathers Nursing Home DS0000062576.V359763.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 The Heathers Nursing Home DS0000062576.V359763.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 process of admission is well planned and managed with clear information to enable the service users to make a decision about the services provided at the home. EVIDENCE: The home’s service users guide remains unchanged and contains required information to enable prospective service users to make informed choice about moving to the home. The care files of two recently admitted individuals showed that the people were assessed before admission to the home to enable the home develop to care plans to meet their individual needs. One individual confirmed that her relatives visited the home before she moved in to the home. The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 10 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 adequate. This judgement has been made using available evidence including a visit to this service. The home offers care and support to residents throughout their life and towards the end however, it fails to provide care plans, reviews of care plans and risk assessment of identified individuals. Improvements are needed in the handling and recording of medication in the home, to make sure residents’ health is protected. EVIDENCE: On the day of this visit six care files were reviewed. There was evidence of preadmission assessment before admission of two new individuals to the home. This assessment was to determine whether the home is suitable and able to meet peoples’ needs. Whilst care plans are provided detailing how the assessed needs are to be met, these have not been followed up by monthly reviews to ensure that appropriate intervention is put in place as needs change. The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 11 At a discussion, the Deputy Manager stated that the registered nurses are aware that care plans need to be reviewed monthly to reflect the changing needs of the resident. He would ensure that this is implemented. Evidence from one of the care files of an individual on respite admitted on 3/02/08 had no care plans and risk assessments to guide staff in meeting the needs of this person. We looked at the care file of one individual with agitation and behaviour that challenges. Records show that this person had been verbally and physically aggressive towards staff on four occasions. However, there was no evidence in the care plan on how this behaviour was being managed in order to protect this person, other service users and staff. Furthermore the person had bed rails applied with no risk assessment completed and no evidence that either the individual or their relatives were consulted. In addition the care plans noted in the care file regarding poor mobility and personal hygiene were last reviewed on 13/03/07. This individual is at risk of pressure area breakdown, a risk assessment was in place, however there was no evidence that this has been reviewed since 25/08/07. The registered manager is reminded that this practice is unacceptable and that appropriate measures must be put in place to avoid a repeat. A requirement has been issued. This would be closely monitored and would be reviewed at the next inspection. One individual told us “staff are very kind, they look after us well”. Another person told us “I get up when I want, staff answer the bell when I ring”. One relative mentioned that “mum’s care is very good, staff are kind and caring”. There was evidence of General Practitioner (GP), Dentist, Chiropodist and Optician visits. Observation during the visit showed that staff have good awareness of how to protect service users’ privacy and dignity. They were seen knocking at doors and waiting for an answer before entering residents’ rooms to assist them with personal care. Two service users spoken with confirmed that this was usual practice. One comment card received from a relative states “The care is excellent, I appreciate that it is not easy job but my relative always appears clean, comfortable and well cared for”. The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 12 One person is currently able to look after their own medicines. The home has a brief self-medication policy but this does not include a risk assessment to make sure that people are safe to look after their own medicines. Nursing staff look after all other medicines, some creams and ointments are applied by care staff. Residents are registered with a number of different doctors’ practices and medicines are provided from a local pharmacy using a monthly blister pack system. Secure storage is available to keep medicine safely. A medicine trolley is used to transport medicines around the home. A medicine fridge is also available for medicines needing refrigeration. Several Oxygen cylinders are kept securely, with appropriate warning signs on the door. An additional sign is needed for the cylinder kept on the first floor. Some medicines, called Controlled Drugs, need particular secure storage. Action is needed to make sure that these medicines are stored in a cupboard that meets the requirements of the Misuse of Drugs Act (Safe Custody) regulations. A register is used to record these medicines and staff check the stock balances. Blister packs of medicines indicated that they had been given as prescribed by the doctor. It was not possible to check many of the medicines supplied in standard packs because there is no indication of when the pack has been started. Action should be taken to address this, so that staff can check that medicines have been given correctly. Two records of administration of medicines did not coincide with the number of tablets taken from the pack indicating that the record was incorrect. A medicine policy is available but this needs to be updated to reflect current practice. This is so that staff are aware of the safe procedures to use in the home. Nursing and Midwifery Council (NMC) guidance is available for staff. During the inspection, we saw the lunchtime medicines being given by staff. These were given safely and the medicines administration record sheet signed after the medicines had been taken. Residents we spoke to said that they were happy with the way they are given their medicines. The pharmacy provides printed medicines administration record sheets each month for staff to complete. In some cases this included medicines that are not given. Staff said that some of these medicines had been discontinued and some were skin preparations applied by care staff and recorded on a separate sheet. This must be made clear on the medicines administration record sheet so that the correct medicines are always given. Gaps were also seen in the separate records for the applying of creams and ointments. Action must be taken to make sure that all medicines given by staff are recorded The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 13 Staff have made some handwritten additions and changes to the medicines administration record sheets. These should always be signed, dated and checked by a second member of staff to reduce the risks of mistakes being made, which could result in medicines being given incorrectly. Receipt of monthly medicines had been recorded but we also saw that no record had been made of the receipt of some other medicines. All medicines received by staff into the home must be recorded. No records have been kept of the disposal of medicines from the home. This means that there is no clear audit trail to show that unused medicines have been disposed of safely. An immediate requirement was made concerning this. We looked at a number of care plans to see if information to help staff give medicines safely had been included. In a number of cases there was insufficient information about medicines to help staff meet the needs of the people using the service and action is needed to address this. An additional more detailed pharmacist letter has also been sent to the registered provider and the registered manager for their information. There was evidence in the care files viewed of details of residents’ wishes in the event of death. Staff spoken with were aware of policies and procedures for dealing with a dying person and at the time of death. Two staff members spoken with are aware of the importance of keeping information about residents confidential. The Heathers Nursing Home DS0000062576.V359763.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. The home enables residents to maintain contact with family, friends and community. It also provides meaningful activities and choice in respect of meals and meal times EVIDENCE: People using the service at The Heathers told us that the home supports them to remain in contact with their family and friends. One resident stated, “My daughter comes every week. Sometimes my grandchildren visit because they live not far from here.” Staff spoken with confirmed that the visitors are not restricted from coming into the home. The home’s visitor’s book showed that there are a number of regular visitors to the home. The home’s activities programme was reviewed. The Manager stated that the home has an activities person 10 –12 hours a week to provide activities for the service users. The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 15 Information about weekly and forthcoming activities were displayed in the lounge and the dining area and included, Hair and Beauty, Exercises, Bingo, Quiz time, Communion (once a month), Art and craft, Cinema and Supper night, Board game and Sing along. People we spoke with told us that they enjoyed the activities provided at the home and that their relatives, friends and families visit the home regularly and at any time. One of the comment cards that we received from a relative stated, “ I feel that the home provides a very homely atmosphere. They try to involve all of the residents in the activities that they provide, they involve relatives in all aspects of the residents lives”. At a discussion, the manager told us that care staff interact with service users on a one to one basis whilst providing personal care and specifically for people who choose to stay in their rooms or are unable to participate in activities due to their medical condition. The menu on the day contained a choice of two nutritional meals at lunchtime. Individuals spoken with stated that they enjoyed the food. The chef told us that all staff working at the home have attended basic food hygiene training. Their certificates were noted displayed in the hallway. The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 16 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 adequate This judgement has been made using available evidence including a visit to this service. Service Users are enabled to complain and are confident that their concerns will be listened to and that they would be protected from abuse. However complaints made to the home have not been recorded. EVIDENCE: The Home has a complaints policy and procedure. The document contained information about the Commission for Social Care Inspection to enable residents’ families and friends to complain if unsatisfied with the outcome of their complaint. Information on how to make a complaint was seen displayed at the entrance of the home. Four complaints were received by CSCI since the last inspection. Two were from staff members in the past three months in relation to poor care and poor relationships with a member of the senior management team. Two were anonymous from the relatives regarding care of service users. Two were referred to the provider and manager to investigate and the response received was satisfactory. The other complaint was in regards to the management of the home and this is discussed under Standard 32. The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 17 At the visit it was disappointing that none of the complaints were recorded in the complaints record. This was discussed with the manager and a requirement has been made to ensure that this practice is not repeated. The Home has a Protection of Vulnerable Adults Policy in place including the South Gloucestershire Policy and Procedure to safeguard residents from abuse. Staff members spoken with demonstrated awareness of adult abuse issues and had attended abuse training. A number of service users were noted with easy access to their call bells to summon for help in an emergency. The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a safe, well-maintained environment, comfortable bedrooms and specialist equipment suitable for service users needs. However the kitchen cleaning needs to improve. EVIDENCE: No changes had occurred in relation to the home’s suitability for its stated purpose on the provision of care for the residents. Individuals living in the home were found sitting in the communal areas and appeared relaxed in their homely environment. The home was found, warm, well lit and free from unpleasant odours. The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 19 Whilst the home was found to be generally clean we noted that there was a build up of grease on kitchen shelves and areas on the floors that needed to be deep cleaned The chef stated that there was a cleaning schedule, however, this was not being followed and that the handyman would usually do the deep cleaning. At a adiscussion the manager confirmed that the handyman would usually deep clean the kitchen regularly and would ensure that this is undertaken as soon as possible. A requirement was made to deal with this issue to ensure that the service users are provided with a clean environment for food preparation and storage. Clinical waste is correctly disposed of to prevent the spread of infections. There is an infection control policy in place. Service Users spoken with stated that they felt safe at the home. The home’s maintenance book was up to date and a handy person ensures that the home remains in a state of good repair. The laundry person stated that the laundry area is always clean and tidy and that she had attended courses on Control of Substances Hazardous to Health (COSHH). The Chef stated that there is a risk assessment for the kitchen kept in the folder however this is kept in the office. It was agreed that this document would be better kept in the kitchen for easy access by the kitchen staff in an emergency and when necessary. The fridge and freezer temperatures were up to date and the foods in the fridge were labelled. The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 20 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. The recruitment procedure of the home is robust and offers protection to residents at the home. There are adequate numbers of staff that are competent to meet the needs of the service users. EVIDENCE: On the day of inspections there were twenty-three service users at the home. The rota showed that there were one registered nurse and five staff members in the morning, one registered nurse and two staff members in the afternoon and one registered nurse and two staff on night duty. The deputy manager stated that the numbers of staff on duty adequately meets the care needs of individuals living in the home. The home has a robust recruitment procedure and whilst there has been no recruitment since the last inspection evidence from previous recruitment showed that the statutory requirements in relation to protection of service users were met. These included satisfactory Criminal Record Bureau disclosures, two satisfactory references and proof of identity. Staff training records reviewed showed that staff had attended courses to include protection of vulnerable adults, manual handling, infection control, and fire training. The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 21 The home’s training coordinator told us that six staff members obtained certificates in National Vocational Qualification at level 2 and two staff members have certificates in National Vocational Qualification at level 3. The training coordinator has a certificate in National Vocational Qualification at level 3 and is also an NVQ Assessor. The person informed us that she works with staff during their training to ensure that they obtain necessary skills before assisting service users independently. Furthermore, she confirmed that the induction-training programme for new staff members meets the Skills for Care Induction and foundation training programme. This ensures that new staff are well equipped for their responsibilities of meeting needs, before working with service users in an older peoples’ setting. Evidence from service users spoken with showed that they were satisfied with the knowledge and skills acquired by staff whilst attending training courses. One staff member spoken with confirmed that she had attended training courses to enable her to perform her duties effectively. Individuals living at the home stated that staff are very kind and are sensitive to their needs. As a part of this visit we looked into the concerns raised by four care staff regarding their relationship with a senior member of the management team. They told us that the issues had affected the health and wellbeing of people living in the home in the past. They also told us that breakdown in communication with the individual had resulted in low moral and that it was affecting the care of individuals living in the home. We sent the concerns we received to the provider and the manager and asked them to investigate. The provider told us that the issues regarding the staff members and the management are being dealt with under the home’s grievance policy and procedure. The outcome is yet to be determined. Staff we spoke with at the visit told us that a recent staff meeting was very helpful. It enabled them to discuss ways of developing team building in order to provide better care for the service users. It was agreed that the home would provide equality and diversity training for all staff and especially in terms of cultural differences amongst staff to promote tolerance. It was also recommended that the senior members of the management team undertake courses to enhance their people management The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 22 skills. The provider stated that the final outcome of the investigation into staff grievance would be forwarded to the Commission for Social Care Inspection. The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is supported by the registered provider and staff to provide leadership at the home. All staff demonstrate understanding and awareness of their roles and responsibilities to the needs of the service users. However some health and safety practices do not adequately protect the health and safety of individuals living at the home. EVIDENCE: Mr Tippings the registered manager has a dual qualification as a Registered General Nurse and a Registered Mental Health Nurse. Mr Tippings has attended various courses to assist him with training staff in order to raise the standard of care at the home. Mr Tipping also holds a Registered Managers Award The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 24 certificate. The Deputy Manager and Mr Patel (the Registered Provider) support Mr Tippings to provide quality care for individuals living in the home. Staff members we spoke with told us that the manager and deputy are approachable and would listen to concerns. However it has been difficult recently because of the ongoing issue. One staff member states, “ I like working here, but the moral is low, I want it to be resolved so we can get on with our jobs”. As mentioned earlier in this report the management is aware that effective communication is important to delivering good service and meeting peoples’ needs. In order to resolve the issues raised by four staff members the provider was meeting the staff members on the day of the visit. It is expected that the issues would be resolved satisfactorily. Staff records viewed evidenced that staff are receiving supervision however not regularly, the deputy manager stated that he is aware of the importance of regular staff supervision and would ensure that this is undertaken more regularly. Furthermore the Deputy Manager had stated that he receives informal supervision, however, this is not documented. The last documented formal supervision was over a year ago. A requirement has been issued to ensure that the Deputy Manager along with other staff members receive regular documented formal supervision to enable them to express their concerns on areas of responsibility and to receive feedback on their performance. The fire logbook is well maintained as well as the home’s maintenance book. There is evidence that staff have attended fire lectures and regular fire drills. There is a service record of the lifts, hoists, nurse call system and portable appliance tests (PAT) of all electrical appliances. The accident book was viewed and all service user accidents were recorded, however one service user who had an accident on 04/02/08 has no risk assessment to ensure that the individual is adequately protected from further falls. There were policies and procedures in relation to Grievance, Whistle blowing Health and Safety, Complaints, Protection of Vulnerable Adults and Medication. The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 25 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 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 2 17 3 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X 3 2 3 2 The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Ensure a care plan is developed to manage an identified service user’s assessed needs, in consultation with them and or their representatives. All care plans must be reviewed regularly as needs change. The registered manager must ensure that: Controlled Drugs, which need increased security, are stored in a cupboard that meets the requirements of the Misuse of Dugs Act (Safe Custody) regulations. Records are kept of all medicines received into the home and all medicines administered to residents. Records must be kept of the disposal of all unwanted medicines. An immediate requirement has been made concerning this. Ensure that all areas of the kitchen are kept clean at all DS0000062576.V359763.R01.S.doc Timescale for action 06/03/08 2. OP9 13.2 06/03/08 3 OP9 13.2 08/02/08 4. OP26 23 06/03/08 The Heathers Nursing Home Version 5.2 Page 27 5 OP36 18 6 OP7 13 7 OP16 22 times to protect the service users from food hazards. Ensure that all staff are supervised regularly to enable them to perform their duties effectively. Ensure that appropriate risk assessment is in place along side consent from the service user or their relatives before bedrails are put in place. All complaints received at the home must be recorded and the outcome must be clearly recorded. 06/03/08 06/03/08 06/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP9 Good Practice Recommendations Action should be taken to make sure that medicines supplied in standard packs could be audited. This is so that staff can check that medicines have been given as recorded. Handwritten additions to the medicines administration record sheets should be signed and dated and checked by a second person. This is to reduce the risks of mistakes being made which could lead to medicines being given incorrectly. 2. OP30 It is recommended that the senior members of the management team undertake courses to enhance their people management skills. The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 The Heathers Nursing Home DS0000062576.V359763.R01.S.doc Version 5.2 Page 29 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!