Care Home: Headlands Specialist Care and Ventilation Unit

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What the care home does well The service aims to provide a highly specialised service to people with a high level of dependency who might not otherwise be able to integrate into the local community. People who use the service told us that they had received information about the service before they had decided to move in. There is evidence that the service, obtains assessment documentation from funding authorities, and conducts their own assessments to ensure that they are able to meet the needs of the individual before they are admitted to the home. There is evidence that people who use the service are supported to make decisions about their lives. People told us that they had opportunities to be involved in determining arrangements to facilitate their discharge into the community. They also told us that they were able to make decisions about their routines, such as times for retiring to bed and how to spend their time. People using the service are supported to maximise their independence. Records indicate that provision was being made for people to return to live with their family in the community. There was also reference to people resuming paid employment at some time in the future. The service has its own transport which can be used to enable people to visit family and friends in their own homes. Arrangements are also in place to enable relatives and friends to stay at the home. Visitors are welcomed and were seen to play an active role. People who use the service have access to telephone and wireless broadband internet. People who use the service told us that they were able to make choices about their daily lives such as how they spend their time and choices of food specific to their culture and individual preference. People were well presented. People told us, that they were well looked after and, that the staff were aware of their needs and were nice to them. People who use the service have access to appropriate health services and professionals. These include Hospital Services, General Practitioners, Dieticians, Podiatrists, Opticians and Physiotherapists. Medication systems are in general satisfactory, and there is evidence that consent is sought from the people who use the service for staff to contact their General Practitioner and arrange for prescriptions, on their behalf. There was also consent for staff to arrange admission to the Accident and Emergency department of the local hospital, in the event of a medical emergency. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 People who use the service told us that they felt that they would be able to raise any concerns with the manager. The expectation was that these would be appropriately addressed. The complaints procedure is accessible to people who were using the service at the time of inspection via the Statement of Purpose and Service Users Guide. We were also told that they felt safe, living at Headlands Specialist Ventilation Unit. The standard of the environment is good. It is clean, hygienic and well maintained. It has been adapted to provide ground floor accommodation and is accessible to people who use wheelchairs. All bedrooms are single with ensuite facilities. There is also a lounge/dining room on the ground floor. The manager ensures that new staff have the right checks in place before they start working in the home. What has improved since the last inspection? This is the first key unannounced inspection following registration in January 2009. What the care home could do better: The Statement of Purpose and other documentation need to be clear about the range of conditions that the service provides care for, and how this is provided, including access to twenty four hour nursing care. Individual plans of care need to be improved to ensure that they contain all of the information to enable staff to support people properly. Management of risk needs to improve so that people who use the service have the right checks in place to ensure that they are safe during all of their activities. Staff need to make sure that they do all checks required, such as blood pressure monitoring, to meet people`s health needs. Records need to be maintained fully and accurately. They need to make sure that they monitor the care records of the people who use the service to ensure that they are receiving the right care. Continence care, such as support to people with urinary catheters must be managed appropriately, according to current best practice and as specified in the individual plan of care. The equipment to support people needs to be maintained in good working order.Headlands Specialist Care and Ventilation UnitDS0000072957.V375858.R01.S.doc Version 5.2 Bathing arrangements need to be reviewed, so that staff can ensure that people who use the service are immersed in safe and comfortable water temperatures. Medication systems need to be reviewed, to ensure that medication is administered by registered nurses, and that the appropriate records are maintained. Recruitment practices and training programmes need to take into account the category of registration for whom care is to be provided. This is to ensure that staff have the skills to care all people who will use the service, which includes people with a learning disability and sensory impairment. They need to review staff training, to make sure that all staff have the right skills, including a thorough induction programme, first aid and basic food hygiene training, to meet the needs of people admitted into the home. We were concerned during the inspection, that there were insufficient registered nurses throughout the twenty four hour period to meet people`s nursing needs. As Headlands provides care that includes nursing, for people with very specific health needs, it is essential that a registered nurse is on duty at all times. The registered provider has confirmed, following this inspection, that they have acted to address these concerns and that there is now a registered nurse on duty at all times. Key inspection report CARE HOME ADULTS 18-65 Headlands Specialist Care and Ventilation Unit 63 Headlands Kettering Northants NN15 7EU Lead Inspector Stephanie Vaughan Unannounced Inspection 8th June 2009 09:30 Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 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. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 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 Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Headlands Specialist Care and Ventilation Unit Address 63 Headlands Kettering Northants NN15 7EU 01536268807 01536401619 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) www.communicare.uk.com Communicare Rehabilitation LLP Jetinder Garcha Care Home 5 Category(ies) of Learning disability (5), Old age, not falling registration, with number within any other category (5), Physical disability of places (5), Sensory impairment (5) Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories 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: Old age, not falling within any other category - Code OP Learning Disability - Code LD Physical Disability - Code PD Sensory Impairment - Code SI The maximum number of service users who can be accommodated is 5 2. Date of last inspection New Service Brief Description of the Service: Headlands Specialist Ventilation Unit is registered to provide nursing care for five people with long term neuromuscular conditions, neurological conditions physical disability, sensory disability, learning disability and ventilator dependency. The accommodation is a converted and extended period property. It provides five single bedrooms with en-suite facilities and a lounge/dining room, all of which are located on the ground floor. Headlands has been adapted to accommodate wheelchair use and the provision of other aids and adaptations, such as assisted bathing facilities. There is a car park to the rear of the property and there is good access, to road and rail links. Fees range from £700 to £5,000 per week depending on the needs of the individual. Additional charges are made for the use of transport at 50 pence per mile. Extra charges of £20 per night for staff, who support people who stay overnight away from the home. Individual activities and outings are available at variable costs. Services such as hairdressing, clothing, dry cleaning and other personal items are also available at variable costs. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 5 Where treatment is not available through National Health Services, arrangements can be made for treatment from podiatrists, dentists and opticians. This is charged separately. There are also additional charges associated with the use of a telephone and internet access. People who are funded by the local authority or primary care trust may be required to pay additional top up fees. The service intends to make the Care Quality Commission inspection reports available in the home. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience ‘Adequate’ quality outcomes. Headlands was registered in January 2009. This is the first Key Inspection to be conducted for this service. Prior to this statutory inspection, a period of three hours was spent in preparation, which included a review of the registration reports, for the service and the manager, the current inspection record and the service history. We have received no concerns, complaints or allegations about this service. The service sent us their completed Annual Quality Assurance Assessment, which provided us with information about the service and this was used to inform our inspection activity. We sent out five surveys for the people who use the service, five to staff members and one to a General Practitioner, to tell us what they think about the service. No surveys have been received from people who use the service, one was completed by the General Practitioner and one completed survey was returned by a member of staff. The Commission has a focus on Equality and Diversity. Issues relating to this are included in the main body of the report. The site visit to the home was conducted over a period of ten and a half hours, during which time the inspector made observations, spoke to the people who use the service, the staff and management. A limited tour of the premises was conducted which involved viewing the communal areas and a selection of the private accommodation. Case tracking is a method used during inspection to help us understand, the experiences of people using the service and all aspects of their care. This included talking to people and reviewing individual plans of care and associated documentation. The Registered Manager was present throughout the inspection. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 7 What the service does well: The service aims to provide a highly specialised service to people with a high level of dependency who might not otherwise be able to integrate into the local community. People who use the service told us that they had received information about the service before they had decided to move in. There is evidence that the service, obtains assessment documentation from funding authorities, and conducts their own assessments to ensure that they are able to meet the needs of the individual before they are admitted to the home. There is evidence that people who use the service are supported to make decisions about their lives. People told us that they had opportunities to be involved in determining arrangements to facilitate their discharge into the community. They also told us that they were able to make decisions about their routines, such as times for retiring to bed and how to spend their time. People using the service are supported to maximise their independence. Records indicate that provision was being made for people to return to live with their family in the community. There was also reference to people resuming paid employment at some time in the future. The service has its own transport which can be used to enable people to visit family and friends in their own homes. Arrangements are also in place to enable relatives and friends to stay at the home. Visitors are welcomed and were seen to play an active role. People who use the service have access to telephone and wireless broadband internet. People who use the service told us that they were able to make choices about their daily lives such as how they spend their time and choices of food specific to their culture and individual preference. People were well presented. People told us, that they were well looked after and, that the staff were aware of their needs and were nice to them. People who use the service have access to appropriate health services and professionals. These include Hospital Services, General Practitioners, Dieticians, Podiatrists, Opticians and Physiotherapists. Medication systems are in general satisfactory, and there is evidence that consent is sought from the people who use the service for staff to contact their General Practitioner and arrange for prescriptions, on their behalf. There was also consent for staff to arrange admission to the Accident and Emergency department of the local hospital, in the event of a medical emergency. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 8 People who use the service told us that they felt that they would be able to raise any concerns with the manager. The expectation was that these would be appropriately addressed. The complaints procedure is accessible to people who were using the service at the time of inspection via the Statement of Purpose and Service Users Guide. We were also told that they felt safe, living at Headlands Specialist Ventilation Unit. The standard of the environment is good. It is clean, hygienic and well maintained. It has been adapted to provide ground floor accommodation and is accessible to people who use wheelchairs. All bedrooms are single with ensuite facilities. There is also a lounge/dining room on the ground floor. The manager ensures that new staff have the right checks in place before they start working in the home. What has improved since the last inspection? What they could do better: The Statement of Purpose and other documentation need to be clear about the range of conditions that the service provides care for, and how this is provided, including access to twenty four hour nursing care. Individual plans of care need to be improved to ensure that they contain all of the information to enable staff to support people properly. Management of risk needs to improve so that people who use the service have the right checks in place to ensure that they are safe during all of their activities. Staff need to make sure that they do all checks required, such as blood pressure monitoring, to meet people’s health needs. Records need to be maintained fully and accurately. They need to make sure that they monitor the care records of the people who use the service to ensure that they are receiving the right care. Continence care, such as support to people with urinary catheters must be managed appropriately, according to current best practice and as specified in the individual plan of care. The equipment to support people needs to be maintained in good working order. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 9 Bathing arrangements need to be reviewed, so that staff can ensure that people who use the service are immersed in safe and comfortable water temperatures. Medication systems need to be reviewed, to ensure that medication is administered by registered nurses, and that the appropriate records are maintained. Recruitment practices and training programmes need to take into account the category of registration for whom care is to be provided. This is to ensure that staff have the skills to care all people who will use the service, which includes people with a learning disability and sensory impairment. They need to review staff training, to make sure that all staff have the right skills, including a thorough induction programme, first aid and basic food hygiene training, to meet the needs of people admitted into the home. We were concerned during the inspection, that there were insufficient registered nurses throughout the twenty four hour period to meet people’s nursing needs. As Headlands provides care that includes nursing, for people with very specific health needs, it is essential that a registered nurse is on duty at all times. The registered provider has confirmed, following this inspection, that they have acted to address these concerns and that there is now a registered nurse on duty at all times. 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. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 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 Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 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): 1, 2, 3, 5. 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. More information about the service and how needs will be met would help people choosing a home make more informed choices. EVIDENCE: The service has a Statement of Purpose which is not fully completed. It does not describe the range of health and care needs, that the service can provide support for. The service is registered to provide nursing care to people with long term neuromuscular and neurological conditions. This may include people who may have a learning disability and or sensory impairment. Information on the service is not produced in suitable formats to meet the needs of these groups of people. Information should be made available in a format that is accessible to all people who might want to use this service. At the present time there are no people living in the home who require information in these formats. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 12 People who use the service told us that they had received information about Headlands before moving in and had subsequently provided information about their experiences of living at the Headlands for the website. The service obtains assessment details from funding authorities. They also conduct their own assessment to enable senior staff to determine whether the service is able to meet the needs of the individual. Funding authorities assessments clearly indicate that the administration of medication needs to be administered by a registered nurse and other nursing duties are also specified within the assessments. It is important that, prior to making a decision about admission, the manager ensures that arrangements are in place to meet people’s assessed needs. In this instance, as a care home registered to provide nursing, and offering a service to people with complex health needs, the assessment process needs to confirm that identified needs can be met by a suitably skilled and qualified person. The service has contracts in place with the funding authorities. There are at present no contracts in place between the service and the people who use it. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 13 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): 6, 7, & 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 are involved in making decisions about their care and daily lives. EVIDENCE: The information obtained through the pre admission assessment process is used to develop an individual plan of care. There is no evidence within these plans that the people who use the service are involved in the development and review of their individual plan of care. There is evidence that people who use the service are able to direct their care and are able to make decisions about their lives. People told us that they had opportunities to be involved in determining arrangements to facilitate their discharge into the community. They also told us that they were able to make Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 14 decisions about their routines, such as times of retiring to bed and how to spend their time. Arrangements are being made for the people who use the service to have meetings with the staff, to obtain their views and inform service delivery. Individual plans of care contain inconsistent detail about the interests and lifestyles of the people who use the service. At the present time people who use the service are able to communicate with staff about choices and previous lifestyles. Information was not available to demonstrate how risks are minimised or how people are supported to take informed risks. For example one of the risks identified was an inability to sense burning, becoming uncomfortable, inability to move, change position or cover up to protect from the sun. There were no risk assessments in place for the management of these risks. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 15 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: 12, 13, 15, 16 & 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. People who use the service have control over their lives which promotes choice and maximises their independence. EVIDENCE: There is evidence that people who use the service are supported to maximise their independence. Records indicate that provision was being made for people to return to live with their family in the community. There was also reference to people resuming paid employment at some time in the future. Arrangements had not been made to date for people who use the service to participate in the recent local and European elections. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 16 Arrangements are in place for people, who use the service, to maintain links with family and friends. The service has its own transport which can be used to enable people to visit the family and friends in their own homes. Arrangements are also in place to enable relatives and friends to stay at the home. Visitors are welcomed and were seen to play an active role. People who use the service have access to telephone and wireless broadband internet. People who use the service told us that routines were flexible. They can choose how to spend their time, and what activities they become involved in. They also told us that they were able to make choices about the food that was served, that it was to a good standard and that they had enough to eat and drink. Arrangements are in place for people to have meals that are appropriate for their faith and culture. By agreement this is provided by relatives for one resident. This means that precooked food is bought into the home and is reheated by relatives. Risk assessments need to be put in place when precooked food is brought into the home and for relatives to use the kitchen facilities. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 17 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): 18, 19 & 20 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. The lack of detailed care planning documentation could result in staff not having sufficient information to meet people’s needs. EVIDENCE: Individual plans of care lack sufficient detail to ensure that care is holistic, personalised and consistent. For example one funding authorities care plan indicated a previous history of Deep Vein Thrombosis; this was not referenced in the care plans produced by the service. There was no reference to observations to be made by staff, signs and symptoms or action required to prevent reoccurrence. People are assessed for the risks of developing pressure ulcers. Although people are in receipt of appropriate pressure relieving equipment there is insufficient information included in the care plan about how the risks are to be Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 18 reduced or managed. This is important in helping to ensure that staff are providing appropriate and consistent care. One person was admitted to the service with pressure ulcers and although not specifically documented there was evidence that these have now healed indicating a good outcome. Individual plans of care also indicated that people using the service required frequent checks on the vital signs, such as blood pressure, pulse and temperature. The care plans contained no clear indication on the required frequency of the checks. One of the people using the service had commenced a course of antibiotics for an infection that was documented in the daily records. There was no care plan in place for the management of this infection. Daily records referred to the use of splints. There was no care plan in place to show the rationale for why, when or how these were to be used. Care plans are in place for the management of bladder care and catheter care. One care plan stated that the catheter should be replaced on a monthly basis. The last record of the catheter being changed was 4th March 2009. We have since been advised that the catheter was changed again on the 14th May 2009. Recording of fluid intake was inconsistent. Fluid balance charts were not totalled indicating that checks were not taking place to ensure that people who use the service were having sufficient fluid intake. People, who were using the service at the time of the inspection, were able to tell us that they had regular fluids and presented as being well hydrated. The manager is working with the dietetic service to develop tools to monitor the nutritional well being of people. People who use the service are not able to be weighed in the conventional way or able to use the Malnutrition Universal Screening Tool. This is a tool used to calculate the level of risk of people becoming malnourished. People who use the service have movement and handling assessments in place which make reference to the use of a hoist. The information supplied lacks details such as the type of hoist to be used, the size of the sling and whether each person has their own sling. One of the people spoken with during the inspection said that they had originally had their own sling until another person was admitted. They also stated that they had sometimes had to wait until up to 14:00hrs for a bath if other people also needed to use the facilities. Details about the equipment needed to meet people’s individual assessed needs, is important in helping to ensure it can be made available and that their needs are safely met. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 19 There were no specific care plans relating to the emotional and mental health needs of the people who use the service. The care plan provided by the funding authority identified that at least one person had experienced psychological needs. Daily records contained some information about emotional status however there was no reference as to how the service was to support the individual. There are no current links in place with the Community Psychiatric Nursing Service. We noted that some of the people who use the service have requested the use of bedrails. Staff told us that this was at the request of the individuals who confirmed this to be the case. There was no record of consent being obtained, and there was no risk assessment in place regarding the risk of falls from the bed or controls to reduce and manage the risks associated with the use of bedrails such as entrapment. Care plans for people provided by funding authorities state ‘that temperature regulatory mechanisms do not function normally’. There are no risk assessments in place to reduce and manage the risks associated with this medical condition. The individual plan of care contained little information about maintaining the stability of body temperature. This condition can include being unable to sense burning, becoming uncomfortable, unable to move, change position or cover up to protect themselves from the sun. There were no risk assessments in place for the management of temperature. The service has an assisted bathing facility which is regularly serviced and is thermostatically controlled. Staff told us that bath water is set to be dispensed to achieve a maximum temperature of between 37.8 degrees Celsius for showers and bathing temperature at 40.1 degrees Celsius. This is below the 43 degrees Celsius as specified in the National Minimum Standards. Care plans contained no information about personal preference or recommended bathing temperatures and staff were unable to clarify what would be the optimum temperature for the individual. When staff were asked how they checked the temperature before emersion they said that they used their elbow to check the temperature. As maintaining a stable body temperature is critical for people using the service, it is important that there is clear information and protocols in place for staff to ensure water is at the correct temperature for people using the service. The service is registered to provide nursing care to the people who use the service. During the inspection we identified that care assistants were providing nursing care and that there were regular and frequent occasions where no registered nursing staff were on duty. Since the inspection the manager has confirmed that there is now a registered nurse on duty at all times. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 20 There was evidence that people who use the service have access to health care services and professionals such as a General Practitioner, Dieticians, Podiatrists, Opticians and Physiotherapists. A survey received from a health professional identified a good level of satisfaction with the service provided. Medication administration records were in good order with the exception of two dates where there was no record of medication having been administered on the medication administration record. We looked at the daily records and identified that the person concerned had been at home during these days and this had not been appropriately recorded on the medication administration records. Medication systems were generally satisfactory, with appropriate stock control measures being in place. An appropriate storage cabinet for controlled drugs has been obtained. There was no evidence that formal consent is obtained for staff to administer medication on behalf of the people who use the service, although there was consent for staff to contact the GP and obtain prescriptions, on behalf of people who use the service. There was also consent for the staff to arrange admission to the Accident and Emergency department of the local hospital in the event of a medical emergency. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 21 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): 22 & 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. Staff are aware of their responsibilities in relation to safeguarding vulnerable adult procedures. EVIDENCE: The complaints procedure is included in the Service Users Guide and the Statement of Purpose and as such is accessible to the people who currently use the service. The service is also registered to provide care for people with Learning Disability or Sensory Impairment. Neither document are produced in appropriate formats for people with these disabilities. Both documents provide people who use the service with information about how to complain, however at present the documentation contains no information about appropriate timescales for acknowledgement and resolution. We have since been informed that this is included within the appendix. We looked at the complaints file which indicated that there have been no complaints about the service. People using the service told us that they had had no cause to complain about anything. They would feel confident in raising Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 22 concerns with the manager if they needed to do so and that they anticipated that their concerns would be addressed. People using the service told us that they felt safe living at the Headlands and that the staff were nice to them. Staff files indicated that staff have received training in the Safeguarding of Vulnerable Adults and knew what action they should take. We have received no complaints, concerns or allegations about this service. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 23 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): 24 & 30 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 use the service live in a safe and well maintained environment, which is furnished and decorated to a good standard. EVIDENCE: The service is a period property which has been extended to provide ground floor accommodation for five people. The extension and provision of a car park to the rear of the property means that there is very little usable outdoor space for the people who use the service to enjoy. The interior of the home has been adapted to meet the needs of people who use wheelchairs, providing automatic doors to the rear of the property. There Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 24 is one communal area which comprises a lounge / dining room which is adequate for the existing people who use the service. All of the bedrooms are single and have sufficient space to enable the use of equipment such as hoists. All have en-suite shower facilities. In addition the service provides assisted bathing facilities and specialist hoist facilities. No hazards were identified, there are adequate supplies of hot water and the service was clean and hygienic throughout. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 25 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): 32, 34 & 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. The absence of a registered nurse on duty on each shift meant that there was insufficient oversight of nursing care. EVIDENCE: The manager calculates staffing levels based on the assessed dependency of the people who use the service. Current staffing levels include one waking and one sleeping staff on duty throughout the night. There are three carers on duty in the morning and two in the afternoon. Headlands is registered to provide nursing care. At the time of the inspection, records indicated that there was not a registered nurse on duty throughout the twenty four hour period. Training records indicated that care staff are being trained to routinely perform nursing duties. The duty rota identified that care staff are often the most senior member of staff on duty, particularly in the Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 26 evening and at weekends. Since the inspection the manager has confirmed that there is now a registered nurse on duty at all times. Recruitment procedures are in place and are satisfactory with staff having appropriate checks and references. The service is also registered to provide care to people with sensory impairment and learning disability however; the current staff group lack both the skills and the training to provide care for these groups. People who use the services told us that they had been involved in the recruitment of care staff and that staff were friendly. Staff have induction training. Nursing and care staff have access to training which is specific to the needs of the individuals such as management of Autonomic Dysreflexia, Ventilation Management, Management of Bowels and Bladder, Catheter Care and Assisted Coughing. The service expects care staff to perform these nursing duties in the absence of a registered nurse. The staff files did not contain any information about how the delegation of nursing tasks was being overseen or managed. Following the inspection the registered provider has organised a registered nurse to be on duty at all times to take responsibility for nursing care. Staff have access to mandatory training, most of which is internal e.g. Fire Safety, Administration and Management of Medication, Movement & Handling, Health and Safety, Life Support/ Resuscitation, Safeguarding of Adults and Infection Control. There was no evidence that staff receive training in First Aid or basic Food Hygiene training from the staff files seen. This training is important in helping to ensure that staff have up to date knowledge in relation to dealing with emergencies and safe working practices. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 27 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): 37, 39 & 42 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. The management of the service has not taken sufficient account of their responsibilities in relation to the Care Homes Regulations 2001 which are in place to safeguard the interests of people who use the service. EVIDENCE: The Registered Manager for Headlands is also the Registered Manager for two other services including Communicare GB a Domiciliary Care Agency and Nursing Agency. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 28 The Registered Manager has delegated day to day management of the Headlands to a newly appointed Unit Manager, who has several years experience in working in an intensive care environment and the management of assisted respiration by ventilation. We have identified that the Registered Nurse cover for the home is inconsistent, particularly in the evenings and at weekends. This means that carers are performing nursing duties such as the administration of medication, monitoring vital signs, are responsible for identifying and taking action in the event of Autonomic Dysreflexia, a medical emergency, the provision of catheter care, the management of bladder and bowels. Records and discussions with staff confirmed that they had received training in carrying out these tasks and that there was a protocol in place for contacting a registered nurse as the need arose. As Headlands is registered for nursing care, the expectation is that there is a registered nurse to provide nursing care at all times. Failure to provide sufficiently qualified staff is a breach of the Care Home Regulations 2001 and may put people at risk. The service does not routinely hold any money on behalf of the people who use the service. Quality assurance systems such as a care plan or medication audits have not yet been conducted. There have been shortfalls identified in this report which include care planning, record keeping including recording and monitoring of fluid intake, medication recording and the management of risk. The implementation of quality audit systems will enable the service to monitor and improve in these areas. Given that the service specialises in the care of people requiring the use of assisted respiration via ventilation we asked what provision was available in the event of a power cut. It has been confirmed that there is an emergency generator to cover this eventuality. Staff training records identified that staff have not had training in First Aid and that there is not an appointed person on duty for each shift. This is important in helping to ensure that staff are able to deal with emergencies as they arise. We also noted that some of the staff had not received training in Basic Food Hygiene. This is important as staff are involved in the handling and preparation of food. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 29 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 2 2 3 3 2 4 X 5 2 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000072957.V375858.R01.S.doc 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 2 X X 2 X Version 5.2 Page 30 Headlands Specialist Care and Ventilation Unit No 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 YA1 Regulation 4.1 Requirement The Statement of Purpose must be reviewed to ensure that it contains specific reference to the range of needs. Timescale for action 30/09/09 2 YA6 YA18 15 1&2 To ensure that people who use the service have access to accurate information. 01/08/09 Individual plans of care must be reviewed to ensure that they contain detailed instruction to staff about how all of the health, personal and social care needs of the people who use the service are to be met. To ensure the health and well being of the people who use the service. Risk assessments must be developed based on the needs and risks relating to the individual and reviewed regularly. This may include the use of bedrails, risks of falls, risks associated with variation of external temperatures including extreme weather conditions and risks of pressure ulcers. DS0000072957.V375858.R01.S.doc 3 YA9 13.4 01/08/09 Headlands Specialist Care and Ventilation Unit Version 5.2 Page 31 To ensure the health and safety of the people who use the service. 4 YA17 13.4 Risk assessments must be 01/08/09 developed to reduce and manage the risks associated with pre prepared and precooked food being brought into the home and relatives using the kitchen facilities. To ensure the health and safety of the people who use the service. 5 YA18 12.1 The monitoring and recording of vital signs must be conducted as specified in the individual plans of care. 01/08/09 6 YA18 12.1 To ensure the health and safety of the people who use the service. The management of bladder care 01/08/09 and associated catheter care must be reviewed to ensure that people using the service have catheters changed at the appropriate time and as specified in the individual plan of care. To ensure the health and wellbeing of the people who use the service. The management of fluid balance 14/07/09 must be reviewed to ensure that the records are accurately maintained and that there is a system for monitoring the intake and output of the people who use the service. To ensure the health and wellbeing of the people who use the service Movement and handling assessments need to be DS0000072957.V375858.R01.S.doc 7 YA18 12.1 8 YA18 13.5 01/08/09 Page 32 Headlands Specialist Care and Ventilation Unit Version 5.2 reviewed to ensure that they include detailed instruction to staff about how the person needs and wishes to be moved including details of the type of hoist, size of the slings and personalisation. To ensure the health and safety of the people who use the service Medication administration records must be accurately maintained. 9 YA20 13.2 14/07/09 YA32 10 To ensure the safe administration of medication. 18.3 a & b There must be a Registered Nurse on duty at all times. To ensure that the service is able to meet the needs of the people who use the service and to comply with the CHR 2001. 10/06/09 11 YA34 18.1 Recruitment practices and the 30/09/09 staff training programme must take into account the needs of people for which care is provided, including Learning Disability, Sensory Impairment and any specialist nursing needs. To ensure that people’s needs can be met. First Aid training must be arranged for staff, to enable a nominated person to be on duty for each shift. To ensure the health and safety of the people who use the service. Basic food hygiene training must be arranged for staff with responsibility for handling, preparing or assisting people to eat and drink. DS0000072957.V375858.R01.S.doc 12 YA35 18.1 01/08/09 13 YA35 18.1 01/08/09 Headlands Specialist Care and Ventilation Unit Version 5.2 Page 33 To ensure the health and safety of the people who use the service. 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 YA1 Good Practice Recommendations The Statement of Purpose should be produced in formats appropriate to the needs of the people for whom the service is registered, including learning Disability and sensory Impairment. There should be appropriate contracts in place between themselves and the people who are accommodated. Records should be in place which confirms people who use the service have been involved in the development and review of their individual plans of care. Arrangements should be made so that the people who use the service have access to a named nurse or key worker. The individual plan of care should be reviewed so that they contain information about previous lifestyles, interests and activities, in order for the staff to promote the individuality of the people who use the service. Arrangements should be made for the people who use the service to participate in local and national elections. The management of the risks of pressure should be reviewed to ensure that it complies with current best practice issued by NICE Risk assessments should be conducted to establish if people who use the service are able to manage their own medication and arrangements made for them to do so should they wish and be assessed as able to do so. Written agreement should be obtained from the person using the service for staff to administer medication on their behalf. The complaints procedure should be developed to ensure that it is accessible to the people, from whom the service is registered to provide care, including Learning Disability and Sensory Impairment. The staff induction training should be reviewed to ensure DS0000072957.V375858.R01.S.doc Version 5.2 Page 34 2 3 4. 5. YA5 YA6 YA6 YA6 7. 8 9 YA13 YA18 YA20 10 11 YA20 YA22 12 YA25 Headlands Specialist Care and Ventilation Unit 13 YA35 14 YA35 that it covers all of the necessary information to enable staff to meet the needs and wishes of the individuals and that it complies with current best practice. Staff recruited from acute hospital environments should have opportunities to broaden their understanding and experience of provision of care in the community and the primary health care team. Staff with management responsibilities should undertake the training specific to the role of the Registered Manager. Headlands Specialist Care and Ventilation Unit DS0000072957.V375858.R01.S.doc Version 5.2 Page 35 Care Quality Commission Eastern Region Care Quality Commission Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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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