Care Home: Heanton Nursing Home

What the care home does well What has improved since the last inspection? Plans of care now include information about what strategies are in place in respect of if and when to consider as needed (PRN) medications. This ensures that a consistent approach is adopted by staff particularly when considering sedation for someone who appears distressed or has displayed challenging behaviour. The registered provider has invested in new equipment to ensure that individuals` nursing needs can be met safely. There are now more hoists and other equipment that assists individuals mobilise. New lounge furniture and curtains have been purchased to make living areas more homely. Staff morale has improved and staff say that they are now working well a team and most believe that they provide good quality outcomes for people they care for. The kitchen areas are much cleaner and there are clear systems in place for ensuring regular cleaning schedules take place. Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 What the care home could do better: Individuals who need to be moved via wheelchairs must have footplates that are suitable to their individual needs, or have been assessed by a specialist such as an occupational therapist or physiotherapist and a clear reason why footplates should not be used, needs to be documented. Despite good efforts by cleaning staff, there is still malodorous smells evident throughout some parts of the home. The registered providers may need to consider further carpet replacements as they have done in the upstairs lounge to remove odour from that area. Staff need to have updated training in fire safety. We saw that 5 care staff that cover night shifts had last had their fire training in August 2008. They had not been involved in any fire drills or other training since that date, which is clearly inadequate. We saw that 30 out of 53 staff had not had infection control training. This is being planned for the next few weeks. The home needs to consider how it will ensure that staff have ongoing training in dementia care, as most have completed some basic training in this area, but this should now be expanded, particularly as the home takes people with complex nursing needs and individuals with the advanced stages of dementia. Key inspection report CARE HOMES FOR OLDER PEOPLE Heanton Nursing Home Heanton Punchardon Barnstaple North Devon EX31 4DJ Lead Inspector Jo Walsh Key Unannounced Inspection 09:30 4 and 6th August 2009 th DS0000068924.V376254.R01.S.do c 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 homes for older people 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. Heanton Nursing Home DS0000068924.V376254.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 Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heanton Nursing Home Address Heanton Punchardon Barnstaple North Devon EX31 4DJ 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) 0870 286 9462 0870 286 9463 heanton@psphealthcare.com www.psphealthcare.com PSP Healthcare Ltd Manager post vacant Care Home 64 Category(ies) of Dementia - over 65 years of age (64), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (64) Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th September 2008 Brief Description of the Service: Heanton Nursing Home is a service that is provided in a large Victorian house situated in the small village of Heanton Punchardon, close to Braunton and Barnstaple in North Devon. The service changed ownership in February 2007 and is now owned by PSP Healthcare Limited. The house is set in well-maintained grounds, which includes to the front a sensory garden and extensive views over the Taw Estuary and Bideford Bay. There is ample parking space and disabled access is available at the side of the house. Heanton church is within walking / wheelchair distance and there is a post office and general store close by in the village. The house has been adapted for use as a care home with nursing. The registration categories allow for a maximum of 64 service users to live in the home, the present categories to provide care for those with a mental disorder and dementia. The service mainly provides specialist care to older people who have dementia. There are three separate areas within the home that cater for different levels of health care need. These are known as, Williamson, Tarka and Chichester. These are arranged over the ground and first floors and are accessed by two shaft lifts. The home has an activities co-ordinators who help service users to pursue activities and interests. There is ample communal space and areas in which service users can wander freely. The fees are generally reviewed once a year in April and are agreed before admission; additional charges are made for personal items such as toiletries, magazines, newspapers, chiropody and hairdressing. Copies of previous inspection reports are available within the home. Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection took over two days in August and looked at all the key standards and focussed on listening to the views of the people who live at the home. We did this by using surveys and by the use of an expert by experience. CQC are trying to improve the way we engage with people who use services so we gain a real understanding of their views and experiences of social care services. We are now using a method of working where ‘experts by experience’ are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term ‘experts by experience’ used in this report describes people whose knowledge about social care services comes directly from using them. The expert helped to speak to people about their experiences of living at the home as well as making some general observations. Their comments are included throughout this report. The senior nurse, who is applying to be the registered manager was available throughout the inspection and ensured access to key documents such as plans of care, staff records in relation to training, supervision and recruitment, and records in relation to administration of medications. Time was also spent talking to staff and observing care practice during different times of the day. We spoke with three nursing staff, six carers, a cleaner and the cook. Some staff were also asked to complete surveys that gives us information about how well supported and trained staff are to enable them to do their job. We also took the opportunity to speak with 4 visiting relatives during this inspection and their comments have been included and have helped us to make a judgement on the quality of care and support provided in the home. Prior to the inspection the home completed an Annual Quality Assurance Assessment (AQAA), which gives us information about how the home maintains a safe environment, what training has been completed and tells us how they are reviewing their services to improve the care and support provided. This information helps to inform the inspection process. Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 6 What the service does well: Heanton Nursing home ensures that individuals have a through assessment prior to being admitted. This helps staff to plan for care and support. They provide nursing placements for people with complex needs mainly due to dementia type illness. Plans of care ensure that staff provide care and support in a consistent way. Plans have good information about individuals nursing, personal and health care needs. They also have risk assessments and are reviewed on a regular basis. The home is working to make plans more person centred by asking family and friends where possible to complete a personal profile on the individual. Relatives of people who live at Heanton who we spoke to or who returned surveys were on the whole very positive about the care and support provided. Comments included • • • • • Most of the staff are very caring towards the residents and do a difficult job very well The staff really care and we appreciate all that they do for us We have recently moved in and the staff have been wonderful. They are very helpful caring and attentive and we are very happy. Monitor and care for my relatives with love and kindness My xx is extremely well cared for. The expert by experience stated in her report ‘Throughout the time I spent at the Home, all the staff were very helpful and polite. My observations of them with the people they were caring for were very positive; they were always kind and caring. They conversed with people and talked to them at times when they were using hoists and helping with meals etc. they showed genuine concern for their wellbeing responding well to their needs. I met two relatives during the morning who told me that their mother had been at the Home for three years and they were very satisfied with her care.’ Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 7 The home provides a range of activities that takes into account individuals needs and wishes. They have invested in some quality equipment such as sensory and visual aids that enable the activities coordinator to engage people in things such as relaxation sessions. The expert by experience was particularly impressed by the activities she saw on the day. ‘The activity group I joined was excellent and the attitude and approach of staff to the people in their care during my visit was very good.’ Staff have knowledge and skills in working with people with dementia and complex needs. Staff say that they have been successful in working with people who have been aggressive due to their dementia, through being calm and working well as a team ensuring a consistent approach. This was supported by two visiting relatives. One commented ‘staff work really well here with some quite difficult people.’ What has improved since the last inspection? Plans of care now include information about what strategies are in place in respect of if and when to consider as needed (PRN) medications. This ensures that a consistent approach is adopted by staff particularly when considering sedation for someone who appears distressed or has displayed challenging behaviour. The registered provider has invested in new equipment to ensure that individuals’ nursing needs can be met safely. There are now more hoists and other equipment that assists individuals mobilise. New lounge furniture and curtains have been purchased to make living areas more homely. Staff morale has improved and staff say that they are now working well a team and most believe that they provide good quality outcomes for people they care for. The kitchen areas are much cleaner and there are clear systems in place for ensuring regular cleaning schedules take place. Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 8 What they could do better: 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. Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 9 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 Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 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. Individuals’ needs will be fully assessed prior to admission to ensure that the home can meet their needs EVIDENCE: The pre admission information was looked at and discussed with the senior nurse on duty for three of the newest people to the home. Where possible the nurse in charge of one of the units will visit the person at the home or hospital and talks to them, their care givers and any family members. They try to involve families as much as possible and encourage them to complete a person profile that gives the individuals background, where they worked, who are important to them and what they enjoyed doing. The pre admission information gives good basic details of the individuals personal and health care needs and where possible if known any social or Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 11 diverse needs. This information is then used to help the senior nurse team decide if the home can provide a placement. A Pre admission draft care plan is then drawn up and shared with the staff team, usually just prior to the persons’ admission. Staff spoken to said that they had access to good information prior to a new person being admitted, but as one staff member stated ‘sometimes people are not what they would appear on paper, and we need to give them time to adjust and to settle into Heanton.’ The AQAA states ‘All potential residents are assessed by either the manager or a unit sister. This assessment involves a visit to the potential resident either at their home or in hospital. We then ask the resident (if possible) and / or a family member to come to visit the home to see the environment and discuss the care needs of the resident and how the can be met. With the aim of providing a high level of reassurance and support, a member of staff will dedicate a significant amount of time to spend with the family on their visit to the home.’ None of the people we case tracked could tell us if they had been involved in the pre admission assessment, but one visiting family member did confirm that the nurse from the unit had visited their relative at the hospital and that family members had been asked for information about what their relative enjoyed doing. Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 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. Individuals’ personal and health care needs are mostly well met, although plans of care need to be checked for accuracy to ensure consistent care and support is provided. EVIDENCE: We looked at four individuals’ plans of care and other information held by the home in respect of these people. Where possible we also spoke with the individuals and/or observed them in communal areas and their interactions with staff and other people who live at Heanton. Individuals were we looked at for case tracking included two newer people to the service, one person with complex nursing needs, who has a longstanding pressure area and one person who presents with some challenges due to their dementia related illness. Only one of these people was able to give us a clear verbal response to how they Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 13 saw life at Heanton, and they were happy with the care and support, but did not wish to be in a home. Plans of care are well organised and give detailed information and key assessments and risk assessments in relation to individuals personal, health and social needs. For one person we saw there are now clear written steps for staff to follow before considering PRN (as needed) medication in respect of if this individual shows signs of aggression. This is good practice and has been implemented as a result of a requirement made following the key inspection last year. This shows us that the home listen and act on advice and directions to improve services for people they care for. The AQAA states ‘our care plan are written in a positive, constructive manner and allow our staff see the person’s positive outcomes and manages the negatives in a positive manner. Residents are encouraged to have choice in all aspects of daily life. We are developing the first person care plans as suggested at the 2008 inspection and have made significant progress in this area.’ We saw that individuals have regular input from health care professionals such as their local doctor, consultant psychiatrist, continence advisor and the community speech and language therapist. The home are now looking at how best to record individuals’ mental capacity and ability to make decisions in everyday life. We did note that in one persons plan of care it had as a recommendation for if the individuals was uncomfortable under the section ‘falls/physical frailty’, which stated ‘sit in Tyson chair if uncomfortable’ This individual could mobilize and it would therefore be inappropriate for them to use a Tyson chair as they can be seen as form of restraight and are not helpful in terms of encouraging good posture. This issue was also picked up by the expert by experience who reported ‘The sitting rooms had easy chairs, but there seemed to be a number of reclining chairs in use, inappropriate use of these, to restrict liberty, would be of great concern. These reclining chairs are known to have detrimental affects on posture, walking and general physical well-being, when used for people who are able to walk and therefore should only be used with the support of expert opinion/assessment.’ We also noted that people were being transferred in wheelchairs without the use of footplates. This was discussed with both the senior nurse and PSP operations manager. They stated that individuals have been risk assessed and that this is noted as part of their care plan. We looked at examples of these risk assessments and sought further advice from an occupational therapist. The expert by experience noted ‘Many people were moved around the home in Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 14 wheelchairs I did not see any wheelchairs with footplates being used, people’s feet were often close to, or dragging on the floor, therefore with a risk of injury to their feet or legs.’ We also received a comment via a survey from a relative who in answer to the question what could the home do better states ‘’supply better and clean wheelchairs with brakes that work, also complete with safety belts and foot rests.’’ People are being put at risk if they are moved around in wheelchairs without the correct use of footplates. Advice was sought by us from an occupational therapist who highlighted the possible risks of not using footplates as being: Pressure on the backs of the legs from the edge of the seat, feet dragging on the ground which could cause varying degrees of damage to the feet. Foot getting caught up under the chair, in the wheel etc resulting in injury. People being asked to lift their feet up, usually results in them holding them stiffly out in front, foot could get caught on door frame or other furniture, which, could result in a fracture. We have made a requirement stating that footplates must always be used unless someone has been professionally assessed, by an occupational therapist or a physiotherapist, for walking their wheelchair i.e. using their feet to propel the wheelchair rather than their hands. The expert also noted ‘We were told that some people spend periods of time in there room in bed, for rest and for pressure relief, they are unable to use a call systems because of their dementia and are visited hourly, which could be a significantly long time if someone had a problem.’ When we checked this with staff, we were told that often some individuals were checked two hourly and not hourly, particularly during busy times such as getting ready for meals and assisting people to use the toilet. Whilst we recognise the need for people to have best rest to ease pressure on their sacral area, some thought needs to be given as to how they can be better monitored, whilst in their bedrooms. This particularly relates to individuals on the downstairs unit where the bedrooms are sited away from communal areas. Relatives of people who live at Heanton who we spoke to or who returned surveys were on the whole very positive about the care and support provided. Comments included • • • Most of the staff are very caring towards the residents and do a difficult job very well The staff really care and we appreciate all that they do for us We have recently moved in and the staff have been wonderful. They are very helpful caring and attentive and we are very happy. DS0000068924.V376254.R01.S.doc Version 5.2 Page 15 Heanton Nursing Home • • Monitor and care for my relatives with love and kindness My xx is extremely well cared for. The expert by experience stated in her report ‘Throughout the time I spent at the Home, all the staff were very helpful and polite. My observations of them with the people they were caring for were very positive; they were always kind and caring. They conversed with people and talked to them at times when they were using hoists and helping with meals etc. they showed genuine concern for their wellbeing responding well to their needs. I met two relatives during the morning who told me that their mother had been at the Home for three years and they were very satisfied with her care.’ Staff spoken to and those who returned surveys felt that they provided care and support very well. Staff appeared to understand the needs of the people they care for and said that they were given good information via the plans of care and that ongoing training was also helpful in enabling them to understand the needs of people they care for. Staff were observed giving people time to explain what they wanted, staff were seen to guide people in a gentle manner to a lounge area. Other examples of good practice we observed included, sitting with an individual who was clearly distressed and talking to them in a calm and gentle manner. We looked at medication storage and records relating to medication administration. These appeared well organised and accurate. The home now includes details within plans of care about when and if PRN (as needed) medications should be considered as we required this previously. Only staff who are qualified nurses administer medications and the senior nurse said that their competencies are checked as part of clinical supervision. Controlled drugs are appropriately stored and recorded and the senior nurse audits this on a regular basis, to check for errors, and ensure that staff are following correct procedures of double signing for any administered controlled drugs. Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 16 Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides some excellent activities to keep individuals stimulated and involved, but improvements could be made to further enhance opportunities for individuals to make choices. EVIDENCE: Heanton provides care and support for people with advanced stages of dementia and it is not always easy to provide activities and social engagement for people with this type of illness. The activities coordinators work extremely hard and the providers have invested in some quality equipment to enable activities to be geared towards individuals needs. They have begun to use the Pool assessment tool to help them gather information about individuals’ level of engagement and type of activities that would suit their needs. They also try to get families to complete a profile to help them gain information about the sorts of activities people enjoyed doing in the past. Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 18 The expert by experience was asked to look at this area and reported ‘During the morning, I was able to spend time with a group of about twelve people who were involved in a multi sensory relaxation group. The group was organised by a volunteer who had previously been employed as an activity coordinator. The person was very committed to what she was doing and to the welfare of people in the group. The room had soft coloured lights, which changed gently and soft soothing music, with a bubble tube creating a further sensory aspect to the session. People in the group had also been offered the opportunity to have a hand massage with oils. It was clearly evident that the session had promoted relaxation, people were very calm and some were almost asleep. I sat with a lady who was able to say how she had enjoyed a hand massage and how she loved the music, she was humming softly to the music closing her eyes and gently rocking. The session ended with a gentle wake up preparing people to go into the dining room for lunch. There were no specific activities planned for the afternoon, although a member of staff did say that she was going to put a DVD on for those who wanted to watch it. There was a poster which listed Church services at the Home and also one or two other posters relating to events in the home on the wall in the corridor. I asked a member of staff if people were able to go out and was told that people were taken out in the grounds when possible, either walking or in wheelchairs if needed.’ People that we spoke to and visiting family members said that staff tried hard to include people in activities and that visitors were always welcome at any time. One person said ‘I visit my xx three times a week, and am always made welcome and given a cup of tea, but more importantly, I am sure that in xx own way my xx is happy, extremely well cared for and well fed. There is always staff about and the atmosphere is happy and cheerful. The staff are really caring and ready to help in any situation.’ The AQAA states ‘We provide a wide range of stimulating activities for all residents based on information gained from their life history profile and from their strengths assessment. There are regular entertainers brought into the home and the reaction and participation of residents is very evident. Our visiting physiotherapist (weekly) also provides a vital form of stimulation for many of our residents. Our dedicated activities organisers use imaginative techniques to stimulate residents in different ways.’ Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 19 The expert by experience was asked to sample lunch with people in the upstairs unit. She reports ‘On my arrival at the home in the morning lunch had been booked for me. I was told that the meal was meat loaf with roast potatoes, cauliflower cheese and chocolate mousse for pudding; I was not given a choice or alternative option. On the upper floor of the Home, people have their meals in two small dining areas; the food is cooked in the main kitchen and transported in a heated trolley up to the dining rooms. People were taken into the dining rooms and seated around small tables, in what was quite a cramped area. The tables had table cloths, but no cutlery, place mats , condiments or drinks, the chairs were sturdy, with arms which were helpful for people when sitting and getting up from the table. Overall the mealtime was calm and orderly, individuals were served by the staff and cutlery and glasses of fruit juice were brought to the table with the meal. The meals were plated up at the trolley, I did not hear anyone being asked what they would like to eat, and the same plated meals were given out to everyone. I sat at a table to with two ladies, one was able to eat without help and the other needed help. The cauliflower cheese and the roast potatoes were tasty, but I did not enjoy the meatloaf. I tried the dessert of chocolate mousse, but it tasted synthetic and flavourless, it did not look appetising. The fruit juice served with the meal was good and people were offered extra drinks as needed. People were encouraged by the staff to eat their lunch and help and support given appropriately, with some friendly conversation in-between. Tabards and paper towels were used to help prevent soiling clothes of those people who found eating difficult. There were three/four members of staff helping with the mealtime. The staff gave help to those people who needed it and they sat down with the person to do this they did not rush and seemed sensitive to the needs of the individual. One person refused lunch and was offered the option of an omelette or a sandwich instead, which she declined. People in the main did appear to eat their lunch. I did not see drinks around the home only at lunchtime.’ Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 20 We observed and sampled lunch in the downstairs unit and experienced similar things. People were served plated up meals, they were not told what the meal was or offered an alternative, although the menu shows an alternative should be available. The cook said she had not prepared the alternative that day as most people would enjoy the main option of meatloaf. Although staff provided support to people over the lunchtime period in a caring and respectful way, they could have offered individuals more choice and given them opportunities to express their choice in the meal option. One further observation made by the expert was ‘People living in the Home appear to spend most of their day in the communal rooms there are key pad security systems for safety, which prevent access to stairways, offices clinical rooms etc. and also bedroom areas. The bedrooms did seem to be away from the communal rooms and not easily accessible for people, this may be difficult if people wish to visit their room, maybe to see photographs and things significant to them and I wonder if this is made possible by the staff?’ Some staff were asked about this and they said that if someone asked, they would be supported to go to their room, but the difficulty is that they may not be able to ask and staff maybe too busy at that time to accommodate their request. Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 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. Individuals’ views are listened and acted upon. People are protected via good recruitment practices and training in understanding abuse. EVIDENCE: The home have a stated complaints procedure and hold regular meeting with people who live at the home and their carers/family members to enable them to voice their views about the quality of care and support provided. The home have received two complaints since the last inspection and one was received by the Commission and sent to the provider for investigation. We are satisfied that complaints are investigated and responded to appropriately. These are always followed up during monthly unannounced visits by a representative of the registered provider. Relatives we spoke to and those who returned surveys said that they knew how to make complaints if necessary. There has been one safeguarding issue raised by a health care professional in respect of some individuals who were being placed at risk of choking due to being fed in a reclined position. Following training staff have been made aware Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 22 of the risk of choking and more appropriate positions to feed an individual. The home worked with the speech and language therapist to improve services. Following this there have been no further concerns raised. The staff have training in the protection of vulnerable adults and those staff we spoke with were able to say what they would do if they suspected abuse happening. Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 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. Heanton provides people with a safe and homely environment, but some improvements are needed to ensure it is more consistently fresh smelling. EVIDENCE: Heanton is a very large residence that has been adapted to provide two units for people with complex needs as a result of dementia type illnesses. There are key pads on exit doors and a number of communal spaces that have been improved with new furniture and curtains. The environment could be further improved with the use of clearer signage as to where rooms are and what specific use each room has. Homes have successfully used brighter colour schemes on doors to help people with dementia become more orientated to Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 24 where toilets and bedrooms are or example. The expert reported ‘Heanton NH is a large old house, with accommodation on two floors. My first impression was that there were lots of corridors and doors, with a lack of colour and clear signage, The decoration, paintwork and soft furnishings appeared in need of attention in parts of the Home. In some of the communal rooms, the lovely views were obstructed because of condensation between the double glazed window panels. When I visited the ground floor accommodation during the afternoon, there was a strong smell of incontinence evident. There were lovely colourful flower arrangements around the Home, some were fresh flowers and others silk flowers. I was told by the person helping with activities that some of the people living in the Home liked to help with flower arranging and that Sainsbury’s often donated their unwanted flowers to the Home.’ There are strong pockets of odour despite domestic staffs’ best efforts. The registered providers may need to consider further carpet replacements as they have done in the upstairs lounge to remove odour from that area. Some relatives we spoke to said that this was the one area that could improve. During This inspection we did look at all communal areas and some of the individual bedrooms, which people are encouraged to personalise. The grounds looked really nice and well maintained. The laundry area looked well organised and good infection control policies are in place to ensure that a ‘no touch’ technique is used for soiled linen. Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 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. Staff are reasonably well trained and supported to do their job, but there are still gaps in training that could impact on the safety of people EVIDENCE: The current staffing levels appear sufficient for the current needs and numbers of people living at Heanton, but should be kept under review. Last year prior to the inspection we had a number of complaints and concerns raised to us in respect of staffing levels. We have had no complaints raised in respect of staffing levels this year. Staff spoken to and those who returned surveys say that staffing levels are ‘usually’ enough to meet the needs of all of the people who use the service. One out of six surveys from staff answered ‘never’ enough staff, but did not qualify or expand on this answer. We did note that staff morale appeared to have improved since the last inspection and staff spoken to said that the atmosphere and team approach and working had improved. Several staff said that they had been disappointed by the previous inspection report and that over this last year team work has improved. Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 26 Staff said that they had good support and training opportunities, but we found that there were some significant gaps in core training. Five of the staff who provide night time care for example have not had fire training since August 2008, and when we checked the fire log book they had not been involved in evacuation practices either. We also noted that 30 out of 53 staff have not had training in infection control for over a year. We were told this was due to happen over the next few weeks. The home clearly needs to prioritize fire safety training for night staff and ensure that this is updated on a more regular basis. Staff training records show that as well as training n core areas of health and safety, staff have had training in basic dementia care awareness, person centred planning, mental capacity act, dealing with aggression and the protection of vulnerable people. We checked the recruitment files for four newer staff and saw that checks and references were obtained prior to them taking up their post in the home. Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 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. Systems are in place to ensure that the home is well managed and run in the best interests of the people who live there. EVIDENCE: Although the home does not have a registered manager in post that has been approved by CQC, they do have one of the unit nurses acting in this post and in the process of applying to register with the Commission. The provider did recruit an experienced manager who has been instrumental to making some positive changes, who had to resign due to personal issues. Throughout his period the home has been supported by the registered manager at their sister Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 28 home in Ilfracombe. She is experienced and qualified and has been providing support on a daily basis. Staff spoken to report a greater confidence in the management of the home and records show that staff are being given regular supervision and support, which had not been happening previously. The supervision records show that individuals have been given opportunities to discuss how they feel their role works within the home and to make suggestions and comments for any improvements. One person for example had raised the fact that a member of staff from another unit had tried to introduce practices that they considered institutional. This matter was dealt with by the senior nurse and the poor practice issue was raised with the whole staff team, to eliminate any further occurrences. The home has systems in place for ensuring the views of the people who live at the home, and their relatives/representatives are used to review the quality of care and support provided. Surveys are used and the results of these are collated and posted around the home. The PSP health care group holds all individuals’ finances centrally. The monies are held in a separate account from the business and they keep audit trails to ensure that people are protected. As a limited company all accounts are audited independently. We did not directly audit any financial records on this occasion. All new staff completes an induction programme that looks at all the key safe working practices. This follows the skills for Care guidelines. The home gave good information in their annual self-assessment, to show how they maintain a safe environment. They health and safety issues are addressed via training for staff and regular checks and audits on equipment and facilities. We have already stated that they need to ensure that fire training is given urgent priority to ensure that both people who live at the home and staff are kept safe. Heanton Nursing Home DS0000068924.V376254.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 3 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 30 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 OP8 Regulation 13(5) Requirement Footplates on wheel chairs must always be used unless someone has been professionally assessed, by an occupational therapist or a physiotherapist, for walking their wheelchair i.e. using their feet to propel the wheelchair rather than their hands. All staff must have regular training in fire safety to ensure that they know what to do in the case of a fire. Timescale for action 30/09/09 2 OP27 18(C) 30/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP27 Good Practice Recommendations Staff should have up to date and ongoing training on caring for people with dementia and dealing with aggression Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 31 2 3 OP12 OP14 4 OP26 Staff need to ensure that the routines of the home particularly around mealtimes are flexible and allow individuals to make choices. Consideration needs to be given to how individuals who need bed rest can summon help if they are unable to use call bells, and how those individuals who may wish to visit their room to see familiar items such as photos can do so when they wish. The registered provider needs to take action to eliminate odours from all parts of the home. Heanton Nursing Home DS0000068924.V376254.R01.S.doc Version 5.2 Page 32 Care Quality Commission South West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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