Care Home: Heath House Care Centre

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What the care home does well There is a good amount of information collected about people`s needs before they are admitted into the home and this helps to ensure that these needs are met. There were good interactions between staff and people that live in the home. People had their personal hygiene needs met and wore clothes that were well laundered and reflected their tastes. Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.2 People have a good selection of food and are assisted to make choices. There are good systems in place to ensure residents’ finances are protected. Staff are recruited well and have the appropriate checks to ensure they are safe to work with vulnerable people. The home was clean and fresh on the day of the inspection. Appropriate health and safety checks and inspections are done to ensure gas, electrical, fire and lifting equipment safety. What has improved since the last inspection? Since the last key inspection new pressure relieving equipment has been purchased to meet the needs of individual people and nursing staff have received update training on pressure area care. This helps to ensure that people`s skin remains healthy. Moving and handling equipment is available, people were observed to be moved from place to place well. Medication administration processes have improved and people are receiving appropriate medication to ensure their health and wellbeing. The management of the home has become less unsettled and this has meant that required improvements can be acted upon and followed through. There is a permanent manager for the home and we have been advised of their intention to apply for registration with us. Improvements have been achieved in the recording of accidents and incidents and the monitoring and referrals of incidents that may have a safeguarding element. The home has undertaken redecoration and refurbishment of the lounges, some bedrooms and created a reception area. What the care home could do better: Information about the home needs to be reviewed so as to detail the changes to the service. Directions for people to gain entry into the home could be improved to ensure that new visitors know how to get into the home. Once admitted they can be shown where to sign in and where the person they are visiting is. Care plans need to be more personalised so that they manage people`s mental health conditions, behaviour and activity needs better. Care plans need more detail about the person`s previous experiences and lifestyle. Reviews of careHeath House Care CentreDS0000024852.V378864.R01.S.doc Version 5.2 plans need to take account of what has happened to the person in the last month so decisions can be made about what is working well for the person. The home needed to develop further an environment that promotes the activity and wellbeing of people with mental health conditions including dementia and staff need in depth training so it becomes part of their practice. The home needs to have available for inspection the medicines returned book so that a full audit of medication can be undertaken. Although the home has a formal complaints procedure more informal methods of collecting the views of people, their relatives and professionals is needed to improve the service. Where formal surveys are used more detail in recording is needed so any trends can be found to improve the service. Although generally the building is meeting people`s needs some further improvements could be made to assist people to know where they are in the building, toilet and bathing facilities. Staff received training but systems were not always in place to ensure that copies of certificates were on file and the training matrix updated. Some changes are needed in admission procedures and practice to ensure the home can demonstrate they have considered the Mental Capacity Act and the potential deprivation of liberty when people are admitted. Key inspection report CARE HOMES FOR OLDER PEOPLE Heath House Care Centre 81 Walkers Heath Road Kings Norton Birmingham West Midlands B38 0AN Lead Inspector Jill Brown Key Unannounced Inspection 15th &16th December 2009 08:50 DS0000024852.V378864.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care 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. Heath House Care Centre DS0000024852.V378864.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 Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heath House Care Centre Address 81 Walkers Heath Road Kings Norton Birmingham West Midlands B38 0AN 0121 459 1430 0121 486 1728 lizansah@aol.com www.schealthcare.co.uk Exceler Healthcare Services Limited 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) Manager post vacant Care Home 50 Category(ies) of Dementia - over 65 years of age (50), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (50), Old age, not falling within any other category (50) Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - over 65 years of age (DE(E)) 50 Mental Disorder, excluding learning disability or dementia - over 65 years of age (DE(E)) 50 Old age, not falling within any other category (OP) 50 The maximum number of service users who can be accommodated is: 50 14th July 2009 2. Date of last inspection Brief Description of the Service: Heath House offers nursing care for up to 50 older adults with mental health needs. This includes both dementias and those with enduring mental illness. The premises have been converted with an extension of an existing property and are situated to the south of Birmingham. The home is located close to public transport links. The building is divided into two units, Heathside and Walkers Lodge. There are car parking facilities to the front of the premises and an enclosed garden area to the sides and rear. The accommodation provides a mixture of single and shared rooms. All bathing facilities are shared, although some bedrooms have en-suite toilets. There are communal dining areas and lounges on the ground floor, together with the kitchen, offices and laundry, large conservatory (designated smoking area) and some bedrooms. The first floor consists of bedrooms and bathing/toilet facilities but has no communal space and is accessed by stairs or shaft lift. Fees vary and are dependent on the needs of the service users. Items not covered by the fees include toiletries, private treatments such as physiotherapy Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.2 Page 5 and chiropody, hairdressings and newspapers. People who are funded by social services are expected to provide a third party top up fee. People who pay privately are also expected to contribute the RNCC nursing determination. For up to date fee information the public are advised to contact the home. Heath House Care Centre DS0000024852.V378864.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 that people who use this service experience Adequate quality outcomes. We visited the home unannounced in December 2009. We completed a Key Inspection which means we inspected the homes performance against most of the National Minimum Standards. We were at the home for two days. Since the last inspection in May 2009 when the home was rated poor we have undertaken 4 Random Inspection visits to the home to secure improvements and the results of these visits are also reported in this report. We looked at the information we had received about this service whilst we planning the inspection. Information comes to us from notifications sent by the home and meetings that we have attended. During the inspection we case tracked three peoples care. This means we looked at all the homes records about the person, their medication, any money held on their behalf and their bedrooms. We looked around parts of the building. We also looked at other records about the safety of the building, complaints accidents and so on. We completed a Short Observational Framework for Inspection (SOFI) because some of the people in the home are unable to verbally tell us about their experiences, we use a formal way to observe people to help us understand. The SOFI involved us observing four people who use the services for one and half hours and recording their experiences at regular intervals. This included their state of well being, how they interacted with staff members other people who use the service and the environment. The results of this observation are included within this report. We also spoke to two visitors to the home and six staff as well the manager of the home. What the service does well: There is a good amount of information collected about peoples needs before they are admitted into the home and this helps to ensure that these needs are met. There were good interactions between staff and people that live in the home. People had their personal hygiene needs met and wore clothes that were well laundered and reflected their tastes. Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.2 Page 7 People have a good selection of food and are assisted to make choices. There are good systems in place to ensure residents’ finances are protected. Staff are recruited well and have the appropriate checks to ensure they are safe to work with vulnerable people. The home was clean and fresh on the day of the inspection. Appropriate health and safety checks and inspections are done to ensure gas, electrical, fire and lifting equipment safety. What has improved since the last inspection? What they could do better: Information about the home needs to be reviewed so as to detail the changes to the service. Directions for people to gain entry into the home could be improved to ensure that new visitors know how to get into the home. Once admitted they can be shown where to sign in and where the person they are visiting is. Care plans need to be more personalised so that they manage peoples mental health conditions, behaviour and activity needs better. Care plans need more detail about the persons previous experiences and lifestyle. Reviews of care Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.2 Page 8 plans need to take account of what has happened to the person in the last month so decisions can be made about what is working well for the person. The home needed to develop further an environment that promotes the activity and wellbeing of people with mental health conditions including dementia and staff need in depth training so it becomes part of their practice. The home needs to have available for inspection the medicines returned book so that a full audit of medication can be undertaken. Although the home has a formal complaints procedure more informal methods of collecting the views of people, their relatives and professionals is needed to improve the service. Where formal surveys are used more detail in recording is needed so any trends can be found to improve the service. Although generally the building is meeting peoples needs some further improvements could be made to assist people to know where they are in the building, toilet and bathing facilities. Staff received training but systems were not always in place to ensure that copies of certificates were on file and the training matrix updated. Some changes are needed in admission procedures and practice to ensure the home can demonstrate they have considered the Mental Capacity Act and the potential deprivation of liberty when people are admitted. 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. Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 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 Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 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): 1,3,5 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. People cannot be fully confident they have all the information they need in an easy form for them to understand and make a decision about the home. Information is collected about peoples needs before admission and this assists the home deciding how to care for the person. EVIDENCE: The homes statement of purpose and service user guide are available and displayed. The manager of the home advised us these documents need to be reviewed to ensure that the information is up to date. There have been a large number of changes in the service since the last key inspection in May 2009 including the home having a new manager and responsible individual. In addition there have been changes to how the home is organised and these Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 Page 11 details need to be available to new people admitted to the home and their representatives. Any changes made should also be made to the audio cassette versions. The manager needs to look at other ways to provide information for people that have mental health needs such as dementia. There is a written admission procedure that states that people should come to visit the home before admission. This does not always happen. This means opportunities are missed to assess how the person manages within the homes environment, to introduce a staff member who will oversee the admission and to determine whether the person is willing to be admitted. The admission procedure needs to show what steps need to be undertaken if a person does not want to be admitted but does not have the capacity to make this decision so that the home acts within the terms and provision of the Mental Capacity Act. We looked at the information collected for two people before they were admitted to the home. The information included the persons health conditions, how they communicate and the contact details of people that are important to the person. Details of the persons mental health difficulties or dementia were recorded and what effects this may have on providing personal care. In addition information about what the person likes to do, eat and so on was also collected. This information was sufficient for staff to be able to determine what care may be needed for the person when they come into the home. The admission procedure suggests that peoples skin condition is looked at to ensure that there are no pressure areas or injuries. However for one person this was not recorded until two weeks after admission and this needs to improve. No intermediate nursing care is provided at the home. Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that their immediate heath and social care needs are met. However further development is needed on mental health and dementia care to ensure that people have the benefit of a specialised service. People can be assured that medication is administered well and this helps to ensure peoples health and well being. EVIDENCE: The service provider expects for each person to have care plans based on the assessment completed before the person moves into the home and risk assessments taking place such as skin integrity, nutrition, falls, moving and handling and body mapping. Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 Page 13 We looked at the care plans and risk assessments for three people and found that care plans were in place for the conditions that were identified in the assessment. We found that people had lots of care plans, in one case 29 which showed the home were aware of the needs of the people they care for. Some plans were no longer needed for example where people had achieved a good weight or the condition was short term. There were repeated care plans in one persons file; two plans were found for asthma and a number for challenging behaviour. This can make it difficult to review the whole care plan properly. Information collected was individual to the person such as likes comments about their hair but sometimes this information was not put into the care plans. Plans needed to be more individual to the person especially for people with dementia focussing on what skills people may retain, what is important to them and any triggers to behaviour that is challenging. We look at the reviews of care plans and found that these took place on a monthly basis. However these reviews did not bring together what had happened to the person in the last the month. For example a fall recorded on an accident form, information about whether a hearing test appointment had undertaken and the outcome of treatment of a skin rash. This information was not recorded in the monthly evaluation. This can mean that important changes in peoples condition and behaviour can be lost. We looked at the outcome of these plans for people in the home. We did this by undertaking a Short Observational Framework Inspection (SOFI), other observations, checking the plan against other records and talking to staff. We found that plans sampled asked for certain monitoring to take place at set intervals such as being weighed weekly and having blood pressure taken daily. However these actions were not always done and recorded. Some contacts with health professionals that had been identified we unable to find the outcome and needed further clarification from staff. We looked at arrangements for maintaining good skin health (tissue viability) and found that where plans were made for a specific number of pillows and a specific mattress these were in place. This helps to ensure that people are comfortable and their skin health needs met. At the last key inspection in May 2009 there were concerns identified about the management of good skin care. Since that inspection the service provider has provided mattresses and cushions above the specification suggested by the community tissue viability nurses and this helped to minimise the risk of pressure sores. We spoke to qualified staff who told us they had received training in tissue viability. We looked at how peoples nutrition care was managed and found that the home had improved their records of what people had eaten and were better at identifying when peoples weight caused concern. Referrals were made to doctors and a decision made whether dietary supplements or a referral to a dietician were needed. Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 Page 14 We looked at how the home was providing mental health care in the home. We were told that the home had a dementia plan based on something to do, something to see and somewhere to go in the environment and that the home was going to train staff in Montessori methods. This would ensure peoples involvement in aspects of daily home life. Our observations showed that the home had some way to go to achieve these aspirations. (Please see Environment, Daily Living and social Care Sections and Staffing sections.) Although staff were observed to be kind and when spoken with had some knowledge of conditions, we did not find that staff had the level of training or the skills needed to provide this type of care at this point. Most staff had undertaken dementia awareness training and challenging behaviour training. However more in depth training and planning is needed. The manager told us that they are expecting a review of the mental health care they give people from January 2010. The home has recently employed a unit manager based on the Walkerside unit which cares for people with mental health conditions such as schizophrenia and bi polar disorder. Training records did not indicate that specific training had been given to help staff to care for people with these conditions. People were dressed in individual styles that were appropriate for their generation. People appeared to have their laundry needs and personal hygiene needs met. At the last key inspection in May 2009 there were concerns about medication administration. A Pharmacist inspector visited the home three times to secure evidence of improvement in July, September and October 2009. We issued a statutory requirement notice for the home to improve their medication administration and this was met in October 2009. On the day of the inspection a representative from the Primary Care Trust was auditing medication and we spoke to him. He found that the medication administration remained improved and the only issue he wished to raise was a missing return of medication book. We spoke to the manager about this who stated that it was missing and that they would ensure it was found. Audits are undertaken about medication however we note that is not an area that is checked and commented upon in the visits by the representative of the service provider. During the SOFI we watched staffs interactions with people living in the home. We found that staff approached people in a calm and sensitive manner. There were no negative interactions seen between staff and people living in the home. Where people had negative interactions or showed sign of ill being this was in response to other people living in the home. During the SOFI 50 of the time people exhibited signs of wellbeing and 17 people were asleep. One persons observation was stopped as they left the lounge for the majority of the time of observation. Staff engaged with people to carry out day to tasks of providing drinks and snacks and all people were offered some activity if they Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 Page 15 were awake. People were allowed to get up and walk if they needed or wanted to. Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 Page 16 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that they will be offered choices in food and this helps peoples nutrition. People have a choice of activities but these are not always representative of peoples past interests or experience. EVIDENCE: We, looked at the information held about peoples previous interests, looked at records kept about activities people have been involved in, observed during the SOFI and spoke to staff. The home has an activities co-ordinator covering both units and another is starting shortly. We found that the amount of information about peoples previous interests varied and that some people were unable to talk about their interests themselves. Not all people with memory problems had a life history book and this collection of information is important to make sure activities relevant to Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 Page 17 the person are provided and to understand some behaviours people may have. The activities assessment information collected tended to limit peoples activities to those that were available in the home rather than looking more widely at experiences the person may have had in their lifetime. The method of recording the activities people have undertaken does not allow more than one activity per day. Records sampled for November 2009 indicated that a range of activities. There is also a sensory room that some people enjoy. People were observed in the main lounge on one of the units and we saw that people were offered the opportunity to play cards or dominoes. We only had the opportunity to speak to two visitors to the home. One told us it was their first time in the home. They were let into the home after pressing the intercom but got to the persons bedroom before they were approached by a member of staff. They did not realise that there was a reception area but were brought the visitors book to sign. Instruction for entry to the home may be useful for visitors. (See Environmental Standards) They said that they would have liked the opportunity to speak to their friend privately rather than in the main lounge of the unit. We observed that other people were visiting their relatives in the main lounge areas. The other person was a health professional that was looking at the medication administration and this is reported under Health and personal care section. People were observed to move around the ground floor unrestricted within their unit, there are locks on doors to the outside and this is to protect people. People have access to walking aids as and when they wish. People have a choice of food at every meal time and there are picture representations of the main options so people are assisted to choose. There is a four week menu so that people have variety in their diet. People are presented with some food six times a day this assists people that walk a lot during the day get the food they need to keep well. Breakfast options include cereals, toast and cooked foods such as scrambled eggs, beans and so on. There is a mid morning snack consisting of a drink and biscuits. The lunchtime meal consists of a hot meal such as chicken in sauce or savoury mince served with vegetables and potatoes. There are biscuits cakes or Danish pastries available mid afternoon. At tea time there is a light hot meal available or soup and sandwiches. Finally there is a supper menu which includes sandwiches biscuits and so on. If people are hungry through the night there are sandwiches and biscuits available. We observed that throughout the day drinks are given to people and where necessary records are kept of the amount people eat and drink. There are meals provided to meet peoples cultural needs if they wish. We observed staff interactions over meal times and found that staff were not always focussed on talking to the person whilst assisting them to eat. We also noted one occasion where Weetabix was given to a person rather than the Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 Page 18 Shredded Wheat asked for without explanation. People with mental health difficulties and or dementia have difficulty expressing choices and these care issues need to improve to ensure that peoples wishes are met. We also noted that at the time one person eating staff were cleaning around them and this is not acceptable. Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 Page 19 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home can be assured that systems are in place to keep them safe. People and their representatives cannot be assured that their comments and views on the service are collected in a way to develop the service further. EVIDENCE: We have received no complaints about this service since the last key inspection. We looked at the homes complaint records and found one recorded. Although we could see that the person making the complaint had been met with, they had to contact the service again to find out what the outcome of their complaint as they hadnt received a written response. There was no information to state whether the complainant was happy with the response. Representatives of the service provider visit the home regularly and a report is written at least monthly. These reports indicate that some people and visitors are spoken to however there is little detail of these conversations. There are few systems in place to get views from people as they happen such as whether activities are enjoyed or not and peoples opinions on the food provided. A large number of people living in the home may not remember if asked later. There was little to indicate that peoples representatives were involved in the way the home could improve. Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 Page 20 We had concerns since the last key inspection about the response to repeated physical incidents between people that live in the home and accidents. This resulted in us issuing statutory requirement notices to ensure that there were appropriate safeguards for people living in the home. We found at this inspection the home were now ensuring that accidents were appropriately recorded and incidents between people living in the home were referred to social services. As a result of these referrals peoples care needs have been reviewed and measures put in place to manage these incidents. The frequency of safeguarding incidents appears to have lessened. We also noted that management are referring where staff performance in an issue within the home or with other professionals this helps to keep people safe. Staff records and discussions with staff indicate that staff have had training in safeguarding and are aware of their responsibilities to keep people safe. Staff are recruited appropriately and this means that they have good checks before working with vulnerable people. Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 Page 21 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): 19,22, 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe comfortable environment that generally meets their needs. People may experience difficulties finding their way around the home and know where they are. EVIDENCE: The home has a level access entry on the ground floor. There are two bells on the front of the home; an intercom which is available during office hours and a bell which sounds inside the home at other times of day. There are no instructions with these for people visiting the home for the first time. (Please see Daily Life and Social Activities section) A reception area has been created from an office to the left of the entrance hall. The signage to this area was not good enough for visitors to immediately Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 Page 22 notice it was there. However if visitors are directed there it gives a better first impression of the home. The home is divided into two units Heathside for people with dementia and Walkerside for people that have mental health difficulties. Staff generally work on one unit to get to know the people that live on that unit and to gain expertise with the difficulties those people may have. There are a number of sitting areas on each unit and this allows people to choose where they sit. One area on Heathside unit main lounge is not easily viewed and during the SOFI a person kept approaching another person in a way that could have led to an incident out of the view of staff. There are limited communal toilet facilities for people on Heathside and this was mentioned to us. Twenty five people have en-suite toilet facilities (all single rooms) and further toilets are available in all bathrooms and shower rooms but access to toilets for people who spend most of their day in lounges needs to be considered. Assisted bathing facilities are not generously sized and are difficult to access with a hoist. Not all baths are utilised. Some people find bathing therapeutic when in pain or stressed. For older people baths may be more within their experience rather than showers. We found that there were curtains in assisted bathrooms and shower rooms to ensure that peoples dignity was maintained. Doors to bathrooms and toilets are one colour and have signs on the door to help people recognise what is behind the door. People do not have information to assist them when they come out of the bedrooms to where key places are. Most bedrooms viewed were personalised there were odours in two rooms viewed but no where else in the home. The home was appropriately maintained and any shortfalls we identified were completed on the day. Some of these shortfalls should have already been reported by staff so that they could have been addressed before the inspection. One bedroom door needed to be looked to ensure that the door closed well enough to protect against fire. Key areas of the home such as the lounges have been redecorated and refurbished. Under the homes plan to have something to see, something to do and somewhere to go further developments are needed to ensure that these are in place. Some thought needed to be given to ensure that displayed items are relevant and evoke good memories for people. We looked around the home and found that generally the home was clean, comfortable and fresh. The homes kitchen had been inspected by the Food Safety Department of Environmental Health in March 2009 and the home had been given a 5 star excellent rating. Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 Page 23 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. There are enough staff to ensure care for people living in the home. Further specific training in peoples mental health conditions would ensure a more specific service. EVIDENCE: We looked at the staffing rotas and found that on an average week there were at least 3 nurses working over the two units but usually four. There was on the day of inspection 8 care staff, an activities co-ordinator, a handy person, domestic, laundry and catering staff. This appeared to be sufficient to meet the needs of the people in the home. We are aware that there has been some staff turnover and this can unsettle the home. We looked at the recruitment records of three staff and found that staff had appropriate checks undertaken before they were employed. Staff completed an application form, made declarations as to their health and any criminal convictions, references were obtained and checks were completed with the Criminal Records Bureau. These measures help to keep people safe. These could be enhanced by ensuring that all references are dated as they are received. Staff files were not always up to date. For example one staff file did not have a copy of a risk assessment undertaken of staff and another evidence Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 Page 24 of immigration status change. Copies of all training certificates were not kept on file. We were given a matrix of the training that staff had undertaken. We found that this gave us some information but did not accurately reflect all the training and competency assessments that had been undertaken for example in medication administration and tissue viability. Information about peoples attainment of the National Vocational Qualification level 2 in care was not recorded. This is the qualification recognised by us to determine that people have received training about the care people need and are able to deliver it. We found that there was insufficient training in skills based dementia care to enable staff to move to providing a more individualised service. We talked to staff and found that whilst training in challenging behaviour had been given there was little known about non-violent crisis intervention strategies. Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 Page 25 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): 31,33,35,37,38 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. This home is providing a generally appropriate and safe service. Developments are needed to ensure that the service develops a specialised service to meet the needs of all the people that live there. EVIDENCE: There has been no Registered Manager in the home since November 2008. The current manager has been employed by the service provider since the end of July 2009 but realistically in post at the end of August 2009. She is intending to become the registered manager of the home. The service undertakes Quality Assurance audits and a representative of the service provider visits the home on a regular basis and produces reports. Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 Page 26 These help to ensure a quality of service. The service provider arranges for surveys to be sent to people that live in the home, their relatives and professionals. However there was a low return rate of the surveys and there was little detail of the comments made. The annual report was not available on request. There is also little space for detail on the visits of the service provider records (Reg 26 visits) to detail comments from relatives, staff and service users and this information may assist in improving the service. Staff meeting records indicate that performance issues are raised with staff however expectation and consequences were not always clearly recorded. We looked at a sample of records of money that was held on behalf of people living in the home. There are computerised records of money that each person has asked the home to keep safe. Money is kept in a specific bank account for people with a small amount of money available in a petty cash system for when people want it. Receipts were kept for any service or goods that the home purchased on behalf of a person. Peoples money is usually brought in by family but for some people this is sent by solicitors or by social services. Receipts are given for any money or cheques brought into the home. Money was usually spent on services such as hairdressing and chiropody. Money is usually only available when the administrator or manager is available unless a person has an expected expense at the weekend. There were no people living in the home that were subject to a deprivation of liberty authorisation at the time of the inspection. Details of how to apply for a Best Interest Assessment under the Mental Capacity Act were in the office with local contact details. Admission procedures had not been updated to include an assessment of peoples willingness to be admitted to the home and this may be important given the homes registration. ( see Choice of Home.) We looked at a number of health and safety records for gas, fire, water and lifting equipment safety and found that these services were maintained and inspected as required. We also looked at the records of accident and incidents held by the home. We found at inspection of the home in July 2009 and subsequently that these records were poor and this resulted in statutory requirement notices. At this inspection we found that these had improved with accidents and incidents being consistently recorded across records of people and where necessary these had been referred to specialists or social services. Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 Page 27 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 2 X 3 X 1 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 3 Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 Page 28 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 12(1)(a) Requirement Individualised care must be in place for each persons mental health need including dementia. This is to ensure that people have care that preserves their skills and abilities. Details of courses attended and copies of certificates must be kept on staff files. This is to ensure that staff have up to date training. Training for staff on dementia care should be sufficient to ensure that appropriate care can be given. Training for staff on the care of people with mental health needs must be sufficient to provide appropriate care. Care manager must submit an application to be registered with the commission Timescale for action 30/04/10 2 OP30 19 sch 2(5) 31/01/10 3 OP30 18(1)(c)(i ) and 12(1)(a) 30/04/10 4 OP31 9 31/01/10 Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 Page 29 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 OP1 Good Practice Recommendations The Service User Guide should be reviewed and amended to reflect the changes in the service. The Service User Guide should be available in pictorial form for those residents that might find the information more accessible in this format. This remains outstanding from April 2008. People should be encouraged to visit the home before admission so the home can determine how best peoples needs can be met and to assure themselves of the persons willingness to be admitted. Reviews of the care plan should take into consideration all events that have affected the person since the last review. This is to ensure that the care plan is still working for the person. The homes medication returns book must be available for inspection when requested. The home should review its activity provision to ensure it meets the needs and wishes of people living at the home. Following these review strategies should be put in place to ensure changes take place in relation to activities. 6. 7. 8. OP13 OP16 OP21 This remains outstanding since the last inspection Access to the home must be reviewed to ensure this enables appropriate people to be admitted quickly. Management of complaints should be improved so that minor dissatisfactions are captured to improve the quality assurance of the home. A review of the toilets and bathrooms should be undertaken to ensure the best practical arrangement to meet peoples needs. A review of the signage in the home should be undertaken to assist people who live in the home. Records of staff meetings should indicate how issues raised are to be resolved and at the next meeting indicate DS0000024852.V378864.R01.S.doc Version 5.3 Page 30 2. OP5 3. OP7 4. 5. OP9 OP12 9. 10. OP22 OP32 Heath House Care Centre 11. 12 OP33 OP37 whether the measures put in place have been successful. Clear action plan should be developed from any audit and survey of the service provided. The services admissions procedure must take into account the Mental Capacity Act considerations. Heath House Care Centre DS0000024852.V378864.R01.S.doc Version 5.3 Page 31 Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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