Care Home: Heathcote

What the care home does well Heathcoate continues to provide easy access to a variety of communal areas. Bedrooms are comfortably furnished and suit the needs of their occupants. It is evident that people who use the service have brought items of furniture, photographs, ornaments and pictures with them to make their rooms more "homely" and, as a result, bedrooms are highly personalised. The staff work well with other agencies in achieving outcomes for the individual. People who use the service and visitors confirm that visiting times at Heathcoate are unrestricted. The feedback received from visitors said that they are always made to feel welcome. Feedback from those who receive the service indicates that staff make many efforts in making them feel comfortable, all stated they felt safe living at Heathcoate. A system is in place for dealing with any complaints, people who use the service expressed a degree of confidence that complaints would be listened to and dealt with appropriately. All spoken to were able to identify the registered manager. Staff are on duty throughout the day and night in numbers that are sufficient to ensure the safety of those at the home and staff training is provided to a satisfactory level. Staff are safely recruited into positions at Heathcoate, the process ensures that all relevant checks are carried out with regard to a potential employees suitability. What has improved since the last inspection? At the time of the inspection the main improvements that were under way relates to the new building works that are being carried out. Once the large extension is complete and the rest of the building refitted the environment should provide a good standard of accommodation, What the care home could do better: The manager must ensure that risk assessments are carried out in relation to the people who live at the home and the environment itself in order to ensure the safety of those who live and work at the home. The manager needs to ensure that staff have robust instructions for the use of medication on a when required basis in order to protect those who use the service from maladministration. Finally the manager needs to establish a Control of Substances Hazardous to Health register to ensure that staff have clear and robust guidance as to the risks they may take when using chemicals within the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Heathcote 6 Cecil Road Swanage Dorset BH19 1JJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: John Hurley     Date: 1 6 0 7 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Heathcote 6 Cecil Road Swanage Dorset BH19 1JJ 01929423778 01929475869 heathcoterch@fsmail.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Lisa Heather Charig,Mr Mark Charig care home 10 Number of places (if applicable): Under 65 Over 65 10 10 dementia mental disorder, excluding learning disability or dementia Additional conditions: 0 0 No more than 4 persons (within the total of 10) under the age of 65 in the category of MD may be accommodated. Date of last inspection Brief description of the care home Heathcote is registered to provide personal care for up to 10 people over the age of 65 years, and has been granted a variation to this condition to enable up to 4 persons (within the total number of 10) below the age of 65 to be accommodated and cared for. The home is registered to Mr and Mrs Charig who live on the top floor of the premises with their family; Mr Charig is the registered manager and Mrs Charig also works within the home. Heathcote is an older style property, situated in a quiet residential road close to Swanage town centre where there are a number of shops, restaurants and other Care Homes for Older People Page 4 of 28 Brief description of the care home facilities including public transport buses. The home has a large garden to the rear and smaller garden with off road parking at the front of the home; additional unrestricted parking is available on the road. Residents accommodation is on the ground and first floors; the owners private accommodation is on the second floor. Access between the first and second floor is by a central stairway and passenger lift from the ground floor. Communal areas include a lounge and an adjoining dining room with patio doors providing access to the rear garden. The home has a laundry equipped with a washing machine and tumble drier. Arrangements can be made for a hairdresser, chiropodists, opticians and other health and social care professionals to visit individual residents. The fee range quoted in the service user guide at the time of inspection was £450 to £625 per person per week. Up to date fee information may be obtained from the service. Additional charges are made for hairdressing and chiropody. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was undertaken over the course of one day in July 2009 by one inspector. The focus of the inspection was to look at relevant key standards under the Commission for Social Care Inspection ( now the Care Quality Commission) Inspecting for Better Lives 2 Framework.This focuses on outcomes for residents and measures the quality of the service under four headings; these are excellent, good adequate and poor. The judgment descriptors for the seven sections are given in the individual outcome groups and these are collated to give an overall rating for the quality of the service provided. Surveys were sent out to medical and health care professionals, staff and people who use the service. The responses have been collated and are incorporated into this Care Homes for Older People Page 6 of 28 report. The home completed an Annual Quality Assurance Assessment( AQAA) and information provided in that is also referred to in this report. We looked at three selected care files in detail, the staff files , undertook a tour of the building and looked at all the documentation relevant to the running of a care home. What the care home does well: What has improved since the last inspection? 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 set out on page 4. Care Homes for Older People Page 8 of 28 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. Care Homes for Older People Page 9 of 28 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 information provided by the home provides a good account of the services on offer. Some improvements are needed with regards to the initial assessment of need in order to ensure that people are clear as to what some of the recorded risks may be and how to safely work with individuals. People are included in the initial assessment process. Evidence: We reviewed the Statement of Purpose and Service user guide and found that they gave a good account of the services on offer at Heathcoate. The manager generally ensures that arrangements are made to carry out an Care Homes for Older People Page 11 of 28 Evidence: assessment of need, which in the main is completed prior to any person moving into the home. The documents sampled were generally well laid out and explored most of the persons needs including areas such as their social and emotional considerations. The documents also demonstrated that the individual and people important to them had been consulted about the admission. However in one case some information supplied by the local authority had not been fully considered and subsequently documented on the homes initial assessment. This meant that the risk assessments had not been carried out robustly which may have put others at risk of harm. We were informed by a visiting relative that prospective residents and their families are invited to visit the home prior to admission to establish if the home would suit their needs. They informed us that they considered that the admissions process worked well and this helped for the individual concerned to make a successful placement. The manager informed the inspector that the home does not offer intermediate care. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans illustrate peoples needs enabling staff to meet them Staff treat the people who live at the home with respect and dignity, promoting their feelings of worth as valued members of the household. The home has systems in place for managing medicines but some aspects need improving to protect residents. Evidence: We looked at the care planning documentation and found that the details on file include information about the person from a social prospective identifying their likes and interests. The management informed the us of their efforts to get more social history relating to the individual from the person themselves and people important to them. Issues relating to the individuals medical needs such as the condition of peoples skin in Care Homes for Older People Page 13 of 28 Evidence: relation to pressure ulcers are fully assessed. The results of assessments are being recorded and action taken to ensure a proactive stance to care is made. Daily fluid and food intake charts are regularly maintained where appropriate. Records evidence visits by doctors and other health care professionals. From discussion with the staff and through our observations we consider that staff offer a person centered approach and treat people as individuals. There were many examples of good practice observed where staff displayed a very patient approach for example, one person who continually made requests from the staff for items was given the same consistent response no matter who they approached. Whilst all staff work in a person centered way some of the care plans are written in a task centered way and could be improved with some further work. This was discussed with the registered manager who agreed to revisit the way plans are recorded. There was sufficient evidence to say that all of the peoples needs are kept under review. The medication was stored securely, a controlled drugs cabinet is available. A medication policy was available to all staff who administer medication, they had signed a copy of this. Medication changes were recorded on a sheet at the front of the medication administration record file and all people who live at the home were identified with photographs. Medication administration records had been correctly completed. The controlled drugs were briefly audited and found to be correct. Weekly medicine audits continue to ensure that all medicines in the home are accounted for. Staff were observed administering medicines in a safe and caring manner. One area that needs improvement is in relation to Per Required Needs medication as there was no recorded rationale for administration via this route for example, pain killers were often prescribed and dispensed for pain relief but there was no associated documentation to describe what type of pain or its location. This may lead to staff dispensing medication for pain that has yet to be diagnosed for example originally given for back pain but as staff do not have guidance individuals may be asking or taking pain relief for pains in the legs. The management of the home acknowledged the inspectors observations relating to this matter. The inspector talked with some of the people who use the service and visiting relatives. These people expressed how much they appreciated the care staff and that they considered that they were treated with respect and dignity. It was clear from observation and the time spent with those who use the service that they feel comfortable and at ease with staff. Care Homes for Older People Page 14 of 28 Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 routines of the people who live at the home are respected. Visitors are welcome and enjoy good relations with the staff The food is plentiful and home cooked Evidence: People who use the service were observed in a number of different locations. They choose when to get up and when to retire. They have free access to their bedroom and communal facilities, those that can access the wider community on their own. Those who were spoken with indicated that they were happy with their life in the home confirming having freedom of movement. Staff support them in following their preferred lifestyle. We observed good and friendly banter between staff and the people who live at the home. We discussed with the individuals how they spend their day and what activities were available. It was established that some activities are planned, some are enjoyed others Care Homes for Older People Page 16 of 28 Evidence: are not, but in the main all considered there was some thing to do if you wished to. The registered manager explained that they have the facilities to provide a range of activities and staff will provide them based on peoples interests at any given time. Whilst this may appear ad hoc this also evidences a person centered approach .Two visiting relatives expressed satisfaction with the many aspects of home life and considered the needs of their relatives to be well met. Visitors were observed entering or leaving the home. All visitors were warmly welcomed. Peoples records and the visitors book in the entrance hall demonstrate contact with family and friends as well as visits by professionals. Visitors can stay for lunch or supper as they wish. The food is home cooked and is based on what people like and need. The people who live at the home expressed satisfaction with the standards of catering. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies and procedures are in place to protect those living at the home but some need updating to reflect the local authorities expectations Evidence: The people who we spoke with informed them that they felt able to complain and said they would have no concerns complaining to any staff member should they have need to. They felt that the management and staff are very approachable and will deal with any issues, no matter how minor, there and then if they could. We sampled the adult protection policy which is in place. It contained procedures and details for contacting the appropriate authorities should any concerns or allegations be made. However the document now needs to be updated to reflect the local authorities expectations of a registered care home. The staff we spoke with were able to tell us of the correct procedure to use should they have any adult protection concerns. The training records indicated that adult protection training is provided on an ongoing basis. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst the home in its present state is adequate the work to bring the home up to a far higher standard has begun and should benefit the well being of those who live at the home. Evidence: At the time of the inspection the home was having a large extension built onto it. This work was fully risk assessed and the work was separated from the main house by a substantial barrier. The home itself was found to be simply furnished but comfortable. The internal decorations in the communal areas were found to be in need of updating. The manager explained that once the extension was finished the rest of the home would also be refitted and brought up to the same standard as the new extension. We noted that the communal bathroom was in poor condition and needed refurbishing, again plans are in place to deal with this. The kitchen was seen as more akin to a large domestic kitchen, again plans are in place to renew the kitchen with a purpose built one fit for commercial catering. We looked in a selection of the peoples own bedrooms and found that they reflected Care Homes for Older People Page 19 of 28 Evidence: individual tastes and were furnished to a good standard. People who we spoke with informed us that their rooms suited their needs. It was noted that not all windows above ground floor had window restrictors in place ,this needs to be addressed for the safety of those who live at the home. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 staff team are knowledgeable with regards to the needs of those who use the service. There are sufficient staff on the rota to meet the current needs of the people who live at the home. Evidence: We talked with the staff on duty who were knowledgeable with regards to how to meet the needs of the people who live in the home. Through discussion with those who live at the home we established that people felt their needs were being met by a staff group who respected their individuality. One person commented that they always have a laugh and joke and tease each other which they appreciate as it reminds them of how it was before they moved into the home. We sampled the staff files and found that they contained sufficient detail with which to establish the prospective employees suitability for the job. The files continue to indicate that staff have undertaken mandatory training in areas such as Moving and Handling, Food Hygiene, Infection Control and general Vulnerable adults issues. Some staff have also attended various day courses and are undertaking Care Homes for Older People Page 21 of 28 Evidence: the NVQ Award in Care at varying levels. There is evidence that staff have a formal induction into the home and its care practices. Staff stated that they enjoyed working at the home, and received appropriate support. Through discussion with the staff group and by observing the people who use the service it is reasonably clear that the staff team have empathy for the people who live at the home. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 management team at the service provide good leadership. Opportunities for developing the staff team through formal supervision, and in turn improving the outcomes for those who use the service are being lost. Evidence: The manager has been in post for some time now and provides positive leadership to the staff team. The records at the home have been updated and kept in good order. Records inspected included care records, the complaints log, accidents, medication, staff files, rotas and the fire logbook, training records, safety checks and maintenance documents. A tour of the premises found a safe and comfortable home free from obvious hazards, Care Homes for Older People Page 23 of 28 Evidence: except window restrictors as already discussed. Fire safety equipment has been serviced and tested as required. Equipment servicing records have been appropriately maintained. The feedback from the people who use the service confirmed that they continue to feel a sense of belonging living at the home and gave examples of how staff do that little bit extra to help out. They informed us that they can raise issues with the management, can identify who the manager is and are confident that issues are dealt with promptly and effectively. We looked at the staff files to establish the frequency of formal staff supervision and found this was erratic. The manager acknowledged that more time needs to be allocated to ensuring staff have the opportunities to discuss their own development and work. All substances that could be potentially hazardous to health are handled and stored safely. A record relating to what is on the premises needs to be established. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered manager must ensure that all information which may suggest a risk of harm to others is fully documented and risk assessed. To ensure the well being of those who live and work at the home 30/09/2009 2 9 13 The manager must ensure 30/10/2009 that staff have written directions for the administration of medication on a Per required Needs Basis. To ensure the safety of those who require medication 3 19 13 The registered manager must ensure that all windows on the upper floors have a restricted opening For the protection and safety of those who use the service 30/10/2009 Care Homes for Older People Page 26 of 28 4 38 13 The manager should ensure that a record of substances hazardous to health is established and maintained To ensure that staff have clear guidance as to the use of the chemicals it may use or come into contact 30/10/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 18 The management should consider reviewing the adult protection policy to ensure that it reflects the expectations of the local authority. The manager should consider caring out formal supervision of staff so that they can ensure the needs of those who use the service are being consistently met. 2 36 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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