Care Home: Heather House Nursing Home

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What the care home does well The environment of the home was generally well maintained, homely and there was a welcoming and friendly response from staff during this visit. Care planning and information about the health and medical needs of individuals is clearly available and records are detailed and give the required information about the nursing needs of the individual. Individuals the inspector spoke with were all very positive about the approach of staff describing staff as "always there when you want them" "all very good and help me when I need it". There was also very positive comments from a general practitioner who visits the home regularly saying that staff were "very responsive" and how "the standard of care has improved over the past year and it has improved quite a lot". There was real sense that staff are very committed to providing quality care to individuals in the home. What has improved since the last inspection? A number of requirements were made at the last inspections. These were looked at on this visit and it was evident from records seen that the areas of practice: medication, care plans, environment and generic risk assessments had been addressed and improvements made to meet the requirements. CARE HOMES FOR OLDER PEOPLE Heather House Nursing Home Bannerdown Road Batheaston Bath Bath & N E Somerset BA1 7PL Lead Inspector Jon Clarke Unannounced Inspection 7th May 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Heather House Nursing Home DS0000020361.V362682.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Heather House Nursing Home DS0000020361.V362682.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heather House Nursing Home Address Bannerdown Road Batheaston Bath Bath & N E Somerset BA1 7PL 08453 455741 01225 859210 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) Mrs Sally Roberts Ms Lorna Flick Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Heather House Nursing Home DS0000020361.V362682.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate 36 Persons aged 50 years and over Staffing Notice dated 10/10/2001 and as amended on 31/03/2003 applies. Manager must be a RN on parts 1 or 12 of the NMC register Date of last inspection 5th July 2007 Brief Description of the Service: Heather House is registered as a care home with nursing for 36 older persons. The home is situated in Bath Easton, which facilitates ready access to Bath. The home itself can be accessed by car or bus. There is easy access to local shops and social venues. The home is a converted older property, providing a mix of single, companion and en-suite rooms. Care is offered over two floors, with communal space in three areas on the ground floor. There is a passenger lift providing access to all resident areas. Heather House is part of the Blanchworth Care Group. Heather House Nursing Home DS0000020361.V362682.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 was an unannounced visit to the home as part of an inspection. A number of records were looked at during this visit including assessments, care plans, staff recruitment and training and those relating to health and safety practice in the home. There was also an opportunity to talk with a number of individuals who live and work in the home. A number of Have Your Say questionnaire were sent to the home before this inspection responses were received from residents, staff, relatives and health professionals. As part of this inspection the manager completed a Annual Quality Assurance Assessment (AQAA) which set out the areas of practice based around the National Minimum Standards summarising what the home does well, the evidence for this, what they could do better and how they have improved in the last 12 months. The information from the AQAA and questionnaires has been used to help make a judgement about the quality of care provided in the home. What the service does well: The environment of the home was generally well maintained, homely and there was a welcoming and friendly response from staff during this visit. Care planning and information about the health and medical needs of individuals is clearly available and records are detailed and give the required information about the nursing needs of the individual. Individuals the inspector spoke with were all very positive about the approach of staff describing staff as “always there when you want them” “all very good and help me when I need it”. There was also very positive comments from a general practitioner who visits the home regularly saying that staff were “very responsive” and how “the standard of care has improved over the past year and it has improved quite a lot”. There was real sense that staff are very committed to providing quality care to individuals in the home. Heather House Nursing Home DS0000020361.V362682.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Heather House Nursing Home DS0000020361.V362682.R01.S.doc Version 5.2 Page 7 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 Heather House Nursing Home DS0000020361.V362682.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs. EVIDENCE: Copies of pre-admission assessments were looked at and showed good information about the health and social care needs of the perspective resident. Where individuals have been discharged to the home from hospital discharge summaries are provided to the home giving current medical needs. Heather House Nursing Home DS0000020361.V362682.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care Planning and arrangements for meeting health care are generally good providing staff with the necessary information so that the health and social care needs of residents are met. The practices of the home around reviewing need to be more consistent. Arrangements for managing resident’s medication make sure that resident’s health needs are protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. EVIDENCE: A number of care plans were looked at and showed good information about care needs and associated tasks to support the individual. Risk assessments had been completed in the use of bed rails associated pressure sore assessments, nutritional assessments. Where individuals have wounds such as ulcers evaluations and specific care plans had been completed. Care plans had been signed by the individual. Monthly reviews of care plans and risk Heather House Nursing Home DS0000020361.V362682.R01.S.doc Version 5.2 Page 10 assessments however in some records these reviews had not been completed i.e. last recorded for one individual 19/02/08 in another a falls risk assessment had not been reviewed since 08/11/07. Consent for use of bed rails were not completed for one individual. The home has access to the full range of community health services such as chiropody, dietician, and opticians. The inspector spoke with a general practitioner who is “attached” to the home they were very positive about the care provided in the home and spoke of the pro-active approach of staff in responding to medical needs of individuals in the home. The arrangements for the storage and administration of medication was looked at and confirmed there was good and secure storage with controlled drugs being stored as required. Administering records were accurate with no gaps and controlled drugs records were checked for accuracy and were as required. Record of disposal is completed. The inspector spoke to a number of individuals who live in the home about the way staff responded to them i.e. when asking for support all said how staff were available when “I need them”. They all said how they felt able to spend their day as they wished “I can do as I like here” and staff “respect us” “they treat me as I like to be treated”. Staff were observed talking with individuals and this was always in a sensitive and appropriate manner. Heather House Nursing Home DS0000020361.V362682.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for meeting the social and recreational needs of residents are good and there are opportunities for residents to maintain links with family, friends and the local community. The home’s practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. EVIDENCE: The home has an activities organiser who provides activities Monday-Friday these include board games, cake making, ball games and bingo. Individuals the inspector spoke with said how they “enjoyed” what was available and thought, “there was enough going on”. There is a key worker system and staff spoke of how this provides one to one time however this is not fixed as part of their workload and this could improve the time individuals have with staff if the rota allowed for this arrangement i.e. specific key worker time for staff. Individuals spoke of their visitors being “welcomed” and how staff were always friendly and thought the home was “always inviting” to their relatives. Heather House Nursing Home DS0000020361.V362682.R01.S.doc Version 5.2 Page 12 In talking with individuals who live in the home they spoke of their ability to decide “ourselves” how they spent their day. The inspector asked one individual about getting up and she said “it is up to me” when asked if she wanted to have a lay-in and how staff responded she replied “its not a problem they always come back later when I ask them”. Individuals were very positive about the meals provided in the home how there was “always a choice” and one described the meals as “lovely I always enjoy my food”. Staff were observed assisting individuals and this was always in a sensitive and supportive manner. There was relaxed and unhurried atmosphere when dinner was being served. Heather House Nursing Home DS0000020361.V362682.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has clear procedures in place and this enables individuals to make a complaint and voice their views about the service they receive and to know that they will be listened to and actions taken where necessary. The home makes sure that as far as possible residents are protected from harm by having policy and procedure about the Protection of Vulnerable Adults and providing training to all staff in this area. EVIDENCE: In talking with individuals who live in the home they spoke of how they would talk to a member of staff or the manager if they had any concerns or worries. One individual said they would “always say something” and “the staff are very good and would do something about it”. The home has a complaints procedure that is displayed in the home and individuals said they were aware of this procedure. The home has a Safeguarding Adults policy and staff have undertaken Vulnerable Adults training this was confirmed by records and staff spoken to on the day of the visit. Heather House Nursing Home DS0000020361.V362682.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe and hygienic environment for the residents and staff. People who live and work in the home benefit from a warm, welcoming and well-maintained environment. EVIDENCE: In looking around the home it was evident that it is generally well maintained and communal areas are welcoming and homely. The manager advised that over the coming year parts of the home were due to be decorated. Individuals spoke of the home “always” being clean and on the day of this visit free from unpleasant odours. Individual’s accommodation was all personalised and well furnished with most rooms having en-suite facilities. Heather House Nursing Home DS0000020361.V362682.R01.S.doc Version 5.2 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing arrangements in the home are generally satisfactory so that the needs of residents can be met in an efficient way with care being provided by skilled and competent staff. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of resident is protected. EVIDENCE: The staffing rota for the month of January was looked at and showed that generally there are 6 staff on duty, 8-2 or 8-8 which include 2 RGNs with 5 pm, include 1 RGN. There is limited use of agency staff which helps in making sure there is continuity of care for individuals in the home. Staff spoken with on the day did feel there was not always adequate staff on duty because of the high level of needs in the home. In talking with individuals who live in the home they said that “most of the time” they felt there was enough staff though “they are always busy”. One area this may impact on is the amount of time staff can spend one to one with individuals particularly those who are unable or choose not to leave their rooms. At present the manager has no way of measuring the needs of individuals against staffing needs. Recruitment records were looked at for two members of staff the necessary checks had taken place; two references, full application with employment history and Criminal Record Bureau checks being completed for all staff. Staff Heather House Nursing Home DS0000020361.V362682.R01.S.doc Version 5.2 Page 16 complete the required training and records confirmed this: moving and handling, health and safety awareness, infection control. Heather House Nursing Home DS0000020361.V362682.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good opportunities for residents and others to express their views about the service they receive. The practices of the home help to make sure that the health, safety and welfare of residents and staff are protected. There is a failure to provide adequate and appropriate formal supervision to staff so that management can review and monitor their practice, look at performance and give staff the opportunity to express any concerns and discuss their professional development. EVIDENCE: The manager of the home has extensive experience and is a first level nurse. She has undertaken the required training to update her skills including wound Heather House Nursing Home DS0000020361.V362682.R01.S.doc Version 5.2 Page 18 management, infection control. On the day of this visit she was welcoming and co-operated fully with this inspection. Individuals the inspector spoke with described her as “someone we can always talk too” and “she is always there if we need her”. Staff spoke of not receiving regular supervision and records confirmed this they also felt that at times there was not adequate communication with no formal handover for staff and infrequent staff meeting. This was discussed with the manager at the time of this visit. Health and Safety records were looked in relation fire drills and testing of equipment they evidenced that staff receive the required training and equipment such as emergency lighting is tested as required. A fire risk assessment and emergency fire plan have been completed in consultation with the fire service and environmental risk assessments have also been completed. Evidence was provided to confirm that equipment such as hoists and baths have been maintained and regularly serviced. An environmental health inspection of the kitchen was undertaken in January 08 and two requirements were made both of these have been addressed. Heather House Nursing Home DS0000020361.V362682.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 2 X 3 Heather House Nursing Home DS0000020361.V362682.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 14 (2) Requirement Timescale for action 30/06/08 2 OP36 18 (2) The manager to make sure that all elements of individual’s care plan are reviewed. (This refers to risk assessments) The manager to make sure all 30/07/08 staff are appropriately supervised. (This refers to staff having recommended formal supervision) 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. 2 Refer to Standard OP27 OP27 Good Practice Recommendations Recommended that the manager look at using dependency scoring as a measure of informing of staffing needs of the home. Recommended that rota includes allocated keyworker time DS0000020361.V362682.R01.S.doc Version 5.2 Page 21 Heather House Nursing Home as a way of ensuring individuals receive 1 to 1 time on regular basis. Heather House Nursing Home DS0000020361.V362682.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Heather House Nursing Home DS0000020361.V362682.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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