Care Home: Heathercroft

What the care home does well All the written and verbal feedback we received from the people who use the service, their professional representatives, and staff that work there was extremely complimentary about the standard of care provided at Heathercroft. The service also continues to benefit from being consistently run by a suitably competent and qualified management team who between them have a lot of experience being in day-to-day charge of a residential care service. Typical comments we received from staff about the managers leadership approach, included - `the manager is a good listener and always on hand to offer us advice and support`, `the manager is lovely - shes knows her stuff`, and `the manager and her deputy work well together and are both very approachable`. A social care professional who completed our survey, added - `the manager of Heathercroft has excellent management skills and a good rapport with her staff team.` Care plans remain person centred and focuses on the individual`s strengths and personal preferences. They celebrate the individual, their life experiences, and set out in detail how all their current requirements and aspirations are to be met through positive individualised support. People who use the service are continually consulted about, and actively encouraged to get involved in the day-to-day running of Heathercroft - where they are willing and capable of doing so. The service also has a very `can do` attitude in respect of encouraging the people who use the service to do more for themselves and actively supports individuals to take `reasonable` risks as part of the process of promoting greater informed choice and independence. For example, we observed a number of staff using pictorial aids and verbal prompts to actively encourage and support the people who use the service to choose what they wanted to eat and drink, prepare their own hot drinks and meals, and clean up after themselves. All the social, leisure, and recreational activities the people who use the service have the chance to participate in each day, both within Heathercroft and the wider community, remains extremely varied, `age` appropriate, and stimulating. We observed all the staff on duty throughout this site visit interacting with the people who use the service in a very caring, respectful, and professional manner. It was also positively noted that the service continued to function well in the managers absence and a lot of initiative was shown by all those staff who were on duty at the time of this inspection, which included a number of relatively new and temporary staff. Finally, the atmosphere remained extremely relaxed and congenial throughout the course of this site visit. What has improved since the last inspection? This section of the report summary is not applicable on this occasion because this is Heathercrofts first key inspection since being taken over by Odyssey in 2009 and reregistered with us as a `new` service. What the care home could do better: All the positive comments made above notwithstanding the services manager acknowledged in the AQAA that there remains room to continue improving Heathercroft and the lives of the people who live there. At the end of this report we have made two requirements for the provider to address and a number of good practise recommendations for them to consider: It was evident from all the written and verbal feedback we received from the manager, staff who work there, and other social care professionals the services physical environment was the single biggest concern stakeholders had about Heathercroft. In the main the people who use the service live in a very homely, safe, and clean environment, but there remains considerable scope to improve its interior decor. The provider should establish time specific rolling maintenance programmes to ensure the rather `shabby` looking front door, skirting boards in the entrance hall, and the stairway banister are all repainted; as well as have the rather `outmoded` ground floor shower facility and all the kitchen units replaced. This will ensure the people who use the service live in a more aesthetically pleasing environment. The name, address, and the relevant qualifications and experience of the new owners of Heathercroft must be included in the services Statement of Purpose. This will ensure anyone with an interest in Heathercroft can assess all the information they need to know about the new providers. All the staff that work at the service must receive up to date basic food hygiene and infection control training. This will ensure the safety of the people who use the service. The services on-call arrangements should be reviewed as a matter of urgency as it is not currently clear which members of staff are designated as on-call each night and whether or not they would be able to reach Heathercroft in sufficient time to effectively deal with any emergencies that arise. Clarification regarding the services on-call arrangements is urgently required to ensure the people who use the service are kept safe at night. The way in which the provider ensures its policies and procedures are kept up to date so they continually reflect `best practise` should be reviewed because the majority are not being sufficiently amended at regular enough intervals. This will ensure the rights and best interests of the people who use the service are safeguarded. Key inspection report Care homes for adults (18-65 years) Name: Address: Heathercroft 43 Old Lodge Lane Purley Surrey CR8 4DL     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lee Willis     Date: 0 8 0 3 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 32 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 Adults (18-65 years) 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Heathercroft 43 Old Lodge Lane Purley Surrey CR8 4DL Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Odyssey Care Solutions For Today Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The regsitered person may provide the following category/ies of service only: Care home only (PC) To service users of the following gender: Either Whose priamry care needs on admission to the home are within the following categories: Learning disability (LD) Date of last inspection Brief description of the care home Heathercroft is a residential care service that offers accommodation and personal support for up to six younger adults with learning disabilities. All five of the people who currently reside at Heathercroft are males. The service has been operating for many years, but was re-registered by us when Odessey Care Solutions for Today took over from Surrey and Borders NHS Trust in November 2009. The services registered manager, Joanne Mingo, has been in operational day-to-day Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 5 Brief description of the care home control of the service for the past two and a half years. Located in a quiet suburban street south of Purley the service is within easy walking distance of a wide variety of community based facilities and services, which includes shops, restaurants, cafes, and banks. The service has its own transportation in the form of a people carrier and a number of bus routes and a local train station are all very nearby ensuring the people who use the service have good links to Croydon and the surrounding areas. This two-storey detached property comprises of six single occupancy bedrooms located over two floors, a main lounge, dining room, kitchen, outside laundry, and first floor office. There are sufficient numbers of toilets, baths, and shower facililties located near peoples bedrooms. The large garden at the rear of the property is well maintained and there is plenty of space on the front drive for parking. More detailed information about the facilities and services provided at Heathrcroft can be found in its Statement of Purpose and Guide. Care Homes for Adults (18-65 years) Page 5 of 32 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Heathercroft has been an excellent performing service for many years, and although we recently re-registered it because new providers took it over, very little else has changed with regards the way it is run. From all the available evidence gathered during the inspection process it was evident this service still has a substantial number of strengths and a sustained track record of delivering excellent quality care. Furthermore, the service continues to recognise what it could do better and manages improvement well. We therefore still rate Heathercroft as a three star residential care home and the people who live there continue to experience excellent quality outcomes. We spent four hours at Heathercroft on a Wednesday between 10.30 in the morning and 2.30 in the afternoon. During this site visit we met three people who use the service; and spoke at length to four members of staff, which included a full-time senior support worker, a long serving bank shift worker, a relatively new member of staff, and a temporary agency worker. We also looked at various records and documents, Care Homes for Adults (18-65 years) Page 6 of 32 including the care plans for two people who live at Heathercroft. The remainder of this site visit was spent touring the premises. Six of our have your say comment cards were returned to us by three people who use the service with support from their keyworkers, two more came back from staff who work there, and one was completed by a social care professional. As part of this inspection process we asked the services manager to complete our Annual Quality Assurance Assessment (AQAA), which she did as we had requested. This self-assessment tool tells us what the service is providing, how it ensures excellent outcomes for the people who live there, and any future development plans the providers may have. We would like to thank all the people who contributed to the inspection process for their time and input. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Adults (18-65 years) Page 8 of 32 All the positive comments made above notwithstanding the services manager acknowledged in the AQAA that there remains room to continue improving Heathercroft and the lives of the people who live there. At the end of this report we have made two requirements for the provider to address and a number of good practise recommendations for them to consider: It was evident from all the written and verbal feedback we received from the manager, staff who work there, and other social care professionals the services physical environment was the single biggest concern stakeholders had about Heathercroft. In the main the people who use the service live in a very homely, safe, and clean environment, but there remains considerable scope to improve its interior decor. The provider should establish time specific rolling maintenance programmes to ensure the rather shabby looking front door, skirting boards in the entrance hall, and the stairway banister are all repainted; as well as have the rather outmoded ground floor shower facility and all the kitchen units replaced. This will ensure the people who use the service live in a more aesthetically pleasing environment. The name, address, and the relevant qualifications and experience of the new owners of Heathercroft must be included in the services Statement of Purpose. This will ensure anyone with an interest in Heathercroft can assess all the information they need to know about the new providers. All the staff that work at the service must receive up to date basic food hygiene and infection control training. This will ensure the safety of the people who use the service. The services on-call arrangements should be reviewed as a matter of urgency as it is not currently clear which members of staff are designated as on-call each night and whether or not they would be able to reach Heathercroft in sufficient time to effectively deal with any emergencies that arise. Clarification regarding the services on-call arrangements is urgently required to ensure the people who use the service are kept safe at night. The way in which the provider ensures its policies and procedures are kept up to date so they continually reflect best practise should be reviewed because the majority are not being sufficiently amended at regular enough intervals. This will ensure the rights and best interests of the people who use the service are safeguarded. 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. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 people who use the service and others enquiring about it do not have access to all the information they need to know about the new owners and organisational structure at Heathercroft. Prospective users of the service can be confident that they and their representatives will have the opportunity to find out about the facilities and services offered at Heathercroft through planned visits and that the views of all the relevant parties will be taken into consideration when deciding whether not to accept a new referral. Evidence: Staff we met were able to provide us with a copy of the services most up to date version of its Statement of Purpose. The document had been reviewed in the past year and contained the vast majority of the information it should, but will need to be amended again to reflect all the changes that have taken place in the last six months since the new providers have taken over. The name, address, relevant qualifications, and experience of the newly registered providers, and their organisational structure, must all be included in the services Statement of Purpose and Guide. Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: All the staff we met told us the service still had one vacant bedroom and that no placements had broken down since its last key inspection, which the manager of Heathercroft had stated in the AQAA. An experienced member of staff we spoke with about the services admissions process was adamant that it was custom and practise to allow all new referrals and their representatives the chance to meet all the people who lived and worked at Heathercroft; tour the building; stay for a meal; and possibly sleep over - before any decisions about moving in on a trial basis are ever taken. This member of staff was also clear that the views of all the people who live at Heathercroft would be taken into account when assessing the suitability of any new referral. A social care professional who returned our survey told us the services assessment arrangements ensure that accurate information is gathered and that the right service is planned for the people who live at Heathercroft. The manager stated in the AQAA that all five of the people currently residing at Heathercroft are funded by a local authority and have been supplied with costed contracts that set out their individualised terms and conditions of occupancy. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are very person centred and can be easily understood by the people who use the service, and staff that work there, thus ensuring all the relevant parties have access to all the up to date information they need. The service has developed excellent arrangements to enable the people who use it to be consulted on, and participate in, all aspects of life at Heathercroft. The service has a very can do attitude when it comes to supporting the people who use it to take responsible risks as part of a structured programme to promote their independent living skills. Evidence: We looked at two care plans in depth. Both these plans were very person centred and available in an easy to read pictorial format that the people who use the service could Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: understand. All the staff who completed our surveys and who we spoke with about the services care plans told us they always contained all the most up to date information they needed to know about the people they supported and what each person unique strengths, preferences, and goals were. It was also evident that care plans are developed with the full involvement of the people for whom they are intended. Both the plans we looked at contained very detailed information about the communication needs of these individuals and what their preferred methods of communication are. Staff we met told us care plans are reviewed at regular intervals and every year a live plan meeting is held to which the person for whom the plan is intended, their relatives, and professional representatives are all invited. The manager wrote in the AQAA - we strive to give everyone living in the house the opportunity & forum to contribute in all decision making processes. The minutes of the last two meetings held at the service involving the people who lived there revealed they were being held at regular intervals, were well attended, and the agendas covered every aspect of life at Heathercroft. In addition to these meetings, staff we met told us people who use the service are invited to help plan the forthcoming weeks menu every Monday. During a tour of the premises we were particularly impressed with the easy to read and understand pictorial information boards conspicuously displayed in the dinning room, which made it clear what meal choices were available that week, what activities were scheduled to take place and who was responsible for various household chores each day. One individual who lives at Heathercroft used these pictorial boards to show us what meals they planned to eat that day and what activities they were going to be doing. All the people using the service who returned our surveys told they could usually make decisions about what they did during the day, in the evening, and at the weekend. A social care professional who returned our survey told us the service always supports the service users to live the life they choose wherever possible. It was evident from the practises we observed during this visit that it was customary for the people who use the service to do as much for themselves as they were capable of doing. For example, we observed staff at various times actively encourage and support the people who use the service to clean up after themselves, prepare their own hot drinks and meals with varying degrees of assistant provided as and when required, and put away their coats when returning from community based activities. One individual who completed our survey with the support of their keyworker told us I enjoy being supported to cook the evening meal sometimes and a social care professional wrote - very impressed by the proactive attitude of staff and the way they motivate the people who use the service to do as much for themselves as they Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: can. The two care plans we looked at contained detailed information about what they needed to do to minimise the risk of the people who use the service being harmed, as well as the support they each required to enable them to maintain and develop their independent living skills safely. For example, management strategies we saw set out clearly how staff should support people who use the service to take responsible risks and pursue their various leisure interests, which included horse riding, travelling abroad, and preparing their own hot meals and drinks. The service is commended for having such a can do attitude toward promoting informed choice and independent living. Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The social, educational and vocational activities the people who use the service have the chance to participate in each day, both at Heathercroft and in the wider community, remain extremely meaningful, varied, and age appropriate. The service continues to offer the people who use the service a real choice of nutritionally well-balanced and varied food and drink at meal times, which meets everyones specific dietary requirements and tastes. Evidence: The two care plans we looked at in depth both contained very detailed information about the spiritual needs and wishes of these individuals. They also covered equality and diversity issues well and included information about peoples sexual orientation and disability for instance. Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: On arrival we noted the majority of the people who use the service were out attending various educational courses and leisure activities at a number of day centres and community based colleges. These activities matched the information displayed on the pictorial activity schedule in the dinning room. An individual who uses the service was able to show us what they planned to do that afternoon from a picture displayed on the activity notice board. Written records contained in the two care plans we were case tracking indicated the people who use the service can choose to live very different social lifes, which some individuals choosing to be far more active that others. It was evident from the comments made by the people we met who use the service that their individualised care plans and weekly activity schedules reflected their unique social interests and expectations. Daily diary notes maintained by staff revealed the people who use the service had been offered the opportunity to go horse riding, cycling, on day trips to the coast, attend concerts, and visit a TV studio. During the visit we observed staff respond positively to an individuals request to play football with them in the garden. All the written and verbal feedback we received from staff who work at Heathercroft and other social care professionals with an interest in the service were all extremely positive about the social and educational opportunities people who lived there had the chance to participate in each day. Typical comments included - we take the people using the service out a lot, the entertainment is good here, this service has an excellent proactive approach to ensure everyone has a full timetable of activities based on their interests and is good at seeking out appropriate college and educational placements. On arrival the member of staff in charge of the early shift checked my identification badge and invited us to sign the visitors book in accordance with the providers visitors policy and best security practises. All the staff we spoke with about visiting times told us the service has an open visitors policy and that some of the relatives of the people who use the service often popped in unannounced. Staff we met also told us relatives are always invited to attend their loved ones care plan reviews and the various social events held at Heathercroft, which included a fancy dress party and summer barbeque last year. It was evident from entries made in daily diaries notes kept for one individual that as identified in their care plan staff regularly take them to visit their relatives where they sometimes stay overnight at the weekends. We noted that throughout the curse of this site visit none of the communal areas, which included the kitchen and toilets, were ever locked, although we aware that the service does operate a locked door policy for the bedrooms, front door and office. This restriction on peoples freedom of movement has been risk assessed and approved by Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: all the relevant professionals involved with the people who use the service as being in their best interests. Staff we met told us they try and reduce the impact this restriction has on the people who use the service by ensuring they immediately open any locked doors on request. We observed all the staff on duty the day we visited unlocking bedrooms doors to allow people who use the service to gain access to their own personal space. A member of staff we spoke at length too told us people who use the service can spend as much time as they choose in their own company and are able to lock their bedrooms doors from the inside, which staff can override if they need to in the event of an emergency. Furthermore, all the staff we observed enter a bedroom always knocked on the door before going in. On arrival we observed one individual enjoying elevenses in the dinning room. This individual told us they liked the food at Heathercroft. Later that morning we observed staff supporting one person who uses the service to make a hot drink and another help an individual to choose what they wanted for their lunch from all the foodstuffs stored in the kitchen, as well as help them make it. The kitchen was well stocked with a good cross section of varied foodstuffs, which matched the meal choices advertised on the weeks planned menu. Staff we met were very aware what everyones food and drink preferences were, which could easily be identified in the care plans we viewed. The weeks menu choices were conspicuously displayed in easy to read pictorial form in the dinning room, which were nutritionally well balanced on the whole. Care Homes for Adults (18-65 years) Page 18 of 32 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. The service has developed some good arrangements to ensure the people who live at Heathercroft receive all the personal and health care support they require and in the way they prefer it to be provided. The people using the service are protected by the homes policies and procedures for dealing with medicines stored by staff at Heathercroft on their behalf. Evidence: All the people we met who use the service were suitably dressed in well maintained clothes that were appropriate for their age and the time of year. We observed one person who uses the service ask staff to open their bedroom door so they could change get changed to go out. A social care professional told us staff at Heathercroft always respect the privacy and dignity of the people who live there. The member of staff in charge of the early shift was able to produce health care action plans on request for the two individuals care we had decided to case track. These plans set out in detail the dates and outcomes of all the appointments these individuals had attended with various health care professionals. It was clear from the information contained in these plans that the staff continue to actively encourage and support the Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: people who use the service to have regular checks with all the relevant health care professionals, such as GPs, community based nurses, dietitians, dentists, opticians ect... A social care professional who returned our survey told us the staff at Heathercroft always properly monitors, reviews, and mets the health care needs of all the people who use the service and seeks advice as and when required to improve their well being. The service also maintains up to date records of any incidents and accidents the people who use the service are involved in that adversely affects their well being and/or health. Senior staff we met confirmed a number of accidents had occurred within the service in the last year, which had all been appropriately dealt with by staff on duty at the time. These staff also demonstrated a good understanding of which parties other than those that worked for the providers needed to be notified without delay about the occurrence of such incidents. Our records indicate the service continues to let us know without the delay about any significant incidents and/or events that affect the well being of the people who use the service. No recording errors were noted on any of the Medication Administration records (MAR sheets) in current use at the service. These records accurately reflected stocks of medication currently held by the home on behalf of the people who live at Heathercroft. Staff in charge of the early shift told us to minimise the risk of medication errors occurring the service uses a Monitored Dosage System and senior staff carry out regular medication audits at least once a week. All the medication currently held by staff on behalf of the people who use the service are stored away in a locked metal cabinet securely fixed to a wall in the dinning area. Senior staff we met confirmed that as stated in the AQAA the service does not currently stock any as required behavioural modification medicines or Controlled Drugs. All the staff who returned our surveys told us the training they had received gave them enough knowledge about the health and medication needs of the people using the service. A social care professional told us the service always manages medication correctly where is not not possible to enable people to administer it themselves. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 service has good arrangements in place for dealing with complaints, which ensures the people who use the service and other major stakeholders feel any concerns they may have will be listened to and acted upon. People who use the service are kept safe because staff understand what constitutes abuse and know what to do if they witness or suspect it. Evidence: Senior staff we met told us that as the manager had stated in the AQAA the service had not received any complaints about its operation in the past year. All the people using the service who returned our surveys told us they knew who to speak to if they were not happy about anything at their home and how to go about making a complaint. Furthermore, all the staff who returned our surveys also told us they knew what to do if someone has concerns about Heathercroft. All the staff met demonstrated a good understanding of what constituted abuse and knew who they needed to notify without delay if they suspected or witnessed it occurring within the service. Staff also told us they had received training on how to prevent, recognise, and report abuse and/or neglect. Both the senior staff in charge of the early and late shifts that day said they were not aware of any safeguarding issues occurring within the service in the past twelve months. Care Homes for Adults (18-65 years) Page 21 of 32 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 people who use the service live in a safe and clean environment, which is also relatively homely, although there remains considerable room to improve the interior decor of some of the communal areas. This maintenance work needs to be carried out within agreed time frames to ensure the people using the service live in a much more comfortable and aesthetically pleasing environment. Evidence: During a tour of the premises we noted the services furnishings and fittings were domestic in appearance, which gave the place a very homely feel. However, we also noted all the units in the kitchen and the ground floor shower facility had all seen better days, and the front door, skirting boards in the hallway, and stairway banisters all looked rather shabby and could do with repainting. All the staff we spoke with about the interior decor of the services communal areas agreed this was an area the provider could significantly improve. Furthermore, a social care professional who returned our survey told us the service would be better - if they had decent accommodation. Senior staff we met told us the services manager was aware of these issues and was currently liaising with the new owners to upgrade the interior decor of Heathercroft. We recommend the new provider establishes time specific rolling maintenance programmes to redecorate a lot of the communal areas,and replace outmoded facilities, such as the ground floor shower unit and kitchen cupboards. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: We viewed two bedrooms with the people who currently occupied them. One person who uses the service told us they liked their bedroom and they had everything they needed. These rooms were decorated and furnished to a relatively good standard and looked very different to one another to reflect the unique tastes and lifestyles of the two individuals who occupied these spaces. It was also positively noted that one bedroom we viewed had been suitably adapted to keep the person who uses it safe from avoidable harm. The service was spotlessly clean throughout and smelt fresh. Its washing machine is capable of washing clothes at appropriate temperatures to comply with infection control standards and is located in a separate building to the side of the house which ensures no laundry has to be taken through areas where food is prepared, stored or eaten. All the people using the service who returned our surveys told us their home was always kept fresh and clean. One member of staff wrote in our survey- this home is always kept very clean. Care Homes for Adults (18-65 years) Page 23 of 32 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 service employs sufficient numbers of competent staff on a daily basis to ensure the needs and wishes of the people who use the service are met by staff who know them, although its nighttime on-call arrangements should be reviewed and clarified. Support workers receive regular support from their line managers, as well as on going training, which ensures most staff have the right knowledge and skills to do there jobs effectively, although more staff still need to up date their basic food hygiene and infection control training. Staff recruitment arrangements are also sufficiently robust to protect the people who use the service. Evidence: All the staff we met during the course of this site visit were observed interacting with the people who use the service in a very kind, respectful, and professional manner. We observed several numbers of staff take into account the views of the people who use the service and then act upon what they had asked for. All the people who use the service who returned our surveys told us the staff who worked there, including the manager, always treated them well and listened to them. One individual wrote - staff look after me here. Other comments we received from staff who completed our surveys included - the team works well together and weve got a good staff team here. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: The manager stated in the AQAA that only one support worker had left Heathercroft in the past year, which represents a very low rate of staff turnover. All the staff we met demonstrated a good understanding of the unique needs and preference of the people they were supporting that day, which included a number of relatively new and temporary staff. One such member of staff who we informally interviewed told us the induction they had recently received on their first day at Heathercroft had been very thorough and had covered the needs of the people who used the service and health and safety practises. This individual demonstrated a good understanding of the services fire evacuation procedures and knew where all the fire exits and external assembly points were when questioned about them. The majority of staff who returned our surveys also told us there were usually enough staff on duty to meet the individual needs of all the people who use the service. On arrival we found three support workers on duty, which corresponded with the numbers indicated on the duty rosters for early shifts. The senior in charge of the early shift told us there is always a minimum of three staff on duty during the day. At night the service has one waking staff on duty with a second person off site, but on-call to cover emergencies. Staff we met all told us they would not necessarily contact the person designated as on-call on a particular night if they did not live nearby, but instead would call those staff who they knew were able to reach Heathercroft within twenty minutes or so. Senior staff we spoke with both told us they could not recall the last time the on-call system was used as it was such a rare occurrence. Nonetheless, the services on-call arrangements will have to be reviewed as they currently lack clarity and there remains a question mark about how practical they are if staff who do not live within twenty minutes of Heathercroft can get there in time to support a waking night deal with an emergency. The manager wrote in the services AQAA that no one is permitted to commence working at the home before all the relevant pre-employment checks have been obtained in respect of them and these checks are satisfactory. All the written and verbal feedback we received from staff confirmed it was custom and practise for all pre-employment checks to be carried out on all new recruits before they could start working at Heathecroft. The manager told us all ten of her permanent staff team have completed additional induction training, which their new employer recently introduced when they took over at Heathercroft. All the staff who returned our surveys told us their induction had either covered everything or most of the things they needed to know to do the job when they started. Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: The manager also wrote in the AQAA that the service has developed an on going programme that ensures all its permanent staff team are suitably trained to perform their work and that nearly three-quarters of them have achieved an National Vocational Qualification in care (Level 2 or above). All the staff who completed our surveys and who we met during this site visit told us they were given enough training, which was relevant to their role; had helped them understand and meet the individual needs of the people using the service; and had kept them up to date with new ways of working. Furthermore, these members of staff all agreed that they had enough support, experience and knowledge to meet the different needs of the people who currently live at Heathercroft. A social care professional who completed our survey also told us staff who work there all have the right skills and experience to support the people who use the service. However, the manager did acknowledge in the AQAA that less than a third of her current staff team had received training in preventing and controlling infection and only half had attended a basic food hygiene course. These gaps in staffs basic knowledge and skills must be rectified as soon as reasonably practicable. All the staff we met and who had completed our surveys told us they regularly received one to one supervision sessions with their manager approximately once every six weeks and were also expected to attend staff meetings with their peers every two months or so. Senior staff we met told us in addition to regular supervision and team meetings their overall work performance is also appraised on an annual basis and any gaps in their training discussed. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service continue to benefit from living in a home that is extremely well run by a competent management team. The providers have established some good quality assurance systems which enables all the people who use the service and their representatives to express their views and influence the running and future development of Heathercroft. The rights and best interests of the people who use the service are not safeguarded sufficient by the homes policies and procedures which are not being reviewed at regular intervals and up dated to reflect the new owners philosophy of care. The services fire, and Health and safety arrangements are sufficiently robust to safeguard the welfare of the people who use the service, their guests, and staff. Evidence: We received a lot of positive feedback from the staff who work at Heathercroft about the managers approach to running the service. Typical comments included - the Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: manager is a good listener and always on hand to offer us advice and support, the manager is lovely - shes knows her stuff, and the manager and her deputy work well together and are both very approachable. A social care professional who completed our survey, added - the manager of Heathercroft has excellent management skills and a good rapport with her staff team. Staff we met told us senior representatives of the provider carry out inspections of Heathercroft approximately every six weeks or so as part of an effective quality monitoring programme. Staff were able to provide us with copies of these inspection reports when we asked for them. In addition these reports, the people who use the service and their representatives are invited to complete the providers own satisfaction questionnaires at least once a year to ascertain their views about how they feel Heathercroft is being run. The manager wrote in the AQAA that approximately a third of the services policies, procedures, and codes of practise had not been reviewed for well over three years and that none had been up dated in the past six months since Odyssey Care Solutions took over the running of Heathercroft from Surrey and Borders NHS Trust. We recommend the new provider develops a time specific action plan to review and amend all its policies and procedures years in order for them to reflect current best practise. The manager wrote in the services AQAA that the premises electrical circuits; portable electrical equipment; fire detection and alarm; fire fighting equipment; emergency lighting; heating system; soiled waste disposal; and gas appliances - have all been served and/or tested in the past year as recommended by the manufacturer or other regulatory body. Fire records revealed the services fire alarm system continues to be tested on a weekly basis and fire drills are being carried out every quarter to comply with recommended good fire safety practises. It was positively noted that all the fire safety notices in the home were available in easy to read pictorial formats and conspicuously displayed throughout Heathercroft. All the staff we met demonstrated a good understanding of the services fire evacuation procedures. All the fire resistant doors we tested at random closed flush into their frames when we released them and none were being inappropriately wedged open. The temperature of hot water emanating from a first floor bath was found to be a safe when we tested it just after lunch. Staff told us they regularly check the temperature of all the homes water outlets. Care Homes for Adults (18-65 years) Page 28 of 32 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 Adults (18-65 years) Page 29 of 32 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 1 4 The name, address, and the 01/05/2010 relevant qualifications and experience of the new owners of Heathercroft must be included in the services Statement of Purpose. This will ensure anyone with an interest in Heathercroft can assess all the information they need to know about its new owners. All the staff that work at the 01/07/2010 service must receive up to date basic food hygiene and infection control training. This will ensure the safety of the people who use the service. 2 35 18 Care Homes for Adults (18-65 years) Page 30 of 32 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 24 The provider should establish time specific maintenance rolling programmes to improve the services interior decor and have the front door, skirting boards in the hallway, stairway banister all repainted; as well as having the old shower facility on the ground floor and kitchen units all replaced. This will ensure the people using the service live in a more homely, comfortable and aesthetically pleasing environment. 2 33 The services on call arrangements should be reviewed as a matter of urgency as it is not currently clear which members of staff are designated on call each night and whether or not it would be practical for them to reach Heathercroft in sufficient time to deal with an emergency. Clarification regarding the services on call arrangements is urgently required to keep the people who use the service safe at night. 3 40 The way in which the provider ensures its policies and procedures are kept up to date so they continually reflect best practise should be reviewed because the majority are not being sufficiently amended at regular enough intervals. Thus will ensure the rights and best interests of the people who use the service are safeguarded. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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