Care Home: Heathercroft Care Home

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What the care home does well People living at Heathercroft live in a welcoming and comfortable homelike care home, which has been improved to offer brighter more comfortable living areas. Flooring in the corridors, dining and lounge areas has been replaced. The corridors, lounges and dining areas have been redecorated and offer a brighter decor. A garden room has been created so people living at the home have a conservatory like room to sit in. This means they have more choice where they spend their day and free time. New dining and lounge furniture has been provided. A new 24 bed facility had also been built next to Heathercroft called Ashberry House that offers care to people living with dementia. People living at the home made positive comments about Heathercroft and Ashberry House and said, "You can`t say more than to have a recommendation from the district nurses. They knew I was worried about leaving my wife and said I would get excellent care here. I have only been here a few hours but feel I am treated really well, not special but normal". Another person said, "I call this the premiere care home, the people of which I am one are well looked after and receive excellent care. The staff are really thoughtful, kind and lovely girls, who are respectful. Being here is nice". There is a training programme so staff were being provided with training and support to do their jobs. There is a stable staff group who have positive attitudes to the people living at Heathercroft which means that people are treated with dignity and respect. Appropriate staffing levels are provided so people living at the home were supported and had their needs met. The personal care and health needs of people living at the home are met to a good standard so they are supported to maintain their personal appearance and hygiene. Visitors are made welcome and visitors` comments support this. A varied menu is available so people living at the home can choose different meals and have a cooked breakfast if they wish. Regular health and safety checks of the building are carried out as well as a continuing programme of redecoration, refurbishment and replacement so people living at the home live in a safe and well maintained building. What has improved since the last inspection? The addition of accommodation for people living with dementia and decoration of Heathercroft has made the home brighter so people that use services live in a more welcoming home. The purchase of new furniture and replacement of flooring has improved the comfort of the home so people living at the home have a more comfortable place to live. Signs put up in Ashberry House and Heathercroft to help people living the home recognise their bedrooms, toilets and bathrooms have improved so people can recognise their surroundings more easily. Improvements have been made in how information is gathered and recorded about the needs of people at the home and the care and support they need so staff have more information about when to provide care and support for them. What the care home could do better: Further work should be done to develop the information gathered about people`s mental health needs so that staff have as much information as possible with which to plan care and support for each person living at the home. Support or care plans plans of people living at the home should include more information about them and how they want their care to be arranged around their lifestyle choices and routines. The way in which decisions about daily living that people living at the home make are reflected in their care plans should be improved so that staff understand these decisions and how important they are to people. This will help to make sure that agreements about how people living at the home make or are supported to make decisions are clearly understood. People living at the home should be provided with more opportunities to be involved in recreational and social activities of their choice so they can live fulfilling lives. The arrangements for how staff are organised to provide support and care and monitor the health of people in Heathercroft should be revised so people do not have to wait for their personal care to be attended to and we are confident the needs of all people living at the home are monitored and attended to without delay. Quality assurance should improve so people living at the home are able to raise concerns and things they want to change or improve so the home is managed more effectively and the welfare of people using it is promoted. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Heathercroft Care Home Heathercroft Care Home Longbarn Lane Woolston Warrington Cheshire WA1 4QB     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: Anthony Cliffe     Date: 0 8 0 9 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 33 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 33 Information about the care home Name of care home: Address: Heathercroft Care Home Longbarn Lane Heathercroft Care Home Woolston Warrington Cheshire WA1 4QB 01925813330 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) : tperry@ashberry.net Ashberry Healthcare Ltd. care home 87 Number of places (if applicable): Under 65 Over 65 0 87 dementia old age, not falling within any other category Additional conditions: 87 0 The registered person may provide the following category of service only: Care home with nursing - Code N To people of the following gender: Either Whose primary care needs on admission to the home are within the following categories Old age, not falling within any other category - Code OP Dementia - DE The maximum number of people who can be accommodated is: 87 Date of last inspection Brief description of the care home Heathercroft is a purpose built care home set in its own grounds in the Woolston area of Warrington. The home provides nursing and personal care for up to 87 older people whose needs result from their age, physical condition and living with dementia. It is on a main bus route and has easy access to local shops, churches and a library. The home has 87 single bedrooms mainly on the ground floor but 12 are situated on the first floor of the neighbouring Ashberry House. Ashberry House is a 24 bed care Care Homes for Older People Page 4 of 33 Brief description of the care home home for people who live with dementia which opened in 2008. Ashberry House has bedroom, bathing, lounge, dining and catering facilities on each floor. In the main building Heathercroft there is a large main lounge, an activities lounge, a smoking room, and recessed seating areas in some corridors. There is a large dining room, a hairdressing salon and garden room. Weekly fees to live at Heathercroft range from three hundred and eighty two pounds to five hundred and seventy pounds per week. Information about the home can be obtained by contacting the manager or administrators by telephone or visiting the providers website. Care Homes for Older People Page 5 of 33 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: References to we, our or us represent the Care Quality Commission This unannounced visit took place on 7 and 8 September 2009 and lasted over twelve hours. One inspector carried out the visit. This visit was just one part of the inspection. Other information received was also looked at. Some weeks before the visit the manager was asked to complete a questionnaire called an annual quality assurance assessment (AQAA) telling us what they thought they did well, what they needed to do better and what they had improved upon since our last visit, to provide us with up to date information about the services at the home. This helps us to determine if the management of the home see the Care Homes for Older People Page 6 of 33 service they provide in the same way we do and if our judgements are consistent with home owners or managers. During our visit we looked at various records and the premises. People living at Heathercroft, relatives, staff and senior managers were spoken with and gave their views about the service. We provided questionnaires to people living at the home, staff and health and social care professionals involved in their care so they could tell us their views about the service the home provides. In July 2008 we did an annual service review of the home, which told us the home was still providing a good service. An annual service review is a summary of our knowledge about how a service that has not had a visit in the last year is still performing. It is also how we decide if a service is still as good as we thought it was since our last visit or annual service review. What the care home does well: What has improved since the last inspection? The addition of accommodation for people living with dementia and decoration of Heathercroft has made the home brighter so people that use services live in a more welcoming home. The purchase of new furniture and replacement of flooring has improved the comfort of the home so people living at the home have a more comfortable place to live. Signs put up in Ashberry House and Heathercroft to help people living the home recognise their bedrooms, toilets and bathrooms have improved so people can recognise their surroundings more easily. Improvements have been made in how information is gathered and recorded about the needs of people at the home and the care and support they need so staff have more information about when to provide care and support for them. Care Homes for Older People Page 8 of 33 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. 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 33 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 33 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. Important information is gathered about peoples needs before they move into the home so they can decide if staff at the home can provide the right care to meet their needs. Evidence: We saw that the home provides information to people living or moving in there in an information pack. The pack contained information about the facilities and services available at the home as well as how care could be arranged so people choosing a home could decide if their needs could be met there. This information is called the service user guide. The pack also contained information about the type of needs the home could care for and the arrangements to make sure that the right support and care could be provided for each person when they moved in. This information is called the statement of purpose. The information pack also contained details about the organisation that owns the home as well as information about meals and activities Care Homes for Older People Page 11 of 33 Evidence: available so people choosing a home had other useful information to help them make a decision about living there. This information can be made available in different ways such as large print to help people read it more easily. The manager confirmed a brochure is being put together which will contain photographs of the home as well as pictures, symbols and short explanations about the services provided so people with memory problems can have information made available for them. People choosing a care home are encouraged to visit the home and can have a trial period so they can decide if they want to live there and the home meets their expectations. We could see that before people moved into the home information was gathered about their needs so they could decide if the home was right for them. Information gathered before people moved into the home was obtained from people themselves where possible, their relatives and others with an interest in their care. This means as much information as possible would be provided on which to make decisions about each persons care. The information we saw that had been gathered about people before they moved into the home was detailed and included some information about peoples routines and lifestyles. We saw this covered information on their physical and mental health, how they communicated with people, maintaining their safety, managing finances, help with personal care, and some information about their life histories so staff had information about the people they cared for and supported. Information has also been gathered from health and social care professionals involved with the person so staff would know what their health and social needs were. The form used to gather information about peoples needs did not cover the needs of people living with dementia so would not have important information about how these people would need to be cared for and supported. Care Homes for Older People Page 12 of 33 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. People are supported to be safe and well although it is not clear whether they are as involved as they should be in decisions about their everyday routines and care. Arrangements for administering medicines to people living at Heathercroft are good so that people receive their medicines safely. Evidence: Since our last visit to the home, changes have been made and people living with dementia are accommodated in Ashberry House, which is next door to Heathercroft. Staff with mental health qualifications had been employed to provide support and to give guidance to other staff about the mental health care of the people living at the home. Since our last visit a new document to gather information about peoples needs had been developed. We could see this was very detailed and when completed by staff would provide lots of useful and important information. This was then being used by staff so they could provide the support and care that each person needed. We could Care Homes for Older People Page 13 of 33 Evidence: see some examples that showed that a person centred approach to care was being used at the home but staff do not use person centred thinking and planning to make sure that the care people living at the home receive is based on their needs and choices. Person centred planning is a really good way for people using care services to take control of their lives. Person centred thinking helps staff providing care and support to listen to people and then help them to do things in the way they prefer. A person centred plan contains information on what is positive about people; for example, what people like and admire about them and their gifts and talents. Information should be included about what and who is important to people living at the home from their viewpoint, as well as what people want for their future. A person centred plan should have information about how people want to be supported to stay healthy, safe and well. This is called a support plan but may be called a care plan. This should be detailed enough to provide a good description of how each person living in the home wants to be supported, how they make decisions and says who will do what by when. The information the manager sent to us before our visit said that care plans were individual to people using the service and included personal routines and choices about personal care. The care plans we saw said some positive things about how people could help themselves but did not tell us how people wanted their care to be arranged, how staff would provide support or care to help them to care for themselves or if care was arranged or planned around their daily routines. So care based on their personal preferences was not always provided. For example, the care plans did provide staff with guidance on supporting people to remain independent by encouraging them to attend to their personal care and saying how people helped themselves. Reviews of peoples care contained lots of personal information about how they cared for themselves and lifestyle choices they made, so we could see staff used a person centred approach to care. Staff at the home had been gathering some information about the life histories of people living there but this information was not reflected in the care plans we saw so staff did not have information to provide individual care. Care plans were very detailed and guided staff to help and support people but did not reflect a person centred approach and only contained little information on how people could care for themselves or be involved in their personal care. We could not see examples of how people living at the home had chosen their daily routines or followed their preferred lifestyles. Care plans were kept in offices in each of the buildings so we could not see how people had been involved in writing their own care plan. This means that people would not know what was written in their care plan and perhaps would not be able to understand some of the words used in them. Care Homes for Older People Page 14 of 33 Evidence: We saw that staff treated people living at the home with courtesy, dignity and respect. They sought their views about how they wanted to be supported and we saw staff help people to make decisions. We saw care plans refer to staff making decisions for people but did not see information about how people living at the home made decisions for themselves. If people living at the home could not make decisions because they lacked capacity, experience or judgement to make them, we could not could not see anything recorded to confirm why, when, where and how staff supported them to make decisions. This means that it was not clear what decisions staff had made for people living at the home or had helped them to make for themselves. We could see that where there were restrictions such as bed rails or electronic locks on doors being used, the reasons for this were recorded so people living at the home, their relatives and staff would understand why such decisions had been made. Care plans contained important information about the health of people that use services. An example of this was when a person living at the home had moved in from hospital and had a history of falling and injuring themselves. The staff at the home had written records called risk assessments, which are records that tell staff and others if people place themselves or others at risk of harm or being hurt because they may not realise they are doing so. Risk assessments have plans to prevent people from harming themselves by accident. The person who had a lot of falls before they moved to the home had not had any since 2008 so staff were making sure he was safe and following the guidance in the risk assessment to help prevent falls. The local doctors surgery provided medical support for the people living at the home which meant that their healthcare needs were looked at regularly. Information was being gathered about how much people living at the home were eating and drinking, how much they weighed, if their skin was in danger of breaking down, their ability to mobilise and walk, if they were at risk of falling as well as their ability to care for themselves. This means that staff had information on which to base health care and support. Psychological services are provided to help staff at the home provide appropriate care for people living with dementia. Medication policies and procedures were detailed so staff understood their responsibilities and accountability for their actions when administering medicines to people living at the home. Both Heathercroft and Ashberry House had similar medicine storage facilities and used the same policies and procedures. Medicine fridges were used, with the operational temperatures regularly recorded so staff knew these were operating safely. Each storage area contained the policies and procedures for medicine administration with specimen signatures of staff responsible for administering medicines. We looked at the arrangements for the ordering, receipt, administration and disposal of medicines and controlled drugs and found no errors. This showed us Care Homes for Older People Page 15 of 33 Evidence: that people living in the home were receiving their medicines safely. We talked to staff who were administering medicines about the arrangements for giving out medicines during mid morning. Staff who carried this out told us they were often disturbed by other staff asking for advice, taking telephone calls or seeing to visiting social and health care professionals. This meant the medicine round could take a few hours. At Ashberry House medicine administration was arranged around the routines of people living in the home so staff did not do a large medicine round. The manager agreed to look at the medicine administration practise in the home to make sure this was arranged around the needs of people living at the home. Care Homes for Older People Page 16 of 33 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. People living at Heathercroft are supported to make everyday choices but could be offered more opportunities for recreational and social contact so they have control over and lead more fulfilling lives. Evidence: An information board at the main entrance home displayed information about events taking place inside and outside of the home as well as the range of activities available in the home. There were many pictures of people being involved in activities in the home and proudly displaying pictures they had done and things they had made. This also displayed the complaints procedure as well as cards of thanks from relatives. Outside entertainment was provided by visiting entertainers. Local clergy visit the home to speak with people living there and hold regular religious services so they have opportunities to practice their faith. The activities organiser had worked with some people living at the home to make mementos of events or things they enjoyed to celebrate their lives so people who visited the home and staff had important information about their life achievements. Care Homes for Older People Page 17 of 33 Evidence: We saw these displayed outside peoples bedrooms and they provided profiles of things people had achieved or enjoyed that other people and staff could talk with them about. In Ashberry House, the activities coordinator had made displays of activities that people living at the home had been involved in and where they had received certificates of achievement so had a memento of things they had done. At the time of our visit two activities co-ordinators were employed at the home for a total of 60 hours a week so there was some one to plan and encourage people to do activities. We saw staff involved in some activities during the day so people living at the home had some opportunities for social and recreational contact. We saw some people reading newspapers and magazines, watching TV and listening to music. We saw staff in Heathercroft occasionally sitting and talking with people and in Ashberry House staff were constantly sitting and talking with people living at the home. We saw in Ashberry House that there was usually a member of staff sitting in the communal areas of the home but in Heathercroft, this was not usual so people living at the home did not always have contact with staff. We saw people living at the home were sleeping at times during the day so were not engaged in doing anything. Activities were planned mainly on the days the activities organiser worked so were limited to Monday to Friday but some activities had taken place at the weekend in August and September when the home had a garden fete and pet therapy was arranged for weekends. Activities also include exercise, arts and crafts, trips out, gardening, pampering and baking. Before our visit seven people living at the home returned surveys to us that said activities were usually or sometimes arranged that they could join in. One person said activities were never arranged. During our visit we spoke with people living at the home and we sat in communal areas to see how staff interacted with people living at the home. In Heathercroft we sat in the large communal lounge for two hours. During this time one staff member came in on three occasions to assist people living at the home back to where they were sitting after lunch. People sitting in the lounge were either sleeping or talking to one another. Two people living at the home told us there were not enough activities going on for them during the day so they were unstimulated and slept. Meals were seen to be varied and provided people with a balanced diet, with advice sought from dietitians where necessary. The menu suited a variety of tastes. As there are a number of dining areas in the home, meal times were generally quiet so staff could support people to enjoy their meals without interruption. The food provided was freshly prepared and included alternative choices of meals through the day. The menus were displayed on black boards in the dining areas. The menu covered a five week period and was changed regularly. Breakfast was a choice of porridge, cereals, fruit, Care Homes for Older People Page 18 of 33 Evidence: yogurt and toast. The menu included a choice of a cooked breakfast so people living at the home had a variety of breakfast items from which to choose. Lunch was a choice of lentil soup to start, meat and potato pie, fish fingers, mashed potatoes, mixed vegetables, and for pudding trifle or ice cream . There were stocks of cooked meats, cheeses, eggs, fruit, vegetables and a variety of frozen foods so people living at the home had the choice of other meals if they did not want the alternatives available on the day. Staff were available to assist people living at the home with their meals. We received mixed comments from people about the variety of food served. Some people described the meals as bland with too many cooked dinners, while others said the food was good and varied. Surveys returned to us by people living at the home said they usually enjoyed the meals. When we discussed this with people living in Ashberry House they said they preferred to have lighter meals at lunchtime instead of cooked dinners, and wanted more variety such as salads, pasta and curry. We saw that information about peoples meal preferences were gathered but could not see how this information was then reflected in the menu. There were no regular meetings involving people living at the home and catering staff so they were not able to voice their opinions about the quality of food. Care Homes for Older People Page 19 of 33 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. There are procedures in place for the home and staff have received training on safeguarding adults so the people living at Heathercroft are protected from abuse. Evidence: We saw that the complaints procedure was displayed in the entrance to Heathercroft but not Ashberry House so some people living at the home had access to it. We looked at the complaints the home had received and complaints received within the last twelve months had been dealt with satisfactorily. The complaints procedure is included in information about the home provided to people choosing to live there before they move in. However we cannot yet say if people with memory related problems will be able to understand the information provided or the current complaints procedure in place. Before our visit seven people living at the home returned surveys to us and five said they knew who to speak to informally if they had concerns and how to use the complaints procedure for the home. Policies and procedures were in place to protect vulnerable adults, called the safeguarding adults procedures. The safeguarding adults procedure is how we, the local council, police and other agencies respond to and manage allegations or suspicions of abuse against vulnerable adults. Care Homes for Older People Page 20 of 33 Evidence: The manager provided training records that recorded staff had received safeguarding training. Staff had received training on how to recognise and respond to suspicions of abuse so should be able to protect vulnerable adults. We spoke to three staff and they said they had received safeguarding adults training and described what they would do if they witnessed abuse or neglect or someone reported abuse or neglect to them. This meant they could respond to suspicions or allegations of abuse or neglect to make sure vulnerable adults were protected. The home had a copy of the Warrington Borough Council safeguarding adults procedure and had access to the local councils safeguarding adults training programme through the local training consortium. The home had made three safeguarding referrals to the local council since the last visit and had cooperated with the local council in the investigation of these. Care Homes for Older People Page 21 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained so that people living there do so in comfortable and safe surroundings where their health and safety is promoted. Evidence: We looked around the main building, Heathercroft, and saw improvements on the first floor. The building had been redecorated throughout with the main corridors, dining room, main lounge decorated in light colours. New flooring had been laid in these areas. A new garden room had been built so people living at the home had a bright room near to the garden to sit and relax. At the entrance to the home the administration office had been enlarged so there was more facilities for staff to carry out everyday business. The staff office had been enlarged so there was more space for them to meet to discuss the care and support of people living at the home, as well as having somewhere to discuss the care of people and meet with visitors. Dining furniture had been replaced in the main dining room. A programme to replace vanity unit tops, drawer fronts and cupboard doors in bedrooms had started. Ashberry House is a new 24 bed facility for people living with dementia. There are 12 bedrooms on each floor. All bedrooms are for single occupancy and have en suite facilities. Each floor has a small kitchen, and dining area with lounge. On the ground floor is a small quiet room and on the first floor a storage room. There are bathrooms Care Homes for Older People Page 22 of 33 Evidence: on each floor with assisted bathing facilities so people with different disabilities or physical conditions can use them. Electronic key pads are fitted to the front doors of both buildings and first floor entrance at Ashberry House to give greater security and reduce the risk of people with memory related problems leaving the building and not being familiar with the local area. We could see that a lot of new equipment had been bought and this included electric beds so people could position themselves comfortably. Care Homes for Older People Page 23 of 33 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. Good employment procedures and a varied training programme are in place so people living at the home are protected by a thorough recruitment process and a skilled staff team. Evidence: We saw the staff numbers at the home supported the needs of people living there so they had sufficient help with their needs. The home was not fully occupied and there were enough staff to provide care and support for the number of people living at the home at the time of our visit. Additional staff were on duty to assist with domestic, laundry and catering duties. The manager works at the home five days a week and is not included as part of the care and nursing staff on duty so is able to offer support and supervision to the staff team. We received comments from people living at the home, or people responding to us on their behalf, and staff that said there were not enough staff on duty to provide care for the people living at the home. Comments were that staff took time to respond to calls for assistance from people living at the home so sometimes their needs were not met or they would try to help themselves resulting in injury. Relatives of people who lived at the home said they thought there was insufficient staff to provide fluids, personal care or check on the safety of people who preferred to stay or cared for in their Care Homes for Older People Page 24 of 33 Evidence: bedrooms. We could see that at the time of the visit there was only one activity coordinator on duty and there were times when people using services in Heathercroft were sleeping and were not checked on by staff so had no contact with staff to ensure they were occupied, safe and well. The homes staff induction programme was based on standards identified by the home manager. Following this staff complete the local councils induction programme which is based on Skills for Care induction standards. These are nationally recognised standards for people who work in social care to make sure that staff understand their roles and responsibilities. There were 54 care staff working at the home at the time of our visit and 18 of these had an national vocational qualification (NVQ) in care at level 2, with another 20 staff are working toward completing one. Four staff had an NVQ level 3 in care and three staff were working toward completing one. This showed us that staff are supported to do additional training. NVQs are nationally recognised qualifications for staff working in care and show they are competent to provide good quality care. We examined the recruitment records of four staff employed at the home. Recruitment procedures were good and included staff having to complete an application form, full employment history and two references sought about their suitability for employment. The recruitment of staff also included a Criminal Records Bureau (CRB) disclosure which is a check of staff to see they are suitable people to provide personal care and support to vulnerable adults. The manager said the home used exit interviews when staff left so they can monitor why staff leave and respond to this. Staff were provided with training which included infection control, safer food handling, safeguarding adults, moving and handling, fire safety, nutrition, care of the dying, preventing pressure ulcers and medicine administration so a varied training programme is provided for staff. The manager provided us with a record for all staff training that had been planned and completed as well as having individual training files so we could see staff received regular training to be able to do their jobs. Before our visit staff returned surveys to us that said they usually received regular support from the manager and training that helped them to do their jobs, which meant they were being provided with the training they needed to do their jobs. A comment received was, Provides a welcoming, caring and safe environment for our residents. With a friendly and warm atmosphere. I think the home has improved greatly. All mandatory training in moving and handling, food hygiene, infection control, health and safety and safeguarding adults had been completed. All staff have training in infection control. Staff received training in malnutrition care and assistance with eating, safer food handling training inclusive of catering staff. Registered nurses and Care Homes for Older People Page 25 of 33 Evidence: senior care staff had completed medicine management training, end of life care and tissue viability training. Care Homes for Older People Page 26 of 33 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 home is well managed to make sure the quality of the service is being maintained and the home is safe for people to live and work in. Evidence: At the time of our visit the manager was working in the home. She is an experienced manager with several years of management experience who was appointed of manager of the home in 2007. Since her appointment she has made many improvements to the home. The manager is doing a nationally recognised NVQ 4 qualification in leadership and management. She told us that she wanted more time to develop quality assurance within the home so she could respond to concerns quickly and improve the service. A deputy manager who has specialist experience of working wider mix of experience. There are three administrators who work at the home to support the manager in the large number of day to day administrative tasks needed to run a home of this size. Care Homes for Older People Page 27 of 33 Evidence: The manager was making regular checks in a number of areas to make sure that the home was running properly, information being gathered by staff was up to date, how safety was being maintained, that staff were doing their jobs correctly and that people living there were satisfied with the care they received. This is called quality assurance and was done by doing lots of checks called audits so the manager could see how everything was working in the home. The managers checks were then checked again by her manager during monthly visits, so Ashberry Health Care, the owners, were aware of any matters in the home which needed to be improved upon and could tell the manager if she was doing a good job or needed to make improvements. The operations director from Ashberry Health Care visits the home every month to do quality assurance checks, talk with people living there, talk with staff and look at important records so they can write a report to say if the think the home is being properly managed. We spoke with the manager about how people living at the home are asked for their views about the quality of care and management at the home. The manager said the operations director sends out surveys to people living at the home, their relatives and staff so they can make comments about the management of the home. If compliments, concerns or complaints are received the manager is informed of these so she can act on them. The manager told us that in August 2008 a family forum was held at the home as a way of inviting families to the home to talk about the home so they could contribute ideas , raise concerns or become involved in the management of the home. The manager said this was due to be repeated in September 2009. As a result of the the family forum held in 2008, a garden room had been created with funds provided from a government grant. Surveys had been used in 2009 to gain peoples views about living at Heathercroft and Ashberry House. The surveys ask questions about how they were welcomed, staff attitude, being treated with dignity and respect, activities and entertainments, variety of menu and laundry and cleaning services so people living at the home can comment on the services they receive. People had said that they wanted more trips out, more walks in the local community park, that the staff were helpful, caring and welcoming and the laundry had improved. There were no regular meetings at the home with people living there, relatives and the managers to discuss things they might be unhappy with and need to be attended to without waiting for the results of satisfaction surveys or complaints to be made. For example comments received about the numbers of staff available and variety of the menu. We looked at how the Mental Capacity Act, a law about making decisions and what to do when people cannot make some decisions for themselves, was used in the home. When people cannot make decisions for themselves, this is called lacking capacity. The Mental Capacity Act sets up safeguards that must be used when a person living in a Care Homes for Older People Page 28 of 33 Evidence: care home, who cannot make decisions for themselves, is restricted in a way that deprives them of their liberty. This provides extra protection for them to make sure that anything being done is done in their best interests. Sometimes people may be stopped doing things they want to do, to give them extra protection. This may restrict them and might be done to keep them safe or protect them from harm. We saw that where restrictions had been used to promote the health and safety of people there was clear information identified about the circumstances where restrictions were used. Examples of restrictions were electronic locks on front doors to prevent people who were living with dementia leaving the home and getting lost in the local community. We could see that restrictions were used in peoples best interest to safeguard their welfare. Staff at the home or the company do not act as appointees for anybody living there or manage finances on their behalf. All the people living at the home have an account opened for them to deposit money for personal use but they or their relatives may choose not to use this facility so manage their finances themselves. Some money was held at the home on behalf of people living there so they could pay for items such as chiropody, newspapers, hairdressing and personal items. Balances were checked against the records held in the home and the amounts held tallied against the records on the computer so financial procedures were safe. Money held on behalf of people living at the home was checked every month as part of the quality assurance system so there was an independent check of financial procedures. The AQAA told us that all the required maintenance checks and health and safety checks had been completed as required so people that use services lived in a safe building. We checked the records for fire safety and found all fire safety systems were checked regularly so the safety of people that lived at the home was promoted. Care Homes for Older People Page 29 of 33 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 30 of 33 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 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 3 The document used for gathering information about people before they move into the home should be developed so that it includes information about peoples mental health needs. This will help to make sure that care and support plans are based on full information about peoples needs. Support or care plans plans of people living at the home should include more information about them and how they want their care to be arranged around their lifestyle choices and routines. The way in which decisions made by people who live at the home about their daily lives should be recorded in their care plans. This will help staff understand how important peoples decisions about their lives and future are to them so the agreements about how they make or are supported to make decisions are clearly understood. People that use services should be provided with more opportunities to be involved in recreational and social activities of their choice so they can live fulfilling lives. The arrangements for how staff are organised to provide support and care and monitor the health of people in Heathercroft should be revised so people do not have to wait for their personal care to be attended to and we are Page 31 of 33 2 7 3 7 4 12 5 14 Care Homes for Older People confident the needs of all people living at the home are monitored and attended to without delay. 6 33 Consideration should be given to providing processes by which people living at the home are able to raise concerns about things they want to change or improve. This will help to make sure that the home is run in the best interests of the people who live there. Care Homes for Older People Page 32 of 33 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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