Care Home: Heatherside House

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What the care home does well People who use the service, asked what the home does best, told us: • • • • • “Very kind. Won’t go to another home. Like it here.” “Got everything I want.” “I want to stay here. I like the food. I’ve got my own room, my own television.” “Staff are good when they speak to me and I speak to them. Food is alright. Enjoy routine of what I do.” “Alright, lovely, the food is good and I like the staff.”Heatherside HouseDS0000069209.V376544.R01.S.docVersion 5.2People who use the service show confidence and affection to the manager Samantha Gomm. There are also some good relationships between them and staff, some who have known each other for a long time. The manager and staff have shown resilience and commitment to improving the lives of the people for whom they care and support. The registered provider has ensured that there is continuing investment in the physical environment and support of the manager. People are given opportunity and support to make their needs and wishes known. How this will be achieved is planned and delivered with enthusiasm and professionalism by staff. People look very well cared for and their individuality is supported. No new staff start to work at the home unless all the checks, necessary to ensure they are safe to work with vulnerable adults, have been completed. What has improved since the last inspection? All previously made requirements are now met: • • • • Advice and instruction from health care professionals is now followed Movement of medicines is now properly recorded Staff are now better trained in conditions which affect the people for whom they care Staff are better supervised as they do their workAll health care professionals with knowledge of the home have spoken of the huge improvements in the service and outcomes for people who live at Heatherside House. Comments include: • “I am impressed with the home because of the starting point. They deserve the acknowledgement of the vast improvement they’ve made”. • “Sam Gomm has done a remarkable job”. • “Heatherside House have made noticeable efforts to provide more individualised support and routines.” Staff told us: • “I think the manager and staff have worked really hard and I have noticed a vast improvement. Documentation is much clearer, there are more activities, we have a good team of staff and the atmosphere seems warmer and the home appears more welcoming.” • “I’ve worked here for 7 ½ years and seen many changes. I think clients lives have improved greatly.” There has been continued investment in the home which is now a bright, well furnished, more homely environment which feels cared for.Heatherside HouseDS0000069209.V376544.R01.S.docVersion 5.2People at Heatherside House are now happier and the atmosphere is more relaxed. What the care home could do better: Health and safety need much more attention. All health and safety training should be provided within the recommended timescale, especially that of fire safety, and there must be risk assessment for portable heaters which have the potential to be a cause of fire. Freestanding radiators should not be used without first consulting the fire service. All medicines brought into the home must be recorded, so that a full audit is always possible. Where staff have made a handwritten entry regarding a medicine, two staff should check and record that the entry is correct. The information people receive about the home should inform them about any arrangements made for personal finances and what cost will be incurred when using the minibus. There should be a formalised training and development plan and training programme so as to ensure that all required training is completed and that which is necessary to meet individual people’s needs is undertaken. Staff should receive planned and regular formal supervision of their work to help them carry out their job with the best outcome for people who use the service. There should be a systematic cycle of planning, action and review reflecting the aims and outcomes for people who use the service. This should include the surveying of opinion from all people connected with the service. Key inspection report CARE HOME ADULTS 18-65 Heatherside House Dousland Yelverton Devon PL20 6NN Lead Inspector Anita Sutcliffe Key Unannounced Inspection 12th November 2009 09:00 Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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. Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heatherside House Address Dousland Yelverton Devon PL20 6NN 01822 854771 01822 855972 samgomm@lineone.net Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Sheval Limited Miss Samantha Ann Louise Gomm Care Home 25 Category(ies) of Learning disability (25) registration, with number of places Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning Disability (Code LD) The maximum number of service users who can be accommodated is 25. 19th November 2008 Date of last inspection Brief Description of the Service: Heatherside House is a care home providing personal care and accommodation for a maximum of twenty-five people with learning disabilities aged 18 and over, some of whom have been in care for decades and are at or approaching older age. The current ownership commenced October 2006. There is a manager and 24 hour staffing. Health care is provided through community health care services, as the home is not registered to provide nursing. This home is located at the end of a private driveway in the village of Dousland on the edge of Dartmoor. There are local amenities such as shops, pubs and post offices in the local village of Dousland and in the nearby towns of Yelverton and Tavistock. The home is a detached, two storey property, with a single storey extension and large gardens that are well maintained and accessible. The home has been going through a major, phased refurbishment for over a year and will soon be restored to three units within the home itself, each with its own laundry and kitchen facilities. Many bedrooms have been refurbished and now have en suite facilities. The Statement of Purpose and Service User Guide are available in the office of the home and the last inspection report displayed at the entrance. We were told that the current fees received are between £450 and £720 a week. There is an additional charge for personal purchases, clothing, toiletries, trips Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 5 out, hairdressing and chiropody. Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. We have collected information about the home since the previous key inspection November 2008. This included events which the home notified us about. Toward the inspection the home sent us their annual quality assurance assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We also sent surveys to people who use the service (10 were returned, completed with the help of an advocate), staff (6 were returned) and four health and social care professionals (each was returned). For this key inspection we did one unannounced visit to the home. We looked in detail at the care and support three people receive. We spoke with people at the home, key workers/support staff and the manager about their care. As part of the visit to the home we looked at all communal areas, some bedrooms, the kitchen and laundry. We were updated regarding the planned changes. Throughout the inspection the manager and all staff at the home were helpful and provided assistance. People who use the service may be described within this report as people, residents, clients or service users. What the service does well: People who use the service, asked what the home does best, told us: • • • • • “Very kind. Won’t go to another home. Like it here.” “Got everything I want.” “I want to stay here. I like the food. I’ve got my own room, my own television.” “Staff are good when they speak to me and I speak to them. Food is alright. Enjoy routine of what I do.” “Alright, lovely, the food is good and I like the staff.” Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 7 People who use the service show confidence and affection to the manager Samantha Gomm. There are also some good relationships between them and staff, some who have known each other for a long time. The manager and staff have shown resilience and commitment to improving the lives of the people for whom they care and support. The registered provider has ensured that there is continuing investment in the physical environment and support of the manager. People are given opportunity and support to make their needs and wishes known. How this will be achieved is planned and delivered with enthusiasm and professionalism by staff. People look very well cared for and their individuality is supported. No new staff start to work at the home unless all the checks, necessary to ensure they are safe to work with vulnerable adults, have been completed. What has improved since the last inspection? All previously made requirements are now met: • • • • Advice and instruction from health care professionals is now followed Movement of medicines is now properly recorded Staff are now better trained in conditions which affect the people for whom they care Staff are better supervised as they do their work All health care professionals with knowledge of the home have spoken of the huge improvements in the service and outcomes for people who live at Heatherside House. Comments include: • “I am impressed with the home because of the starting point. They deserve the acknowledgement of the vast improvement they’ve made”. • “Sam Gomm has done a remarkable job”. • “Heatherside House have made noticeable efforts to provide more individualised support and routines.” Staff told us: • “I think the manager and staff have worked really hard and I have noticed a vast improvement. Documentation is much clearer, there are more activities, we have a good team of staff and the atmosphere seems warmer and the home appears more welcoming.” • “I’ve worked here for 7 ½ years and seen many changes. I think clients lives have improved greatly.” There has been continued investment in the home which is now a bright, well furnished, more homely environment which feels cared for. Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 8 People at Heatherside House are now happier and the atmosphere is more relaxed. 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 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. Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Quality in this outcome area could not be assessed, as there have not been any new people admitted to the home since the previous inspection. Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7& 9 People using the 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’s needs and personal goals are understood and the home strives to ensure they can be met in a planned and measured way. EVIDENCE: We looked at the care plans of three people who currently use the service. Changing needs and personal goals should be reflected in a care plan so that staff are aware of how they are to help people improve their lives. Health care professionals told us through survey: “They’re developing friendly, caring and respectful relationships, offering more individually planned opportunities that are meaningful and stimulating” and “They cope well with complex clients”. We found a structured approach to care planning. Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 12 Care plans are now planned around each individual, setting out their needs, and identifying any specialist input which is required. Each plan describes how the person’s needs and wishes should be achieved and the home has taken much, necessary, professional advice where those needs are complex. This was very evident during our visit, where behaviour which was a concern had required advice and medical involvement. Staff told us they are given up to date information about the needs of people they support and care for. Most of the people who use the service are able to make decisions about their lives with some assistance. Where they are not able independent advocacy has been arranged on their behalf. People are now given much opportunity to communicate their wishes through contact with people helping them plan their care, communication groups, communication aids, a more inclusive atmosphere at the home and staff keen to listen. People are supported to take more risk and live a more independent lifestyle. However, many at the home are now elderly and have lived most of their lives subject to institutional practices. This is a barrier the manager and staff at Heatherside House continue to work against. The home reports that there is an updated in-house policy for people’s unexplained absence from the home. Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 14, 15, 16 & 17 People using the 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 more enabled to lead fulfilled lives. They appear settled and happy. EVIDENCE: We saw lots of friendly, smiling faces at the home when we visited. The atmosphere appeared relaxed, welcoming and comfortable. People were having fun. The home reports: ‘A wide range of in-house and external activities are available’ and a health care professional told us: “They offer a good in-house activity programme.” We looked at whether people are encouraged to improve their skills. We found Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 14 that one person helps with the home’s administration, and has their own computer, another organises the post, one likes to work in the garden and five go out to work at a local centre. None are in paid employment, wither inside or outside the home. We discussed this with the manager. We saw that people are able to go out into the community for shopping and entertainment. Each person had a holiday this year and people will be visiting the Plymouth Christmas lights and a pantomime. People are encouraged to make their preferences known through meetings and individual discussion. Some, with no family to support them, have independent advocacy arrangements in place. People are supported to meet any faith needs. We saw people in the home knitting, reading, chatting and spending time with each other and staff. Sitting rooms are comfortable and television reception has been improved. Some entertainment is brought into the home and the home has a sensory room for relaxation. People told us: “I like my food. Very good”, “The food is good and I like the staff” and “Food is alright”. The home employs a cook and at the moment all meals are cooked in the one kitchen. The manager and staff talked of how they have tried to expand people’s experience of different foods with some successes and some failures. Some people at the home are now elderly and not keen to try new things. However, there is a fairly varied menu and this is discussed at resident meetings. We tested one of the meals and it was tasty and much enjoyed. People receive good sized portions and are able to have snacks as they wish and are regularly seen in the kitchen. We observed people eating in one of the dining rooms. It was disappointing that meals were served plated, as people are used to. We discussed how this ‘institutional’ practice might be overcome and were told this will be considered more as new people enter the home and the additional kitchens are brought into use. Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People using the 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’s health care needs are well met with support. EVIDENCE: People’s health care needs are met through a local G.P surgery where there are several doctors, including female, so there is choice available to people. People look very well cared for at Heatherside House and it is clear that their individuality is well supported. We were told that each person has a key worker to helps them shop for clothes and personal items. Care plans provide clear information on each person’s personal care needs and how they prefer assistance to be provided. Where the person is unable to state their preferences the home tries to build up a picture of this from behaviour that indicates likes or dislikes. We received information about the home from four health care professionals who have close association with the home. One told us: “They are especially Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 16 good at communicating any health concerns to the local primary care team and follow up on recommendations made and ensuring primary and specialist health care are working together”. Another said: “They cope well with complex clients”. We saw much documentation of health care input for people, some who now have conditions associated with older age in addition to those associated with learning difficulties. Staff receive training associated with those conditions. We looked at how well people are supported with regard to medicines. We were told that currently no person at the home is able to manage their own medicines so the home does this for them. The home reports: ‘The homes medication system underwent a review and staff training was implemented’. We found that the home works closely with health care professionals where medicines review is necessary. Medicines are properly stored at the home and where a medicine needs to be taken out of the building, such as in case of emergency, this is now clearly recorded. We saw that medicine records are clear and detailed. However, where a record is hand written this is not signed by the person making the record and the amount of medicine is not checked into the home. This means there cannot be full audit of use, necessary and required as a protection for the person receiving the medicines. Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People using the 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 fully protected from abuse at Heatherside House and much effort is taken to listen to their views. EVIDENCE: People who were able to respond to survey told us they knew who to talk to if they were unhappy. It is unlikely that any of the people who live at Heatherside House would be able to make a formal complaint. However, the home has a complaints policy available to people associated with the home. People who use the service have a lot of input from health and social care professionals and therefore are not isolated in the home environment; this includes sessions specifically about communication. Some now have specialist communication aids made available for them. Independent advocacy has been arranged where there was no relevant person to act on a person’s behalf other then the home’s (paid) staff. Each person has a key worker and time is spent trying to match the right staff to that person so that the relationship works as well as it might. There have been no complaints to the home and the Commission has received no complaints about the service. Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 18 All staff told us through survey that they know what to do if someone has concerns about the home. We saw that the whistle blowing policy (how staff should alert concerns, which might be abuse to the police or social services) was openly displayed in the staff room. Two staff we spoke with were able to describe most types of abuse and knew who to contact if they had concerns. There have been no concerns raised about the home which might have indicated the possibility of abuse. We were told that there is no personal money kept in the business account of the provider Sheval Ltd. Some people have money kept for them at the home. This is securely kept on their behalf with good records and a running balance. Only the manager and deputy are allocated access to people’s money. We asked about the arrangements for use of the minibus and travel. People are charged according to their use of the minibus but this is not mentioned within the guide to the service and needs to be included. Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 29 & 30. People using the 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 environment meets the needs of the people who currently live there and this is under regular review. EVIDENCE: There has been much upgrading at the home since the previous key inspection. The home reports: ‘External areas of the home and grounds have been improved. There is increased choice of lounge/dining rooms for clients to access and use. The main kitchen is refurbished. There are two new kitchens for clients/staff use and television reception has been improved to all occupied rooms’. We toured the building with the manager. Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 20 There are now three kitchens and three laundries at the home but it is not felt, at this time, that three distinct units would benefit people living there, all of whom are very used to the large home environment. This is under regular review and we saw how people are being encouraged to ‘claim’ areas of the home as their chosen space, toward a more homely and personal lifestyle. We found the home to be bright, clean, fresh, well equipped and well decorated. We saw no maintenance concerns. However, the home makes use of freestanding radiators to supplement the heating. The use of them had not been risk assessed as it must so that safety is properly considered and their use should be discussed with a Fire Safety Officer. People’s bedrooms are very individual and contain things of importance to them. People told us: “Like it here. Got everything I want” and “I’ve got my own room, my own television.” All rooms either have en suite facility or are within close proximity to a bath or shower room. Staff told us they have all the equipment they need to ensure their safety and help support people’s independence. There are large gardens available for use and adequate parking space for visitors. The home reports: ‘The main laundry room is to be increased in size to enable clean /soiled laundry to be separated’. However, the laundry arrangements, although far from perfect, are currently meeting the needs of the home. Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team have achieved a lot in the last twelve months which is much to the benefit of people who use the service. EVIDENCE: People who use the service told us: “Good staff”. It was clear that people were very comfortable and relaxed around the staff. There is now more clarity around staff roles at the home. The manager is supported by a deputy and each person has a named person to work with them. The manager recognises that they must continue to change staffs mindset from out of date work practices to a more modern approach, which will include delegating certain responsibilities where appropriate. Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 22 Staff are of varying ages and, although most are female, there are some males employed so it is not a wholly female environment for male residents. There is a long established staff team at the home. We looked at the recruitment practices at the home, looking at the records of the one staff recruited since the previous key inspection. All the necessary checks had been completed to ensure they were safe to work with vulnerable adults. We were told that new staff are always additional to normal staff numbers and are closely supervised by a senior staff member until they are considered sufficiently competent. Most staff told us through survey that their induction covered what they needed to know to do the job when they started and the manager says staff will now use an induction training system “over 6 or 7 months” the results of which she will personally check. Six of the staff told us through survey that they receive training which is relevant, helps them meet people’s individual needs, keeps them up to date with new ways of working and gives them health care knowledge. During 2009 there has been training in Autism, moving and handling and for some, fire safety. Training in the condition of epilepsy is in date and staff have received training from health care professionals, including information about people’s individual health and ‘management’ needs. When asked what the home could do better three staff said training. (Also see the Outcome called Conduct and Management of the Home). A health care professional told us through survey: “Staff receive training, there is lots of follow up and enthusiasm and good outcomes and improvement.” The home reports that nine of the fourteen care staff have achieved National Vocational Qualifications (NVQ) in care to level 2 or above. This is an indicator of their competence. We asked to see records of staff training and found those shown were a little muddled and not fully in date. Neither is there a training schedule, to ensure training can be properly planned and achieved. Three staff told us through survey that there are always enough staff to meet the individual needs of all the people who use the service, four told us there usually are and two said there sometimes are. Staff we spoke with during the visit felt that people’s individual needs could be met. The survey responses from health and social care professionals strongly indicate that there are sufficient staff most of the time. The home has not employed any agency staff in the last 12 months. We looked to see whether staff receive a formal supervision of their work. The manager says this is not yet achieved on a regular basis, although the new staff has had a review of their work. Records indicate that five staff have had Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 23 supervision in 2009 and staff said they receive this “now and then”. We were told that arrangements are being made for the deputy manager to have more responsibility in this area. Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42. People using the 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 benefit from a well run home where their needs are the priority but health and safety needs more attention. EVIDENCE: A health care professional told us: “Sam Gomm has done a remarkable job” adding: “I am impressed with the home because of the starting point. They deserve the acknowledgement of the vast improvement they’ve made”. The registered manager, Samantha Gomm, has qualifications in care and management, which indicate she should be competent to run the home. She shows a strong commitment to the welfare and wellbeing of the people who Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 25 live at Heatherside House and communicates a clear sense of direction to staff. She has seen the home through a difficult phase, which has now ended. The home reports that they have improved through: • Registered Managers Award qualification achieved • Staff practices • Manager has increased delegation to members of staff • Sourced relevant training for staff The home now presents as a more positive and inclusive service. Much effort has been made to involve people in the day to day running and longer term direction of the service. Health care professionals told us: “Staff receive training, there is lots of follow up and enthusiasm and good outcomes and improvement” and “I have observed good relationships between staff and service users and good interactions.” Staff said: “The home has improved 100 and the clients are so much more settled and happy” and “I think the manager and staff have worked really hard and I have noticed a vast improvement. Documentation is much clearer, there are more activities, we have a good team of staff and the atmosphere seems warmer and the home appears more welcoming.” We saw that there has been much effort to include people who use the service in decision making at the home. There are now specialist aids for communication with those where this is difficult, ‘communication’ groups and much improved planning of how to meet people’s needs and preferences. People have picture and written information about what happens in their lives. The registered provider ensures that a monthly visit, to look at standards at the home, is undertaken and records kept. Samantha Gomm and the provider organisation work in close partnership. We saw that the manager audits the standards of staff work. This includes accident records and incident forms. We recommend a more formal and systematic cycle of planning, action and review of the quality of service, including surveying opinion of all people who have involvement with the home. We looked at how health and safety is managed at the home. Accidents and incidents are monitored by the home’s manager. Although no maintenance concerns were noticed we saw that free standing radiators are in use to supplement the central heating system. These radiators pose a risk, for example, being covered, but there had been no general or individual risk assessment. Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 26 We found that not all staff health and safety training was in date. Fire safety training is only provided once a year and we found that only ten of the eighteen staff had received it in 2009. One staff had also missed this training in 2008. The organisation which provides the training confirmed to us that it is expected a second training session should be arranged each year. We made an immediate requirement that plans be in place to ensure all staff must have fire safety training this year; the arrangements for this were completed before we left the premises. The home reports that no staff have received training in safe food handling but all support staff will handle food at the home. Three staff told us through survey, when asked what the home could do better: “More training i.e. first aid, food hygiene, health and safety” and “A lot more training and ensure that basic training like health and safety, food hygiene etc. is kept up to date”. We confirmed that equipment is serviced and maintained in a safe standard. Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X X 1 X Version 5.2 Page 28 Heatherside House DS0000069209.V376544.R01.S.doc No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA20 YA24 Regulation 13(2) 13(4) Requirement All medicines brought into the home must be recorded, so that a full audit is always possible. Any risk from the use of freestanding radiators must be generally and individually risk assessed. Timescale for action 30/11/09 12/12/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA20 YA23 Good Practice Recommendations It is recommended that where staff have to make any handwritten entry regarding a medicine, that two staff check and record that the entry is correct. The information people receive about the home should inform them about any arrangements made for personal finances and what cost will be incurred when using the minibus. There should be a formalised training and development plan and training programme so as to ensure that all required training is completed and that which is necessary to meet individual people’s needs is undertaken. Staff should receive planned and regular formal DS0000069209.V376544.R01.S.doc Version 5.2 Page 29 3 YA35 3 YA36 Heatherside House 2 YA39 2 YA24 supervision of their work to help them carry out their job with the best outcome for people who use the service. There should be a systematic cycle of planning, action and review reflecting the aims and outcomes for people who use the service. This should include the surveying of opinion from all people connected with the service. Freestanding radiators should not be used other than as an emergency measure where a central heating system has failed. The home should take advice about this from a Fire Safety Officer. Heatherside House DS0000069209.V376544.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission South West Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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