Care Home: Heatherwood

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What the care home does well There are sound systems in place for those wishing to be admitted to the home with information given to people interested in the service and opportunities to view the home. People who provided feedback during this inspection spoke highly of the care received by residents and provided by staff. People are treated with respect and dignity. One resident told us that they were "well cared for by the staff here." Some comments from relatives included "I cannot praise the staff highly enough" and when asked what they do for their relative "All that`s asked of them". Staff have good information to ensure they provide care and support to meet each persons` needs and are sensitive when undertaking personal care. The quality of food is "excellent" according to one relative talking about the "home-cooked" food provided and one resident told us of how their preferences are met by being "offered something else to eat" because "I don`t like potatoes." She also said "Whenever I turn around there is always a drink there." The home offers a small range of internal activities and stimulation with routines set around individuals wishes and needs. "I enjoy doing the craftwork" said one resident, whilst another told us they "liked listening to the violinist." The manager`s open and inclusive approach enables residents, staff or relatives to discuss issues or concerns and be sure that they will be listened to and issues managed sensitively, respecting individuals` rights and ensuring their residents` safety. Heatherwood provides a warm, safe, clean and comfortable place for people to live in with staff who are trained to ensure they can meet their needs. The home is generally well-managed and people kept safe by a manager who is qualified and experienced and understands about good standards of care. She is supported by a Provider, who looks to monitor and try and improve care, for each individual living in the home. What has improved since the last inspection? The Service Users` Guide and Statement of Purpose have been amended and all residents have now received a copy of the providers` terms and conditions of residency. This ensures they are aware of their rights and responsibilities and what to expect from the service. Staff have now received training in First Aid and the Providers have taken on board our requirement to change how staff are trained with core training now taking place. Medication practices have improved ensuring residents health is maintained. Activities have improved over the last two years giving residents more opportunities for a stimulating environment and maintaining their physical and emotional well-being. A relative wrote about how much this area has improved with the new Providers. The fire doors are now fully functioning making the home safer in the event of a fire. What the care home could do better: There are some areas that require improvement and include the need to develop local medication procedures as well as obtaining a Controlled Drugs cupboard to ensure safe storage of these drugs and also to provide staff with the guidance to ensure they administer medication safely. Care plans must also be improved to provide staff with the information on all of a person`s needs to ensure they are being met. Our main concern is around the recruitment and training of staff. The organisation must train bank staff during induction and in the provision of core training as they would permanent staff. If they do not, this may lead to potential risks to residents, as staff may not be safe or competent to care for residents living in the home. The recruitment procedures must be made more robust to protect residents from unsuitable staff being employed. CARE HOMES FOR OLDER PEOPLE Heatherwood 33 Station Road Orpington Kent BR6 0RZ Lead Inspector Wendy Owen Key Unannounced Inspection 2nd May 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heatherwood Address 33 Station Road Orpington Kent BR6 0RZ 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) 01689 813041 01689 822760 mandy.knighton1@virgin.net Chislehurst Care Ltd Ms Sally Ann Perry Care Home 8 Category(ies) of Old age, not falling within any other category registration, with number (8) of places Heatherwood DS0000067234.V363896.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 (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 8 1st November 2007 Date of last inspection Brief Description of the Service: Heatherwood has recently changed ownership to Chislehurst Care Ltd. It was first registered in April 1987 to provide care for eight older people. Heatherwood is an older style, three-storey house which has been converted to provide residential care. It is very conveniently situated for shops, transport and other local facilities very close to Orpington town centre. The home has a lounge, dining room, kitchen, bathroom/toilet and one double bedroom on the ground floor. On the first floor there is a second double bedroom and four single bedrooms. Bathroom facilities on this floor include a separate toilet with a rail surround and a wash hand basin next to a bathroom with a walk in bath and toilet facility. The administration office is located on the third floor with a flat occupying the remainder of the floor. To the rear of the property there is seating on a veranda overlooking an enclosed garden. The Manager of Heatherwood also manages another of the Provider’s homes, Ashling Lodge, located opposite. A Service Users Guide is available for all residents containing the information on what the home has to offer and a copy of the latest inspection report is available, on request, from the home. The fees range from £358-£551 per week. The charges for Local Authority clients are different to those for private. Personal expenditure such as toiletries, clothing, newspapers and private healthcare is not included in the fee. Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 5 Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 2 star. This means the people who use this service experience good. This unannounced inspection took place over one and a half days and included obtaining feedback from residents, relatives and professionals, verbally and in writing. We also toured the home, spoke to staff, the manager and Provider and looked at records in the home. We also looked at other information such as the annual assessment questionnaire (AQAA) completed by the manager and any other reports sent to us. We received comment cards from five relatives, one care manager and three service users. Currently there are eight ladies living at Heatherwood with one resident in hospital. During the inspection we asked people living in the home how they would like to be addressed in this report. They would like to be called “residents.” What the service does well: There are sound systems in place for those wishing to be admitted to the home with information given to people interested in the service and opportunities to view the home. People who provided feedback during this inspection spoke highly of the care received by residents and provided by staff. People are treated with respect and dignity. One resident told us that they were “well cared for by the staff here.” Some comments from relatives included “I cannot praise the staff highly enough” and when asked what they do for their relative “All that’s asked of them”. Staff have good information to ensure they provide care and support to meet each persons’ needs and are sensitive when undertaking personal care. The quality of food is “excellent” according to one relative talking about the “home-cooked” food provided and one resident told us of how their Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 7 preferences are met by being “offered something else to eat” because “I don’t like potatoes.” She also said “Whenever I turn around there is always a drink there.” The home offers a small range of internal activities and stimulation with routines set around individuals wishes and needs. “I enjoy doing the craftwork” said one resident, whilst another told us they “liked listening to the violinist.” The manager’s open and inclusive approach enables residents, staff or relatives to discuss issues or concerns and be sure that they will be listened to and issues managed sensitively, respecting individuals’ rights and ensuring their residents’ safety. Heatherwood provides a warm, safe, clean and comfortable place for people to live in with staff who are trained to ensure they can meet their needs. The home is generally well-managed and people kept safe by a manager who is qualified and experienced and understands about good standards of care. She is supported by a Provider, who looks to monitor and try and improve care, for each individual living in the home. What has improved since the last inspection? The Service Users Guide and Statement of Purpose have been amended and all residents have now received a copy of the providers’ terms and conditions of residency. This ensures they are aware of their rights and responsibilities and what to expect from the service. Staff have now received training in First Aid and the Providers have taken on board our requirement to change how staff are trained with core training now taking place. Medication practices have improved ensuring residents health is maintained. Activities have improved over the last two years giving residents more opportunities for a stimulating environment and maintaining their physical and emotional well-being. A relative wrote about how much this area has improved with the new Providers. The fire doors are now fully functioning making the home safer in the event of a fire. Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4, 5 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good systems in place for ensuring those people that wish to live in the home can be assured that their needs can be met. EVIDENCE: The Service Users’ Guide and Statement of Purpose have both been updated as required at the last inspection to ensure they meet with the Regulations and the current situation in the home. This provides prospective people interested in the service information they need to make a decision on whether it is right for them. The manager told us in the AQAA that further improvements could be made in this aspect of care by encouraging more people to visit the home and look around before making any decisions. Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 11 One lady told us that she visited the home with her family and as soon as she came in she said “don’t look any more, this is the one.” She has not regretted that decision and told us that talking to the manager and staff was the reason why. The comment cards received and viewing of individual files show that people had received information on the home in the form of a Service Users Guide and contract. This enables people to make a decision on whether the home is right for them Since the last inspection a new resident has been admitted. Discussions with the manager, and viewing of the individual files, show that the individual was assessed prior to admission to ensure their needs could be met by staff and that there were systems in place to enable people to view the home prior to making any decision. It is positive to note that there is also confirmation in writing by the manager that their needs could be met. There has also been an improvement in the provision of contracts to people living there providing them with details about what to expect during their time spent in the home. The home does not provide intermediate care and therefore this standard was not applicable. Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home have their personal, social and healthcare needs met by staff who understand their needs and medication practices ensure their health and well-being. They have their dignity and privacy respected by kind and caring staff. EVIDENCE: Staff in the home have a very good understanding of each individual’s needs and this is reflected in the feedback received through written comment, discussions with residents and a relative, as well as observations of practice. Five relatives when asked “Does the home meet their needs”? 4 said “always” and 1 said “usually”. Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 13 And when asked “Does the home keep you up to date with important issues”? All the five relatives who responded said “always”. “ I am very happy with the care X receives at Heatherwood and feel the staff are genuinely fond of X” said one relative, whilst another relative wrote of the “Personal one-one care by lovely staff.” Service users comment cards also provided a positive response to the care received. When asked “Do you receive the care you need” and “Do staff listen and act on what you say” all three said “yes”. We observed staff practices and noted that residents were all well-groomed and well-presented showing that staff had taken particular care and attention to details. Some ladies wore make up and jewellery and we noted that spectacles were clean and not smudged or dirty. It is clear that there are positive relationships between staff and residents and they are treated with kindness and sensitivity. Viewing of three files showed there to be some good written information on care plans that detailed each person’s needs and reflected their current situation. This is an area that should continue to be improved to ensure information such as finances and social needs and are also provided for staff. There is evidence of monitoring each month and also the implementation of a system for reviewing individuals’ care that involves keyworkers, residents and relatives. This is, according to the manager and area manager, enabling staff to have good information to ensure specific and individual needs can be met and ensures people are involved in decisions about their care. Risk assessments had been produced in respect of moving and handling, falls, nutrition and pressure care. There was some evidence of the home developing strategies and interventions to minimise the risks and, where they were recommended to develop a separate care plan regarding pressure care risks, this had been completed. Healthcare records viewed were found to be of a good standard with clear evidence of where the home is requesting the support of the health professional, taking advice and ensuring they provide the required treatment. One care manager wrote of the care received. “The manager responded very quickly to the change in my service users’ behaviour. She liased with the GP and together they have monitored the situation.” Medication procedures were audited and found to be in good order with clear information and good recording. The AQAA told us that staff had been trained in safe administration and this was confirmed during the inspection. Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 14 Where there were hand-transcriptions these had been countersigned and all records of administration were complete with non-administration documented with the reasons why. Medication carried forward from one month to the next had the numbers recorded to ensure there is a clear audit trail of medication being administered. Some staff have received training through the distance learning “Safe handling of medication” course run by local colleges whilst others have received training from the pharmacist responsible for dispensing the medication. The certificate shows that he is an accredited trainer. The manager was reminded of the training module available on the Skills Sector website to provide guidance for staff and to include some observation of practice in training to ensure a judgement can be made about staff competency. When two members of staff ware asked how they administered medication they demonstrated good practice. Whilst no person has been prescribed a controlled drug (CD) there is a need to ensure a CD cupboard is fitted in the likelihood that a person maybe prescribed such a drug in the future. It is also necessary for the medication procedures to be reviewed to ensure they detail procedures that are specific to Heatherwood, rather than general information applicable to all homes. Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines are flexible and an improvement in activities offered means people are provided with more varied stimulation to ensure their continued emotional and physical well-being. People enjoy a varied and healthy choice of home-cooked food. EVIDENCE: Throughout the visit to the home routines were observed with staff assisting with personal care, completing domestic tasks and the preparation and serving of meals. It is clear from the observations that residents are assisted to get up when they want (within reason) and that they can take their breakfast in their rooms either before getting ready for the day or after. This is flexible and according Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 16 to peoples’ preferences. One lady spoken to told us that she was “more than happy here” During a short meeting with residents they told the inspector that they were able to get up and go to bed when they wish. There is an activity schedule in place and according to staff and residents this is an area that has been improved since the employment of a part-time activity co-ordinator and staff are also encouraged to interact and take responsibility for providing stimulation. Residents also have the opportunity for visiting the home opposite to enjoy the entertainment on offer. One resident told us they enjoyed the craftwork and another the violinist. A number of residents take the daily newspaper which they enjoy reading throughout the day. The AQAA shows that there are weekly movement to music classes, a monthly visit by the violinist and some craft activity with the co-ordinator and that they would like to encourage family as volunteers to support them in taking residents out more. We spoke to one resident and family member who told us that there is enough to do in the home with different entertainment. During our discussions there was a violinist playing to the other residents in the lounge. The hairdresser also visits each week and residents enjoy this part of their week. The written survey asked people. “Are there activities arranged by the home that you can take part in?” Each one said “yes”. It is hoped that residents will benefit from the improvement made to the back patio where decking has been laid for individuals to gain access to areas they cannot at present. It is clear from the comment cards received from relatives and residents and from observations that people living in the home are encouraged to keep in contact with their family. Families visit the home and are “made very welcome” with some relatives taking family members out. Residents are also encouraged to take part in formal meetings about their care as well as discussions about how they wish to live. This enables them to make choices and decisions about their everyday life in the home. Previous inspections have shown mixed feedback on whether people are provided with choices at meal times. We viewed the menu and found it to contain choices for lunch. Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 17 Meals are cooked by one of the staff in the home and are generally enjoyed. When the comment card asked “Do you like meals in the home”? Two residents said 2 “always” and one said “usually”. Observation of the lunchtime meal showed that lunch to be eaten by all with the exception of one person, who has a poor appetite. This is being addressed through the GP who is monitoring their health and has prescribed nutritional supplements. Cold drinks are provided during the meal and a hot drink when lunch has been eaten. Breakfast is taken in individuals’ rooms if they wish and throughout the day residents are offered refreshments of a hot drink and biscuit or snack. One resident told us that they enjoyed the food and staff made sure they had an alternative to the food they did not like and n were always ready to make her something else. She also told us when asked if she had enough to drink “whenever I turn around there is a drink there” as staff tell her she needs to drink a lot for a specific reason. Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are free to raise issues or concerns in a safe environment where they can be assured they will be listened to and concerns addressed. Staff have the knowledge and understanding of how they can make sure vulnerable people remain safe. EVIDENCE: Procedures have been developed on how complaints, concerns or allegations should be managed. A copy of the procedure is on display in the hall and included in the Service Users Guide (information provided to each person living there). We have not received any complaints nor have there been any complaints received by the service about the quality of care provided. The manager is very much hands on and deals with concerns or issues as they arise and therefore there are few formal complaints. The verbal and written feedback shows that people feel able to raise any concerns but not all relatives who provided feedback are aware of how to make a complaint. Two of the five Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 19 who responded said they did not know how to make a complaint but all felt there would be appropriate responses if they did raise a concern. When people living in the home were asked in a comment card “Do you know how to make a complaint?” all three said “yes” and when asked “Do you know who to speak to?” two said “usually” and one said “always”. We spoke to one person living there together with a member of their family. They told us they had no problems with raising any concerns and felt comfortable to do so. From observations it is clear that the relationship between people living in the home and staff, including the manager, is one where individuals can talk openly about the care they receive. A Care Manager who provided feedback wrote “rather than alert us when there is a concern she uses her skills and experience to work together to ensure the resident receives the right service.” Adult protection procedures have been developed and are in place together with the Bromley inter-agency guidelines on adult protection. We suggested that the home’s procedures could be presented in a more easy to read format. Two staff spoken to understood their role in ensuring any issues around abuse of people living in the home are passed on to the manager. Discussions showed a lack of understanding of whistle-blowing and its meaning to staff. The manager had already taken action to address this prior to the draft report being sent and confirmed to us that the majority of staff did understand these areas when answering written questions on the subject. This is important as staff should now how they are protected enabling them to raise concerns. We also spoke to the manager who understood the need to refer to her line manager in any cases where allegations of abuse are reported. She was also clear as to the role of the adult protection co-ordinator in taking responsibility for co-ordinating any investigations. At the last inspection we required that staff be provided with training in adult protection. This has yet to be provided but has dates scheduled in the next two months for staff as detailed in the recent AQAA. We are not aware of any incidents or allegations made requiring investigation under the safeguarding procedures. Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are provided with a safe, comfortable, homely and clean place in which to live. EVIDENCE: Heatherwood is an adapted Victorian house close to Orpington town centre. Communal and private rooms are located on the ground floor and further bedrooms and bathrooms on the first floor. There is a sleep in room and office on the second floor. Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 21 It is furnished in a homely and comfortable way which presents on entering as a warm and inviting environment. Private rooms are personalised and quite individually furnished with alarm calls in all areas. The Provider is currently installing a new alarm system Some rooms have been recently decorated and carpet fitted in a communal area. Whilst bathrooms and WCs are still a little basic discussions with the Provider and viewing of the AQAA showed that this is in their action plan for the home during the year, along with decorating the hallway. Since the last inspection last inspection the rear of the premises has seen a new external sitting area, decking, ready for the summer. New furniture is about to be purchased. Also need to ensure there is access to this area ie ramps from the doorways. A stairlift is in place but had not been serviced for a year. This was discussed and fond to be due to the service agents not fulfilling their contract. This was addressed before the draft report went out. We reminded the manager that it is her responsibility to ensure these checks take place. It is clear from relatives and residents that the home is always fresh and clean. Infection control practices have improved and staff had a satisfactory understanding of good practice in this area. Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff provide a caring and sensitive environment for people to live in although further progress is needed in staff achieving the NVQ qualification to ensure staff are competent to provide care for individual needs. Recruitment and training for casual staff does not ensure that people living there receive a consistent quality of care and may leave them open to potential harm. EVIDENCE: Two care staff are on duty in the morning and evening and a domestic who works two hours per day. One person works during the night. Care staff also prepare and cook meals and an activity co-ordinator works part time sharing her time between Ashling Lodge (opposite) and Heatherwood. When asked “Do care staff have the right skills and experience to look after people properly?” five said “always”. Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 23 One relative wrote, “This particular care home accommodates only eight ladies. The catering is done in-house and is excellent. Turnover of staff is minimal. These factors contribute to it not becoming an institutionalised regime.” One person has been employed at Heatherwood since the last inspection to undertake bank work. We noted POVA1st and Criminal Records Bureau check in place, references and proof of identity. There was no confirmation in writing about reasons for leaving previous care employment. Induction to the home was recorded but no certificates obtained except NVQ 3. Whilst there was no reference from the last employer the previous manager (now manager of one of the Mills Group services) had given a reference and the area manager had written a statement about this. There was little evidence of any TOPSS induction or CIS although evidence of fire training provided. We looked at two more personnel files of staff employed to work in the second home managed by the manger. These showed appropriate checks completed, except in one there was no record of a gap in employment between education and employment. References were received from previous employers both in care in the one case. A stamp to show authenticity had been provided in the first reference but not in the second. The second file viewed contained two references from the previous employer and a personal reference. The records also showed s record of induction in the home and both contained proof of identity. The manager and area manager were reminded of the need to ensure all care staff are provided with the same checks and training and induction as any other staff member, especially when bank workers can work the same or even more than permanent staff and people living there need to be assured of being cared for by competent and skilled staff. Training for staff audited through viewing the training matrix and discussions with three care staff. The training matrix that has now been developed makes it easier to monitor and plan training. This showed core training to be provided through the Bromley consortium and other training via use of DVDs. During our discussions with staff we discussed their role in making sure people are kept safe and risk of infections reduced. Staff had a satisfactory knowledge and understanding of these areas, although we suggest that more information and guidance is provided on clostridium difficile due to its higher prevalence. When viewing training records and the AQAA we found that 3 of the 11 staff have obtained the NVQ qualification. The manager is trying to address this through employing staff who have obtained the qualification. Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service us generally well run in an open and inclusive way with systems in place for ensuring the quality of care is improved and the safety of people maintained. EVIDENCE: The Manager is experienced and qualified with a commitment to improving the quality of care. Her open and inclusive approach enables residents and staff to Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 25 approach her and raise concerns, issues or suggestions for improving the care. She is “hands on” which makes it easier to monitor staff and resolve issues as they arise. The employment of an administrator has been a great support to the manager and improved the organisation and record keeping. The Employers Liability certificate is on display, in date and to the appropriate amount as well as our Certificate of Registration confirming the home and manager is registered. The manager and provider are reminded of the need to ensure all care staff employed, including bank workers receive the same checks and training as permanent staff to ensure continuity of care by trained and competent staff. This area will be viewed at the next inspection and shortfalls in this area may result in changes to the rating. The quality of care is monitored and continuously improved through an annual review of the service and monthly visits by the area manager. She obtains feedback from residents and relatives and audits and reports on the visit. The new reviewing system in place for reviewing individuals’ care provides for more input and a way of improving the care and support provided. Residents meetings are also held with the last one taking place 04/08. During this meeting discussed food provided, how to make a complaint, the Service Users Guide, activities and registering with a dentist and shows how the manager is trying to involve residents in their day to day care. The health and safety of the home is maintained through regular checks, although they must ensure this is diarised so no equipment missed. Adequate fire precautions are being taken including servicing of the system and emergency lighting, weekly checks on the fire alarm and a fire risk assessment in place. Fire drills are taking place and must ensure that all staff working in the home are included. It is also important to ensure all staff are provided with fire training at least annually and once again this had been addressed prior to the draft report being sent. The fire doors are also now fully closing ensuring the safety of all people in a fire. Individuals’ monies are not held by the home. Where purchases made these are receipted and sent to Head Office for the relative to be invoiced. Staff told us that they had received formal supervision although viewing of individuals’ files showed that this is not as regular as they should be. Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 26 Heatherwood DS0000067234.V363896.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 3 Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 14 Requirement Care plans must include the individuals’ needs including personal, health, social, financial and spiritual needs to ensure they receive appropriate care. Training must be provided for bank workers recruited to work in the home to ensue they are skilled and competent to care for the people living there. When recruiting new staff, the manager must ensure that any previous employment in care is verified as to the reasons for leaving ensuring vulnerable people are not placed at risk and any gaps in employment are explored. This is a repeated requirement. The timescale of 01/01/08 has expired. A Controlled Drugs cupboard must be obtained to ensure safe storage of medication and local medication procedures developed to ensure staff are aware of medication practices relating to their home. DS0000067234.V363896.R01.S.doc Timescale for action 01/09/08 2 OP30 18 01/08/08 3 OP29 19 01/07/08 3 OP9 13 01/11/08 Heatherwood Version 5.2 Page 29 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. Refer to Standard OP7 Good Practice Recommendations Residents’ needs should be reviewed with the residents and their family or representative at least six monthly. The time that fire drills are taking place should be recorded. Where medication is carried over to the next cycle this should be recorded. Staff should be provided with guidance on MRSA and clostridium difficile. There should be a clear system for contacting individuals in an emergency that is easily accessed by staff. 2. OP38 3. 4. 5. OP9 OP26 OP38 Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Heatherwood DS0000067234.V363896.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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