Care Home: Heathfield Residential Home

What the care home does well Positive, relaxed and warm relationships were seen to exist between residents and staff members during the visit. What the care home could do better: Following the previous key inspection we had to change the quality rating for the home from Good to Poor. This was due to a general lack of management within the home and the deterioration of the assessments, care planning, risk assessments and recruitment processes. Although an acting manager is in post and some improvements have been made there are still many issues that need to be addressed in order to improve the quality of the service provided to residents; this can only be achieved however if the manager is given the authority to manage the home appropriately. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Heathfield Residential Home 20/22 Alexandra Road Grappenhall Warrington Cheshire WA4 2EL zero star poor service 24/11/2008 The quality rating for this care home is: The rating was made on: 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. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Paul Ramsden Date: 2 5 0 2 2 0 0 9 Information about the care home Name of care home: Address: Heathfield Residential Home 20/22 Alexandra Road Grappenhall Warrington Cheshire WA4 2EL 01925602195 01925611248 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) : Heathfield Residential Home Limited care home 25 Number of places (if applicable): Under 65 Over 65 25 old age, not falling within any other category Conditions of registration: 0 The registered person may provide the following category of service only: Care home only - Code PC. To service users 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. The maximum number of services users who can be accommodated is: 25. Date of last inspection Brief description of the care home Heathfield is a large Victorian three-storey privately owned care home. Access between floors is via a shaft lift or the stairs. Residents are accommodated on all floors. The home is located in the Warrington suburb of Grappenhall and is close to a variety of shops, churches and other community facilities. Heathfield is registered to provide personal care for up to twenty-five older people. It is the homes policy to only provide 2 4 1 1 2 0 0 8 Care Homes for Older People Page 2 of 10 Brief description of the care home accommodation to female residents. Residents accommodation consists of fifteen single and five double rooms. All of the bedrooms, with the exception of one double and two single bedrooms that have an en-suite facility, are fitted with wash hand basins. There are three separate day lounges and a separate dining room available for residents use. Heathfield has an adequate number of toilets and a variety of bathrooms available. Aids to facilitate independence are in evidence throughout the home; these include bath hoists, grab rails and an emergency call bell system. The current fee range for the home is 347 - 500 pounds per week. A copy of this inspection report can be made available to anyone who may be thinking of choosing this service. Existing residents can also have a copy if requested. Care Homes for Older People Page 3 of 10 What we found: We visited the home in order to check on the progress made since the quality rating was changed from Good to Poor following the key inspection that took place on the 24 November 2008. Any referenced to we or us in the report refers to the Commission. New assessment documentation, plus some provided by the acting manager is now in place but has not been used yet as there have been no admissions to the home since the key inspection. A privately funded resident was due to be admitted from another home two days after this visit. She has visited the home with a relative and decided she wants to move in. The acting manager said he will complete the appropriate assessment documentation before she is admitted. The acting manager confirmed that the new care plans were not completed yet; this contradicts the action plan we received from the owners on 10 February 2009 which clearly stated; All care plans have now been rewritten. The manager said that he was currently training staff members on how to complete the new plans. We looked at a random sample of completed plans and found that there were still some areas of major concern. One persons plan had been rewritten on the 17 January 2009, it did not however have an appropriate falls risk assessment even though this was obviously an issue. This care plan had not been reviewed since even though over a month had elapsed. The accident record for this same person was also unclear; two accident forms were filled in for the same unwitnessed fall, there was a gap of between one and a half hours between them and they had been filled in by different people. The information within them was contradictory, the 10.30AM form stated slight bruises to wrist on right hand. The other completed at 08.30AM said, wrist is inflamed? We could not find any evidence to prove that any action other than the application of a cold compress having been applied had been taken, there was no medical advice sought at the time. The owner has recently undertaken an audit of accidents within the home for Warrington Borough Council who have some concerns regarding the documentation being maintained and the moving and handling practice of the staff members. We saw that the number of accident forms for one person did not tally with the number of entries on the audit undertaken. A falls risk assessment for this resident was completed using the new documentation on the 17 December 2008; it had not been updated since even though five falls have occurred. The daily records maintained by staff were varied in their quality, for example, some simply stated, slept well whilst other were more detailed and provided the reader with a more complete picture as to how the person actually was. Following a recent safeguarding referral we went to look at one of the bedrooms; on the way past the downstairs toilet we noticed the door was wide open and there was a lady sitting on the loo, the resident did not have mobility so had been assisted to the toilet. When the carer returned she assisted the resident into a wheelchair and moved her off without using the footrests. We expressed concern at both the apparant lack of privacy and dignity and the fact that using a wheelchair without footrests is both an Care Homes for Older People Page 4 of 10 inappropriate and very dangerous practice. The manager and care manager who were also present stated that there was a large notice on the front of the daily notes that stated footrests must be used at all times, there was no excuse for this and they would address it immediately. The care manager told us later that the carer said she had closed the door but that another resident must have opened it. Although we had visited the home to check the requirements made at the previous key inspection visit we did identify some further issues. The acting manager said that some residents go to bed straight after tea, this can be as early as 5.30PM; we consider this to be unusually early; we do know that there has been some comments regarding the lack of availability of snacks for supper because of the cooks hours. In addition we are also aware that the night staff are asked to get some people up before they finish in the morning; we are unable to say in both instances whether this is the persons preference or staff routines. Care plans should state the preferred rising and retiring preferences for each person, this needs to be done as soon as possible so that all staff members are aware of them and appropriate care can be provided at the requested time. We spoke to the homes main chef, she is working 6/7 days a week; one of the night staff covers the kitchen when she is unable to work. she works from 8.00AM until 2.00PM. She is expected to prepare breakfast, a three course lunch and the tea. She also provides all of the drinks. The cook told us that she is unable to provide hot food at teatime because she does not have the time to do this; she has to stay behind to get the cleaning done. We were told at the key inspection that choices were always available, however we have since been informed by the acting manager and the chef that this was not the case and in fact a choice of lunch has only been available since Christmas. A record of what people are actually eating is now being kept. She confirmed fresh fruit and veg are now more readily available and fresh milk rather than powdered was being used. We asked the chef about the hours she worked, she said she would like to increase her daily hours and finish at 4.30PM so she could provide a better tea and prepare a supper. She does not know what the care staff members provide at this time but did say she did not leave anything. We have been told by various people that the carers do not like having to prepare snacks etc as it takes them away from their own job. It is the homes responsibility to meet the needs of the people living there but we believe changes to the catering arrangements are needed quickly. The acting manager said that to try and improve the teatime an extra member of staff was now on duty between 5.00PM and 8.00PM. The acting manager explained that a dishwasher was fitted the Friday before this visit, staff washed up previously. We observed kitchen tiles and seals in the utility to be dirty. There were some issues [drawers broken, sink seals, tiles missing, floor covering split] in the main part of the kitchen but it was generally clean. The Kelvinator fridge in the cellar was very old with poor seals and it did not seem to be cold enough. We observed that one of the washing machines was broken and the reliability of the other machine was in doubt. We observed very small amounts of tinned and dry stock, for example, it was beans or scrambled eggs for tea but there was only four tins of beans. The storeroom wall was flaking and dried foods were not stored in sealed containers. The acting manager said Care Homes for Older People Page 5 of 10 that stocks were inadequate and did not provide enough choice for people and there was not enough variety at teatime. We also noted some food supplements in the store room, these did not always say who they were for and some were out of date. These are prescribed by a GP so it is important that the person receives them at the correct time, the fact that some are out of date shows that some people had not been getting them. No new staff members have been employed since the last key so we were unable to check the requirement made regarding the staff recruitment procedures made following the key inspection. What the care home does well: 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 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 3 14 Residents must not be admitted into the home unless an appropriate assessment has been undertaken by a person qualified to do so. This will ensure that the needs of the individual concerned can be safely met. 12/12/2008 2 7 15 A care plan that fully details 23/12/2008 how an individuals needs are to be identified and met must be completed. So that staff members are able to fully meet the assessed needs of the residents they are caring for. 3 8 12 Proper provision for the health and welfare of residents must be made. This will ensure they receive any medical or other attention they need. 23/12/2008 4 29 19 A robust recruitment procedure needs to be implemented. This will ensure residents are protected from possible harm. 23/12/2008 Care Homes for Older People Page 7 of 10 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 5 31 12 In the absence of the 23/12/2008 registered manager proper arrangements the day to day running of the home must be in place. In order to ensure the home is run in the best interests of the people living there. Care Homes for Older People Page 8 of 10 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 15 16 Provide suitable, food which is properly prepared and available at such time as may be reasonably required by residents. So that residents receive an appealing diet at times convenient to them. 31/03/2009 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 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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