Care Home: Heathlands Care Centre

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What the care home does well The registered manager and her staff are working hard to develop a non institutional environment in this new purpose built home for residents who have a range of complex needs. Many of the residents had transferred from an NHS setting and were seen to be settling in very well. One relative told us; "I am no expert but as far as I can tell the staff are doing a good job and the home manager is approachable and helpful". Another relative told us; "They talk to people. They explain what they are doing when they need to tend to them". The Ex by Ex commented; "....the overall impression was of very good attitudes and a good home where residents are respected and given choices". What has improved since the last inspection? This is the first inspection of the home since it was registered with the Commission. What the care home could do better: Four requirements are made at this inspection in the following areas: to improve the process of recording who undertakes assessments and re-assessments of need, and when, to make sure staff have access to the latest information on people`s changing needs; to make sure that more detailed records are kept in regard to one identified person`s skin condition, to help promote that person`s health care; to make sure more detailed records are kept about how one identified person`s challenging behaviour is managed, for the protection of all concerned; and, to make sure that the home`s procedures regarding the safe administration of medication are fully complied with, to maximise protection for residents in this area. Four good practice recommendations are also made. These are regarding: obtaining more information on people`s needs and preferences regarding equality and diversity, to help make sure they receive care and support in ways they prefer; for key workers to write monthly summaries of their work, to help the home review and evaluate care plans; for a copy of the home`s medication policy and procedures to be kept on each unit, so they are more accessible to staff; and, for the home to continue to discuss with relatives the best use of the physical spaces in the home. Key inspection report Care homes for older people Name: Address: Heathlands Care Centre 2b Hatch Lane Chingford London E4 6NF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Peter Illes     Date: 2 9 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) 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 Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Heathlands Care Centre 2b Hatch Lane Chingford London E4 6NF 01202767776 01202764555 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Churchcrest Ltd Name of registered manager (if applicable) Miss Pamela Mauchaza Type of registration: Number of places registered: care home 84 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is :84 The Registered Person may provide the following category of service only - Code N to service users of the following gender:Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Old Age - Code OP Mental Disorder - Code MD/10 Date of last inspection Brief description of the care home Heathlands Care Centre is a purpose built care home owned and operated by Churchcrest Ltd, a private company. The home is situated in a residential area of Chingford in the London Borough of Waltham Forest and is close to shops and public Care Homes for Older People Page 4 of 33 Over 65 84 10 84 84 10 0 Brief description of the care home transport. The home can accommodate up to 84 people and is registered to provide nursing care to older people, people with a diagnosis of dementia and people with needs relating to their mental health. Accommodation is provided in five units over three floors and all the bedrooms are single with en-suite facilites. Fifty of the beds are currently block purchased by Waltham Forest Primary Care Trust with residents placed in these beds having moved from a local NHS facility. At the time of this inspection the fees for the home were from £800 per week depending on peoples needs. Information about the home, including this CQC inspection report, is available from the homes reception on request. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is the first key inspection by CQC as the home opened and was first registered in May 2009. This inspection took approximately thirteen and half hours over two days, 28th & 29th September 2009, with the registered manager being available to assist throughout. There were fifty five people accommodated at the time of the inspection and twenty nine vacancies. The home was continuing to admit residents on a planned basis to make sure that people settled into the home with as little stress as was possible. The inspection was undertaken by the lead inspector who was assisted by an expert by experience, employed by Help the Aged (referred to as Ex by Ex in this report). An expert by experience is a person who, because of their shared experience of using services, and/ or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The Ex by Exs views Care Homes for Older People Page 6 of 33 are referred to and reflected in this report. However, terms such as we, our and us are also used where appropriate to indicate that inspection activity is undertaken on behalf of the Commission. The inspection activity included: meeting and speaking with the majority of people living in the home, although communication with most was limited due to their communication needs; independent discussion with relatives and representatives who visited on the day; detailed discussion with the registered manager; discussions with the provider organisations director of operations and operations manager, both of whom visited the home on both days of the inspection; independent discussion with a number of staff, including nursing staff, care staff, the homes housekeeper, administrator, a chef, a laundry person and the handy person. Information was also obtained by an independent telephone discussion with a safeguarding manager from L.B. of Waltham Forest. Further information was also obtained from: an Annual Quality Assurance Assessment (AQAA), submitted by the home to the Commission prior to the inspection; questionnaires from eleven residents/ relatives and twelve staff. Further information was gathered from a tour of the premises and documentation kept at the home. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? 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. Care Homes for Older People Page 8 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has up to date information about the services it provides, and is continuing to work hard to make this more accessible, so that people who are considering living to the home know what to expect from the home. The needs of people admitted to the home are properly assessed to help staff in meeting these needs although some further developments in this process are needed to strengthen it. Evidence: The homes annual quality assurance assessment, AQAA, states; We take our time to show prospective clients around and give them a chance to ask all the questions they need to ask and to reserve any room of their choice. Prospective residents (when possible) are encouraged to view the home themselves and ask any questions. We were given a copy of the homes statement of purpose and service user guide, which were detailed and contained relevant information about the home and how it operates. The documents were in ordinary text but we saw evidence of work underway Care Homes for Older People Page 10 of 33 Evidence: to make accessible versions of these, including photographs. The homes AQAA also stated that the home is going to; Provide our pre-admission documentation in large print and audio to allow service users with visual impairments to access the same information. Relatives and others spoken to stated that they had enough information about the home and that they were able to visit (with or without their relative if that was applicable) as part of the admission process. However, one relative told us in their survey form, We had no choice (in the admission), we were just informed that Thorpe Coombe (the hospital setting the person was living in previously) was closing down and we had to go to Heathlands. We inspected the files of six people, all of whom had been admitted to the home from a hospital setting. The files seen had a range of relevant assessment information including continuing care assessments, specialist medical assessments and a copy of the homes in-house assessment. The in house assessments gave information on the persons needs including regarding: mobility, personal care, nutrition, continence, communication and behaviour. Our judgement was that the assessment information was generally satisfactory. However, it was noted that there was often little information in the assessments seen about the persons needs regarding equality and diversity, e.g. if they had any specific needs or preferences in how their care was delivered regarding their ethnic origin, religion, gender and sexuality. This was discussed with managers and a good practice recommendation is made regarding this, which also relates to information on peoples care plans (see the Health and Personal Care section of this report). A copy of an Age Concern resource pack for professionals, called The whole of me..... was given to the registered manager to assist in this process. This particular pack relates to meeting the needs of older lesbians, gay men and bisexuals living in care homes. Once admitted assessment information is regularly monitored, including in such areas as skin condition and frailty, and, nutrition and continence, in order for staff to be aware of any changing needs. Although these were generally satisfactory some of these assessments did not show who had carried out the assessment and/ or the date the assessment was carried out. Given the very complex health needs of the people living in the home, including nursing needs, a requirement is made regarding this to help ensure that the home keeps a clear audit and accountability trail of any changing needs a person may have. The home does not provide intermediate care. Care Homes for Older People Page 11 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is working hard to develop care plans that meet peoples needs and preferences although further work is needed in this, including to ensure that the plans are more person centred. People are properly supported by the home regarding their health care needs and have access to a range of healthcare professionals. Satisfactory medication policies and procedures are in place to assist protect people living in the home although further work is needed to ensure that these are properly implemented. Evidence: The homes annual quality assurance assessment, AQAA, states; We are in the process of formulating person centred care plans with the involvement of families. We work with the resident, their relatives and carers in partnership, in order to provide the best support for the individual. The files of six people living in the home were inspected and these contained clear care plans. The care plans seen were detailed and contained a range of relevant information regarding the persons needs including: personal care, moving/ mobility, nutrition, communication and activities. The plans also gave guidance to staff on how Care Homes for Older People Page 12 of 33 Evidence: to meet these needs. Evidence was seen that the home has started to develop a life history for some people to help staff know what was important to them before they needed nursing care. The registered manager told us that the home was working hard to develop person centred care plans, which is a different concept from treatment based plans that some nursing staff had been used to writing in a hospital setting. A good practice recommendation is made in the Choice of Home section of this report to reinforce this. Care plans seen were informed by risk assessments, including a moving and handling risk assessment. It was noted that the home was continuing to work hard to further develop the care plans. Evidence was seen that care plans were being regularly reviewed. Residents are allocated a named nurse on admission and the home is training care staff to become key workers for individual residents. This includes being a contact person for relatives and to take an overview of the persons progress. A good practice recommendation is made that key workers should write a monthly summary of the work they have undertaken with a resident, which would assist in meaningfully reviewing care plans with the named nurse. Evidence was seen that relatives and other relevant stakeholders are being properly consulted when care plans are being written. This included a written care plan consent form and those seen had been signed by a relative involved with the person. Feedback from residents about the care of their person was positive. One person told us; They talk to people. They explain what they are doing when they need to tend to them. Another relative told us; The carers look after my wife very well. One of the six people who we case tracked (looked in some detail about how their needs and preferences were being met) had very vulnerable skin. The element of their care plan relating to this included that the person must use a pressure relieving mattress on their bed. We also saw evidence that the home had consulted a specialist Tissue Viability Nurse and were following their advice. However, the care plan did not specify the pressure the mattress should be kept inflated to. When we checked the mattress the person was using it was found not to be at the correct pressure for the persons weight at that time. This was dealt with by the nurse on duty in the unit straight away and she also told us that she thought there was a possible fault with the mattress and that would be looked into as a priority. Given the complex needs of the person concerned a requirement is made about this. The home must keep a record on peoples care plan of the correct pressure setting of any mattress that residents are using to help protect their skin, and ensure that this is being adhered to. Care Homes for Older People Page 13 of 33 Evidence: Another person we case tracked sometimes displayed challenging behaviour, including significant physical aggression to others. The element of this persons care relating to the possibility of physical aggression to others contained a range of appropriate guidance to staff. This included trying to diffuse the situation, to offer medication that had been prescribed to be taken when needed by the person to assist with this behaviour and as a last resort to physically restrain the person to keep them and/ or others safe. While the use of physical restraint as a last resort was appropriate, the care plan did not give further guidance on how this restraint was to be applied. A requirement is made that further written guidance regarding this must be produced for staff. This must include what methods of physical restraint staff are permitted to use, what level of training the staff must have before they restrain the person, what other initial action should be taken if a trained member of staff is not immediately available in order to keep others safe and how the situation should be dealt with after any restraint has been used. We were pleased to see that the home was in the process of applying to L.B. of Waltham Forest for a deprivation of liberty safeguard authorisation in relation to using restraint with this person. Evidence was seen that the home is working hard to promote the health needs of residents generally. As stated in the Choice of Home section of this report a range of health assessments are undertaken regularly on residents, including skin condition and frailty, nutrition, weight, blood pressure and pulse and continence. However, these must be properly signed and dated. People are registered with a GP, who visits the home on a weekly basis. An optician visited the home during the inspection and we saw evidence that a mobile dentist also visits the home. People living at the home have access to specialist healthcare professionals such as a psychiatrist, psychologist, occupational therapist and physiotherapist. This access was through a referral to community based services and was judged to be satisfactory. However, some relatives told us that they regretted that these specialist healthcare professionals were not employed directly by the home in the same way as they were in a hospital setting. We sampled medication on each unit that accommodated residents (one unit was still unoccupied by residents at the time). Although there was a range of evidence that residents were receiving their medication properly there were a number of identified errors in the recording of the process. These included one resident that had refused their medication on an identified occasion but the medication administration record (MAR) chart recorded that the person had taken the medication. Because of their particular needs some residents are administered their medication hidden in food, known as covert administration of medication. Although this is appropriate in identified circumstances the homes medication procedure states that this must be properly agreed and recorded by appropriate stakeholders. Although signed by staff Care Homes for Older People Page 14 of 33 Evidence: and a relative, the consent forms relating to this for two different residents had not been properly authorised by an identified healthcare professional in accordance with the homes policy. There was not a proper record of a 28 day supply of medication entering the home for one resident which meant that a proper audit trail of that medication could not be followed. A requirement is made regarding proper recording of peoples medication. The home has a detailed and up to date medication policy that was seen to contain proper guidance regarding the recording issues noted above. However, a copy was seen was in the main office but no copies could be located on the individual units and a good practice recommendation is made regarding this. Although a number of requirements are made in this section of the report it is our judgement that the overall outcomes for the health and personal care of residents are still good and improving, especially given the relatively short time the home has been registered. A contributory factor to this judgement is that the registered manager and senior managers in the provider organisation had identified where further improvements were needed and evidence was seen that they are taking robust action to deal with these. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is working hard to develop meaningful activities that meet residents needs and preferences. Families and visitors are made welcome at the home, which they and people living there appreciate. People are encouraged to exercise as much choice and control over their lives as they can to maximise their independence. People are also served good quality and appetising meals that they enjoy. Evidence: The homes annual quality assurance assessment, AQAA, states; The home employs an enthusiastic and capable activities coordinator who coordinates a dedicated team. Our activities coordinator has worked closely with the occupational therapist from the provider, which has enabled an appropriate level of activities to be offered. We saw evidence throughout the inspection that the home has an activities programme for residents each day, this includes group activities and one to one time for residents who are unwilling or unable to take part in group activities. Sessions included gentle exercise, reminiscence activities such as quizzes, arts and crafts and general entertainment. The Ex by Ex stated; After lunch when the group moved into the sitting room there Care Homes for Older People Page 16 of 33 Evidence: was a session with the activity worker and an extra worker (presumably sessional) doing karaoke. I was pleased to see that the care staff took part in the activities assisting residents to participate and did not simply leave this to the activities workers. Staff worked well together without overt discussion: one woman in short sleeves was cold and a worker was giving her arms a rub to warm her up. I thought she needs a cardigan but in fact another worker was going to her room to fetch it and appeared with it shortly. I met with the staff nurse who I thought had an excellent attitude toward residents. I moved on to Unit 3 where residents were sitting in the sitting room. I noticed how all the women have beautifully manicured hands with attractive nail varnish, so I assumed that someone is offering this service. All residents I met looked appropriately dressed and cared for. However, the Ex by Ex did notice a few interactions between staff and residents that could be interpreted as being patronising albeit well meaning. As agreed with the Ex by Ex these have been fed back to the registered manager for information and to inform the homes ongoing staff training programme. Relatives and friends are encouraged to visit the home at any time during the day and evening, many relatives spoken to visit the home most days or several times a week. The majority expressed satisfaction with the home. Comments included; Staff are always polite and friendly, and I am no expert but as far as I can tell the staff are doing a good job and the home manager is approachable and helpful. Evidence was seen that residents are helped to exercise choice and control over their lives to the extent they are able. The home has satisfactory systems for dealing with residents finances. People living in the home are encouraged to personalise their rooms and evidence was seen that the home is assessing people as appropriate under the Mental Capacity Act, to assist safeguard their interests. The home is working hard to provide meals that people will enjoy and a residents and relatives committee has been set up to help oversee this. The Ex by Ex stated; After talking to managers, who reported that the residents had adapted very well to the change from the hospital setting, I went to visit the residents on Unit 5. Care Homes for Older People Page 17 of 33 Evidence: They were gathered in the dining room and were getting ready for lunch. I made attempts to engage with several residents in conversation but all of them were distracted or withdrawn at the time. I therefore observed before and during lunch. The overwhelming impression was of good, enthusiastic and dynamic care staff engaging well with residents, and having a kindly and caring approach. I noted that staff were respectful of residents dignity, for instance in the way they asked them if they could put on protective aprons, apologising for disturbing them if it was awkward to put on and so on. I also saw that when one resident threw his food all over himself and also onto a worker, no fuss was made about it, he was distracted from his anger and not told off and it was dealt with practically and calmly. Residents were given plenty of choice about food and drink and those who did not want their dinner were not judged or harassed about it and were asked what they wanted instead and given that (e.g. biscuits and a cup of tea). It seemed that staffing levels were adequate (on this day at least) to allow for such accommodation to residents preferences which was impressive. As everyone looked well fed I dont think there was any issue of anyone skipping too many meals. However, the Ex by Ex went on to say, The food was tasty (I had some myself) but my only comment is that spaghetti was clearly hard to handle for people who were feeding themselves but had reduced manual skills, as it kept falling off the spoon. As stated above, the Ex by Ex also noted some interactions between staff and residents that may have been handled differently and these were fed back to the registered manager. Care Homes for Older People Page 18 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home, and their relatives, have any concerns they raise taken seriously and acted upon appropriately. The home has clear policies and procedures to assist protect people from abuse and staff are aware of these. Evidence: The homes annual quality assurance assessment, AQAA, states; We have a clearly defined company complaints policy with agreed timescales for managing complaints.The home has robust policies for dealing with allegations of abuse or neglect. We firmly believe that we have nothing to hide and work toward lasting relationships with other stakeholders. The homes complaints policy was seen and was satisfactory, a copy of this policy was also seen displayed by the signing-in book in the entrance hall, so that it was accessible to all who enter the home. We also noted a suggestion box by the signing-in book and were told that this had been fitted following a suggestion made at a relatives meeting. Ten complaints had been recorded at the home since it opened, nine of those being more minor concerns that had been dealt with at the time, however, we were pleased to see that these had been properly recorded. The other complaint was more formal and the record showed that this had been properly investigated and responded to in accordance with the homes policy. Relatives and residents told us that they were confident that any concerns or complaints raised would be taken seriously by the home. One relative commented regarding the meals; Care Homes for Older People Page 19 of 33 Evidence: Complaints are being listened to and changes are being made. Another relative commented; The manager is always available to talk and listen. The home has a satisfactory in house safeguarding adults (adult abuse) policy and a copy of the L.B. of Waltham Forests safeguarding adults policy and procedure, both of which were seen. Four safeguarding adult referrals had been made by the home to L.B. of Waltham Forest since the home was opened, each relating to different incidents of challenging behaviour by one resident on another. These had also been reported to the Commission as is required by Government regulation. Records seen shown that these had been properly dealt with and actions taken to protect the people involved. The registered manager told us that she had met with the LB of Waltham Forests safeguarding manager to assist the home develop its practice in safeguarding further. The Waltham Forest safeguarding manager was spoken to independently by phone. The safeguarding manager told us that she was impressed by the homes proactive efforts to develop their practice further, including by accessing staff training from Waltham Forest. We were pleased that staff spoken to were aware of the importance of protecting residents through the homes safeguarding processes. There had been no other disclosures or allegations of abuse made to the home or to the Commission, since the home opened. Care Homes for Older People Page 20 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a modern, purpose built home that is well equipped, well decorated, well furnished, well maintained and which meets their needs. The home was clean and tidy throughout creating a pleasant environment for people accommodated, staff and visitors. Evidence: The homes annual quality assurance assessment, AQAA, states; We ensure that the environment is well maintained and offers service users a homely place in which to live. A program of routine maintenance works is kept within the home. The home is purpose built and was opened and registered in May 2009. We undertook a tour of the building and found it to be well furnished, well decorated and well maintained and meets the needs of people that live there. Accommodation for residents is in five units spread over three floors, each connected by two lifts and two stair cases. Unit 1 is on the ground floor and has 21 places, this unit was unoccupied at the time of this inspection, although we were told the unit would be used for people with predominately nursing needs. Units 2 and 3 are on the first floor; Unit 2 has 17 places and accommodates people with nursing needs and unit 3 has 17 places for people with needs predominately relating to dementia. Unit 4 and 5 are on the second floor; unit 4 has 16 places for people with needs relating to Care Homes for Older People Page 21 of 33 Evidence: dementia and unit 5 has 13 places, also for people with needs relating to dementia. The ground floor also contains the homes main entrance, main office and general office. The home also has a basement that contains the kitchen, laundry and staff facilities. There is also a walled roof terrace on a third floor, which is also accessible by one of the lifts and stairs. In addition the home has pleasant gardens and a car park. Each of the five units has a lounge, kitchenette, dining room and activities room. We were pleased to see that the chairs in the lounges had been set out in small groups, which is less institutional than having the chairs around the walls of the lounge. Residents seemed to interact well with this lay out. The home also has a range of suitable specialist equipment such as hoists and grab rails to meet peoples needs. Appropriate signage was seen on each unit to assist residents with dementia to find where they want to go, we were impressed by some of the signage in some units, including large pictures of a London bus, a red pillar box and individual signs on the majority of residents bedrooms. All the bedrooms have an en-suite toilet and those bedrooms seen during the inspection were comfortable and had been personalised to the taste of the person living in them. In addition, the home has a range of suitably adapted and equipped bath and shower rooms, which met peoples needs. Two relatives spoken to independently told us that they appreciated the modern facilities but regretted that there was no one particular space big enough to hold large gatherings for the majority of the residents and their relatives. They told us they had been used to a large day room at the hospital facility where their particular residents had lived before. We acknowledge that some relatives feel strongly about this but our judgement is that the communal space supplements single en-suite bedrooms and overall the accommodation is much more homely and appropriate than a hospital setting. However, given the views of some relatives, a good practice recommendation is made that the home continues to work with relatives to creatively identify the best location for larger functions to be held in. The laundry facilities are suitable to meet peoples needs and the home although the registered manager is in the process of moving some equipment to maximise health and safety in the laundry area. The home had suitable infection control procedures that staff spoken to were aware of. The home was free from unpleasant smells, clean and tidy throughout during the inspection. Care Homes for Older People Page 22 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported by a staff team with sufficient numbers to address their needs, and who have a range of competencies. People also benefit from staff that have access to a wide range of training opportunities to help them develop their skills and knowledge and keep these up to date. People accommodated are protected by the homes recruitment procedures. Evidence: The homes annual quality assurance assessment, AQAA, states; Heathlands has comprehensive policies to aid effective recruitment and staff management. Our dependency levels are constantly reviewed taking into account of the individual needs of the residents. Staff rotas were seen on each unit and were correct at the time of the inspection. Staff at the home were deployed as follows: 1st floor - Unit 2: 1 nurse and four care staff during the day and 1 nurse and 1 care staff at night. Unit 3: 1 nurse and 5 care staff during the day and 1 nurse and 2 care staff at night. 2nd floor - Unit 4 and 5: Each unit had 1 nurse and 4 care staff during the day and 1 nurse and 1 care staff at night. (Unit 1 was unoccupied at the time). The registered manager is in addition to the above and the home also employs a range of other staff including: an activity coordinator, 3 assistant activity coordinators, administrative staff, kitchen staff, laundry staff and domestic staff. Care Homes for Older People Page 23 of 33 Evidence: From observation throughout this inspection and from feedback from people living at the home and relatives, the staffing levels were judged to be sufficient to meet the needs of the people living at the home at that time. However, the registered manager is aware that staffing numbers will need to be kept under review as the home accepts more residents, to ensure that peoples needs continue to be properly met. Evidence was seen that the home is working hard to support care staff to work toward the national vocational qualification (NVQ) in level 2 and level 3 in care. The home has registered with a college with all current care staff registered and working toward NVQ level 2 in care. We were told that staff would register for NVQ level 3 in care in 2010. We looked at the recruitment files for three newly recruited staff; a registered nurse, a care assistant and a second chef. Each of these files showed evidence of a robust recruitment procedure and included: proof of identity, with evidence of the persons entitlement to work in the UK where applicable; a protection of vulnerable adults (POVA) clearance and either an enhanced criminal records bureau (CRB) check, or for staff very recently recruited, a copy of the CRB application (those staff were being supervised by staff that a CRB check had been returned for) and two references that had been suitably verified. In addition evidence was seen that the home had checked the registration of the qualified nurse with the Nursing and Midwife Council (NMC) to ensure that this was still current. Newly recruited staff spoken to independently told us that they thought their recruitment process had been very thorough. We saw evidence from a staff training matrix and from individual staff files inspected that the home was providing staff with a proper induction and training in core subjects. Recent training had included: first aid, safeguarding adults, challenging behaviour, infection control and moving and handling. In addition the qualified nurses are supported to keep their professional training updated with evidence of courses undertaken in wound care, palliative care and diabetes. We were told that the home was intending to enrol some staff at the home on palliative care training to the National Health Service gold standard level. Staff spoken indicated in a number of ways that the training was enjoyable, of good quality and helped them develop their skills and knowledge. Care Homes for Older People Page 24 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home benefit from the service being managed by a competent, qualified and experienced registered manager. People accommodated and other stakeholders are being regularly consulted to promote and monitor the quality of the service they receive. Peoples financial interests are safeguarded while living in the home. Staff supervision is provided to support staff meet the needs of people accommodated and to assist in their own development. A range of effective health and safety procedures protect people living in the home. Evidence: The homes annual quality assurance assessment, AQAA, states; In the home we have qualified staff in key areas starting from the home manager, the head of care and head of dementia. Regular staff meetings are held to give staff the opportunity to communicate any issues. The home has a clear and accountable management structure appropriate for its size. The registered manager is appropriately qualified and experienced. This includes being Care Homes for Older People Page 25 of 33 Evidence: registered general nurse, achieving her registered managers award, an advanced diploma in social care supported housing, disability management and being an NVQ assessor. The registered manager also has substantial experience of managing registered residential cares home with nursing in the community. She presented as being competent, knowledgeable and very enthusiastic to develop the home to its full potential. Residents and relatives spoke highly of her. Comments from one relative included; Management are always willing to meet with families and discuss any problems. The registered manager is supported by two managers who deputise for her when she is not on duty, a head of general nursing, who is a registered general nurse and a head of dementia, who is a registered mental nurse. Unfortunately the head of dementia care has been on sick leave for most of the time the home has been open. We met the provider organisations director of operations and operations manager, both of whom spent time at the home during both days of the inspection. These managers also presented as being committed to ensuring the home operates and develops as effectively as possible. The home has developed a range of ways of monitoring the quality of care provided. The home is holding regular meetings with relatives, and feedback from relatives was that this was very helpful during the major changes they had experienced with their loved one moving from a hospital environment. The home has set up a catering committee including residents and relatives to review the homes meals. The home has also held its first contract review meeting with the health commissioners of the service (Waltham Forest Primary Care Trust). In August 2009 the home commissioned a consultant to undertake an inspection of the home using similar methods to a CQC inspection, including sending out questionnaires to relatives and other interested parties. The provider organisation undertakes monthly unannounced visits to the home. The documentation regarding the above was sampled and showed a range of evidence that the home is consulting a range of stakeholder regularly and continuing to develop the service positively. The homes AQAA stated that the home was working hard to assist those nurses who had previously worked in a health setting to develop the concept of more personalised care and delivering such care in a home setting. We were impressed by the feedback from the registered manager, operations director and operations manager on their understanding of this issue and how they are working with staff to develop more personalised care. As stated in the Health and Personal Care section of this report, it is a contributory factor to the quality rating of that section of the report being judged Care Homes for Older People Page 26 of 33 Evidence: as good. It is important that they continue to develop this aspect of the functioning of the home. We were told that none of the staff at the home act as an appointee for any of the residents finances, and that the majority of residents are funded by the Waltham Forest Primary Care Trust under continuing care arrangements. Relatives for many residents look after all their financial affairs. Where money is held for a resident this is sent to the provider organisations head office and deposited in a separate provider organisation bank account for residents and we sampled satisfactory individual records on the homes system for that money. However, no actual residents cash is held at the home and if a resident needs to make a purchase this is done by the home through the petty cash system and is then claimed back from the head office as appropriate. Evidence was available, including from staff spoken to independently, that staff receive supervision at least every two months. Staff spoken to felt that this was useful. A range of satisfactory health and safety documentation was seen. This included: gas safety certificate, electrical installation certificate and water tank maintenance to minimise the risk of legionella. Evidence was seen that the home has a satisfactory fire risk assessment and fire fighting equipment. Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The registered persons must 30/10/2009 ensure that peoples needs have been assessed by a suitably qualified or trained person and that the assessment shall be kept under review. This is to include who has carried out any such assessment or reassessment and when this was done. This requirement is made to help the home keep a clear audit and accountability trail of any changing needs a person may have. 2 7 13 The registered persons must 30/10/2009 ensure that unnecessary risks to the health and safety of residents are identified and as far as possible eliminated. This must include recording detailed guidance for staff where physical restraint is needed as a last resort in Page 29 of 33 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action order to keep residents and others in the home safe. This guidance must include what methods of physical restraint staff are permitted to use, what level of training the staff must have before they restrain the person, what other initial action should be taken if a trained member of staff is not immediately available in order to keep others safe and how the situation should be dealt with after any restraint has been used. This requirement is made to maximise the health and safety of residents and to protect staff who have to deal with physical aggression. 3 7 13 The registered persons must 30/10/2009 ensure that unnecessary risks to the health and safety of residents are identified and as far as possible eliminated. This must include ensuring that a record is kept on care plans of the correct pressure setting of any pressure mattress in use for an individual and to ensure that the correct setting is being adhered to at all times. Care Homes for Older People Page 30 of 33 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This requirement is made to promote the health, welfare and well being of residents with vulnerable skin. 4 9 13 The registered persons must 30/10/2009 ensure that suitable arrangements are made for the recording, handling, safekeeping, safe administration and disposal of medication received into the home. This must include an accurate and up to date record of: medication received into the home, medication administered to each resident and the proper completion of consent forms for administering covert medication. This requirement is made to maximise protection to residents receiving prescribed medication and for the protection of staff administering that medication. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 The registered persons should record more information on any equality and diversity needs or preferences a person Care Homes for Older People Page 31 of 33 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 may have. This should include if the person has any specific needs or preferences in how their care is delivered regarding their ethnic origin, religion, gender and sexuality. 2 7 Key workers should write a monthly summary of the work they have undertaken with a resident, which will assist in meaningfully reviewing care plans. A copy of the homes medication policy and procedures should be kept with the medication stored in each unit to assist make this more accessible to staff on a day to day basis. The home should continue to work with relatives to creatively identify the best location in the home for larger functions to be held in. 3 9 4 19 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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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