Care Home: Heathside

What the care home does well The home was being appropriately managed and residents and their relatives expressed satisfaction with the care and support provided by the home. Comments made by residents to the inspector included `the staff are lovely and I like them a lot`, `they are very good and take good care of me`, `what I see when visiting is that the staff are kind and look after them all very well`. On the day of inspection staff were seen to interact positively with residents and show them respect, protect their dignity and assist them properly throughout the day. Residents and visitors appeared to have a good relationship with the manager and his staff. Relatives of residents all spoke very positively of the care and attention provided to their relations at the home. What has improved since the last inspection? The home have addressed the requirements made at the last key inspection in January 2007. A new shower room has been provided and a number of resident`s bedrooms have been refurbished. At the time of this inspection senior staff were in the middle of conducting a review of the process of managing resident`s medicines. And the manager and his team are seeking ways to improve leisure and social activities for residents. What the care home could do better: CARE HOMES FOR OLDER PEOPLE Heathside Plank Lane Leigh Greater Manchester WN7 4ND Lead Inspector Mike Murphy Unannounced Inspection 28th November 2007 09:30 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 Heathside DS0000005739.V337347.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. Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heathside Address Plank Lane Leigh Greater Manchester WN7 4ND 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) 01942 602328 01942 682937 Wigan Social Services Department ** Post Vacant *** Care Home 32 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (32) of places Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Within the maximum registered number (32), there can be up to 2 service users aged between 60 and 65 in the category of DE. The service should at all times employ a suitable qualified and experienced manager who is registered with the CSCI. Staffing levels are to be calculated in accordance with the Residential Forum Guidance (Older People) by April 2004. 10th January 2007 Date of last inspection Brief Description of the Service: Heathside is owned by Wigan Council and is run by the Social Services Department. The home is purpose built on one level and can accommodate up to 28 older people with dementia care needs and two respite care beds are also available. The home is situated near Leigh town centre, close to local shops and public transport. All of the bedrooms are single with fifteen of these being provided with en-suite facilities. Communal space within the home includes, two dining rooms, three lounges, and a conservatory, all of which are suitably decorated and furnished, and a separate hairdressing room is also available. There are two secure central garden areas that are easily accessible from the main building. The layout of the building allows residents to walk freely and securely around the home. Specific colours have been used in different parts of the home’s walking area, which helps to orientate the residents. A Service User Guide that describes the home’s services is readily available in the home and the staff give other information about the home to new and prospective residents and their families verbally. A copy of the latest inspection report and the home’s Statement of Purpose are also displayed in the home. At the time of writing this report the charge for accommodation and services is £274.38 to £581.41 per week (information supplied by home at time of this inspection). Additional charges are made for hairdressing, preferred toiletries and privately purchased chiropody services. Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 28th of November 2007. The inspection took place over seven hours. The inspection included discussion with residents, their relatives, a tour of the premises, inspection of care and other records maintained at the home and discussion with the home manager and care staff. What the service does well: What has improved since the last inspection? What they could do better: The home must ensure that all staff be provided with up to date medicine awareness training. A priority must be to develop a programme of leisure activities in and outside the home, which suit resident’s needs. The décor on the main corridors is damaged in a number of areas and the corridor floor covering is also quite marked (not dirty) in places. Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 6 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. Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 7 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 Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 8 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): 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. No prospective residents are admitted to the home without their care and support needs being assessed appropriately. EVIDENCE: Prior to residents being admitted to the home the home manager (or one of the assistant managers) carries out an assessment of the prospective resident’s needs in consultation with the resident, their relatives and relevant health (for example doctors) and social care professionals (for example social workers). The purpose of such an assessment is to assist the prospective resident and their relatives in their considerations of how appropriate a placement at the home would be and enable the person conducting the assessment to judge if the home will be able to meet the prospective resident’s needs appropriately. Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 9 3 recently admitted residents pre-admission assessments were inspected. The records identified that pre-admission assessments had been carried out by the home and were supplemented by assessments conducted by Social Services. Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 10 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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care provided is suitable, organised, and meets the expectations of residents and their relatives. EVIDENCE: The care records of three residents were inspected. These contained care plans that were initially based on the pre-admission assessment that is referred to earlier in this report. Care plans addressed the health and personal care needs of residents in a clear, organised way and were evaluated at least monthly. Risk assessments, that seek to protect resident’s health and welfare are recorded in respect of residents skin integrity (assessing the risk of pressure sores), mobility/moving and handling, nutrition, (including regular weight monitoring) and other areas of potential risk for individual residents were also assessed at least monthly (for example in relation to continence). Daily statements regarding resident’s progress are also recorded. All residents are registered with a local GP and it was evident that all were enabled to access dieticians, opticians, chiropodists, dentists, district nurses Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 11 and other specialist services as individual residents needed. Pre-inspection comment cards completed by relatives and discussion with them on the day of inspection indicated that they are kept informed of all changes in their relation’s health. The practices for the receipt, recording, storage, handling, administration and disposal of resident’s medicines were appropriate and safe. Most staff responsible for the management of resident’s medicines have received recent appropriate medicines awareness training – the manager informed the inspector that a request has been made for other staff to receive up-dated training in this important area. Medicine records had been completed properly. Discussion with residents and staff and responses in Pre-inspection comment cards completed by residents and relatives revealed that residents were treated with respect and that their right to privacy was upheld. Comments made included; ‘the staff are lovely and I like them a lot’, ‘they are very good and take good care of me’, ‘what I see when visiting is that the staff are kind and look after them all very well’. On the day of inspection staff were seen to interact positively with residents and show them respect, protect their dignity and assist them properly throughout the day. Residents and visitors appeared to have a good relationship with the manager and his staff. Relatives of residents all spoke very positively of the care and attention provided to their relations at the home. Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 12 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 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are at times being supported by staff to participate in social activities and are enabled to retain the ability to make personal choices as far as possible. However social/leisure activity provision needs to be extended. There was a general satisfaction with meals provision at the home EVIDENCE: Whilst it was evident that the home manager and his team are seeking ways to improve leisure and social activities for resident’s comments in pre-inspection questionnaires and discussions with residents, visitors and staff indicate this is still a problem area. The general view is that resident’s need to be regularly provided with opportunity to engage in stimulating and appropriate activities. It was evident that in the run up to Christmas a number of such activities had been planned. A future priority must be to develop leisure activities in and outside the home, which suit resident’s needs. Residents and relatives spoken to expressed satisfaction with care provided and organisation of life at the home. Observation of care practice and information in care plans indicated residents are encouraged to make choices. For example what time they like to get up/go to bed, where to sit and in which lounge to go to. Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 13 Residents wishing to maintain their religious links are enabled to do so. The home has an open visiting policy. There are no restrictions on the time people visit. The only time restrictions would be imposed is when requested by residents. Relatives spoken to during the inspection said they were always made welcome at the home and were able to see their relatives in the privacy of their own room or in a quieter communal area. Meals are cooked and delivered by a local NHS catering provider who have been contracted to supply resident’s meals to the home. Kitchen assistants are employed at the home to ensure that the correct procedures are followed in respect of storing and preparing meals prior to being served to residents Menus are varied and balanced and provide choice. A food advisor from the local authority supports the home. Meals are served in two designated dining rooms. These are appropriately furnished and provide comfortable area for residents to have their meals. Residents’ meal times are as reasonable and as flexible as they can be in a communal setting. Lunch was observed on the day of inspection. This was a hot and substantial meal and staff assisted and served residents their meals appropriately. Discussion with residents and relatives and staff revealed a general satisfaction with the meals provided. Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 14 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives knew how to make a complaint if they felt it necessary. Written guidance and training arrangements ensure that staff members have knowledge of abuse and protection arrangements and safeguards were in place to protect the welfare of residents EVIDENCE: The complaints procedure was prominently displayed in the home and included details of how to contact the CSCI. Relatives spoken to (and in responses in pre-inspection questionnaires) said in the main concerns or worries brought to the manager’s attention are responded to quickly and don’t become formal complaints. Policies and practices aimed at protecting residents from abuse are in place. Also Wigan’s inter agency safeguarding procedure is held on site. Staff spoken to confirmed that they had received adult protection training (this was also reflected in training records maintained by the home) and were aware of the whistle-blowing policy operated by the home. Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 15 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, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and appropriate environment to accommodate, care for and support residents. However some improvements do need to be made to the corridors of the home. EVIDENCE: A tour of the premises revealed that the home was very clean and free of malodour. Discussion with visiting relatives and responses to pre-inspection survey questions revealed that the home is regularly cleaned to a high standard. The lounges and dining rooms provide appropriate and comfortable communal areas for residents. However the décor on the main corridors – that are extensively used by resident’s as they ‘potter’ around the home is damaged in a number of areas. The corridor floor covering were also quite marked (not dirty) in places – clearly from the constant use this is subject to. Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 16 There is adequate provision of bath/shower and WC facilities and these have been suitably fitted and adapted. A new shower room has been provided since the last key inspection. Eight resident’s bedrooms were inspected on this occasion – these were clean, warm, suitably ventilated, furnished, personalised and comfortable. Half the bedrooms are provided with an en-suite WC. Residents and their relatives are encouraged to bring personal items into the home and this creates a more personalised atmosphere in resident’s own rooms. Appropriate measures to prevent the spread of infection were in place – including adequate hand washing/cleaning facilities, laundry and sluicing arrangements, provision of disposable gloves and aprons for staff, adequate provision of house keeping staff and appropriate arrangements for the disposal of waste. Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 17 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The recruitment, provision and training of staff employed at the home are being managed appropriately. This is important to ensure resident’ are being cared for adequately and appropriately by staff who are able to deliver this support safely and competently. EVIDENCE: Inspection of staffing rotas indicated that staffing provision at the home complied with the current minimum requirements that apply to care homes for older people. The manager has recently reviewed and adjusted staffing rotas. Discussion with the manager and staff at the home indicated that they were of the view that staffing levels were appropriate to meet the dependency levels and needs of resident’s. 22 were resident at the time of this inspection. There is also adequate provision of housekeeping, catering and ancillary staff at the home. There is a commitment to NVQ (with over 85 of all care staff having at least an NVQ 2 in care) training, moving and handling, fire safety, first aid, protection of vulnerable adults and other training provision for all staff at the home. The manager has been working in conjunction with the local authority training department to ensure that the induction and ongoing training provided by the home meets the common foundation standards and other requirements Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 18 of ‘Skills for Care’ (part of the Sector Skills Council). He is also seeking to access more training that relates to caring for people with dementia so that staff can develop and improve their existing skills in meeting resident’s needs adequately and appropriately – this is necessary as all residents who are admitted to Heathside suffer from dementia. Inspection of the recruitment process adopted by Wigan local authority for staff employed in services registered with the CSCI was conducted in June 2007. This included staff that work at Heathside care home. Files examined evidenced that the appropriate checks and information had been gathered prior to new staff commencing their employment with Wigan MBC. Such robust procedures are important to ensure residents are being cared for and supported by suitable people. Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 19 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): 31,33,35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was being appropriately managed in a way that enables residents, their relatives and staff to feel that they are being supported properly. EVIDENCE: The home manager is experienced, has achieved the NVQ Level 4 in care and management and has completed the registered managers award. He is also in the process of seeking registration with the CSCI as a ‘registered manager’ as legally required by the Care Standards Act (2000) Discussion with residents, their relatives and staff indicate that the manager operates a management style that is open and accessible. The home was well organised with a clear Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 20 management structure. Four assistant managers, an administrator and a team of care staff support the manager. Senior managers from Wigan local authority who own and run the home also regularly provide support to the manager and his team. The manager has developed a quality assurance system to measure residents and their relative’s satisfaction, with the level of care and accommodation provided. This is essential as such information will enable a quality improvement plan to be fully developed and implemented to further improve the quality of life for residents. The manager informed the inspector that he has also improved the quality assurance system by seeking the views of visiting doctors, nurses, social workers and others who regularly come to the home. This is supplemented by a system of checks (for example of care records, medicines, social activities, catering, complaints/protection, the home environment, staff training and management processes generally) to ensure practices in the home are of as a high a standard as possible. Measures were in place to ensure that residents’ financial interests are safeguarded. Personal allowances are managed by the home. The arrangements for this were secure and appropriately documented. The health, safety and welfare of residents and others is promoted and protected. For example staff are provided with regular training and appropriate equipment to ensure resident’s moving and handling needs are met. An example of this would be for a resident who needs to be safely moved with the aid of a hoist. Information provided by the home indicates that electrical/gas/other equipment safety inspections/servicing has been carried out. Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 21 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 2 3 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2) 18(1)c(i) Requirement Inform the CSCI in writing what arrangements have been made in respect to provide staff with up-dated medication awareness training. That the CSCI is informed in writing what progress has been made in developing leisure activities in and outside the home, which suit resident’s needs. That the CSCI is informed in writing what action is being taken in respect of the damaged décor and marked floor covering in the corridors of the home Timescale for action 31/01/08 2 OP12 16(2)(m) (n) 31/01/08 3 OP20 16(2)c 23(2)(d) 31/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Heathside DS0000005739.V337347.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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. 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