Care Home: Heightside House Nursing Home

What the care home does well People referred to the home from health and social care professionals had an assessment of their needs carried out. The assessment took into account peoples circumstances and the level of support they would require. Needs such as personal care, mental health care needs, family, communication, diet, and medication are assessed. Planned admissions supported people who were detained under the Mental Health Act to stay at the home on leave. Residents who provided written comments for this inspection considered they made decisions about their lives and they were treated well by staff and managers. Where residents lacked this capacity, staff or other professionals made decisions on their behalf with advocate support where required. Person centred care planning supported residents to be cared for as they needed and wished. This meant there was recognition within the service of residents` right to take control over their life and make their own decisions and choices within their capabilities. Where residents lacked this capacity, staff or other professionals made decisions on their behalf with advocate support where required. Staff interviewed and those who provided written comments for this inspection considered the service did well as they usually had up to date information about the needs of the people they cared for. Written comments included, `All staff will try their utmost to ensure service users are happy with the care they receive.` And `The home is welcoming to new service users and their families.` To ensure Equality and Diversity is considered, information for staff, and policies and procedures are available on each unit identifying how staff and residents should dealwith and expect issues related to race, gender, disability and sexual orientation to bedealt with. This includes clear guidelines for staff ensuring zero tolerance of anydiscrimination. Where residents lacked capacity to make informed choices they have access to an advocate at Heightside House, and through the East Lancashire advocacy service for Independent Mental Capacity Advocate representation. Activities were provided for residents. For example residents enjoyed cake making, film shows, social evenings, pamper mornings, reminiscence, pool and darts, getting out and about with much more on offer. Visiting arrangements were good, and residents were supported to maintain family contact. Residents were also supported to recognise social values and therefore be able to build good relationships with other people. Residents health care was being monitored with routine check ups and specialist support. Medication records checked were found to be in good order. The storage and administration of medication was good. Meals provided generally met with residents tastes, needs, and choice. Those residents spoken to during inspection said the food was `good`. They said they could have what they wanted. Special diets were catered for and cultural needs met. One resident who provided written comments said, `sometimes, when you are not expecting it, they make some lovely meals and puddings.` Residents who were consulted, generally knew who to talk to if they were not happy.Staff working at the home had been trained in adult protection and those spoken to during inspection knew their responsibility in this area. The service has shown it is quick to take the right action to any allegation made of abuse in any form, and protect the people they care for. The home was maintained, clean, and tidy, and provided a homely and pleasant environment for residents, visitors, and staff. Residents were satisfied with their bedrooms and living arrangements. Written comments from residents showed they considered the home to be always clean and fresh. One resident wrote, `I love how the cleaners leave the place looking good and smelling really clean.` Supervision of staff was fairly regular and structured. Staff interviewed were very professional and clear about their duty of care to provide a good service for residents at Heightside. They were familiar with conditions of mental health and the effect it had on residents` everyday life. Learning opportunities were relevant to the homes purpose. The home was managed and run in the interests of the people living and workingthere. The home sent us their Annual Quality Assurance Assessment (AQAA), that gave us information we asked for. Overall the self assessment indicated the conduct and management of the home ensured it was run in the interests of the residents, respecting individuals` rights and ensured residents best interests were safe guarded. What has improved since the last inspection? Residents identified at risk with weight loss have a clear action plan to ensure their nutritional intake is satisfactory. During inspection staff were observed giving residents at risk additional food supplements and one to one support with meals. Contractual arrangements for staff protects residents from any financial exploitation. Staff had received training on Adult Protection and staff are encouraged raise any issue of concern regarding the care and welfare of residents to senior management. An emergency call pendant was issued to residents in the Mews. This allows them to summon help in an emergency. Maintenance was ongoing and minor repairs attended to. There was evidence to show information disclosed as a result of any checks carried out had been fully considered. A written account was made of the circumstances to support a decision to employ and ensure the right people are employed to care for residents. The use of agency staff had been reduced as staff had been recruited to work permanently in the home. This action will provide stability for residents and consistency when receiving personal care. Staff meetings had increased therefore allowing staff to know their views are valued and they can help to improve practice. Staff training records were up to date, and staff received regular formal supervision that provided them with support to do their work professionally and ensure only qualified and competent staff care for residents. Staff were issued with the terms and conditions of their employment. This helped to make sure residents` staff and employer are protected. What the care home could do better: All residents must have an up to date care plan based on assessed needs. This is because progress to complete reviews and write a person centred care plan to ensure individuals were cared for as they wish and require had not been completed. The following are good practice recommendations to improve the service. Consideration should be made to ensure care plans provided an up to date working tool used by the staff team, professionals and the resident where appropriate. This is because the format of care planning consists of a lengthy document, and a daily living plan had not been written to support staff to make quick reference to assessed need and support requirements. To support residents understand and have their say with care planning and reviews, different methods to engage residents should be used. This is because there is little evidence to show resident consultation. Where residents require financial budgeting support, this should be planned for better as it was not clear as to the level of support provided such as shopping within a set budget for food, or managing a weekly personal allowance. To manage risk effectively, guidance should be clear for staff to know what to do and keep safe. This is because risk identified such as staff assisting resident`s to bathe, were not considered and therefore staff were vulnerable during this activity. Short term goal planning should be managed to provide some structure for residents rather than an ad hoc arrangement. This is because care planning was generalised in some areas and issues for residents linked to every day living were not recognised or planned for. Daily routines should not be institutionalised and should allow for a more person centred approach to meeting needs. Residents living long term in the home should have as part of the basic contract price the option of a minimum seven day holiday they help to choose and plan. The role of the key worker should be developed. This will provide residents with a named care and provide them with a better opportunity to build a professional relationship with identified staff who will support them overcome and manage issues around personal hygiene needs. This will also ensure gender issues in relation to personal care is considered. Consent to medication should be recorded and options for medication management discussed with residents. Locks on bedroom doors must be replaced with a more suitable type. The locks do not provide residents with the facility to lock their doors independently when in their room and leave them at risk of unwanted visitors. There is also a risk of being locked in their rooms as a means of restraint. Where people lack insight into dressing appropriately, support should be planned for. This will help to prevent unnecessary attention to them when out in the community. The use of pendants for residents accommodated in the Mews, to use in an emergency should be evaluated. This is because this system does not readily identify the caller and residents reported they are at times disturbed by staff that are looking for the caller. More care should be taken when accepting an application form to ensure it is complete and satisfactory in providing a work history. Gaps in employment should be explored during interview and a record made of any explanation given. Care should be made to ensure referees include the last employer. Induction should be evidenced better to show induction is a planned and staged over a period of time as currently records show 1 day induction. Residents should have a more active and structured role in recruiting staff. Quality Assurance monitoring should be developed. This will help residents to have a valid opportunity to appraise staff performance and attitudes, care practices, and their environment. An individual risk assessment should be completed to identify and plan for the diverse needs of residents in the event of an emergency evacuation of the home. This will support staff to know what to do and identify who is at greatest risk. Key inspection report Care homes for adults (18-65 years) Name: Address: Heightside House Nursing Home Newchurch Road Rawtenstall Rossendale Lancashire BB4 9HG     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: Marie Dickinson     Date: 0 6 0 5 2 0 1 0 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 Adults (18-65 years) Page 2 of 34 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 Adults (18-65 years) 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Heightside House Nursing Home Newchurch Road Rawtenstall Rossendale Lancashire BB4 9HG 01706830570 01706220206 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Randomlight Limited Name of registered manager (if applicable) Mr Graham Joseph Glascott Type of registration: Number of places registered: care home 78 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The registered person may provide the following category/ies of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 78 Date of last inspection Brief description of the care home Heightside House is registered to provide nursing care for up to 78 people who have mental health care needs. The home comprises three separate units; The House, The Mews and Close Care. The House is an extended detached property. Bedroom accommodation is provided on 4 floors and consists of some single and some shared bedrooms. None have en-suite facilities although there are ample bathrooms and toilets. Communal space comprises reception/lounge area, a separate lounge and a Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 78 1 9 0 6 2 0 0 9 Brief description of the care home dining room. A new lounge has been created on the first floor of The House. The Mews comprises 10 units. These vary from single apartments with a bedroom, kitchen and bathroom, to larger buildings, with shared rooms, accommodating up to 6 residents. Communal space in The Mews is provided in a reception/lounge area and a dining/lounge area. Some of the shared apartments also have lounge areas. Accommodation in the Close Care unit consists of 1 separate bungalow for 4 residents and 6 single rooms in the main building. There are shared toilets and bathrooms. Communal space comprises a reception/lounge area, a second lounge and a dining room. Each of the areas has their own staff team. Meals are prepared in the main kitchen, attached to The House, and transported to The Mews and Close Care. At the time of the key inspection part of The Mews was temporarily closed for refurbishment. Information about the home is sent out to anyone making enquiries about admission. Copies of Commission for Social Care Inspection reports are available from the home manager on request. Weekly fees are dependent on the assessment of the individual. Additional charges are made for hairdressing, transport (not included in a residents care plan) and some activities or trips outside the home. Care Homes for Adults (18-65 years) Page 5 of 34 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: A key unannounced inspection was carried out in respect of Heightside House Nursing Home on the 5th and 6th May 2010. An Annual Quality Assurance Assessment (AQAA) was sent to us by the manager prior to this inspection. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service, such as number of staff trained, and of essential maintenance to keep the home safe being carried out. There were written comments from residents and staff who gave their views as to how well they considered the service met their needs. Discussion took place with the manager, staff, and residents during inspection. Documents including policies, procedures, and staff and residents records were looked Care Homes for Adults (18-65 years) Page 6 of 34 at. The premises were inspected as part of the process. Areas that had been required to improve at the last key inspection were looked at for progress made. Other information the service had notified us about was also considered, such as notifications when people were admitted to hospital and where safeguarding procedures had been followed. The home was assessed against the National Minimum Standards for Younger Adults. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: People referred to the home from health and social care professionals had an assessment of their needs carried out. The assessment took into account peoples circumstances and the level of support they would require. Needs such as personal care, mental health care needs, family, communication, diet, and medication are assessed. Planned admissions supported people who were detained under the Mental Health Act to stay at the home on leave. Residents who provided written comments for this inspection considered they made decisions about their lives and they were treated well by staff and managers. Where residents lacked this capacity, staff or other professionals made decisions on their behalf with advocate support where required. Person centred care planning supported residents to be cared for as they needed and wished. This meant there was recognition within the service of residents right to take control over their life and make their own decisions and choices within their capabilities. Where residents lacked this capacity, staff or other professionals made decisions on their behalf with advocate support where required. Staff interviewed and those who provided written comments for this inspection considered the service did well as they usually had up to date information about the needs of the people they cared for. Written comments included, All staff will try their utmost to ensure service users are happy with the care they receive. And The home is welcoming to new service users and their families. To ensure Equality and Diversity is considered, information for staff, and policies and procedures are available on each unit identifying how staff and residents should dealwith and expect issues related to race, gender, disability and sexual orientation to bedealt with. This includes clear guidelines for staff ensuring zero tolerance of anydiscrimination. Where residents lacked capacity to make informed choices they have access to an advocate at Heightside House, and through the East Lancashire advocacy service for Independent Mental Capacity Advocate representation. Activities were provided for residents. For example residents enjoyed cake making, film shows, social evenings, pamper mornings, reminiscence, pool and darts, getting out and about with much more on offer. Visiting arrangements were good, and residents were supported to maintain family contact. Residents were also supported to recognise social values and therefore be able to build good relationships with other people. Residents health care was being monitored with routine check ups and specialist support. Medication records checked were found to be in good order. The storage and administration of medication was good. Meals provided generally met with residents tastes, needs, and choice. Those residents spoken to during inspection said the food was good. They said they could have what Care Homes for Adults (18-65 years) Page 8 of 34 they wanted. Special diets were catered for and cultural needs met. One resident who provided written comments said, sometimes, when you are not expecting it, they make some lovely meals and puddings. Residents who were consulted, generally knew who to talk to if they were not happy.Staff working at the home had been trained in adult protection and those spoken to during inspection knew their responsibility in this area. The service has shown it is quick to take the right action to any allegation made of abuse in any form, and protect the people they care for. The home was maintained, clean, and tidy, and provided a homely and pleasant environment for residents, visitors, and staff. Residents were satisfied with their bedrooms and living arrangements. Written comments from residents showed they considered the home to be always clean and fresh. One resident wrote, I love how the cleaners leave the place looking good and smelling really clean. Supervision of staff was fairly regular and structured. Staff interviewed were very professional and clear about their duty of care to provide a good service for residents at Heightside. They were familiar with conditions of mental health and the effect it had on residents everyday life. Learning opportunities were relevant to the homes purpose. The home was managed and run in the interests of the people living and workingthere. The home sent us their Annual Quality Assurance Assessment (AQAA), that gave us information we asked for. Overall the self assessment indicated the conduct and management of the home ensured it was run in the interests of the residents, respecting individuals rights and ensured residents best interests were safe guarded. What has improved since the last inspection? Residents identified at risk with weight loss have a clear action plan to ensure their nutritional intake is satisfactory. During inspection staff were observed giving residents at risk additional food supplements and one to one support with meals. Contractual arrangements for staff protects residents from any financial exploitation. Staff had received training on Adult Protection and staff are encouraged raise any issue of concern regarding the care and welfare of residents to senior management. An emergency call pendant was issued to residents in the Mews. This allows them to summon help in an emergency. Maintenance was ongoing and minor repairs attended to. There was evidence to show information disclosed as a result of any checks carried out had been fully considered. A written account was made of the circumstances to support a decision to employ and ensure the right people are employed to care for residents. The use of agency staff had been reduced as staff had been recruited to work permanently in the home. This action will provide stability for residents and consistency when receiving personal care. Staff meetings had increased therefore allowing staff to know their views are valued and they can help to improve practice. Staff training records were up to date, and staff received regular formal supervision that provided them with support to do their work professionally and ensure only qualified and competent staff care for residents. Staff were issued with the terms and conditions of their employment. This helped to Care Homes for Adults (18-65 years) Page 9 of 34 make sure residents staff and employer are protected. What they could do better: All residents must have an up to date care plan based on assessed needs. This is because progress to complete reviews and write a person centred care plan to ensure individuals were cared for as they wish and require had not been completed. The following are good practice recommendations to improve the service. Consideration should be made to ensure care plans provided an up to date working tool used by the staff team, professionals and the resident where appropriate. This is because the format of care planning consists of a lengthy document, and a daily living plan had not been written to support staff to make quick reference to assessed need and support requirements. To support residents understand and have their say with care planning and reviews, different methods to engage residents should be used. This is because there is little evidence to show resident consultation. Where residents require financial budgeting support, this should be planned for better as it was not clear as to the level of support provided such as shopping within a set budget for food, or managing a weekly personal allowance. To manage risk effectively, guidance should be clear for staff to know what to do and keep safe. This is because risk identified such as staff assisting residents to bathe, were not considered and therefore staff were vulnerable during this activity. Short term goal planning should be managed to provide some structure for residents rather than an ad hoc arrangement. This is because care planning was generalised in some areas and issues for residents linked to every day living were not recognised or planned for. Daily routines should not be institutionalised and should allow for a more person centred approach to meeting needs. Residents living long term in the home should have as part of the basic contract price the option of a minimum seven day holiday they help to choose and plan. The role of the key worker should be developed. This will provide residents with a named care and provide them with a better opportunity to build a professional relationship with identified staff who will support them overcome and manage issues around personal hygiene needs. This will also ensure gender issues in relation to personal care is considered. Consent to medication should be recorded and options for medication management discussed with residents. Locks on bedroom doors must be replaced with a more suitable type. The locks do not provide residents with the facility to lock their doors independently when in their room and leave them at risk of unwanted visitors. There is also a risk of being locked in their rooms as a means of restraint. Where people lack insight into dressing appropriately, support should be planned for. This will help to prevent unnecessary attention to them when out in the community. The use of pendants for residents accommodated in the Mews, to use in an emergency Care Homes for Adults (18-65 years) Page 10 of 34 should be evaluated. This is because this system does not readily identify the caller and residents reported they are at times disturbed by staff that are looking for the caller. More care should be taken when accepting an application form to ensure it is complete and satisfactory in providing a work history. Gaps in employment should be explored during interview and a record made of any explanation given. Care should be made to ensure referees include the last employer. Induction should be evidenced better to show induction is a planned and staged over a period of time as currently records show 1 day induction. Residents should have a more active and structured role in recruiting staff. Quality Assurance monitoring should be developed. This will help residents to have a valid opportunity to appraise staff performance and attitudes, care practices, and their environment. An individual risk assessment should be completed to identify and plan for the diverse needs of residents in the event of an emergency evacuation of the home. This will support staff to know what to do and identify who is at greatest risk. 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 Adults (18-65 years) Page 11 of 34 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 12 of 34 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Pre admission assessments and very good admission procedures followed, meant people admitted to the home would be cared for and supported according to their needs and wishes. Evidence: There was evidence to show where possible admissions are planned for. People referred to the home from health and social care professionals had an assessment of their needs carried out. The assessment took into account for example, personal care, mental health care needs, family, communication, diet, and medication, past history, presenting needs, and support required to ensure needs are met. Planned admissions supported people who were detained under the Mental Health Act to stay at the home on leave. This means there is an arranged period of time to carry out a more thorough assessment of need to determine if the placement is suitable, and assessed needs can be met as required. It will also ensure staff have the required skills and knowledge to support individual ethnic and diverse needs and focus on achieving positive outcomes for people. Care Homes for Adults (18-65 years) Page 13 of 34 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning supported some residents to take control of their lives, and make good decisions and choices in achieving this. Evidence: Some residents living at the home completed a survey that was sent to them asking for their views for example about making decisions and how well they were treated at Heightside. Generally they considered they made decisions about their lives and they were treated well by staff and managers. Where residents lacked this capacity, staff or other professionals made decisions on their behalf with advocate support where required. Several care plans were looked at in detail. Whilst improvements in writing care plans was evident, more work was required to make sure the plans provide an up to date working tool used by the staff team, professionals and the resident where appropriate. Care should be taken to ensure the plan can be used easily and quickly by new staff who are not familiar with the resident therefore providing a continuity in delivering a Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: personalised quality service. Good information was recorded however, and the plans had taken on a more person centred approach to meeting needs and included risk assessments for health and daily living. There was some written evidence in residents care plans to show the service respected residents right to have control over their own life and supported them to make their own decisions and choices. Care plans were generally person centred and linked to assessed needs, and placed residents central to any activity. For example I would like my key worker to invite me to have a shower in the morning when I get up. Staff who provided written comments for this inspection considered they always or usually received up to date information about the needs of people they cared for. A key worker system was in operation, however the full potential of this needs to be developed to enable staff to take more responsibility in giving a person centred approach to resident care, and have accountability within their role to ensure consistency and a personalised service. Information received in the AQAA stated, Staff build positive relationships with residents and residents. And if They are unhappy, they are supported to express their opinions and to have them valued and acted upon accordingly. Whilst care plans in some instances took into account what was important to residents, such as support with some personal care, they should be specific as to the type and level of support to be provided. To ensure this will consistently happen, areas of responsibility should be clearly outlined for example, the role of key worker, self, family, and other professional people involved in resident care. Short term goals should also be identifiable, achievable and provide a good audit trail for accomplishment and further support needs. Not all residents had up to date care plans. These were being written during inspection. All residents had a signed agreement for the sharing of information confirming their right to confidentiality. There was evidence that where person centred care planning had been used, management of identified risk had been agreed. Where limitations were in place, residents knew about them, and had been involved in deciding how these would be managed and understood how these agreements helped them. Good examples of this included management of residents environment and mental health issues. Other examples of risk however, such as staff assisting residents to bathe, were not considered and therefore staff were vulnerable during this activity. Some residents managed their own money which was given to them each week. More Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: work could be done in this area where budget management support was required and show how this was accomplished. Arrangements were in place however for the purchasing of items such as cigarettes for residents who lacked capacity to do this independently. Proper accounting meant receipts were kept and records maintained showed all transactions made were accounted for. Care Homes for Adults (18-65 years) Page 16 of 34 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. Residents had a degree of independence and opportunity to take part in chosen activities, access community resources and keep in touch with families and friends. The meals were sufficient in providing for residents cultural requirements, taste and choice. Evidence: Although care plans did not include a daily living plan with preferred routines recorded to support residents personalise their day, it appeared residents had a degree of freedom and choice over their lives within their capability. There was evidence to show residents living within the Mews were supported to be more independent and be involved in all daily living activities in and around their accommodation. This meant their routines were flexible therefore supporting them to make informed choices in areas of their lives and daily living. This included for Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: example planning meals, shopping and keeping their accommodation safe and clean with staff support as required. Care planning and daily records maintained showed how some residents were supported to develop skills that included social, emotional, communication, and independent living skills, and encouraged to use community resources. However as identified in the last inspection care planning did not always identify short term goals to support residents reach long term outcomes. This meant that care planning was generalised and issues for example overcoming phobias linked to every day living was not recognised or planned for. Activities were provided for residents. They were varied to suit all tastes with weekly programmes arranged. For example residents enjoyed cake making, film shows, social evenings, pamper mornings, reminiscence, pool and darts, getting out and about and much more was on offer. There was sufficient evidence to show residents had opportunity to maintain family contact. Residents were also supported to recognise social values and therefore be able to build good relationships with other people. Residents visited their family and visiting arrangements in the home was good. Where residents were at risk or vulnerable in the community, this had been identified and managed properly. Weekly planners for some residents were used to help provide some order in their lives. For example they knew when they had occupational therapy, or cleaned their room. Visits into the community were encouraged. Residents did not however have as part of the basic contract price, the option of a minimum seven-day holiday outside the home they helped to choose. One resident said he was going on holiday he had arranged. The manager said the home was managed in a manner aimed to avoid any institutional routines. However some practices remain institutional such as the method of distribution of cigarettes and drinks. And, where people lack insight regarding dress and appearance, there was no support plan to help them dress appropriately and avoid drawing unnecessary attention to them when out in the community. Staff spoken to were sensitive to residents needs showing good insight into respecting residents right to make choices in the lives. All bedrooms had locks on their doors and residents who could, held their own key. The type of lock fitted however meant residents could not lock the door when in their room and therefore compromised their right to privacy. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: Observations made during meal times showed residents requiring assistance were given sensitive support by staff. Discussions with staff during this period showed staff had a good understanding of individual needs and requirements with diet and nutrition. Meals appeared to be nourishing and menus seen were varied. Special diets were catered for and cultural needs met. Two residents in the Mews who were interviewed said they did their own shopping and cooked their own food. They received a weekly food allowance for this purpose. This was discussed with the manager as both residents felt it needed to improve. Those residents spoken to during inspection said the food was very good. Choices were offered and no complaints in this department. Care Homes for Adults (18-65 years) Page 19 of 34 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Residents health and general wellbeing was being monitored, with support being provided to access health care services. Medication was managed safely. Evidence: Records showed people using the service were registered with a General Practitioner and that appointments had been made and kept. Appointments had also been kept with care coordinators, consultants, and community health services as required, such as dental visits and routine medical checkups. Care plans instructed staff to support resident with personal care, with some indication of what residents preferred. For example, I prefer a shower in the morning and prefer to shave later in the day. A key worker system was used; however the role of the key worker was not extended to providing residents with support from a named carer. This meant residents did not necessarily have an opportunity to build a professional relationship with identified staff to support them overcome and manage issues around personal hygiene needs. This was provided with different staff, and gender issues in relation to personal care were not recorded. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: Staff had some training in mental health care, to support them in providing the right approach to care for people with mental health problems. Residents had health care risk assessments for example reduced mobility, pressure sore risk. Blood pressure and nutrition were also being monitored. The home operated with a monitored dosage system for medication. Records of residents medication were kept, and registered nurses had responsibility for the administering of medication. Some residents self medicated following a risk assessment completed, to ensure this would be done safely. Those records seen were up to date and complete. Storage of medication was good, and medications opened with a limited shelf life were dated. Consent to medication should be recorded and options for medication management discussed. Care Homes for Adults (18-65 years) Page 21 of 34 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 complaints procedure was available and used properly, which helped residents and other people have confidence to raise any concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues. This meant residents rights, safety, and welfare was promoted Evidence: Residents who provided written comments for this inspection said they knew who to speak to if they were not happy, and knew how to make a complaint. Information contained in the AQAA stated, There is a copy of the complaints procedure in the residents handbook, which has been given to everyone living at the home. Records show that all complaints are investigated and responded to. During inspection residents who were spoken to were generally aware of how to make a complaint. The procedure was displayed in the home and included in information given to residents when they are admitted. There have been no complaints received at the Commission about this service. Staff who provided written comments for this inspection indicated they knew what to do to protect residents and procedures to be followed. Policies and procedures forsafeguarding adults were available in the home. Records showed staff training in Safeguarding Vulnerable Adults was provided. The service has shown it is quick to take the right action to any allegation made of abuse in any form, and protect the Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: people they care for. Contractual arrangements for staff require compliance with the homes policies and procedures and provided a code of conduct and professional ethics that included issues such as financial protection for residents. Training records showed staff were trained in handling aggression properly. Information in the AQAA included We provide all new starters with information and teaching sessions on how to use the agreed basic physical intervention until they can attend the full introductory and foundation courses. Care Homes for Adults (18-65 years) Page 23 of 34 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 was warm, comfortable, and generally well maintained. This meant residents were provided with accommodation that met their needs. Evidence: Written information received for this inspection considered the home did well as All areas of Heightside House have or are due to be refurbished. New furniture has been provided to bedrooms that is homely and suits the environment. The home is set in its own spacious grounds, with large well maintained lawns and walking areas. There are ample areas residents can sit out and enjoy the views weather permitting. Accommodation is provided in three units, The House, a detached mansion type property, the Mews and Close Care. Bedrooms in The House are in single and shared rooms, in the Mews single and shared apartments and in Close care single rooms with a separate bungalow that accommodates four people. During a tour of Heightside the following observations were made. In the House, the home was very clean, tidy, well lit, and smelt fresh. The lounges were comfortable and residents were able to walk about freely. Bedrooms were comfortable and residents Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: possessions accommodated very well. They were clean, and furniture, bedding and floor coverings were suitable for residents needs. Locks fitted on bedroom doors were not suitable. This was because the type used did not allow residents to lock their doors when in their rooms, and therefore placing them at risk from unwanted visitors, or be locked in their room as a means of restraint. Bathrooms and toilets were clean and in sufficient numbers to meet with residents needs. The manager said there was ongoing upgrading of areas of the Mews. Following the last inspection residents had been supplied with pendant alarms in response to a requirement made to provide residents occupying these rooms a means of alerting staff in an emergency. Residents spoken to said this was not entirely satisfactory as the alarm does not identify who is summoning help. This can be disturbing, particularly during the night when staff need to check all residents whilst looking for the caller. During inspection residents enjoyed sitting out in the courtyard. Residents spoken to reported the gardener who usually helped with the courtyard garden beds was not available to help with planting this year. Laundry facilities were clean and very well organised. A high proportion of staff employed had completed infection control training. The home was very clean, tidy,and smelt fresh. Care Homes for Adults (18-65 years) Page 25 of 34 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 numbers of staff employed, training provided, and relatively safe recruitment practices, meant residents should be protected, and their needs effectively met. Evidence: Rotas completed showed the compliment of staff appeared sufficient to cover all essential duties in providing care, and maintaining essential standards in the home such as hygiene and catering, with senior staff on duty at all times. Written comments from residents for this inspection showed they considered staff were always available when needed. Written comments from staff showed they considered recruitment was done fairly with relevant checks carried out before they started work. A number of staff files examined showed pre employment checks such as, identity checks were carried out. All files contained a completed application form, two references and police checks. There were areas that require improvements as full employment history did not include requests for dates of previous employment. The request for this information was not always supplied and where gaps were seen this was not explored further. In one application care had not been taken to require a reference from the previous employer. All applicants had been required to attend the office for interview, and interview notes had been made. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: Staff who provided written comments for the inspection said they had received good induction training that covered everything they needed to know to do their job. Better records of full induction should be made as records with one day induction only was evidenced. However other training was provided to help staff understand and meet residents individual needs, keep them up to date with new ways of working and gave them enough knowledge about health care and associated needs. Training in specialist areas such as mental health care was provided. Over half the staff employed had been trained to National Vocational Qualification in care level 2 and 3. Regular formal supervision had improved and staff did meet throughout the day at various times to discuss resident care and receive delegated duties from the nurse in charge. Supervision included topics such as Understands each clients needs and differences for level of support to achieve this. Level of support to colleagues. Taking responsibility for actions. Use of language, completion of tasks and record keeping. Knowledge and implementation of policies and procedures etc. Confidentiality, Management support. Key responsibilities and targets agreed. For example, To attempt to read policies and procedures and care plans. Agreed objectives and development needs such as learn about policies and procedures. Agreed actions and a review date set. Staff present during inspection said supervision was good and confirmed training issues were discussed. Regular staff meetings took place. Minutes of the meetings were taken and the records showed agendas were associated with best practice issues and topics relevant to the day-to-day running of the home. The attendance was very poor given the number of staff employed at the home with five staff present at the last meeting held in April. Some staff that provided written comments for this inspection had mixed views as to the level of support they had from their manager. Some considered they regularly had enough support from the manager; however it was concerning that a staff indicated sometimes and never. Staff interviewed during inspection was very professional and clear about their duty of care to provide a good service for residents at Heightside. They were familiar with conditions of mental health and the effect it had on residents everyday life. Staff who provided written comments for this inspection said Heightside did well as All staff will try their utmost to ensure service users are happy with care they are receiving. Their views on the service showed they considered there was usually enough staff to support residents. Care Homes for Adults (18-65 years) Page 27 of 34 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 was managed and run in the best interests of the residents. Evidence: The home sent us their annual quality assurance assessment (AQAA), that gave us information we asked for. Overall the self assessment indicated the conduct and management of the home ensured it was run in the interests of the residents, respecting individuals rights and ensured residents best interests were safe guarded. Areas that had improved was included with intentions stated where improvements needed to be made and the plans to ensure this happens. The manager of Heightside is both qualified and experienced to run the home and is supported in his role by unit managers and senior staff. He meets regularly with the corporate manager and provider to discuss requirements for the service. This can include for example, refurbishment requirements of the home, and staff training needs, and reported he had no difficulties being financially supported in these areas. Requests were always considered and dealt with as required. Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: The manager was aware of the need to keep up to date with best practice, and attends training relevant to his role. To ensure Equality and Diversity was considered, information for staff about the needs of people they care for was provided and ethnicity and cultural values was considered when planning care. Policies and procedures are available on each unit relating to this with an expectation of zero tolerance to any form of discrimination. Residents have access to an advocate at Heightside House and through the East Lancashire advocacy service for Independent Mental Capacity Advocate representation. Heightside holds Investors In People award and external (ISO9001:2000) monitoring award. Social Services also carry out quality monitoring and Quality Assurance is in place with residents in one to ones, and in meetings, although these were not well attended. More work could be done to ensure residents were given an opportunity to give their views formally in areas such as staff performance, management arrangements and facilities provided. From observations made, and comments from residents and staff it appears the management approach in the home did allow residents to be consulted regarding any proposed changes that may affect them such as redecoration of their rooms. Staff who completed questionnaires for this inspection considered they usually had enough support, experience and knowledge to meet the different needs of the residents. They considered the home did well in providing a good service of being at home, and Is welcoming to new service users and their families. Staff considered the home could do better as communication between management and staff members is a little lapse. There is an open door policy so that residents and staff can come and chat to management with any urgent issues. Information received at the Commission showed regular maintenance of the homes fixtures, fitting and equipment. Policies and procedures for safe working practices were in place. Staff training records included first aid and fire safety, and fire drills were carried out. However as highlighted in the last key inspection an individual risk assessment should be completed to identify and plan for the diverse needs of residents in the event of an emergency evacuation of the home. This will support staff to know what to do and identify who is at greatest risk. Care Homes for Adults (18-65 years) Page 29 of 34 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 Adults (18-65 years) Page 30 of 34 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 6 15 All residents must have an up to date care plan based on assessed needs. This is because not all plans had been reviewed and written in a person centred way to ensure residents are cared for as they wish and require. 15/07/2010 2 25 13 Locks on bedroom doors must be replaced with a more suitable type. The locks do not provide residents with the facility to lock their doors independently when in their room and they are at risk of unwanted visitors and at risk of being locked in their rooms as a means of restraint. 30/07/2010 Care Homes for Adults (18-65 years) Page 31 of 34 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 6 Care plans should be provide an up to date working tool used by the staff team, professionals and the resident where appropriate. This was because the format of care planning was a lengthy document and a daily living plan had not been written to support staff to make quick reference to assessed need and support requirements. To support residents understand and have their say with care planning and reviews, different methods to engage residents should be used. For example, illustrations, discussions and staff observations, key worker and knowledge of current needs of residents. Good communication methods such as large print in plain English, all help to make sure the service provided is what was needed and wanted. Where residents require financial budgeting support, this should be planned for better as it was not clear as to the level of support provided such as shopping within a set budget for food, or managing a weekly personal allowance. To manage risk effectively, guidance should be clear for staff to know what to do and keep safe. Residents living long term in the home should have as part of the basic contract price the option of a minimum seven day holiday they help to choose and plan. Short term goal planning should be managed to provide some structure for residents rather than an ad hoc arrangement. This is because care planning was generalised in some areas and issues for residents linked to every day living were not recognised or planned for. Where people lack insight into dressing appropriately, support should be planned for. This will help to prevent unecessary attention to them when out in the community. Daily routines should not be institutionalised and should allow for a more person centred approach to meeting needs. The role of the key worker should be developed. This will provide residents with a named care and provide them with a better opportunity to build a professional relationship with identified staff who will support them overcome and manage issues around personal hygiene needs. This will also ensure gender issues in relation to personal care is Page 32 of 34 2 6 3 7 4 5 9 14 6 14 7 16 8 16 9 18 Care Homes for Adults (18-65 years) 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 considered. 10 11 20 29 Consent to medication should be recorded and options for medication management discussed with residents. The use of pendents for residents to use in an emergency should be evaluated. This is because this system does not readily identify the caller and residents reported they are at times disturbed by staff who are looking for the caller. f Residents should have a more active and structured role in recruiting staff. More care should be taken when accepting an application form to ensure it is complete and satisfactory in providing a work history. Gaps in employment should be explored during interview and a record made of any explanation given. Care should be made to ensure referees include the last employer. Induction should be evidenced better to show induction is a planned and staged over a period of time as currently records show 1 day induction. Quality Assurance monitoring should be developed. This will help residents to have a valid opportunity to appraise staff performance and attitudes, care practices, and their environment. An individual risk assessment should be completed to identify and plan for the diverse needs of residents in the event of an emergency evacuation of the home. This will support staff to know what to do and identify who is at greatest risk. 12 13 34 34 14 15 34 35 16 39 17 42 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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