Care Home: Heron House

What the care home does well We did not assess what the service does well, on this occasion. What the care home could do better: We consider that the requirement about care planning has not been met and we have made a new requirement about this, with more specific wording. We have also made a new requirement about people`s health and personal care. Inspecting for better lives Random inspection report Care homes for older people Name: Address: Heron House Coronation Close March Cambridgeshire PE15 9PP one star adequate service 20/11/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Elaine Boismier Date: 1 1 0 3 2 0 0 9 Information about the care home Name of care home: Address: Heron House Coronation Close March Cambridgeshire PE15 9PP 01354661551 01354657291 heron.house@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Four Seasons Homes (No 4) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) care home 95 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 42 36 36 dementia old age, not falling within any other category physical disability Conditions of registration: 17 0 17 1 named individual under the age of 65 with DE DE service users to be accommodated in Wendreda unit only. A maximum of 42 places to provide nursing care to category DE(E). Physical Disability (PD) PD(E)) only in association with Dementia (DE DE(E)). A maximum of 36 places to provide nursing care under category OP. Up to 17 places to provide nursing care to category DE. Date of last inspection Care Homes for Older People 2 0 1 1 2 0 0 8 Page 2 of 9 Brief description of the care home Heron House is a purpose built home situated off a main road in a residential area of the market town of March. It is owned by Four Seasons Healthcare Ltd and provides care and support for up to 95 service users from the age of 18 years and over. Most of the bedrooms are used for single occupancy rooms only and ensuite facilities are available. Resident accommodation is on one level. There are a variety of communal areas available to service users and the home provides bathing and additional toilet facilities with aids and equipment to enable the needs of service users to be met. Service users can access the gardens and courtyards throughout the home. The home is situated approximately 1 mile away from the centre of March, where there is a range of shops, pubs and a post-office. Fees for the home range between £347and £791 depending on the needs of the residents. Additional costs include those for private chiropody, toiletries and newspapers. Further information about fees can be obtained from the care home. Copies of our CSCI inspection reports are available on request, from the home, or via our CSCI website at www.csci.org.uk Care Homes for Older People Page 3 of 9 What we found: Following our key unannounced inspection, of the 20th November 2008, a requirement was made for care plans to be up to date and accurate and drawn up in consultation , with the resident, wherever possible. The timescale for this requirement was by the 28th February 2009. We received an action plan, from Four Seasons Health Care Limited, stating that action was being taken, to meet this requirement and within the set timescale. We looked at 2 peoples care records, spoke with a member of the staff and visited the peoples rooms. Because both of these people appeared to be asleep we did not speak with them. For the first person we saw that they were assessed as being at very high risk of pressure sore development with a past history of developing pressure sores. The last record, that their pressure sore risk assessment had been carried out, was the 8th December 2008 and none thereafter. The member of the staff stated that the person stayed in bed, due to having painful arthritis, and would get up only for a shower and having their hair done. The member of the staff told us that the person sometimes needed to have their position changed in bed; the progress notes showed that this was the case. The member of the staff said that the person had a pressure relieving mattress in bed and we saw that this was the case when we visited th persons room. We, and the member of the staff, could find no care plan for care of the persons pressure areas and none of us could find a care plan for care of the pressure relieving mattress and what pressure setting this mattress should be set at. The persons care records, including their fluid intake, indicated that the person had a history of drinking less that one litre of drink each day: there was, for example on the 18th October 2008, a record of the person having less than one litre of drink i.e. between 700 and 800 millilitres (mls); the member of the staff stated that the person was currently drinking less that one litre each day; the accumulated fluid intake, for this person, for the 9th March 2009, was 600 mls and, for the 10th March 2009, the accumulated recorded fluid balance, was 495 mls. The care plan for this person was drawn up on, the 9th December 2008, that stated the person should ideally be drinking 1.5 to 2 litres of drink each day. This care plan was not person centered; it failed to accurately reflect what the person was able to drink, historically and currently. We also noted that the person had been left a plastic beaker containing a drink, that would have been originally hot, and this was placed on their bedside table. The member of the staff told us that the person needed help with their drinks; we felt the outside of this beaker and we found that the drink was luke warm. The persons food charts were examined and we saw that the person had little to eat between the 7th and 10th March 2009. The food offered to the person lacked variety as this included weetabix, soup, sandwiches, yoghurt and pudding such as jelly. On the 8th March 2009 the person was offered a banana, at breakfast time, of which a quarter of this was eaten and we found no other offer of fruit recorded on the other days. We also found no record of any other choices of food or drink offered to the Care Homes for Older People Page 4 of 9 person when they did not eat their food, or only part of it. For the second person we saw that they had a recorded history of pressure sores occurring in 2007 and 2008. The person currently had acquired a grade 2 pressure sore, in the sacral area. The wound assessment chart noted that this pressure sore had become green and sloughy (slough is dead tissue). The person had been assessed as being at very high risk of pressure sore development. A care plan was in place, for reducing the risk of the person developing pressure sores, that included staff helping the person change their position, when in bed, every 4 hours. The member of the staff stated that the person had their position changed every 2-4 hours. The repositioning charts, for this person were examined and we found, for example that, on the 19th February 2009, the person was turned to their right side, at 20:30; at 1:05 the person was assisted to lay on their back i.e. just over 4.5 hours later. The next entry (although this is not dated) is when the person was assisted to lay on their right side at 6:00. There were no recorded entries for the 20th, 21st and 22nd February 2009 until the 23rd February 2009 when at 9:00 the person was up in chair until 14:00 (5 hours later) when they were put back to bed (there is no record in what position the person was lying) and, on the same day, at 16:00, the persons incontinence pad was changed. There was no record to say if the person had any pressure area care, to include repostioning. Following this latest entry, there were no other recorded entries until the 28th February 2009 i.e. 5 days later. When entering the persons room we noted a smell of body odour that came from the person; we saw that the person was recorded to have had help with their personal care, on the 28th February 2009; on the 10th March 2009 the night staff had recorded, in the progress notes, the person was resistant to some personal care, although there was no description of what personal care had been provided. This person was assessed to be at risk of malnutrition and there was a care plan for helping with their nutrition although the information, provided by the member of the staff, indicated that the care plan had not been updated. We were told that, due to the person becoming tired as the day wore on, the person was being given food in a liquidised form for the last 4 or 5 days as the person was unable to chew in the afternoon. The persons food intake chart, for the 7th March 2009, indicated that they had a liquidised meal for their lunch although the record for their evening meal, for the same day, was blank; for the evening meal, of the 8th March 2009, the record indicated that the person was offered soup, sandwiches and pudding although the person ate none of this food. Although we were told, by the member of the staff, the person was offered liquidised food, after lunchtime, we were uncertain about how the sandwiches could have been eaten, if the person wanted their food. Because we were unable to speak with them we were unable to assess if they had been consulted about their care plan. The standard of care records and the standard of health and personal care has placed, at least these two people at unnecessary risk, to their health, welfare and safety. What the care home does well: Care Homes for Older People Page 5 of 9 We did not assess what the service does well, on this occasion. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 9 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action 1 8 13 Residents must have access to health care advice and treatment. To ensure that residents health care is delivered in a proactive way to promote health care and prevent any deterioration in their health 18/12/2008 2 10 12 Residents must have their dignity respected. To ensure that residents welfare is safeguarded. 05/12/2008 3 12 16 Residents must be offered meaningful activities. To ensure that residents do not suffer from isolation, depression and increased incidents of challenging behaviours 01/04/2009 Care Homes for Older People Page 7 of 9 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 7 15 Care plans and care records must be accurate and updated with particular regard to care of peoples pressure area care and nutrition. This is to ensure that people are protected from harm to their health, welfare and safety 12/05/2009 2 8 13 People must receive the right 01/04/2009 health and personal care with particular regard to nutrition, pressure areas and personal hygiene. To ensure that people are protected from the risk of harm and to value their dignity. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 8 of 9 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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