Care Home: Heslam Homes Limited

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What the care home does well The majority of the staff team have worked at the home for a substantial period of time. This means that members of staff have got to know the individual needs, wants and requirements of people living at the home very well. This helps people living at the home to feel safe and comfortable. The relationships between staff and those living at the home appeared to be warm, supportive and affectionate. Without exception the residents spoken with spoke very highly of the staff team describing them as “Very good, very caring and kind” and “All marvellous”. There is a good system in place to make sure that the individual needs and requirements of each prospective new resident are known prior to admission. This helps to make sure that people are only admitted to the home if there individual strengths and needs can be met by the staff team. Staff training is given high priority to make sure that the staff team is well trained in order to offer a consistent service that meets resident’s needs and requirements. Privacy and dignity is well respected. The staff team work well together and showed a good understanding of the needs of individual residents. What has improved since the last inspection? The way medication is administered and recorded has improved. This means that people are better protected and ensures that they receive their medication as prescribed. Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.2 Care plans have been strengthened to make sure that staff have clear direction so that individual wants and needs can be met in a consistent way. A nutritional risk assessment has been introduced. This helps to make sure that people living at the home are offered balanced menus that meet their individual requirements. Since the last inspection an activities coordinator has been appointed and a planned programme of activities now takes place two days a week to supplement the range of activities already available. Improvements have been made to the environment of the home. The main hallway, stairs, landing and one of the lounges have been redecorated, a lounge has been provided with new chairs and new industrial expel-air fans have been purchased for the kitchen. What the care home could do better: Although there has been improvement in the way medication is managed, there is still room for further improvement. It is important that when a resident chooses to self administer their own prescribed medication either wholly or in part, a formal risk assessment should be in place to make sure that the resident can self administer and store their medication safely. This helps to protect all people living at the home. It was also recommended that individual protocols should be in place for medication that is to be taken ‘when required’. Staff should be given clear guidance of ‘when required’ medication should be given to help ensure consistency of use. A substantial number of radiators in resident accommodation are not guarded or have guaranteed low temperature surfaces. All radiators and any pipe work in communal areas of the home and individual bedroom accommodation should be guarded or have guaranteed low temperature surfaces. This would help to prevent the risk of accidental scalding and help to keep people safe. Although the homeowner visits the home regularly and speaks with residents and staff, there is a requirement that the homeowner produces a monthly written report on the conduct of the home. A copy of this report should be given to the registered manager and made available for inspection. At the time of the visit, there were no written reports available at the home to inspect.Heslam Homes LimitedDS0000005825.V378148.R01.S.docVersion 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Heslam Homes Limited Heslam House 3 St Francis Road Blackburn Lancs BB2 2TZ Lead Inspector Denise Upton Key Unannounced Inspection 23rd July 2009 09:00 DS0000005825.V378148.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heslam Homes Limited Address Heslam House 3 St Francis Road Blackburn Lancs BB2 2TZ 01254 201513 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) Mrs Carina Lamb Mr Philip Richard Lamb Miss Linda McCallion Miss Sharon Louise Park Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 24 Date of last inspection 19th August 2008 Brief Description of the Service: Heslam House is registered to provide personal care to a maximum of 24 older people. The home is a large detached property set in its own established and wellmaintained grounds. There is a large enclosed garden and patio area with seating for residents. Parking space is provided at the front and side of the building. Heslam House is located in a residential area of Blackburn, within easy reach of shops and other local amenities. The home has three lounges and one dining room. Bedroom accommodation is provided on two floors, the upper floor is accessed by a stair lift. All rooms are currently used for single occupancy. People thinking about using the service are given information about the home during a pre-admission visit. They are given a copy of the service user’s guide on admission and a copy of the latest Care Quality Commission report is displayed on the resident’s notice board. Information regarding current fees and what is included in the fees is available from the registered manager at the home. Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. This unannounced site visit took place during the course of a mid-week day and a short period of time on a second day. In total the visits spanned a period of approximately eleven hours. The twenty-one core standards, plus an additional standard of the thirty-eight standards identified in the National Minimum Standards-Care Homes for Older People were assessed, along with a re-assessment of the requirements and recommendations identified in the last inspection report. We spoke with the registered manager and spoke individually with three members of the care staff team. In addition, individual discussion took place with two people living at the home, two further residents were spoken with collectively in a lounge area and discussion took place with the relative of three different residents. Several other residents were also briefly spoken with in various communal areas of the home during the course of the site visits. A number of records were examined and a partial tour of the building took place that included communal areas of the home, kitchen and laundry areas and some bedroom accommodation. Information was also gained from the Annual Quality Assurance Assessment completed by the registered manager. Prior to the site visit taking place, three Care Quality Commission (CQC) surveys were completed and returned by people living at the home. This helped to form an opinion as to whether individual needs and requirements were being met to the satisfaction of people living at Heslam House. The last key inspection at Heslam House took place on 19th August 2008. This key inspection focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.2 Page 6 What the service does well: The majority of the staff team have worked at the home for a substantial period of time. This means that members of staff have got to know the individual needs, wants and requirements of people living at the home very well. This helps people living at the home to feel safe and comfortable. The relationships between staff and those living at the home appeared to be warm, supportive and affectionate. Without exception the residents spoken with spoke very highly of the staff team describing them as “Very good, very caring and kind” and “All marvellous”. There is a good system in place to make sure that the individual needs and requirements of each prospective new resident are known prior to admission. This helps to make sure that people are only admitted to the home if there individual strengths and needs can be met by the staff team. Staff training is given high priority to make sure that the staff team is well trained in order to offer a consistent service that meets resident’s needs and requirements. Privacy and dignity is well respected. The staff team work well together and showed a good understanding of the needs of individual residents. What has improved since the last inspection? The way medication is administered and recorded has improved. This means that people are better protected and ensures that they receive their medication as prescribed. Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.2 Page 7 Care plans have been strengthened to make sure that staff have clear direction so that individual wants and needs can be met in a consistent way. A nutritional risk assessment has been introduced. This helps to make sure that people living at the home are offered balanced menus that meet their individual requirements. Since the last inspection an activities coordinator has been appointed and a planned programme of activities now takes place two days a week to supplement the range of activities already available. Improvements have been made to the environment of the home. The main hallway, stairs, landing and one of the lounges have been redecorated, a lounge has been provided with new chairs and new industrial expel-air fans have been purchased for the kitchen. What they could do better: Although there has been improvement in the way medication is managed, there is still room for further improvement. It is important that when a resident chooses to self administer their own prescribed medication either wholly or in part, a formal risk assessment should be in place to make sure that the resident can self administer and store their medication safely. This helps to protect all people living at the home. It was also recommended that individual protocols should be in place for medication that is to be taken ‘when required’. Staff should be given clear guidance of ‘when required’ medication should be given to help ensure consistency of use. A substantial number of radiators in resident accommodation are not guarded or have guaranteed low temperature surfaces. All radiators and any pipe work in communal areas of the home and individual bedroom accommodation should be guarded or have guaranteed low temperature surfaces. This would help to prevent the risk of accidental scalding and help to keep people safe. Although the homeowner visits the home regularly and speaks with residents and staff, there is a requirement that the homeowner produces a monthly written report on the conduct of the home. A copy of this report should be given to the registered manager and made available for inspection. At the time of the visit, there were no written reports available at the home to inspect. Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.2 Page 8 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. Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 9 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 Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3. Standard 6 not assessed, intermediate care service not provided. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given information and have their needs assessed before deciding to move into the home, so they know that their needs can be met. EVIDENCE: Prospective residents are provided with the written information they need to make an informed choice about whether to live at the home. As confirmed by a resident spoken with, an individual copy of the Service Users Guide is given to each new resident. Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 11 In order to ensure that residents are only admitted to Heslam House if their health, personal and social care needs could be met, prior to admission the registered manager undertakes an assessment of peoples current strengths and needs. This is done in order to make sure that the level of care and support required could be provided at the home. This information is recorded, which in some cases is supported by a Health and/or Social Services assessment of current requirements. In the main this collated information, along with any further information provided by family or other advocates, provides the basis of the initial 72 hour plan of care. All this helps to make sure that as much information as possible is gained in order for the registered manager to make an informed judgment as to whether the home could provide the individual care required. A resident spoken with confirmed that the pre admission assessment had been undertaken prior to her admission to the home and that she had received written confirmation that her needs could be met. The daughter of a resident spoken with explained that she had been involved in selecting Heslam House for her mother and that she had also provided some information about her mother during the pre admission assessment. This same person, who visits most days, went on to say that her mother was “Happy here, she is well looked after and I am very happy with the care”. As part of the home’s quality monitoring, recently admitted residents or their relatives are asked to complete a survey about their admission to the home. One resident spoken with told us that staff had been “Welcoming and friendly” and that staff were “Very good”. Standard 6 was not applicable. Intermediate care is not provided at Heslam House. Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 & 10 assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are treated with dignity and respect at this home. Their health, personal and social care needs are taken seriously. EVIDENCE: Following the assessment and admission process, a 72 hour care plan is drawn up from the information obtained. This gives staff some initial guidance as to the newly admitted resident’s needs and requirements and how these should be addressed. This period of time also allows the person a little time to settle into the home whilst providing staff with the opportunity to continue to assess Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 13 the new resident in order to gain a greater understanding of the person’s longer term needs and requirements. The longer term care plans of three people were viewed. These were person centred. This meant that staff knew exactly what they needed to do to help the person to meet their needs in the way they preferred. The plans focused on what people were able to do for themselves, which helped to maintain their independence. Each person has a personal profile that is detailed and covers a diverse range of issues for example, personal care, physical well being, and sleep pattern. For all residents this personal profile is reviewed at least annually or more frequently dependent on need. The outcome of the personal profile identifies the individual needs and requirements of each individual resident. A care plan is then developed for each area of needs identified from the personal profile. Care plans are person centred. For example for one person the care plan stated that the resident should be asked if she would like salt and pepper on her meal. Meals sometimes needed to be liquidized dependent on the ability of this person, staff were instructed in the care plan to use their initiative on a daily basis in respect of this person’s ability to eat more solid foods and also to consider the food served. For another person, the care plan in respect of mental state and cognition identified that the aim was to keep the resident bright and alert by staff frequently chatting with her to keep her stimulated and involved. This was seen to be happening during the course of the site visit. For this same resident there was good instruction for staff on how to assist this resident to use cutlery and instruction on how to minimize the effects of her blindness when eating. There was also good instruction with regard to this person’s social care needs. The social care plan gave a good account of what this person could still enjoy including the company of others, what the limitations were and that “Staff to spend time with ******** and give her daily news, date/day, weather or gossip”. A variety of risk assessments were also in place specific to the requirements of the individual. These also were detailed and person centred. The outcome of a nutritional risk assessment in respect of one person identified action for staff to take. This included assistance with feeding, document all meals and fluids taken and liquidize main meal in order to maintain a healthy weight. The relative of this resident that was spoken with individually, confirmed that this was happening on a daily basis, that her mother enjoyed the meals and that she was “Safe and well looked after”. The was clear evidence that care plans and risk assessments are reviewed on at least a monthly basis to make sure that the information provided remains Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 14 current and accurate. However although care plans are amended, this was by way of putting a line through ‘old’ information and adding the new information at the end of the care plan. Some of the actual care plans seen were over two years old with a number of deletions and additions identifying where needs has changed. This made the care plan more difficult to follow. Where there are a substantial number of amendments to an individual care plan, consideration should be given to rewriting that individual care plan so the current information is easy to follow and for staff to find. Where ever possible, residents are asked to sign their care plan to acknowledge understanding of the content and their agreement to the detail. It was clear this was happening with evidence that the resident and staff had signed the care plan. In instances when a resident is unable to sign, this is also recorded or alternatively with the resident’s permission, a relative may be asked to read, agree and sign the care plan. A relative spoken with told us that she was very aware of her mother’s care plan and that staff were very good at contacting the family if any changes were required, and that dialogue with the staff team was “excellent”. A resident spoken with also said that he had seen and had explained to him his care plan and would not have signed if he was unclear about anything. The health care needs of people living at Heslam House are well met. Health care risk assessments are in place with significant outcomes incorporated in the individual care plan. Resident told us that they always got the medical care and support that they needed when they needed it. Records seen also confirmed that residents health care needs are being fully met. As this is a fairly small home, staff get to know people well and can spot any changes in health and well being. As observed during the course of the site visit, there is a good relationship with health and social care professionals in order to maintain residents health and social well-being. Although good records are kept of health professional visits, outcomes and actions, this is not recorded separately. At present, health visits are recorded within other records. It is recommended that a separate individual record is maintained of all health professional visits for each resident. This would help to ensure that an easily accessible and specific record is kept of all health care visits and the clearly identify the frequency of need and outcome/action taken. All residents spoken with said that they were very well looked after at Heslam House. One person told us that the home, “Gives good care and overall is very good”. Since the last inspection improvements have been made to the way medication is administered and recorded. There are policies and guidance for the management of medication and all staff with responsibility for the Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 15 administration and recording of medication have received appropriate training. This helps to keep people living at the home safe and to maintain their optimum health. Medication is securely stored. There were records of medicines received into the home and medication returned to the pharmacy. Most medicines were supplied in the nomad system, those that were not such as eye drops were dated on opening. This helps to ensure that medication is not used past its “used by” date and so protect the resident. There is now no excess medication held at the home and all residents are only administered medication that is prescribed for that individual person. The medication administration records of three people were viewed. In the main these had been completed correctly and all had a photograph of the person attached, this is good practice and helps prevent mistakes being made. However there was an occasional dose omission without explanation in the medication administration record. It appeared that the medication had been administered but not recorded as such. This suggests that staff are not always following the home’s medication procedures by signing the medication administration record immediately after the medication had been administered. It is important that the medication administration record is signed immediately after the medication is given so that a clear and accurate medication audit is available and to confirm that resident’s medication was given as prescribed. Currently one resident is self administering their own prescribed medication in part. A locked facility is provided in this persons individual bedroom accommodation for the safe storage of personal items such as medication. However there is currently no risk assessment in place to confirm that this person is safe to administer and store their own medication. It is recommended that where ever a resident chooses to administer their medication either wholly or in part, a formal risk assessment is undertaken. This would ensure that the resident is safe to do so and protect other residents living at the home. Generally medication is now well managed, however it was noted that although most hand written entries in the drug administration record were signed, dated and countersigned by a second person this sometimes was not the case if the person recording medication into the home was also signing or countersigning the hand written record. In order to provide clarity, it is recommended that if the person signing or countersigning the hand written record is the same person recording medication into the home, this is indicated by initialling both records. It is also recommended that an individual protocol be developed for when required medication is prescribed for a resident. This would advise staff under Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 16 what circumstances it would be appropriate to give this medication to ensure consistency of use. The management team is now undertaking regular medication audits every two or three weeks. Findings are recorded and action taken to prevent similar mistakes being made. The nomad trays are checked weekly. This helps to ensure medication remains safely managed by the staff team. In addition the dispensing pharmacist undertakes an annual audit of medication practices and advises accordingly. Resident’s privacy and dignity is well respected at this home. The health and personal care that people receive is based on their individual needs so they receive personal care in the way they prefer and in away that shows respect for their privacy and dignity. Discussion with four residents and two relatives confirmed that the maintenance of resident’s privacy and dignity is upheld at all times. A relative spoken with gave a good account of the way staff had been careful to maintain her aunt’s privacy and dignity and said that staff were also very respectful. This relative told us,” Staff are really lovely, very caring. Staff are always smiling, they really are a lovely bunch”. There were no concerns at all about these important matters and the relative felt confident that this would continue to be the case. Policies and procedures are in place that guide staff to ensure residents privacy and dignity is respected at all times. These important topics also form part of the National Vocational Qualification (NVQ) training that has been undertaken by the majority of staff. The preferred term of address of each resident is identified at the time of admission and always respected. Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15 assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive the support they need to live their chosen lifestyles. EVIDENCE: Each resident has an individual social care plan so that their social care needs could be met. The social care plans seen gave a good account of what the individual resident enjoyed and direction to staff as to the assistance required to ensure social care needs were met. For one person this included detail that this particular resident enjoyed the indoor bowling at the church next door. Staff were to escort this lady to the church hall but friends would bring her back to the home. The resident Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 18 confirmed that this did happen and that she enjoyed the bowls, talking with her friends and helping serving the tea and washing up afterwards. This same lady use to enjoy walking that was also identified in the care plan. During the site visit staff were seen to escort this resident for a walk and a visit to the town centre. The resident said that this was a regular event that she enjoyed. Another resident spoken with explained that although there were a variety of activities going on, he preferred to spend most of his time in the individual bedroom and enjoyed watching television especially the football. His wishes were always respected. The same gentleman went on to say that staff, “Know what is needed very well” and that “This is a happy place, everyone gets on”. Two other ladies said they were very comfortable and happy living at Heslam House and that as for activities, they really enjoyed watching television and chatting to each other. A designated activities coordinator is available two days a week. A variety of activities are provided to meet the assessed needs of residents. Birthdays are celebrated and on the day of the site visit, one resident was looking forward to her birthday tea including a birthday cake. Currently in-house activities include quizzes, dominoes, painting, walks in the local area, armchair exercise for the elderly, visits to town and the ‘walk in library’ service visits the home regularly, a service that some residents particularly enjoy. I addition, crosswords, jigsaws and DVD films are available, a singer visits the home approximately every three months to entertain residents and as observed, there is time for staff to sit and chat with residents. Special attention is now given to addressing the social care needs of people with a specific difficulty. For one resident who is blind, staff regularly read to her. People’s spiritual needs are recorded so they can be given the opportunity and any help they need to continue to follow their faith and representatives of several churches visit the home to offer communion or to hold a service. People are encouraged to maintain contact with family, so that they can continue to be part of family life. Visitors are made welcome at any time and residents can entertain their guests in a communal area of the home or in the privacy of their individual bedroom accommodation. During the course of the site visit there were numerous visitors, the relationship between the staff team and relatives was open, cordial and supportive. Relatives spoken with said there were always made very welcome and had full confidence in the staff team. One relative told us, “Everybody here is very well cared for”. Where ever possible, people living at the home are supported to make decisions about their day-to-day lives, such as when to go to bed, when to get up and how to spend their time. Residents are encouraged to personalize their individual bedroom with their own important things. Individuals are also supported to manage their own financial affairs for as long as they are able Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 19 and wish to do so. For some people however, a family member takes on this responsibility. Details of advocacy services are also made available for residents and their family to access if and when they choose. Residents spoken with all said that they enjoyed the meals served. Although there is a free choice of food at breakfast and several choices at tea time, the main meal of the day was a set meal. People were told in the morning what the mid day meal would be and two residents said that if they did not want the set meal, there was always an alternative of the resident’s choice made available. However one of the residents spoken with, while confirming that an alternative would be offered a lunchtime, said that she would give the meals served a score of 92 -93 and that she, “Didn’t want a choice, always happy with what is there, I enjoy the meals, I never send anything back”. Another resident said, “The meals are very good, good variety, if you don’t like something they will always get something else”. Since the last inspection changes have been made to menus and meal planning. Residents were asked what they would like to eat which has been incorporated in the meals served. There is now a rotating menu although this is kept flexible. Specialist diets can be served in respect of medical, religious and cultural needs and requirements. It was noted that one resident frequently requires her meals mashed or blended. Whilst her relative said that this resident enjoyed her foods blended together, for residents that require a soft meal for ease of eating, ideally each specific food item of the meal should be blended separately to enable the resident to taste each element of the meal. Some residents choose to eat their meals in their individual bedroom accommodation and this is supported. Drinks and snacks are served at regular intervals and always available on request. Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were protected by the complaints and safeguarding procedures, which were understood by the staff team. EVIDENCE: Heslam House has an appropriate complaint policy and procedures in place that includes details that any complaint would be investigated and responded to within a maximum of 28 days. From information in the Annual Quality Assurance Assessment (AQAA) completed by the registered manager prior to the site visit, no complaint has been received by the home since the last inspection. The Care Quality Commission also received no complaints or concerns about the home. Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 21 A record is kept of any complaint that was seen at the time of the visit. However this was recorded in a collective book rather than an individual record. In order to maintain confidentially, it is recommended that a complaint form be devised. This should include the name of the complainant, the date the complaint was received, details of the complaint, what action was taken to investigated the complaint, the outcome of the investigation, what action (if any) taken as a result of the investigation and the date the complainant was informed of the outcome of their complaint. This would provide a clear record of the complaint and details of the investigation, outcome and any action taken. The complaint procedure is displayed in a communal area of the home and written details of the complaint procedure are incorporated in the Service User Guide, a copy of which is provided to each resident. Residents spoken with were very clear about who they would speak with if they did have a concern or complaint but one resident spoken with told us that she Had nothing to complain about. People living at the home have formed good relationships with staff, meaning that any issues could be raised and dealt with informally as part of day to day life at the home. The protection of residents is taken very seriously. There is an adult protection policy and procedures and the home has a copy of the multi agency ‘No Secrets in Lancashire’ document that incorporates the local protocols for reporting any allegation of adult abuse. The vast majority of staff have received vulnerable adults training that is updated as required. The three members of staff that have not done so, including newly appointed staff will receive this training as soon as a course is available. This helps to protect people living at the home from abuse or discrimination. There have been no issues of alleged abuse at Heslam House. Care staff also received guidance in respect of adult protection as part of their National Vocational Qualification training (NVQ). The majority of staff at the home have achieved this award. Heslam House continues to have a further variety of policies and procedures in place for the protection of residents. These include policies in respect of verbal and physical aggression that also identifies triggers that may prompt aggression and physical intervention and restraint. There is also a policy and procedure regarding resident’s monies and financial affairs. Policies and procedures are readily available to staff including any amendments to the policy or procedure. Staff are expected to read the documents and sign when read and also to confirm that they understood the content. This is checked out individually during regular one to one supervision. Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 22 Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26 were assessed. Standard 25 was assessed in part. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Heslam House is welcoming, comfortable, homely and maintained to a good standard. However further safety measures should be provided to help protect residents. EVIDENCE: Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 24 Heslam House is an older detached property set in its own grounds and situated in a quiet residential area. Accommodation is provided on the ground and first floor of the building and there is a stair lift for ease of access to the upper floor. Communal accommodation consists of three separate lounges and a large dining room. Currently all residents are accommodated in individual bedroom accommodation that vary in size and individual features. All accommodation is comfortable, airy and maintained to a good standard. The majority of bedrooms are personalized with small items of furniture, pictures, photographs and ornaments from the occupant’s previous home. This provides a homely environment that is very personal to the resident. One resident spoken with explained that the furniture in his bedroom had been brought from home, that he had his own important things around him and that he was “very comfortable”. It was noted however that a substantial number of central heating radiators in resident accommodation, including bedroom accommodation, remain unguarded. This poses a risk for residents. Although risk assessments are in place in respect of the unguarded radiators, these should have been used to identify the radiators that posed the highest risk in order to prioritize those that needed to be guarded more urgently. All radiators in resident accommodation should by now, be guarded or have guaranteed low temperature surfaces. In an exceptional circumstance when an existing resident may refuse to have a radiator guard fitted in their individual bedroom accommodation, the current risk assessment regarding that particular radiator, should be kept under regular review. There is an expectation that once the room became vacant, a radiator guard would be automatically fitted before the room was occupied by a new resident. It is strongly recommended that an action plan be devised to identify and prioritise a programme to ensure that unguarded radiators are covered that includes the intended date for completion. Other safety measures are in place. All hot water outlets in resident accommodation are fitted with a thermostat to control the temperature of the hot water delivered. This is good practice and helps to prevent the risk of accidental scalding. Individual bedroom doors are fitted with a lock with the resident retaining the key if they choose. The registered manager also explained that most, if not all bedrooms were provided with a lockable space to enable the occupant to be confident that they could store items that were personal to them in a safe and private place. Since the last inspection some improvements have been made to the internal environment of the home. A number of new bedside tables have been purchased, the main hallway, stairs, landing and front lounge have been repainted and refreshed, there are new replacement aids to promote independence in toilet areas, toilet seats have been replaced and bathrooms provided with new bath stools. New expel-air fans have been fitted to the Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 25 kitchen and general items such as crockery and towels have been purchased. This has helped to maintain a good standard and to assist residents in their day to day activities. The home was clean and in the main free from offensive odours. Staff try hard to maintain odour control with regular carpet cleaning in specific areas. Resident spoken with had no concerns what so ever about the about the home always been fresh and clean with one person stating that they were “Very satisfied”. Information in the AQAA confirmed that all staff working at the home had received training in the prevention and control of infection. However although protective gloves and liquid soap is now provided in all communal toilets and bathrooms, non-disposable hand towels are still in use in these communal areas. There is a towel changing schedule in place to ensure that towels are changed at least daily, however the use of disposable towels in communal bathrooms and toilets should be reconsidered in order to help prevent the spread of any cross infection. This is particularly important given the risk of a virus inadvertently being brought into the home that then causes a resident to become ill. The chance of the virus spreading is increased when residents are using communal towels. The laundry area is adequately equipped and serves the current needs of the home. There is a good system in place to ensure that personal clothing is returned to the right owner. Residents had no complaints about the laundry service provided at the home. Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30 assessed. People using the 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 people living at Heslam House are supported by well trained, effective staff that have gone through a thorough recruitment process, so people’s needs are met and they are safe from possible harm or poor practice. EVIDENCE: Residents spoken with and those that completed Care Quality Commission (CQC) resident survey all said that staff were either always available when they needed them or usually available when they needed them. This was also confirmed by the members of staff spoken with. The staff group is generally stable with some of the care staff having worked at the home for a considerable period of time. This helps to provide a consistent service by a Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 27 group of staff they know each resident’s individual wants, needs and requirements very well. The registered manager explained that staffing levels are determined by the assessed needs of residents accommodated with additional staff provided when required. One member of staff told us that the home had a “Calming atmosphere. Linda (the registered manager) is laid back and relaxed and this helps to provide a comfortable home”. Another member of staff said the home was “Very comfortable and happy” and a resident told us on a survey form that, “Heslam House is a friendly, well run home”. Another resident in answer to the question, ‘What does the home do well’ had written, “Very clean and comfortable, very good staff”. National Vocational Qualification (NVQ) training is very much encouraged, with the majority of the care staff team having achieved Level 2 of this award. In addition, three members of staff have completed the more advanced level 3 of this award. NVQ training is a nationally recognized qualification for care staff and shows that the majority of staff at the home have had their skills, knowledge and understanding assessed in order to provide a good standard of care. This means that residents can be confident that they are supported by a skilled staff team. Staff have also undertaken a range of additional training including mandatory health and safety training. Other recent training that has been provided includes diabetes care training and dementia care training. Staff training was highly valued by the members of staff spoken with to ensure that they could provide a good service and meet the needs of all residents living at the home. Heslam House has a structured recruitment policy and procedure in place for the employment of new staff. This helps to protect residents and to ensure that only suitable people are employed at the home. The staff files of three members of staff were viewed, two of which were of staff that had been recently appointed. Records included an application form, references, a criminal records bureau disclosure and a check against the nationally held list of people have been deemed unsuitable to work with vulnerable people. A recently appointed member of staff confirmed that the procedure had been followed and that she had not been allowed to take up her post at the home until the required clearances and references had been obtained and deemed satisfactory. It was noted however that in respect of one reference this was from a personal friend of the applicant rather than a professional reference. This was the situation even though the applicant had been in continuous employment with several employers over the last few years. Professional impartial references should always be sought where ever possible. The problem in part, seemed to be in the wording in respect of references in the application form. This says that a reference is required from a previous employer or three character Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 28 references. It is recommended that where possible, only professional references are obtained that includes a reference from the last employer. Consideration should be given to rewording the application form to provide clearer information to the prospective employee. From discussion with the registered manager and observation of training records and completed workbooks, it was clear that any inexperienced newly appointed members of the care staff team are routinely provided with nationally recognized Skills for Care induction training. This makes sure that newly appointed care staff have the basic skills and understanding to ensure that they are competent to provide an appropriate level of care and support. Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 29 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 & 38 assessed. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Heslam House is well managed so that it is run in the best interest of the people who live there. EVIDENCE: Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 30 The registered manager at Heslam Home is well qualified, very experienced and has worked at the home for many years. The registered manager has achieved the Registered Managers Award, a qualification that all managers of care homes is expected to achieve to ensure they have the skills to manage the care home in the best interests of the residents. Staff spoken with said that they felt very well supported by the manager who was approachable and ran the home very well. The registered manager has also undertaken a variety of other training that has included dementia awareness, discrimination, diabetes and pressure area care. This makes sure that the registered manager is familiar with current best practice in order to guide and advise the staff team. One person told us that, “Linda (The registered manager) is a lovely manager, you can talk to her at any time, she always listens, she does a lot for Heslam House”. Another member of staff said of the manager, “The manager is great, no problems at all, but any problems professional or personal she will always support you, ring to see if you are OK and send flowers”. Residents also praised the manager with one person saying that Linda was, Very nice, helpful and kind”. Another resident said that she thought the home was “Very well managed”. There are clear lines of accountability within the home and the homeowner. The homeowner visits the home on at least a monthly basis to audit records and to speak with the registered manager, resident and staff. One resident told us that the homeowner visits the home regularly and “Comes in for a chat”. This helps the homeowner to make a judgment as to whether the home is well managed and whether the care and support provided by staff at the home is meeting the needs of the people that live there. Although it was clear that the homeowner does visit the home on a regular basis and talks with residents and staff, there is a requirement that the homeowner prepares a written report on the finding of the visit, a copy of which must be given to the registered manager at the home. At the time of the inspection visit, no reports completed by the homeowner in respect if these visits were available for inspection. It is important that a record is maintained of visits by the homeowner to Heslam House and that the registered manager is provided with a copy of the monthly report to ensure that any action required is responded to in a timely manner. Ways to gain information regarding quality assurance about the home and whether the support offered is meeting resident’s needs is considered important. Various quality assurance systems are in place including annual questionnaires for residents, their family and other stakeholders, planned residents meetings that are held four times a year and staff meetings. The information obtained from the questionnaires returned helps to bring about positive change. The outcomes of the surveys are incorporated in the Service Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 31 User Guide, a copy of which is given to each individual resident. The home has also obtained the Blackburn and Darwin Quality Assurance Scheme award. This shows that the home has been externally assessed as providing high quality care. The home also has a very clear and detailed annual development plan. Actions taken are signed and dated when a task has been completed. This helps to make sure that the development plan is put into practice for the benefit of people living at the home and to ensure that standards are maintained or improved. The service returned the Annual Quality Assurance Assessment (AQAA) by the date it was due back. However the information provided was in the main, brief. For example, there was nothing completed in the health and personal care section about strategies adopted to make sure that residents are enabled to maintain their optimum health or how residents privacy and dignity is maintained when living at the home. People living at Heslam House are encouraged to remain financially independent or are assisted in this task by a relative or other advocate. Financial transactions were appropriately documented and held in a secure safe. Financial records are audited every month. Staff spoken with confirmed that they did receive regular one to one supervision and also a periodic formal appraisal of their work performance. This included identifying future training needs. The supervision records seen on staff files were signed and dated by the supervisor and supervisee. This is good practice and helps to promote the development of the care worker, shows that the topics discussed were agreed and that a good supervision record was maintained so that progress could be monitored. Records relating to health and safety were seen. Records showed that equipment such as manual handling equipment and fire equipment are regularly serviced and that electrical installation and electrical equipment are also checked. The Fire Service completes a fire risk assessment in respect of the home on an annual basis. Environmental risk assessments are also in place. The staff training matrix confirmed that staff have received mandatory health and safety training including, fire safety training, first aid training, moving and handling training and infection control training. Refresher training regarding these topics is currently being provided. All these checks, along side the training that staff receive help to protect people living at the home, staff and visitors. Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 32 Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 33 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 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 3 X 3 Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 34 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 OP33 Regulation 26 Requirement Timescale for action 30/09/09 2 OP25 13(4)(a) The homeowner must prepare a written monthly report on the conduct of the care home. The registered manager must be provided with a copy of this report that is available for inspection. All radiators in resident 31/03/10 accommodation should be guarded or have guaranteed low temperature surfaces. This would help prevent the risk of accidental injury. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Where there are a substantial number of amendments to the initial long term care plan, consideration should be given to re-writing the individual care plan so that information is easy to follow and for staff to find. It is recommended that an individual record be developed DS0000005825.V378148.R01.S.doc Version 5.3 Page 35 2 OP8 Heslam Homes Limited 3 4 OP9 OP9 5 OP9 6 7 8 9 10 OP9 OP16 OP26 OP29 OP29 for each resident to record health professional visits, outcomes and action taken. The medication administration record should be signed immediately after the medication has been administered to confirm that the medication was given as prescribed. A formal risk assessment should always be undertaken if a resident chooses to self administer their own prescribed medication either wholly or in part. This would help to protect all people living at the home. In order to provide clarity, the initials of the person recording medication into the home, writing a hand written entry in the drug administration record or countersigning the record should always be recorded. It is recommended that a protocol is developed for ‘when required’ medication is prescribed for an individual resident to ensure consistency of use. It is recommended that an individual complaint record be devised in order to protect confidentially. The decision to provide none disposable towels in communal bathrooms and toilets should be re-considered to help prevent the spread of cross infection. References should, where possible, only be obtained from previous employers including the most recent employer. It is recommended that consideration be given to rewording the home’s recruitment application form to make it clear to prospective employees that references are required from previous employers including the current or last employer. Heslam Homes Limited DS0000005825.V378148.R01.S.doc Version 5.3 Page 36 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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