Care Home: Heversham House

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What the care home does well The service provides a homely and comfortable environment for people. The manager makes sure that people are consulted and have their health and social care needs assessed prior to making a decision to move into the home. This helps to ensure that the home will be suitable and able to meet their needs and expectations appropriately. The home works with other healthcare agencies and gets specialist help for residents when this is needed. This includes the local GP`s and District Nursing teams as well as specialist services such as the Macmillan nurse. There is a stable staff team and robust recruitment processes help promote the safety of people living there.People living in the home we talked with spoke very highly of the staff and manager and the help and support they get from them. All residents and visitors spoken with commented on the friendly and open atmosphere in the home. One relative said, "The way the staff relate to the residents is of the highest quality". People living in Heversham House are treated very much as individuals and know that their personal, social and healthcare needs will be met in the way they want. The food at the home is well cooked and nicely presented, the residents all commented on how much they enjoyed their meals. People living there are supported to follow their own interests, religious beliefs and hobbies and people are encouraged to remain as independent as they can. People living there said they are "very happy" and "I have never had need to make a complaint". A relative commented that, "The standard of care is exceptional" and another said, "I have already got my bed booked, it`s that good". Care plans focus on the outcomes for people using this service and indicate that they have been consulted on all aspects of the care planning system and their daily lives. What has improved since the last inspection? The manager has purchased new commodes to replace the old metal commodes people used. The downstairs bathroom has been redecorated and is pleasant and attractive. Externally, the building is being well maintained and a new double glazed bay window has been installed and the exterior woodwork repainted. The communal rooms have recently been redecorated and new carpets laid. Three bedrooms have been improved through redecoration, recarpeting and the replacement of old vanity units. What the care home could do better: No requirements were made at this visit and the service maintains good standards. However, for good practice we recommended that when Medicine Administration Records (MAR) charts are altered or rewritten by hand that two staff check the change and sign the chart. This helps reduce the risk of someone writing it down incorrectly if two people check. CARE HOMES FOR OLDER PEOPLE Heversham House Heversham Milnthorpe Cumbria LA7 7ER Lead Inspector Marian Whittam Unannounced Inspection 30th September 2008 11:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heversham House Address Heversham Milnthorpe Cumbria LA7 7ER 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) 01539 563769 01539 564898 isobelwales@btconnect.com Mrs Isobel Hellena Wales Mrs Isobel Hellena Wales Care Home 13 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (12) of places Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Old Age not falling within any other category (12). To include one named service user in the category of Dementia over 65 years of age (1) 20th November 2006 Date of last inspection Brief Description of the Service: Heversham House is a care home registered to accommodate 13 older people. It is situated in a small village close to Milnthorpe, a market town on the edge of the Lake District. The premises comprise a detached Georgian residence with a very attractive and private walled garden. There is a small car park at the rear of the home. The house has many original features, including attractive bay windows, delft tiled fireplaces and corniced ceilings. There is a large lounge/dining room and a small quiet sitting room on the first floor where residents can meet visitors in private. The home is owned and managed by Mrs Wales, with her daughter working as the deputy manager. Fees payable at the home are £414.00 a week, as at the date of the site visit. There are additional charges for hairdressing. The home makes information about its services available through its colour brochures, service user guide/statement of purpose and the latest inspection reports. These are all available in the home. Heversham House DS0000022651.V368048.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 stars. This means the people who use this service experience good quality outcomes. This site visit to Heversham House forms part of a key inspection. It took place on 30th September 2008 and we (The Commission for Social Care Inspection, CSCI) were in the home for five and a half hours. Information about the service was gathered in different ways: • • • • • Annual Quality Assurance Assessment document completed by the manager identifying what the service evidences it does well and what could be improved. This was returned to CSCI before the visit. The service history. Interviews with residents, relatives and staff on the day of the visit. Observations made by us in the home during the visit. Completed questionnaire survey forms from people living in the home and staff working there. During the visit we spent time with people living in the home and talking to them about their experiences. We looked at care planning documentation and assessments to ensure the level of care provided met the needs of those living in the home and made a tour of the building to inspect the environmental standards and improvements Staff personnel and training files were examined and a selection of the service’s records required by regulation. We assessed the handling of medicines through inspection of relevant documents, storage and meeting with the manager, other staff and residents. What the service does well: The service provides a homely and comfortable environment for people. The manager makes sure that people are consulted and have their health and social care needs assessed prior to making a decision to move into the home. This helps to ensure that the home will be suitable and able to meet their needs and expectations appropriately. The home works with other healthcare agencies and gets specialist help for residents when this is needed. This includes the local GP’s and District Nursing teams as well as specialist services such as the Macmillan nurse. There is a stable staff team and robust recruitment processes help promote the safety of people living there. Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 6 People living in the home we talked with spoke very highly of the staff and manager and the help and support they get from them. All residents and visitors spoken with commented on the friendly and open atmosphere in the home. One relative said, “The way the staff relate to the residents is of the highest quality”. People living in Heversham House are treated very much as individuals and know that their personal, social and healthcare needs will be met in the way they want. The food at the home is well cooked and nicely presented, the residents all commented on how much they enjoyed their meals. People living there are supported to follow their own interests, religious beliefs and hobbies and people are encouraged to remain as independent as they can. People living there said they are “very happy” and “I have never had need to make a complaint”. A relative commented that, “The standard of care is exceptional” and another said, “I have already got my bed booked, it’s that good”. Care plans focus on the outcomes for people using this service and indicate that they have been consulted on all aspects of the care planning system and their daily lives. What has improved since the last inspection? What they could do better: No requirements were made at this visit and the service maintains good standards. However, for good practice we recommended that when Medicine Administration Records (MAR) charts are altered or rewritten by hand that two staff check the change and sign the chart. This helps reduce the risk of someone writing it down incorrectly if two people check. Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 8 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 Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1, 3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Assessments of people’s needs are done before they come to live in the home to make sure they can be met and relevant information is provided to help people make an informed decision about living there. EVIDENCE: Information is available about the service for prospective residents and their families in the statement of purpose, service user guide and brochures specific to the home and its services. This helps people to make an informed choice about using the service. There are colour photographs of the house and the very attractive gardens. The service also publishes a monthly newsletter, telling people what is going on and items of general interest in the home and local community. Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 10 The home has an admissions procedure that ensures no resident is admitted without an assessment of needs completed by the home manager or her deputy. This covers all aspects of daily living as well personal, social and healthcare needs. The pre-admission assessment forms the basis of the care plan for this resident. Time is spent with residents and families prior to admission discussing the level of care required and ensuring all concerned know the home can provide this in the most beneficial way. The pace of admission is dictated by the individual resident, as are the lengths of trial periods. Prospective residents and/or their families are invited and encouraged to visit the home and spend some time there before making the final decision about moving in. This gives an opportunity for them to meet the staff and the other people living there. The service does not provide intermediate care. Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7, 8, 9, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The health and personal care which people using this service receive is based on their individual needs. Privacy, dignity and personal choice are promoted at all times. EVIDENCE: We looked at a sample of three people’s care records in detail. The care plans recognised and respected the individuality of each resident. It was apparent that the residents and their family members are involved in all aspects of the daily life of the home and the care planning process, demonstating they are encouraged and enabled as far as possible in the monitoring of their care needs. People’s preferences and wishes regarding how they want to be cared for and what they wanted to do for themselves were evident. Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 12 The home has a positive relationship with healthcare professionals with the manager accessing some training sessions with the district nurses and the McMillan nursing service. Care records contain an element of risk assessment and risk management. These documents are also regularly reviewed to help ensure that people using this service are supported safely. The information provided covered areas such as a person’s mobility, diet, health needs, personal care and their social and religious preferences. Appropriate equipment to prevent pressure sores is in use. The nutritional and dietary screening is reviewed and updated as needed and a careful watch is kept on weights and diet. The cook speaks with residents each day about what they want to eat and any particular needs. People living there told us they see doctors, dentists and opticians as they need. This information was supported in the surveys we got back and their care records. Medication is administered by the senior staff on duty with the help of a second checker who acts as a witness. Staff who have the responsibility of administering medication have completed training to do this. We observed a medication round done by the manager and senior carer and looked at the medication records of people who live at the home. The records we looked at were up to date and accurate. Quantities of medication coming into the home are checked and recorded and those for return to the pharmacist are accounted for and signed by the accepting pharmacist. The home obtains and keeps patient information sheets about individual medications. Audits to ensure the safety of the medications currently take place weekly and checks are done at each shift change on controlled drugs. Staff have attended training on palliative care and end of life care to help support people living there and their families in this area of care. For good practice we recommended that when Medicine Administration Records (MAR) charts are altered or rewritten by hand that two staff check the change and sign the chart. If two people check the alteration it helps reduce the risk of someone writing it down incorrectly. Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12, 13, 14 and 15 Quality in this outcome area is excellent. This judgement has been made using available evidence, including a visit to this service. People who use this service are offered a variety of leisure activities within the home and community and are able to make positive choices about their lifestyle and are supported to maintain their independence. EVIDENCE: Care plans did have information on interests and hobbies people enjoy and things that are important to them and what their wishes are. For example, one person liked to have communion in their room due to mobility problems, others attended church or the monthly Christian service. Those who enjoy the services appreciate the fact they can still practice their faith. We looked at records of activities and spoke to people about the things they had been doing. The people we spoke with were well aware what activities were going on and we spoke with several who were meeting in the lounge to play cards and dominoes and all spoke positively about the service and the carers. Survey responses indicate that people were happy with the activities available. Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 14 What is going on in the home and local community is in the monthly Newsletter to keep people informed and the Parish news was distributed so people could keep up with local community news in the village. People had televisions in their rooms if they wanted this and some had their own DVD, music systems and video players. One person had an organ in their room they enjoyed playing and they also played for other residents using the organ in the lounge. One of the senior staff oversees activities and we saw staff sitting down and chatting with people and playing cards. The atmosphere was relaxed and informal. People told us about the crafts they did and how several ladies were knitting scarves for a charity overseas. The local library visits and the home has a book club. Several people attend a local Luncheon Club run by Age Concern once a month and this helps keep in touch locally. The service had a Summer garden party to raise funds for Age Concern and a lot of local people attend this too. Local school children come in to do various activities, including singing, flute playing and hand bell ringing and one child brought in their Mountain rescue dog with his father so residents could see him. Some people told us they went out with their relatives, especially at weekends. On the day of the visit the hairdresser was visiting and people were sitting chatting as they had their hair done and this made her visit a sociable occasion. Visitors are welcome at all times. We were able to speak with one visitor who told us that they were, “always made welcome” and that “they do a great job”. We visited the kitchen, which was clean and well organised and spoke with the cook and looked at the menus. The menus showed a varied diet with fresh fish, meat and vegetables and fresh fruit always available. We discussed the menus and special diets and how people living there influence them and their choice of meals. Records are kept of the food served in the home and the alternatives available in addition to the main menu and what size portions people had. People told us that they enjoyed their meals and spoke very highly of the standard of food they were offered comments such as, “Very good standard of food” and “the food is excellent” were made. The cook goes round each day to see what everyone wants and any particular requests. The food is prepared in the home with fresh produce from local suppliers. The cook does her own baking and home-made soups. Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 15 The cook has an audit trail for any hazards in the kitchen and records of cleaning and temperatures. The service received five stars from the environmental health department when they inspected. Kitchen staff have appropriate food hygiene qualifications and have recently attended training with the environmental health department. Residents had ‘high tea’ at 3 o’clock with cakes and said on Sundays they said they have sherry trifle as well, which they liked. People commented on a birthday party the previous day with cakes and champagne and that “Mrs Wales does great parties”. They said that at Christmas “no expense is spared”. A relative said, “I have never heard my mother say she has not liked the food, on the contrary she eats all her meals with relish”. The dining area was attractively furnished and the lunchtime meal was relaxed and sociable and people were able to take their time over lunch and chat at the table. A choice of hot and cold drinks was on offer and people could have an aperitif before their meal if they wished. Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16, 17 and 18 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Accessible policies and procedures are in place, with up to date ‘protection of adults’ training provided. This helps ensure that people are protected and know any concerns will be listened to and acted upon. EVIDENCE: The home has a complaints procedure in place, a copy of which is displayed in the hall. It outlines what a resident should do if they have any concerns at all. All the people we spoke to told us they would “tell Mrs Wales” if they had any worries at all. They also said that they “saw her every day to speak to”. They were all confident that they would be listened to and had been assured that if any action was needed it would be taken. There has been one complaint made to CSCI and this was passed to the home to address using its own procedures. Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 17 The home has policies and procedures in relation to the safeguarding of vulnerable adults (abuse). Staff at the home have received training in this subject to help make sure that they understand abuse and when matters should be reported for further action. This will help to ensure that the home follows the correct process should they need to report matters to social workers. The Deputy Manager has done a trainer’s course so she can train the staff in adult protection. We spoke with the manager who was clear about her responsibilities in regard to safeguarding residents’ interests. There have not been any referrals made under safeguarding. The home has copies of the local authority’s guidance on safeguarding and protecting adults from harm and abuse and the Department of Health “No Secrets” guidance and their own procedures on whistle blowing. The home does not deal with any resident’s personal finances and encourages and supports people to handle their own money. Expenses incurred are invoiced to people, their families or representatives monthly. Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19, 20, 22, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Heversham House provides a warm, safe and comfortable environment for those living there. EVIDENCE: There is regular, planned maintenance of the home and grounds and the standard of decoration and attention to detail in decoration and soft furnishings is of a consistently high standard. There is also a planned programme of continued improvement of the environment for people. There are up to date maintenance records for the testing of emergency equipment, call bells and boilers. Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 19 We looked around the home and found it to be very clean, tidy and with adequate storage space to avoid clutter. The home has a cleaner and staff do the laundry. The home’s laundry is in the cellar and it was well organised and clean. The home has infection control procedures and records indicate that staff have received training in this. There are adaptations and equipment in the home to help residents make the most of their physical independence and to get about the home safely. The communal rooms are well lit, well decorated and furnished to a high standard in a style that suits the lifestyle and needs of the people living there. Seating is in small groups and allows people to sit and chat and have their drinks where they want. The communal areas have recently been redecorated and new carpets laid. Call bells are easily accessible in areas used by residents to summon assistance if they need it. Residents’ rooms are homely and personal to each resident, many of who have brought in personal items from home. Many of the bedrooms have original fireplaces and details that make each one different and homely. Three bedrooms have been improved through redecoration, recarpeting and the replacement of old vanity units. Work is continuing on updating residents’ bedrooms and updating toilet and bathroom facilities. Outside the gardens are very attractive, secure and well maintained with appropriate seating for people and the service employs a gardener. Externally, the building is being well maintained and a new double glazed bay window has been installed and the all exterior woodwork repainted. Residents told us they used the garden a lot and enjoyed sitting out there when the weather allowed. Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The staff team has been correctly recruited and have the necessary skills and experience to provide a high standard of care to vulnerable people. EVIDENCE: The staffing levels were examined and found to be sufficient to meet the needs and expectations of those living in the home. We looked at some of the staff files, including recruitment and training records. The service has also used the specialist nursing services provided by Marie Curie for additional staff support at the end of life. The service has also used agency staff when they need extra to sit with someone whose condition is deteriorating. This ensures they have appropriate care and are properly supervised with a carer with them. The home has a thorough recruitment procedure, which ensures staff do not begin working at the home until all of the required checks have been made, including Criminal Record Bureau (CRB) and obtaining two written references. These checks help to make sure that staff are suitable to work with vulnerable adults. Observations during the visit and comments made by people living there evidenced that staff have a caring, sensitive and respectful approach to giving care and support. Residents responded positively showing that good relationships existed between those living in the home and the staff. Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 21 Staff are being well supported and motivated to undertake training. Staff surveys and people we spoke to indicated that staff enjoyed their work in the home. Most of the staff at the home have completed or are in the process of completing National Vocational Qualifications at different level. Senior staff have done NVQ level 3 training to support them in their roles. Staff surveys indicated that staff had regular one-to-one chats with their manager. One staff member said “Excellent induction and Mrs Wales was always on hand to ask about anything I was unsure about”. The service keeps records and dates of training done and we could see that staff have been given training they need to carry out their work. The manager reviews training needs and during the visit was arranging some health and safety training for staff. Staff comments indicated that the management responded well to requests for particular training to meet staff development needs. One member of staff said, “Our training is always ongoing, NVQ, palliative care, medicines, health and safety, equality and diversity, moving and handling, POVA, etc. Also, if we want to go on a certain course, Mrs Wales will always try and sort it out for you. Mrs Wales encourages everyone to update their knowledge”. Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 32, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home is being well run in the best interests of the people living there. EVIDENCE: The registered manager is qualified and experienced to run this service. She has completed both her NVQ level 4 and the registered manager’s award (RMA). The manager has a very open style of management and communicates a clear sense of direction and the home’s philosophy to staff. Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 23 It was clear that all the residents knew her well and all we spoke to told us that they saw the manager daily. People we spoke to found the manager approachable and said the staff listened to their views and opinions. One person said “I have never had any complaints in all the years I have been here. Residents’ families and friends are asked for their views and opinions using periodic surveys, however the home is of a size whereby residents and families can put forward ideas and comments in an informal way. One person said, “I just tell the manager what I think”. The service does also have residents’ meetings and care staff can discuss any issues during their handover period at the end of each shift. This informal ‘open door’ approach to enabling people to influence the way the service runs was confirmed by residents we talked to and from their surveys. From our observation, there was an open, positive and inclusive atmosphere in the home. A relative we spoke with commented they are always made “very welcome” and kept informed about any changes with their relative’s care and visited often. Staff are supported by the manager in their work and staff surveys indicated that they met with the manager regularly for support and to discuss how they were working. Recently residents had given feedback on menus and changes had been made as people asked. The service reviews its policies and procedures annually and these were last done in July this year to make sure they reflected changes in legislation and good practice. People are supported and encouraged to handle their own affairs as long as they want or are able. Expenses incurred by residents are invoiced to the resident or their representatives monthly. Records of maintenance indicate that the home has up to date fire training for staff and that servicing and testing of equipment and appliances is being done to promote resident health and safety. There is evidence that appropriate testing and servicing of emergency equipment and electrical appliances and boilers is being carried out. Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 24 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 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 X 3 X 3 3 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 3 3 X 3 3 X 3 Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard OP9 Good Practice Recommendations 1 For good practice we recommend that when Medicine Administration Records (MAR) charts are altered or rewritten by hand that two staff check the change and sign the chart. If two people check the alteration it helps reduce the risk of someone writing it down incorrectly. Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Lancashire Area Office Unit 1, 3rd Floor Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Heversham House DS0000022651.V368048.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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