Care Home: Heyberry House

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What the care home does well Good information is given to any new person wanting to stay at Heyberry House, including the option of having a trial visit to the service. This makes sure that Heyberry house is the right place for the person to live in and and that their needs can be met. People living at Heyberry House and the staff have regular meetings to discuss the running of the service. These meetings and discussions help to keep everyone informed and included in the developments of their home. Some of the staff have had training called, " dining with dignity training for staff" and the chef and staff had won various awards through out the company for their catering skills. This has helped achieve a good standard of meals and menus that people were positive about. The manager makes herself available to everyone, including, visitors, staff and people living at the service and offers an "open door policy." Each person has their own letter box and the post man delivers their mail direct to their front door so they personally receive their own mail. This was a good example of what staff had arranged to ensure peoples rights and privacy are maintained at Heyberry house. Some people also had a key for their flat and liked to keep it locked to maintain their privacy within the service. Many of the staff working at the service had been there for several years or more and provide a stable team for the people living there. Regular checks are made on the safety of the building and equipment to make sure the service is a safe place to live. Everyone living at Heyberry house has their own bedroom and en suite toilet. What has improved since the last inspection? The service is meeting the vast majority of the national minimum standard . In a number of respects these standards are being exceeded. The manager continues to look at ways in which the service can exceed their standards. There were various positive comments about the manager and her management style within the service from the staff working at Heyberry House. Staff made comments such as, "I get alot of support from my team manager...." ".....I have great support from my manager who is a fantastic boss and a great manager." "The home is managed well and is run efficently....For me Heyberry house run a very caring home and do everything possible to make their residents happy and comfortable, and do everything possible to meet the needs of each resident." The manager had numerous management tools to show how she was safely managing the service including, self assessments, company audits including medication audits and infection control and a business plan for the company. This helped to set out the developments of the company for the future of Heyberry House. The service is effectively managed and any development was shown to be in the best interests of the people living there, ensuring a good quality of service was provided. We received lots of complimentary comments from people living at the service including 11 surveys submitted to our department and 2 from their relatives, giving comments such as, "The very genuine affection and care of all the staff to the residents, very good response of staff to residents needs. Good quality food provided." "I feel they do everything well." "The staff are all kind and helpfull." "The staff look after us very well, it is what I would say is a well run place." "I feel happy I live here." ".....most things seem alright." "They keep the place nice and clean, you can get attention if you wanted it, its warm and homely, the staff are ok." "The staff are friendly and well motivated and attentive. Good staffing levels, good levels of activity for residents." "They look after you well, they have a lot of outings etc.- go theatre and things. I get good meals, I got a good room." "Good food, its clean and tidy." "The staff are friendly and well motivated and attentive. Good staffing levels, good levels of activity for residents." "I have no complaints." " I have everything I need in my room its nice and comfortable here." "The staff are all kind and helpfull." "The staff look after us very well, it is what I would say is a well run place." We also received a selection of positive comments from staff including 6 comment cards received from staff, which included, "Provides adequate care needs, support and trust, confidentiality, nutritional needs for all service users which are fulfilled and meets all their needs and activities trips out,,,,""Heyberry meets the needs of all our service users very well." "The home does very well there are always activities going on." "We have dignity champions here, ,,," "Our manager and staff all work to meet our service users needs." The service had been successful in being awarded a large grant over 6,000 pounds from the company to develop a sensory garden. Everybody was really looking forward in starting this project so that everybody could enjoy this part of the garden. The service has recently refurbished their hairdressing salon with specially adapted facilities and sinks so that everyone can visit the hairdresser if they wished. They have recently refurbished bathrooms to a very high standard with the latest equipment offering comfortable and modern bathrooms for people to use, including jacuzzi/ spa baths to enjoy. People said they were more than happy with the homes facilities including their bedrooms. All staff were seen knocking on each persons bedroom door before entering, respecting each persons privacy. The company has a good commitment to staff training. At present they have exceeded the basic percentage of staff having a care qualification called an (NVQ, national care qualification) and have 64% of staff with an NVQ qualification at level 2. What the care home could do better: To provide an updated statement of purpose and service user guide in formats that can be used and understood by various people with specific needs who live at Heyberry house. To review comments made about services at Heyberry House with the people who live there and their relatives and staff. To help them have feedback from the company regarding their suggestions and comments raised throughout our report. To provide an activities budget and increased hours for the activities organiser to help her further develop initiatives to provide a programme of day trips out for a larger number of people. To review staffing levels to allow increased staffing levels to support people socially at Heyberry house. To review the current training programme to ensure that training in safeguarding is provided on a regular basis. This training should have agreed updates in this necessary topic for all staff working at Heyberry house so that all staff are kept up to date in safeguarding people. To review the current staffing levels with both staff and people living at the service to show what actions and reviews are taking place to evidence the staffing levels meet the needs of everyone at Heyberry house. To display the basic staffing levels that the company commits to so that people can be informed of staffing levels within the service. To review all staff personnel files and ensure they all have updated staff pictures and have copies of identification when being recruited. This will help to enhance accurate recruitment checks are in place. Key inspection report Care homes for older people Name: Address: Heyberry House 3 Ashville Road Birkenhead Wirral CH41 8AU     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diane Sharrock     Date: 0 9 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 37 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. 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 Care Homes for Older People Page 3 of 37 Information about the care home Name of care home: Address: Heyberry House 3 Ashville Road Birkenhead Wirral CH41 8AU 01516533225 01516533225 stella.dow@anchor.org.uk www.anchor.org.uk Anchor Trust care home 41 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only: Code PC, to people 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 people who can be accommodated is: 41. Date of last inspection Brief description of the care home Heyberry House is a purpose built three storey residential home that is registered to provide personal care for 41 older people. All bedrooms are single with en-suite facilities. There is one large open plan lounge/dining room and a conservatory on the ground floor. In addition, there sre open plan seating areas off the corridors on each floor of the home. Specialist bathing facilities are provided in the service and a passenger lift services all floors. There is a garden/patio area at the rear of the home, which overlooks Birkenhead Park. Parking is available at the front of the building. The home is situated close to Claughton village and Birkenhead town centre, it is within reach of rail and bus services. The weekly fees for the service were 413.86.pounds. Care Homes for Older People Page 4 of 37 Over 65 41 0 Brief description of the care home Additional charges are made private telephone bills, private chiropody, hairdressing, holistic therapy, personal transport to medical services and staff escort to private events. A service user guide and a statement of purpose, which describe the services offered at Heyberry House are made available to new people, their relatives and professionals before a person goes to live at the service. A copy of the most recent inspection report can be obtained from the manager and via the internet and our department. Care Homes for Older People Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three stars. This means the people who use the service experience excellent quality outcomes. We gathered information for this visit in a number of different ways. We carried out an unannounced site visit on the 9th July 2009. This took place over 6 hours and included reading records, meeting people and looking at the building. We spent time looking at the support the people living at Heyberry house receive. This was called case tracking and included looking at, eg, the support they get with their daily lives, care plans, medication, money, activities and environment. We met approx. 5 people who live at Heyberry house and staff on duty. We also spoke throughout the visit to the manager and her senior staff. We reviewed any information we had received about Heyberry house following our last Care Homes for Older People Page 6 of 37 key visit. The manager completed a detailed self assessment form called an (AQAA) which we sent to her before our visit. We used the information in this form and the other information we had to help plan our visit and write this report. A selection of comment cards were also sent before this visit to staff, health professionals and people who live at the service. We have received 6 surveys from staff, 2 from relatives and 11 from people who live at Heyberry House. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? The service is meeting the vast majority of the national minimum standard . In a number of respects these standards are being exceeded. The manager continues to look at ways in which the service can exceed their standards. There were various positive comments about the manager and her management style within the service from the staff working at Heyberry House. Staff made comments such as, I get alot of support from my team manager.... .....I have great support from my manager who is a fantastic boss and a great manager. The home is managed well and is run efficently....For me Heyberry house run a very caring home and do everything possible to make their residents happy and comfortable, and do everything possible to meet the needs of each resident. The manager had numerous management tools to show how she was safely managing Care Homes for Older People Page 8 of 37 the service including, self assessments, company audits including medication audits and infection control and a business plan for the company. This helped to set out the developments of the company for the future of Heyberry House. The service is effectively managed and any development was shown to be in the best interests of the people living there, ensuring a good quality of service was provided. We received lots of complimentary comments from people living at the service including 11 surveys submitted to our department and 2 from their relatives, giving comments such as, The very genuine affection and care of all the staff to the residents, very good response of staff to residents needs. Good quality food provided. I feel they do everything well. The staff are all kind and helpfull. The staff look after us very well, it is what I would say is a well run place. I feel happy I live here. .....most things seem alright. They keep the place nice and clean, you can get attention if you wanted it, its warm and homely, the staff are ok. The staff are friendly and well motivated and attentive. Good staffing levels, good levels of activity for residents. They look after you well, they have a lot of outings etc.- go theatre and things. I get good meals, I got a good room. Good food, its clean and tidy. The staff are friendly and well motivated and attentive. Good staffing levels, good levels of activity for residents. I have no complaints. I have everything I need in my room its nice and comfortable here. The staff are all kind and helpfull. The staff look after us very well, it is what I would say is a well run place. We also received a selection of positive comments from staff including 6 comment cards received from staff, which included, Provides adequate care needs, support and trust, confidentiality, nutritional needs for all service users which are fulfilled and meets all their needs and activities trips out,,,, Care Homes for Older People Page 9 of 37 Heyberry meets the needs of all our service users very well. The home does very well there are always activities going on. We have dignity champions here, ,,, Our manager and staff all work to meet our service users needs. The service had been successful in being awarded a large grant over 6,000 pounds from the company to develop a sensory garden. Everybody was really looking forward in starting this project so that everybody could enjoy this part of the garden. The service has recently refurbished their hairdressing salon with specially adapted facilities and sinks so that everyone can visit the hairdresser if they wished. They have recently refurbished bathrooms to a very high standard with the latest equipment offering comfortable and modern bathrooms for people to use, including jacuzzi/ spa baths to enjoy. People said they were more than happy with the homes facilities including their bedrooms. All staff were seen knocking on each persons bedroom door before entering, respecting each persons privacy. The company has a good commitment to staff training. At present they have exceeded the basic percentage of staff having a care qualification called an (NVQ, national care qualification) and have 64 of staff with an NVQ qualification at level 2. What they could do better: To provide an updated statement of purpose and service user guide in formats that can be used and understood by various people with specific needs who live at Heyberry house. To review comments made about services at Heyberry House with the people who live there and their relatives and staff. To help them have feedback from the company regarding their suggestions and comments raised throughout our report. To provide an activities budget and increased hours for the activities organiser to help her further develop initiatives to provide a programme of day trips out for a larger number of people. To review staffing levels to allow increased staffing levels to support people socially at Heyberry house. To review the current training programme to ensure that training in safeguarding is provided on a regular basis. This training should have agreed updates in this necessary topic for all staff working at Heyberry house so that all staff are kept up to date in safeguarding people. To review the current staffing levels with both staff and people living at the service to show what actions and reviews are taking place to evidence the staffing levels meet the needs of everyone at Heyberry house. To display the basic staffing levels that the Care Homes for Older People Page 10 of 37 company commits to so that people can be informed of staffing levels within the service. To review all staff personnel files and ensure they all have updated staff pictures and have copies of identification when being recruited. This will help to enhance accurate recruitment checks are in place. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 11 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 12 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good information is given to anyone thinking about moving into Heyberry House. This helps people to make choices about were they want to live and ensures it is the right place for their needs to be met. Evidence: We looked at records showing what happens when a new person comes to live at the service. The services aqaa told us that staff had been provided with specialist training to help them carry out assessments for anybody new wanting to live at Heyberry House. Staff completed detailed assessments to make sure that they identify what care and support a person needs and whether they can provide that at their service. We met people at Heyberry House who said they had been made to feel very welcome and helped to settle in because the staff were so good to them. Good information is given to any new person wanting to stay at Heyberry House, including the option of having a trial visit to the service. This makes sure that Care Homes for Older People Page 13 of 37 Evidence: Heyberry house is the right place for the person to live in and and that their needs can be met. The manager has developed a residents guide and a statement of purpose which are available to anyone. The guides include brief details of information on the purpose of the home and the facilities on offer. Staff explained that both of these documents were being developed further at head office and they were waiting for the newly revised ones to be able to give out to people. They were hoping to eventually to be able to have this information transferred onto a CD to help some people who are partially sighted to get the same information. Care Homes for Older People Page 14 of 37 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The individual needs and choices of the people living at Heyberry House are identified so that staff can support them to meet those needs, choices and all aspects of daily living. Evidence: Detailed individual care plans were available for each person, we looked at three of them. As an example of good practice the staff had developed written consent forms for people to sign if they agreed to having their picture taken for their care file. This helped show how staff respect each persons choice and rights in being given the option of having their picture taken. Staff had also developed these plans to include lots of different assessments such as, weights and manual handling assessments. These assessments showed what actions the staff take to help keep people comfortable and safe while living at Heyberry house. The plans were detailed and regularly reviewed and gave enough information to show Care Homes for Older People Page 15 of 37 Evidence: how their personal and medical needs would be met. They covered a diverse range of needs of everyone living at the service, including, immobility, diabetes, poor appetite, regular weighing and monitoring. These plans overall, provided staff with good guidance and were appropriate instructions as to the support people require in a range of environments and situations to enhance their life, especially when they wanted to get up and have a bath and have assistance with their personal care. The records also showed good relationships and contact with members of the multi disciplinary teams, such as the doctors, district nurses and specialist staff at the hospital which helped staff to support people in the right way with their medical needs. District nurses help the staff to get the right equipment and visit regularly offering support and advice. We have received 11 comments cards from people living at Heyberry house which have given mixed opinions about living at the service. We asked various questions in these comment cards and found mixed opinions to the questions raised although most comments made were quite positive in their responses. We asked in the comment cards, do you receive the care and support you need? Five people indicated they, always do, 4 people said they, usually do and 2 people felt they, sometimes do. We asked, Are staff available when you need them? Five people indicated, always, 3 people said, usually and 3 people said, sometimes. We asked, Do staff listen to you? Five people indicated, always, 4 people said, usually and 2 people said, sometimes We also met and chatted to about 5 people living at the service who were very complimentary about the service and overall were very positive about the service. We received lots of complimentary comments such as, The very genuine affection and care of all the staff to the residents, very good response of staff to residents needs. Good quality food provided. I feel they do everything well. The staff are all kind and helpfull. Care Homes for Older People Page 16 of 37 Evidence: The staff look after us very well, it is what I would say is a well run place. I feel happy I live here. .....most things seem alright. They keep the place nice and clean, you can get attention if you wanted it, its warm and homely, the staff are ok. We have also received 2 comment cards from relatives/ visitors with mixed responses, such as, One comment card said they Always meet the needs of their relative/friend and 1 person felt they, sometimes met their needs. However they did make positive comments within the comment cards saying, The staff are friendly and well motivated and attentive. Good staffing levels, good levels of activity for residents. We looked at the storage and procedures of managing medications and they were found to be well maintained and safely managed. One person was supported in managing their own medication to help continue with their own independence for as long as they wished. Staff had developed good auditing of the management of medications which helps to keep up the good standards already achieved in providing a safe system. In discussions with staff on duty they were able to explain the way in which people living there make decisions and how they are able to decide for themselves. For example, staff support people were they choose to have their meal, either in the dining room or in the privacy of their own room. They were very enthusiastic to talk to and they all felt they worked well as a team and always strived to make things better for the people who lived there. Some comments from staff included, Provides adequate care needs, support and trust, confidentiality, nutritional needs for all service users which are fulfilled and meets all their needs and activities trips out,,,, Heyberry meets the needs of all our service users very well. Care Homes for Older People Page 17 of 37 Evidence: Some people made suggestions such as, Give staff more time with the service users and less paperwork so that we can spend more time with them, ie. their background and lifestyle and more knowsledge about their family and work. We noticed that the people we met and chatted to had been supported with their personal care to a good standard. The people we met were well dressed with colour co ordinated clothes and alot of people had visited the hairdresser during the time we had visited. Care Homes for Older People Page 18 of 37 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Heyberry House are supported so they can choose what they want to do each day. Evidence: The manager explained that they had a part time activities organiser (20 hours per week,)who develops a regular programme of activities. The posters advertising the activities on offer that week were seen displayed in reception on the notice board. The services aqaa also told us they had developed a few initiatives with activities including, eg, a newly refurbished hairdressers, 3 times a week they organise a mobile shop, they have developed a reading group......relatives evenings are held twice a year, they offer the availability of fresh water and juice and fresh fruit on tables three times a week, they have organised a mini-break planned for September to Southport..... The aqaa also told us that, they plan to adapt their activity plan for partially sighted people by putting it onto a talking tape to keep them fully informed of events on offer. We acknowledged the activities organiser and staff had managed to access and set up various events over the past 12 months which had shown how much they had done Care Homes for Older People Page 19 of 37 Evidence: with just 20 hours a week and no activities budget. Staff had developed social care plans for every person living at the service and gave some details about what activities each person liked to do. Staff showed great determination and enthusiasm in trying to provide some form of activities for everyone and felt that some people do not like group events so they try and give them 1 to 1 support. Staff acknowledged that with just 20 hours a week this was difficult to provide on a daily level with just one member of staff. Some daily records described activities over the past week, such as watching the television, general chats, watching a film, 1 to 1 chats and bingo and a forthcoming garden party. We noticed the hair dresser was busy with alot of people in the services own newly refurbished hair salon. The hairdresser said she calls every week and sometimes twice a week depending on how many customers want to get their hair done that week. We met various people that had been the to the hairdresser, they advised, we love coming in to get our hair set, it makes me feel alot better. Staff advised they do regular fund raising to help provide various activities for people. They felt they could utilise alot more activities and arrange alot more if they had an increase in the hours allocated for activities and more funds to set things up. They explained that they had just heard how they had been successful in being awarded a large grant over 6,000 pounds from the company to develop a sensory garden. Everybody was really looking forward in starting this project so that everybody could enjoy this part of the garden. Some staff and people living there said they would love more trips out and they said they would like to get involved and go out alot more. Some of the staff felt that if they had their own minibus they would be able to go out regularly with a larger number of people. The activities organiser has set up weekly trips out each Thursday but explained she is only able to safely support 2 to 3 people on trips out. This meant that some people have to wait a while for their turn to go on a trip out. Staff made various positive comments such as, The home does very well there are always activities going on. We have dignity champions here, we are currently waiting to hear about funding as we are in the process of making a sensory garden..... We have received 6 comment cards from staff who have made various suggestions Care Homes for Older People Page 20 of 37 Evidence: regarding how they feel the service could improve such as, Have a minibus to take service users out more. Give staff more time with the service users and less paperwork so that we can spend more time with them, IE. their background and lifestyle and more knowledge about their family and work. Staff should be commended in what they have already achieved with just 20 hours a week for activities. They showed alot of enthusiasm and vision as to what more they could achieve if they had increased activity hours and an activities budget. The reception area had an open and accessible area for alot of information to be shared with people. This included an orientation, weather and date board, lots of information about the service and company including the comments book and the most recent bank statments of the services amenity fund. All of these documents and notices helped to keep everyone informed and included with what was going on within the service. People living at Heyberry House and the staff have regular meetings to discuss the running of the service. We looked at these records which showed good discussions on alot of things, helping to keep everyone informed and included in the developments of their home. We looked at the menus offered. The chef also explained that staff visit each person daily to offer people choices of what the want which helps in planing the meals served. Their aqaa told us they had has dining with dignity training for staff and the chef and staff had won various awards through out the company for their catering skills. The dining room tables were well laid out and had been attractively laid with cloth table clothes, flowers and condiments. There were lots of positive comments about the food, especially about the homemade cakes served daily. The aqaa told us that they are planning to provide, bread and butter with every meal. We noticed that menus are also discussed during house meetings so people have the opportunity to give regular feedback about the meals served. We received 11 comment cards from people living at Heyberry House and we chatted generally to about 5 people living there. Overall they gave very positive comments, they mostly indicated they were happy with the service and facilities at Heyberry House. We asked various questions in our comment cards such as, Does the home arrange Care Homes for Older People Page 21 of 37 Evidence: activities you can take part in if you want to, seven people indicated, always, 2 people said, usually and 2 people said, sometimes. We also asked, do you like meals at the home, eight people indicated, yes and 3 people indicated, no. The people we met and the staff we chatted to felt that routines in the service were flexible so that people were getting up and going to bed when they wanted, and were having their meals and drinks when it suited them. Some people made various comments such as, They look after you well, they have a lot of outings etc.- go theatre and things. I get good meals, I got a good room. Good food, its clean and tidy. The staff are friendly and well motivated and attentive. Good staffing levels, good levels of activity for residents. Care Homes for Older People Page 22 of 37 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected by the services procedure for responding to concerns and complaints Evidence: Information about how to raise a concern or complaint is made available to the people living at Heyberry House. This is good practice as it helps to increase the opportunities for people using the service now and in the future to have a better understanding of the ways in which they can raise concerns. The aqaa told us there had been just 2 complaints dealt with by the company following our previous visit. There has been no cause for any visits from our department to the service since its last routine visit. During our visit it was obvious that the manager always makes herself available to everyone, including, visitors, staff and people living there. She made herself available to everyone at the service and openly practiced an, open door policy. The regional manager looks at any records of complaints during their monthly audits and this helps to make sure that all comments are reviewed by both the manager and the company representatives. Some of the people we chatted to said they were aware of what to do or who to see if Care Homes for Older People Page 23 of 37 Evidence: they had any concerns or issues to discuss. They felt they were well supported by staff. some people said, I have no complaints. We have received 11 comments cards from people living at Heyberry house. We asked various questions in these comment cards, such as, Do you know how to make a complaint, Ten people indicated, yes and 1 person indicated, no Some of the staff we chatted to described various training that they had attended including, safeguarding and abuse awareness which helped them do their job efficiently. They were happy with the training they had been offered and felt supported with their training needs. We noted that regular training for safeguarding had not been provided on a regular basis and had not been included in the services list of mandatory training. The manager acknowledged that staff are provided with this training at induction and all current mandatory training had specific timescales of when staff could expect to be supplied with their updates in necessary training. Staff felt that the newly introduced, e learning on the computer would provide alot of mandatory training including safeguarding and health and safety. However the manager agreed to review this necessary training so that it was included as a mandatory topic with regular updates for all staff. All of the staff we talked to described their safeguarding procedures and felt confident of knowing were to go to report any concerns they might have. This helped to make sure they were well trained in knowing how to safeguard the people they support. Six staff comment cards submitted to our department indicated they knew what to do if someone had concerns about the service. Care Homes for Older People Page 24 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe and well maintained home. Evidence: We looked around the service and viewed a sample of rooms. Each bedroom was very clean and tidy and well maintained with attractive colour co ordinating linen. Every bedroom offers a single room with an en-suite toilet. Some people have chosen to bring in their own furniture and staff explained that they try to encourage people to bring in their own personal belongings to make the room more comfortable and personalised to suit their needs and tastes. One empty bedroom has an en-suite shower room but this is the only bedroom offering that facility. Staff explained that each person has their own letter box and the post man delivers their mail direct to their front door so they personally receive their own mail. This was a good example of what staff had arranged to ensure peoples rights and privacy are maintained at Heyberry house. Those people that we chatted to said they were more than happy with the homes facilities including their bedrooms, People said, Care Homes for Older People Page 25 of 37 Evidence: I have everything I need in my room its nice and comfortable here. Some people had a key for their flat and liked to keep it locked to maintain their privacy within the service. Everybody that we spoke to including staff referred to the rooms as flats and respected each persons privacy and space as their own personal flat. The communal areas and corridors were well maintained and showed a good standard to the decor achieved offering an attractive environment. We looked at the recently refurbished bathrooms which had been decorated to a very high standard with the latest equipment offering comfortable and modern bathrooms for people to use, including jacuzzi/ spa baths to enjoy. The lounge was very large and open plan leading over to the dining room. The manager was hoping for some refurbishment of this area in the coming year and is hoping to replace carpets in this room. There is a large conservatory leading out into the garden which gives some additional day space for those people who want a bit more privacy or quiet time away from the main lounge which is quite busy and full of people. The aqaa gave us alot of information about what developments had taken place in the service and what they planned to do over the next 12 months including, they have customer satisfaction surveys, has a programme of redecoration of flats, has a leather settee in reception, has a bird in the lounge, the home overlooks the park, has infection control audits, .....new plasma TV in lounge, refurbishment of the laundry and the hairdressing room, now has a new spa bath and refurbished bathroom, seating in place in foyer, chefs store room extended, new washing machine,......has a new call system being installed this year and has an ongoing replacement and refurbishment of carpets and bedroom furniture. In speaking to the manager and in looking at records for the developments of the service, it was easy to see how well managed the service was and how the staff looked at initiatives to always provide a better service to the people living at Heyberry house. We looked at a sample of maintenance certificates which showed up to date checks as listed in the homes pre inspection questionnaire which helped show what actions were taken to keep the service safe and well maintained. Care Homes for Older People Page 26 of 37 Evidence: There were various maintenance checks and records to show ongoing and updated checks on eg, water temperatures, in-house fire checks on equipment and systems. Heyberry House has their own part time maintenance person who is responsible for alot of checks within the building to help keep the environment safe and comfortable. Care Homes for Older People Page 27 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Heyberry house are supported by well trained staff who are able to produce a good standard of care and support. Evidence: Records showed that before anyone is appointed to work at Heyberry House they have a series of checks that are carried out. These include obtaining written references and checking with the criminal records bureau (CRB). These checks help to make sure the people living there are safe and that staff are suitable to support them. The manager has developed and produced detailed and well organised personnel files for staff to help show how they are recruited, supported and trained while working at Heyberry house. We discussed the need to ensure these records include copies of up to date pictures and identification of staff members. Some files had up to date records some needed pictures to be kept with their staff files. The manager agreed to review all staff files to ensure all records were up to date. The senior staff have developed a supervision plan which covered the planned dates for support and appraisals for all staff. This helped show how every staff member was supported in their role while working at Heyberry house. Care Homes for Older People Page 28 of 37 Evidence: Observation of staff and in general discussions with them, showed that they knew the needs of the people they support and know their likes and dislikes and personal requests. It was evident they had a good understanding of how to support people and how to make sure their needs are met and their individuality respected and catered for. All staff were seen knocking on each persons bedroom door before entering, respecting their privacy. The aqaa told us they had 5 staff who had received training and been identified as the , dignity at work champions. This is an example of a good initiative to ensure the staff are continually receiving training to enhance their skills to enable them to support people. The Staff rota showed that the service provides 4 staff all day and the manager is supernumerary to the rota.There is also a team of domestic and ancillary staff who help keep the home clean and well maintained. We discussed the current staffing levels as the service currently has 38 people living at Heyberry house. There was no staffing calculation or staff notice to advise people how many staff they can expect to see on duty at any one time or what the basic staffing levels are for the service that they would always be able to commit to. Many of the staff working at the service had been there for several years or more and provide a stable team for the people living there. Staff felt if they had more hours they could help more with activities and trips out. Staff explained that sometimes as a gesture of good will some staff will offer their own time and will go on activities and trips without any payment. We have received 6 comment cards from staff with mixed opinions about working at the service and various positive comments were made, such as, Provides adequate care needs, support and trust, confidentiality, nutritional needs for all service users which are fulfilled and meets all their needs and activities trips out, ,,, Heyberry meets the needs of all our service users very well. We have dignity champions here,,,,,, we are in the process of making a sensory garden..... Our manager and staff all work to meet our service users needs. Care Homes for Older People Page 29 of 37 Evidence: Staff responses submitted to our department in the comment cards told us that, five people indicated their induction was done, very well, and 1 person felt it, mostly covered what they needed to do the job. Four people indicated they, always had enough staff to meet the needs of the people living at Heyberry house and 2 people indicated that they felt they usually had enough staff on duty. The manager has supplied various information regarding previous and current training for staff in obtaining a care qualification(NVQ). This helps to exceed the basic guideline for at least 50 of staff to have a care qualification. Evidence of the companies commitment to staff training is their commitment in trying to make sure that eventually all staff will have an NVQ qualification at either level 2 or 3. At present they have exceeded the basic percentage and had 64 of staff with an NVQ qualification at level 2 and currently 3 people are in the process of doing their NVQ 3. The manager had developed good detailed training records which showed that the staff have received both mandatory and specialist training such as, fire, food hygiene, move and handling, infection control and medications. This type of training shows how staff are supported in trying to meet the diverse needs of people living at Heyberry House. The people we met and chatted to were very positive about the staff and the comment cards submitted to our department were also very positive about the staff. Various comments were made such as, The staff are all kind and helpfull. The staff look after us very well, it is what I would say is a well run place. The very genuine affection and care of all the staff to the residents, very good response of staff to residents needs..... The staff are all kind and helpfull. Care Homes for Older People Page 30 of 37 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Heyberry House was well managed and the health and safety of everyone was promoted and protected. Evidence: The manager has worked at the service for approximately 19 years and offers a great stability and rapport to everyone at Heyberry house. The manager was seen to have an open and positive management approach with an open door policy, approachable to everyone. There were various positive comments about the manager and her management style within the service from the staff working at Heyberry House. Staff made comments such as, I get alot of support from my team manager.... .....I have great support from my manager who is a fantastic boss and a great Care Homes for Older People Page 31 of 37 Evidence: manager. The home is managed well and is run efficently....For me Heyberry house run a very caring home and do everything possible to make their residents happy and comfortable, and do everything possible to meet the needs of each resident. The management structure in the service is very good. The registered manager and senior staff have clear responsibilities. The service is effectively managed and any development is in the best interests of the people living there, ensuring a good quality of service is provided. The service had already been awarded the investors in people award which lasts for 3 years and shows good standards achieved in the training and support of staff within Heyberry House. The manager felt she always strives to improve and develop new initiatives if she felt it would benefit people living at the service. One example was the dignity of work champions were they already have 5 staff identified for this initiative to help support people further. The focus of the service is very much on providing the best to the people living there and responding to their needs. The manager meets with everyone on a regular basis and the minutes of these meetings shows good communication keeping everyone up to date and included with the developments of their home. Some agendas included comments and updates on, eg, health and safety, complaints procedures, meals, activities and the plans for the sensory garden. The service is visited on a regular basis by a representative of the organisation. These visits form part of the quality assurance process and form an opinion on the standard of care provided. These visits are also a requirement of the care home regulations and a report has to be produced to show evidence of these checks. These reports were very detailed and showed regular auditing and monitoring of the standards achieved at Heyberry House. They included information on, eg, interviews and comments made by staff and people at the service, environment checks, accidents, maintenance and developments, activities, care plans and finances. The manager had developed various records to show how health and safety was managed within the service. This included having regular health and safety meetings with nominated people who made sure various risk assessments and risks were monitored and reviewed. We looked at a sample of health and safety risk assessments Care Homes for Older People Page 32 of 37 Evidence: that covered alot of areas within the service including, catering risks, infection control, coshh sheets, hot water, lifts, clinical waste, manual handling and the grounds, with guides on how to complete a risk assessment. They were all regularly reviewed and updated by staff to show what actions had been taken to reduce risks. The manager had numerous management tools to show how she was safely managing the service including self assessments and company audits including medication audits and infection control. She also showed us a business plan for the company which helps set out the developments of the company for the future of Heyberry House. Records and certificates showed that regular checks are carried out on the building and equipment. This includes checking electrical appliances, the gas supply and regular fire checks. These checks help to make sure that the service is well managed and is a safe place to live and work in. We looked at a sample of finances records regarding how each persons money is stored and managed on their behalf. As an example of good practice the company do not always act as , appointee and try to encourage the person or their families representatives to be an appointee. At present they only act as an appointee for 2 people and have detailed procedures which helped to manage their personal allowance and showed a clear process were their records were safely managed. The sample of records seen regarding the management of personal allowances were clear and accurate with receipts kept of any money spent on behalf of each person. Care Homes for Older People Page 33 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 34 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 To provide updated statement of purpose and service user guide in formats that can be used and understood by people who live at Heyberry house. To review comments made about services at Heyberry House with the people who live there and their relatives and staff to help them have feedback from the company regarding their suggestions and comments raised. To provide an activities budget and increased hours for the activities organiser to help her further develop initiatives to provide a regular programme of day trips out for a larger number of people. To review staffing levels to allow increased staffing levels to support people socially at Heyberry house. To review the current training programme to ensure that training in safeguarding is provided on a regular basis. This training should have agreed updates in this necessary topic for all staff working at Heyberry house so that all staff are kept up to date in safeguarding people. To review the current staffing levels with both staff and people living at the service to show what actions and Page 35 of 37 2 7 3 12 4 18 5 27 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations reviews are taking place to make sure the staffing levels meet the needs of everyone at Heyberry house. To display the basic staffing levels that the company commits to so that people can be informed of staffing levels within the service. 6 29 To review all staff personnel files and ensure they all have updated staff pictures and have copies of identification when being recruited. This will help to enhance accurate recruitment checks are in place. Care Homes for Older People Page 36 of 37 Helpline: 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. 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