Care Home: Heyhead House

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What the care home does well Residents and relatives were given useful written information about the home, some of which was in a form that the residents could understand, for example with pictures. Before people went to live in the home, written information about them, and what care and support they needed, was obtained. This helped to make sure that Heyhead House was the right place to live, and that staff understood the residents. The residents` care and support was well planned and made sure that they were well looked after, and had interesting and enjoyable things to do. Some residents went to college during the week and enjoyed hobbies and free time at the weekend. Some residents were able to visit their families at the weekends and were encouraged by the staff to do this. Residents could also choose some of the things they wanted to do and things that happened in the home. There was good written information about the residents, and what support they needed and what they liked to do. The residents and staff appeared to get on well and the residents said that staff were "nice" and "looked after them well". One said she "got on well" with her key worker. There was a friendly atmosphere in the home. The residents` health was well looked after and there were different ways of making sure that people had all the health care they needed. The Medication practices were safe, and made sure that the residents` took the right medication, which helped to keep them well. The staff listened to the residents about their views about the home and what they liked to do and helped them to lead happy, safe and fulfilling lives. The residents knew who to speak to if they were unhappy about anything in the home and there were some pictures on the notice board to help them know what to do. The home was a modern, pleasant, bright and comfortable home for the residents. Residents were pleased that they were able to choose the wallpaper and some of the furniture for their bedrooms. What has improved since the last inspection? There was more written information about the care and support residents needed that now covered the emotional support that people needed, and also what staff can do to help people who become confused and can`t remember things. The way residents` medicines were given was safer, and staff were now checking the prescriptions before going to the pharmacist for dispensing so that mistakes could be found and corrected. Some parts of the house had been repaired and decorated. A piece of the floor in the corridor had been made safe so that people wouldn`t trip. The owner of the home has been making unexpected visits to the home to check how the residents were being looked after, and how the home was being run. What the care home could do better: Some of the written information given to people about the home needed changing and correcting as it had the wrong name on and information about the staff was out of date. The written information about the risks face by residents in their everyday lives could be more accurate and contain more information about how staff helped to protect people and help keep their independence. Some further improvements could be made in the way residents` medicines are given, and for example staff must read the instructions carefully before giving medicines to people and sign the records accurately. The house could be further improved. Some bedrooms still needed decorating, and damage done to some walls and door - frames by, a wheelchair, should be repaired. This would make the home even more pleasant for the residents. The way staff are chosen must be better to make sure that only suitable people are allowed to work in the home. People must not start work in the home until the right checks have been made at the places where they used to work. CARE HOME ADULTS 18-65 Heyhead House 1 Trinity Close Brierfield Lancashire BB9 5ED Lead Inspector Mrs Pat White Key Unannounced Inspection 21st November 2007 10:00 Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 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 Heyhead House DS0000009634.V346696.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 Adults 18-65. 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. Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heyhead House Address 1 Trinity Close Brierfield Lancashire BB9 5ED 01282 617902 01282 617902 S.Brels@hotmail.com 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) Mr Shaun Martin Brelsford Mrs Amanda Jane Brelsford Miss Rachael Elizabeth Simpson Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home should be staffed as follows: Waking Day 7:30 am - 10:00pm Care Staff - 2 staff 8:00 am - 9:30am 1 staff 9:30 am - 4:00pm 2 staff 4:00 pm - 10:00 pm At weekends or whenever there are more than 6 service users at home 2 care staff should be on duty at all times. 2. 3. 4. Night Time - Care staff 2 staff sleeping in No more than one wheelchair user may be accommodated in the home. The service must employ a suitably qualified and experienced manager, who is registered with the Commission for Social Care Inspection. The home is registered for a maximum of 8 service users in the category of Learning Disability 4th October 2006 Date of last inspection Brief Description of the Service: Heyhead House is registered with Commission for Social Care Inspection to provide accommodation and personal care for eight adults (aged 18-65 years) with a Learning Disability. The home is a purpose built single storey building, providing accommodation in eight single rooms, two of which have an ensuite facility, comprising of a toilet and hand wash - basin. The shared space is a lounge and dining room. The home is located approximately half a mile from Brierfield town centre. There is a garden and patio area surrounding the property and small car park at the front of the building. There was written information, the Statement of Purpose and the Service user Guide, to inform people about the home, the facilities and the staff. The fees for the home were £349 to £365, with extra charges for transport, toiletries, papers and magazines. Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection site visit was carried out on the 21st November 2007. This site visit was part of an inspection from which an overall assessment on the quality of the services provided by the home was determined. This included checking important areas of life in the home that should be checked against the National Minimum Standards for Adults (aged 18 – 65), and checking the progress made on the matters that needed improving from the previous inspection. During this site visit Steven Robinson from the Darlington Alliance on Disability also visited the home. Steven has lived in a home like Heyhead House and was asked to visit and give his views about the home because he understood the people living in the home and knew about what sort of a place they would like to live in, and how they would like to spend their time. People like Steven taking part in an inspection are called “Experts by Experience”. The inspection included: touring the house, observation of life in the home, looking at service users’ care records and other documents, written information supplied by the home before the site visit (“The Annual Quality Assurance Assessment”) and discussions with the registered manager and a member of staff on duty. All the people living there were spoken with and they all completed and returned, survey questionnaires from the Commission. Four staff also returned completed survey questionnaires. Some of the views of these people are included in the report. Steven looked around the home and spoke to all the residents both individually and in a group. He then wrote a report, and some of the findings in that report are also included in this report. What the service does well: Residents and relatives were given useful written information about the home, some of which was in a form that the residents could understand, for example with pictures. Before people went to live in the home, written information about them, and what care and support they needed, was obtained. This helped to make sure that Heyhead House was the right place to live, and that staff understood the residents. Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 6 The residents’ care and support was well planned and made sure that they were well looked after, and had interesting and enjoyable things to do. Some residents went to college during the week and enjoyed hobbies and free time at the weekend. Some residents were able to visit their families at the weekends and were encouraged by the staff to do this. Residents could also choose some of the things they wanted to do and things that happened in the home. There was good written information about the residents, and what support they needed and what they liked to do. The residents and staff appeared to get on well and the residents said that staff were “nice” and “looked after them well”. One said she “got on well” with her key worker. There was a friendly atmosphere in the home. The residents’ health was well looked after and there were different ways of making sure that people had all the health care they needed. The Medication practices were safe, and made sure that the residents’ took the right medication, which helped to keep them well. The staff listened to the residents about their views about the home and what they liked to do and helped them to lead happy, safe and fulfilling lives. The residents knew who to speak to if they were unhappy about anything in the home and there were some pictures on the notice board to help them know what to do. The home was a modern, pleasant, bright and comfortable home for the residents. Residents were pleased that they were able to choose the wallpaper and some of the furniture for their bedrooms. What has improved since the last inspection? There was more written information about the care and support residents needed that now covered the emotional support that people needed, and also what staff can do to help people who become confused and can’t remember things. The way residents’ medicines were given was safer, and staff were now checking the prescriptions before going to the pharmacist for dispensing so that mistakes could be found and corrected. Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 7 Some parts of the house had been repaired and decorated. A piece of the floor in the corridor had been made safe so that people wouldn’t trip. The owner of the home has been making unexpected visits to the home to check how the residents were being looked after, and how the home was being run. What they could do better: 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. Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were provided with useful information about the services and facilities provided in the home. Resident’s needs were properly assessed and reviewed. The residents felt they had a choice of whether or not they wanted to live at Heyhead house. EVIDENCE: The Statement of Purpose and Service users Guide provided useful information about the home and was available for service users and relatives. The Service users Guide had been given to all residents and part of the documentation had been produced in a picture format, including the complaints procedure. However some of these documents were out of date. The wrong name was on some pages and the information about staff qualifications was not up to date. There had been no residents admitted to the home since the last visit. However, it was evident from the records viewed that a full assessment of needs had been carried out prior to admission for existing residents. Social workers, and the manager of the home, both carried out assessments before the residents went to live in the home. Residents also stated in the questionnaires they filled in for the Commission that they felt they had a choice about going to live at Heyhead house, and had visited the home to see Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 10 if they liked it. They also said that they had enough information about the home before moving in. There was also evidence from looking at residents’ records and talking to the manager and residents that the residents’ needs were understood, for example all steps were being taken to understand and meet the needs of one of the residents who had a recent diagnosis of dementia. Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 Quality in this outcome area is good. This judgement has been made using available evidence, including a site visit to this service. The care plans had detailed and useful information about the needs of the residents and provided guidance to staff on how these needs were to be met. Relationships within the home were good and assisted the residents to make choices about their lives and participate in the life in the home. EVIDENCE: From the residents’ records seen, it was evident that each resident had a plan of care, based on the assessment of needs. The plans set out in detail the action needed to be taken by staff to care for and support people. Since the last inspection it was evident that the needs and the care required for some residents had been reviewed and updated. One resident with a diagnosis of dementia had relevant written information about this, and the support needed, on the care plan. The care plans also included “person centred plans” which included residents’ preferences, preferred routines and activities and enabled staff to understand Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 12 the different and individual circumstances. The residents had signed the written plans to indicate their involvement and agreement with the plans for their care and support. However some of the useful information from the person centred plan was not on the part of the care plan used every day and would not be easily seen, and on another care plan the information about the person’s “communication” needs was not accurate. Discussion with the residents and staff, the report from the Expert by Experience, and the residents’ questionnaires indicated that the residents had choices in their everyday lives, such as about what to do each day, their preferred routines and how their bedrooms should be decorated. Relationships between the staff and residents were such that residents were listened to and their views taken into account. The questionnaires completed by residents also confirmed this. Resident’s meetings were arranged on a frequent basis and residents were encouraged to express their views on all aspects of life in the home, including activities. It was the practice of the home to support responsible risk taking, and policies stated that the role of staff was to facilitate independence wherever possible. Risk assessments were undertaken on such things as working in the kitchen and going out alone. There was evidence that the risk assessments had been reviewed and updated. However not all the risk assessments defined the level of risk or included detailed useful risk management strategies to minimise the risk and help retain people’s independence. Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents had good opportunities to take part in a range of appropriate activities. They were supported to use leisure and community facilities and encouraged to participate in the life of the home. The residents maintained strong links with their families and enjoyed positive relationships with each other and with staff. The meals served were healthy and varied and appeared to suit the residents’ preferences. EVIDENCE: Some residents attended college courses in line with their interests, and these included cookery and basic life skills. Another resident attended a new centre for people with disabilities. This gave them the opportunity to meet people outside the home environment. Other residents had completed all relevant college courses, but were soon to begin courses at home with a “home tutor”. On the days when residents were at home they were given the opportunity of taking part in crafts such as baking and crafts. Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 14 The residents used leisure facilities in the local area, which included pubs, the cinema, the leisure centre and restaurants. Two residents regularly attended the nearby church and enjoyed participating in the church activities. This showed that residents were encouraged to express their preferred religious faith. Residents told us, including the Expert by Experience, that they enjoyed their activities and one spoken with was looking forward to forthcoming birthday celebrations. A one - week holiday was included in the contract price and this year residents had enjoyed a holiday in Llandudno. They told the Expert by Experience that they “had had a great time and enjoyed themselves”. Residents go out as a group, or individually with staff when there are two members of staff on duty. The opportunity for this and therefore choice of activities was restricted at the weekend when there was usually only one member of staff on duty. However subsequent to the site visit more support worker hours were introduced at the weekend to allow residents more flexibility and choice of activities. The Expert by Experience suggested the use of a “choice board” to encourage people to say and write downwhat they wanted to do. The residents told the Expert by Experience that they all got on well together and with the staff. He felt that there was a “friendly and homely atmosphere in the home”. Residents also told him that families and friends were able to visit the home at any time, but that visitors couldn’t stay over night, due to lack of facilities. Some residents enjoyed regular visits to their parents, and holidays with them. The registered manager and staff supported these relationships. The residents said the routines in the home were flexible, to fit in around their daily arrangements, and were more flexible at the weekends, when residents could get up and go to bed when they wished. Some preferences were recorded on the care plans. Residents participated in the chores of the house, such as cleaning and tidying their bedrooms, preparing food and washing up. The menu was compiled on a weekly basis and residents were able to say what they wanted to eat. Residents told the Expert by Experience that there was a choice of meals and that they were able to help in the shopping, preparing, cooking and serving of food, and that they enjoyed “takeaways” sometimes. Residents were not clear about whether or not they could help themselves to snacks in between meals or had to wait for staff but the manager confirmed that they could help themselves to snacks from the cupboard and that some residents were able to prepare drinks and sandwiches. On the day of the site visit the evening meal was observed and appeared healthy and appetising. Residents appeared to enjoy the meal and said in conversation that they enjoyed the food. Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence, including a site visit to this service. Personal support was provided in a manner, which respected the residents’ rights to privacy, dignity and independence. The residents’ physical and emotional health was monitored and health needs met. Residents’ medication was administered safely. EVIDENCE: With respect to personal support, residents were given prompts and supervision according to their individual needs, and in a way that promoted dignity and independence. The residents’ individual care plans set out the personal support each resident required and provided details of how this support was to be given. The registered manager and staff ensured consistency and continuity of support for residents by the key worker system. A record was also maintained of individual likes and dislikes as part of the assessment and care planning processes. Preferred routines such as times of getting up and going to bed were also recorded and respected. Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 16 The importance of respecting residents’ rights to independence and privacy and dignity was included in the Induction training for new staff and in the residents questionnaire survey all seven residents said that the staff “always” treated them well. One said, “I am very happy, I like my key worker and the staff” The records, and discussion with the manager, showed that the residents’ physical and mental health was monitored, and health problems addressed. At least one care plan had been updated since the previous inspection to show how recent changes in the person’s mental health was being addressed with respect to developing dementia. All residents had a “Health Action Plan” which involved an annual health check and a medication review. Records also showed that the residents had appropriate services from chiropodists, opticians and dentists. There were policies and procedures for the receipt, recording, storage, administration (including self – administration) and disposal of medication, and since the previous inspection these had been developed to cover more practices, for example the use of homely remedies and the ordering of medication. Also prescriptions were now being checked prior to going to the pharmacist for dispensing so that errors could be picked up. Also all staff who administer medication had undertaken appropriate training. The storage of medication was safe and clean, and checks on the medication and the Medication Administration Records (MARs) viewed showed that medication was being given as prescribed. However on one MAR sheet viewed staff had copied signatures resulting in a series of signatures being made at the wrong part of the day, though it appeared that the medication was given at the right time. Not checking the MARs properly when administering medication makes errors much more likely. At the time of the site visit there was no system of auditing and checking the way medication was being administered so errors such as the one outlined were not identified. However soon after the site visit such a system was subsequently developed and implemented. Also one resident was applying cream but there was no risk assessment to support this. There was no formal system for identifying the residents to ensure medication was being given to the correct person. This would be useful for new members of staff who did not know the residents. Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence, including a site visit to this service. Systems were in place to ensure that any concerns of residents would be acted upon. Appropriate policies and procedures were available to respond to any allegations or suspicions of abuse. EVIDENCE: Both informal and formal arrangements were in place for the registered manager and staff to listen and act on the views and concerns of residents. This was achieved through daily conversation, one to one discussion with residents and their key workers, and residents’ meetings. There was a complaints procedure on the notice board in the hall and a copy was in the service users guide. The complaints procedure included pictures to help residents understand who they could speak to. The registered manager had not received any complaints since the last inspection and none had been made to the Commission. However one relative in conversation said the she felt her daughter’s bedroom should be decorated. All the residents who completed questionnaires for the Commission said that they knew who to speak to if they were not happy. Five said they knew how to make a complaint and 2 said they were unsure. Residents told the Expert by Experience that they felt they ”could talk to staff if they had any concerns, complaints or didn’t feel safe”. There was an appropriate procedure for responding to any suspicions or allegations of abuse. No incidents or allegations had been reported in recent years. Staff had also received in-house training on the safeguarding of vulnerable adults, which included a video and questionnaire. Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 28 & 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a site visit to this service. The home was pleasant, modern and homely, and in keeping with the residents’ age group. The residents were able to personalise their bedrooms and create an individual space suitable for their needs. However some areas of the home could be better maintained. EVIDENCE: Heyhead House is a purpose built bungalow, providing accommodation for eight residents. All bedrooms are single occupancy. Communal space consisted of a lounge and dining room. There is also space in the kitchen to eat meals. There was a television in the lounge with a “freeview” box and DVD player. The bedrooms are all at ground floor level and had been decorated according to the personal preferences of the residents. The information supplied by the home to the Commission said that two bedrooms had been recently decorated and that residents could choose their own décor and furnishings. Residents Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 19 confirmed this in conversation with the Expert by Experience. The residents had personalised their rooms with posters and other possessions, for example TVs, music players and an exercise bike. The Expert by Experience reported that all parts of the home were “clean and tidy, homely and well decorated”. However some door - frames and walls were still damaged by a wheelchair and would benefit from restoration, some tiles were loose in the laundry floor and a bedroom blind needed repairing. The manager stated that the blind and the tiles were soon to be repaired. Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents benefited from a competent and qualified staff team, and staff recruitment procedures, though not as thorough as they could be, would help protect residents from unsuitable staff. EVIDENCE: From discussions with staff and the registered manager during the inspection, it was evident that staff had a good understanding of the residents’ needs and knew the residents well. The Expert by Experience also reported a good rapport between the residents and the staff. Members of staff referred to the residents in respectful terms and were observed to interact in a positive and pleasant way. Residents said in the questionnaires that the staff treated them well. At the time of the site visit there was only one member of staff on duty at certain times at the weekend. During these periods the options for residents’ activities was restricted as all residents had to do everything together - either stay in or go out. However subsequent to the site visit additional staffing hours were given to Heyhead House at the weekends to increase residents’ Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 21 opportunities. Four staff completed the survey questionnaires and all said they felt there were enough staff on duty in the home. The records of one member of staff who had commenced work in the home since the last inspection, were viewed. This showed that she had not commenced work in the home until the Protection of Vulnerable Adults (POVA) check had been obtained, and that she did not work alone with residents until the full Criminal Records Bureau (CRB) check had been obtained. The staff questionnaires confirmed that staff did not commence work in the home until POVA checks had been received. However the member of staff whose records were viewed had started work before references had been received and both references were from the same employer even though there were other employment options. This is not in accordance with the Commission’s recruitment guidance for people who commence work before the full CRB check is received, though in this instance had not put people at risk. All staff had training and development files with records of training undertaken. This showed that staff had completed an in house induction in accordance with Government guidelines. These records and information supplied by the home prior to the site visit showed that staff undertook training in health and safety, first aid, moving and handling, food hygiene and adult abuse. However training in matters specifically relating to Learning disability was not undertaken. At the time of the inspection, 60 of the care staff had qualifications to at least NVQ level 2, with another member of staff undertaking this training. In the staff questionnaires all four staff felt the Induction training and on going training was relevant and prepared them for their job. They also felt that they were generally given enough information about resident’s individual and diverse needs to assist them to look after and support people. Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence, including a site visit to this service. Residents benefited from stable management that ensured positive relationships between the staff and the residents. The quality assurance systems ensured the residents’ views were taken into account in the development of the home. The health and safety of both residents and staff was promoted. EVIDENCE: The registered manager had worked in the home for about 6 years, and previously as a care assistant. She had achieved the Registered Manager’s Award and at the time of the inspection had completed NVQ level 4 in care. The registered person visited the home regularly and worked in the home on the rota. She had also recommenced monthly, unannounced visits to the home under Regulation 26 of the Care Homes Regulations and supplied the Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 23 Commission with a report of such visits. The four staff who completed questionnaires indicated that they felt well supported by the manager and the registered person. Support systems included supervision, appraisals and staff meetings. Quality monitoring measures were in place and this included an annual residents’ satisfaction survey. The views of relatives and visiting professionals were also sought. A resident survey had just been completed at the time of the inspection and which showed that no action was required at the present time. The records kept in the home and the information provided to the Commission before the site visit showed that the home provided a safe environment in which to live and work. There was a full set of policies and procedures relating to health and safety. Hot water temperatures were monitored regularly and the boiler adjusted if need be to protect residents from scalding water. Staff records indicated that the staff had received appropriate health and safety training including first aid and food hygiene. The fire equipment, gas installations, electrical wiring and electrical appliances had been maintained and serviced appropriately. Suitable records were kept of fire drills and fire alarm tests and the fire safety risk assessment had been recently updated. Since the previous inspection action had been taken to ensure that the home’s water supply is free from Legionella. Heyhead House DS0000009634.V346696.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 Adults 18-65 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 2 3 3 X 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 x 28 3 29 x 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 3 X X 3 x Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 25 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13 (4) Requirement The risk assessments must contain sufficient detail so that the risk is defined, the level of risk is assessed and there is useful information about how to minimise or eliminate risk that helps retain residents’ independence. Staff must check all the information on the MARs to make sure they are administering and signing correctly and so that errors are noticed. People must not commence work in the home until written references are obtained and that references from different past employers are sought whenever possible. Timescale for action 18/01/08 2. YA20 13 (2) 04/01/08 3. YA34 19 (4) (c) 04/01/08 Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The information about the home – the Statement of Purpose and the Service User Guide – should be updated and corrected so that people have accurate information about the home The care plans should include information about residents’ preferences and likes and dislikes and all the information should be accurate including that about residents’ communication. The need and the facilities for visitors to stay overnight in the home should be reviewed and the outcome of this review explained in the Service User Guide. There should be a formal system of identifying residents to at the time of administering medicines to ensure that the correct medication is given to everyone. Risk assessments should underpin residents administering part or all of their medication, and these should be subject to reviewing. The damaged walls and doorframes should be repaired and repainted. All parts of the home should be in a good state of decorating and repair. The staff training programme should include matters specifically relating to learning disabilities. 2. YA6 3. 4. 5. 6. YA15 YA20 YA20 YA24 7. YA35 Heyhead House DS0000009634.V346696.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Lancashire Area Office Unit 1 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. 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