Care Home: Heywood Court Care Centre

What the care home does well We found that people at Heywood Court have their needs fully assessed before they move into the home. This will make sure that the staff know what to do to meet needs and that no-one whose needs they cannot meet is admitted to the home. We found that care plans and risk assessments continue to improve and all the people at Heywood Court have had their needs reassessed so that the staff know how to meet each persons needs. We found that medication in the home is managed safely and efficiently in keeping with pharmaceutical guidelines. We found that the management team have ensured that enough staff are on duty to be able to meet the needs of the people presently living at the home. We found that the 11 out of 20 staff had successfully completed a (National Vocational Qualification level 2 or above in Care and staff files contain evidence that they have completed an induction course that is in keeping with recommendations of the Skills for Care Council. We found that staff receive opportunities to participate in training that prepares them to do their job, for example dementia care, and helps to keep them up to date with new ways of working. Recruitment and selection is robust and the manager has made sure that all the right employment checks are made, photographs for identity purposes are in place and that application forms show a full record of employment history. This helps to guard against employing unsuitable people. We found that the environment of Heywood Court was pleasant and met the needs of people involved with the home and the layout gives people a choice of where to sit and spend time. The ex-by-ex observed: ‘The whole place appears to have had a “makeover”, which includes very relaxing colours of décor both in corridors and personal rooms.’ We found that all staff had done training in what to do if they suspected people were not being treated properly (protection of vulnerable adult training). We found that staff were positive about the support provided at the home they said: ‘One of the best things about the home is the way staff interact with the residents.’ The relative who was spoken to felt ‘Staff show real affection to the residents.’ What has improved since the last inspection? Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 We found that the improvements achieved at the last Key Inspection had been maintained and built on. Care plans are now more detailed to include specific health care and communication needs and the effectiveness of care plans is monitored to make sure that best practice is achieved in areas of identified need such as pressure area care, nutrition or falls prevention. The manager now makes sure that when the activities co-ordinator is unavailable people still have the opportunity to join in with social activities so that people have more choice in what to do to remain stimulated and interested in the world around them. The manager now ensures that people have baths, washes or showers with enough frequency and effectiveness to make sure that people are clean and free from unpleasant odours. Access to Heywood Court is now easier so that people can enter a part of the building without having to wait outside. Staff have received deaf awareness and other communication training so that they can communicate better with people who have a sensory loss. The menus are produced in bigger print and are made more accessible to the residents. What the care home could do better: We found that staff often called people by endearments such as ‘love’ or ‘darling’, we would like the manager to find out what people think about the endearments used by staff. We would like the manager to ask staff to commence conversations with people by using their names, this will show that staff see people as individuals and is also more respectful. The registered person should prioritise to ensure that senior staff fully understand their role in respect of the new Deprivation of Liberty Safeguard guidelines as soon as possible so that they can be sure to contact the right authority should they consider that someone does need to have their liberty restricted. The registered person must ensure that a suitable person is put forward for the Care Quality Commission registered manager process so that we can be sure that a person with the abilities to improve and sustain improvements for people living at Heywood Court is in day to day control.Heywood Court Care CentreDS0000049296.V376953.R01.S.docVersion 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Heywood Court Care Centre Green Lane Heywood Rochdale Lancs OL10 1NQ Lead Inspector Michelle Haller Key Unannounced Inspection 1st July 2009 09:30 DS0000049296.V376953.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heywood Court Care Centre Address Green Lane Heywood Rochdale Lancs OL10 1NQ 01706 361900 01706 361944 heywoodcourt@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Care Homes No 2 Ltd 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) Manager post vacant Care Home 45 Category(ies) of Dementia (45) registration, with number of places Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE The maximum number of service users who can be accommodated is: 45 Date of last inspection 29th July 2008 Brief Description of the Service: Heywood Court is a dementia care residential unit, owned by Southern Cross Heywood Court is a dementia care residential unit, owned by Southern Cross Healthcare. It can accommodate up to 45 elderly service users on both a permanent or respite stay basis. With the exception of one double bedroom, all others are single and all rooms are equipped with en-suite toilets and wash hand basins. Bedrooms are situated on the ground, first and second floors of the home although at the time of this visit the second floor was unoccupied. A passenger lift is provided to all floors. The home has disabled access and two safe enclosed patio garden areas are provided to the front and rear of the home. The home is well maintained both internally and externally and a large car park is provided. Public transport passes the home and the motorway network is also nearby. The weekly charges, as at July 2009 are as follows: £400.05 to £546. Additional charges are made for private chiropody treatment, toiletries, newspapers, hairdressing and physiotherapy. The provider makes information about the service available upon request, in the form of a Service User Guide and Statement of Purpose, which are given, upon admission, to each new resident and/or their relative. A copy of the most recent Commission for Social Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 5 Care (CSCI) inspection report is displayed in the entrance hall. Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience Good quality outcomes. This was a key inspection that included an unannounced visit to the service. This means the manager did not know in advance that we were coming to do an inspection. During the visits we looked around the building, talked to residents, relatives and staff, including the manager and the Operations Director. We observed the interactions between people living at Heywood Court and staff. Owing to their dementia, the majority of the people living at Heywood Court were unable to communicate with us and tell us what they thought of the care they received, however they did make general comments and relied on what we saw to make our judgements. We also talked to the manager, staff and relatives. We examined care plans, files and other records concerned with the care and support provided to people in the home. We also looked at all the information that we have received or asked for since the last inspection. This included: The annual quality assurance assessment (AQAA) that was sent to us by the Operations Director. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We looked at information about how the manager has managed any complaints and any adult protection issues that may have arisen. We looked at what the manager has told us about incidence and occurrences in the home through ‘notifications.’ We asked an expert-by-experience (ex-by-ex) to assist with this inspection. An ‘expert by experience’ is a person who has used and accessed services that are regulated by the Care Quality Commission. We consider these people to be experts because they have used/or accessed services. Comments from the expert by experience have been included in the body of this report. Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 7 What the service does well: We found that people at Heywood Court have their needs fully assessed before they move into the home. This will make sure that the staff know what to do to meet needs and that no-one whose needs they cannot meet is admitted to the home. We found that care plans and risk assessments continue to improve and all the people at Heywood Court have had their needs reassessed so that the staff know how to meet each persons needs. We found that medication in the home is managed safely and efficiently in keeping with pharmaceutical guidelines. We found that the management team have ensured that enough staff are on duty to be able to meet the needs of the people presently living at the home. We found that the 11 out of 20 staff had successfully completed a (National Vocational Qualification level 2 or above in Care and staff files contain evidence that they have completed an induction course that is in keeping with recommendations of the Skills for Care Council. We found that staff receive opportunities to participate in training that prepares them to do their job, for example dementia care, and helps to keep them up to date with new ways of working. Recruitment and selection is robust and the manager has made sure that all the right employment checks are made, photographs for identity purposes are in place and that application forms show a full record of employment history. This helps to guard against employing unsuitable people. We found that the environment of Heywood Court was pleasant and met the needs of people involved with the home and the layout gives people a choice of where to sit and spend time. The ex-by-ex observed: ‘The whole place appears to have had a “makeover”, which includes very relaxing colours of décor both in corridors and personal rooms.’ We found that all staff had done training in what to do if they suspected people were not being treated properly (protection of vulnerable adult training). We found that staff were positive about the support provided at the home they said: ‘One of the best things about the home is the way staff interact with the residents.’ The relative who was spoken to felt ‘Staff show real affection to the residents.’ What has improved since the last inspection? Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 8 We found that the improvements achieved at the last Key Inspection had been maintained and built on. Care plans are now more detailed to include specific health care and communication needs and the effectiveness of care plans is monitored to make sure that best practice is achieved in areas of identified need such as pressure area care, nutrition or falls prevention. The manager now makes sure that when the activities co-ordinator is unavailable people still have the opportunity to join in with social activities so that people have more choice in what to do to remain stimulated and interested in the world around them. The manager now ensures that people have baths, washes or showers with enough frequency and effectiveness to make sure that people are clean and free from unpleasant odours. Access to Heywood Court is now easier so that people can enter a part of the building without having to wait outside. Staff have received deaf awareness and other communication training so that they can communicate better with people who have a sensory loss. The menus are produced in bigger print and are made more accessible to the residents. What they could do better: We found that staff often called people by endearments such as ‘love’ or ‘darling’, we would like the manager to find out what people think about the endearments used by staff. We would like the manager to ask staff to commence conversations with people by using their names, this will show that staff see people as individuals and is also more respectful. The registered person should prioritise to ensure that senior staff fully understand their role in respect of the new Deprivation of Liberty Safeguard guidelines as soon as possible so that they can be sure to contact the right authority should they consider that someone does need to have their liberty restricted. The registered person must ensure that a suitable person is put forward for the Care Quality Commission registered manager process so that we can be sure that a person with the abilities to improve and sustain improvements for people living at Heywood Court is in day to day control. Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 9 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. Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 (standard 6 is not applicable) People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New admissions to Heywood Court have their needs fully assessed so that they (service users) can be sure that these needs can be met by the service available. EVIDENCE: We were told that since the last key inspection the home has only had two new admissions. We looked at the files for these people. We found that each held a completed pre-admission assessment and information gathered included personal care; physical wellbeing; mental state; mobility; diet, sight; hearing; continence; sleep; social history; sexuality; personal safety; skin care and family involvement. Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 12 We saw that a pre-admission draft care plan had been completed and that these were updated as staff became more aware of peoples abilities and needs. As well as general health and personal care needs we saw that base line checks and care plans were made concerning pressure area care needs, weight and mobility. This was good because it showed that staff were quickly aware of the support people needed to remain well or achieve improvements in these areas. Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Heywood Court benefit from having their health and personal care met effectively and mostly in a manner that promotes their dignity feeling of self worth. EVIDENCE: We found that since the previous key inspection, there have been substantial improvements in many aspects of health and personal care, especially in relation to pressure area and wound care, getting medical help quickly and supporting people to achieve an acceptable level of personal hygiene. We also found that support in relation to use of communication aids such as glasses and hearing-aids has improved. We were told that there was one person with a skin tear (small wound) and one person with a red area on their bottom living at Heywood Court on the day Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 14 of inspection. We were told that no one was on the End of Life Pathway or considered critical in relation to their health. We found that there were fifteen people living at Heywood Court on the day inspection and we looked at three care files. These included the most recent admission and someone with complex care needs. We found that two of the people whose files we looked at had lived at Heywood Court for a number of years and their health, psychological and social needs had been fully reassessed with new care plans developed to reflect the changes in their needs. We were told by the operations manager that the care needs and interests of all the people living at Heywood Court had been fully reassessed and so new updated care plans and risk assessments had been developed with everyone. She stated that this was because she wanted to be certain that assessments had been completed to a high standard and that care plans and risk assessments are relevant and effective. We found that each care plan provided detailed information and showed what care and support each person needed. We saw that the assessment document involved scoring the outcome in each section and this score then determined the complexity of the care plan required and also prompted staff to complete additional risk assessments or to make referrals to health care specialists, such as dieticians or the continence service. We noted that this was successful in that records confirmed that specialist risk assessments were developed and additional health input such as district nurses, dentist or dietician or podiatry was sought. We saw that the assessments linked in with the Activities of Daily Living (ADL’s) and looked at the strengths and needs people had in each of the areas. We assessed that if the care plans were followed people would be supported to access effective levels of health care and would remain comfortable and healthy for as long as possible. We looked at the records of professional contact and also the daily records for each person and found that emergency and routine medical and health care was provided to people living at Heywood Court. This included: the general practitioner, hospital consultations, district nurse input, podiatry, dental care and opticians. We saw that people wore glasses and on this occasion none were left around the home. We noted that people were wearing dentures which were clean. We saw that people wore hearing aids. We saw that nutritional care plans recorded exactly what action was needed to reduce any risk of malnutrition and advice of dieticians was been taken as and when needed. Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 15 We noted from weight records that people gained weight during their time at Heywood Court, but if weight loss was noted then appropriate steps such as more frequent monitoring and referral to the dietician were quickly taken. At the previous inspection we noted that there appeared to be high level of people with urinary tract infections at Heywood Court, although this was not specifically discussed on this occasion, we found that none of the people whose files we looked had current infections and we also noted that people were supported to have drinks throughout the day. The operations manager stated that as a precaution against dehydration all the people living at the home were on fluid intake charts. We discussed the need to make sure that staff ensured that people actually received all the drinks recorded because there could be times when, people who were slow at drinking, had their drinks removed before they were finished and the staff recording the amounts consumed were not always the staff removing the drinks. We saw that daily records detailing the events of a person’s day were completed. We found that each one provided a clear picture of type of day each person has had. We found that comments were written with respect and gave an individual reflection daily and key events were documented including staff interaction with people and their families, falls, a persons mood, health care issues and the choices people have made. We also found that the files we looked at held weekly updates and this provided useful information about the over all progress for people. We noted that when assessments and care plans had been reviewed, the person, their relatives, social worker and the relevant health care professional was also invited. We observed that staff spoke to people in kindly manner and explained what they were doing. We noted that all the staff were consistent in their dealings with people and appeared fair and caring. They seemed to know people well. We found that the system continues by which following a fall, people are closely monitored by staff and a form completed. We noted that falls prevention strategy continues to be effective in finding the best solution for reducing the risk. We noted that people have sensors and pressure pads to alert staff to their movement. We also noted that staff are made aware of risks associated with dealing specifically with dementia care such as a person walking around the home who may become lost. It was noted that the care plan concerning keeping this person sage was very well thought out and comprehensive and included knowing where the person was. Ensuring that empty rooms were kept locked. Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 16 We looked at the management of medication at Heywood Court. We looked that the medication administration record sheets (MARS), the storage and actual administration of medication. We saw that there were no unaccounted for gaps in the MARS which were looked at. We found that the home could confirm though signatures on the MARS that all medication had been counted into the home. We noted that the sample signatures of staff with a responsibility to administer medication were in the front of each medication file. The training calendar confirmed that staff who had a responsibility to administer medication had received accredited training from Boots the Chemist. We saw that a picture of each resident was in the medication file to assist with identifying that the medication was been offered to the correct person. We noted that the effect of medication was monitored and the general practitioner approached if it was thought the medication was not having an acceptable effect. We saw that medication care plans for short term drugs, such as antibiotics, are still in use. We looked at the controlled medication storage and recording systems and this was found to be in order. We assessed at this inspection there was no indication that people’s health was at risk due to poor medication practice. Ordering of medication continues to make sure residents do not go without their prescribed medicines. We found that all other aspects of medication handling such as temperature of storage and general security were satisfactory and staff who administered medication had all been assessed as competent to do so safely. We were informed that and this was also observed that in order to uphold privacy, professional visitors to the home saw people in the privacy of their rooms. We observed at this inspection that many of the fundamental problems identified with health and personal care had been resolved at this key inspection. We found that staff no longer spoke loudly to people but made sure that the person could see them before they spoke. We noted that glasses were no longer left around the home and that people were wearing glasses that were clean and well fitting. We also saw that people had regular eye checks through the prescriptions that were placed in peoples records. Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 17 We found that more effective steps were taken to respond to peoples needs when care plans clearly identified when people were vulnerable to skin damage and guidelines were in place to prevent these occurring and ensure that skin problems are recognised. We saw evidence that intervention is provided and the district nurses alerted at the very first stage of the development of a pressure sore. We have found that the effectiveness and diligence of staff in relation to pressure area care provided to residents has improved. We found that the standard in personal care and hygiene that people are supported to achieve has improved. We noted that people’s clothes were clean and that they had been enabled to have baths, showers and washes that were through enough to prevent the development of unpleasant odours. We were informed that staff have been encouraged to take a more active role in ensuring that people achieve a good level of grooming between visits from the hair dresser. We were informed that the hairdresser visits weekly and that a hairdressing room is now available. We noted that people were very content with the personal care they received. We observed people had their nails manicured and their hair washed and curled. We noted that people wore socks or tights and were fully dressed. People looked well cared for. We found that the importance of people making choices about day to day aspects of life was recognised because care plans made it plain when people were able to and wanted to choose what clothes to wear, and whether the person wanted assistance with personal hygiene. We found that the expert by experience (ex-by-ex) noted an improvement in respect of health and personal care and commented: ‘There was an improvement in the state of dress of residents and there were no off-putting odours anywhere in the home.’ The ex-by-ex was also complimentary about the laundry person stating: ‘Her ironing capabilities were very good, and she appeared to be able to identify each residents clothing, which also appeared to be named by laundry markers. It was stated that residents’ laundry did not go astray.’ We looked at the bathing record which confirmed that most people received a full immersion bath or shower about once a week. We found through cross-referencing assessments with the care plans that assessed needs were now planned for fully, we noted that instructions concerned with diabetic care was more detailed. We found one area that the manager should look at and this concerns the endearments and colloquialisms used by staff when they talk to residents. We noted that at times staff used endearments to an excessive extent. We feel that although culturally this may be acceptable the managers and staff must be mindful that this may not suit everyone. We feel that it is better for staff to Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 18 mostly address people by their preferred name. This is because it demonstrates respect and that people are thought of as individuals. Also if staff always use people’s names it will help people to learn each others names more quickly. We feel that people’s names should be used especially at the beginning of a conversation. We would like the manager to find out what people think about the endearments used by staff. We would like the manager to ask staff to commence conversations with people by using that person’s name. We talked to one person involved with the home. They told us: ‘Health is cared for very well.’ Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 19 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Heywood Court have opportunities to experience a stimulating lifestyle through access to a variety of activities and events that they enjoy and receive a varied menu that is nourishing. EVIDENCE: We looked at how the activities program in the home had been changed. We saw through the activities records, weekly summaries of care and photographs that people enjoyed a variety of activities. These included: one to one chats, arts and crafts, concerts in the home, discussion groups, reminiscence, baking and trips out for example to Southport. The home also owns its own minibus. We saw that service users were supported to complete a ‘Map of Life’ with their key worker, this is a booklet recording their social histories and this helps staff to understand peoples past and why they may make certain choices and how Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 20 they can be supported to live a lifestyle that they are used to, and would choose for themselves. We found that in some cases staff supported people in making choices by offering two alternatives and it was noted that choice was highlighted as an important aspect of care in the assessments and care plans. We noted that this method of providing choice did not always appear appropriate, as the expert by experience commented in relation to choice at mealtimes: ‘I was concerned how the residents were offered a choice. A carer brought two different meals to the table and each person was asked to choose. I don’t know whether these meals were given to other people or whether they were just to show each resident to enable them to make a choice and then thrown away.’ We found that the home has access to an activity co-ordinator who organises a variety of things to do on a daily basis. We also found that the environment itself was been furnished and refurbished to meet the needs of people with symptoms of dementia. The Operations Manager was able to show us changes that made the environment more interesting and stimulating for the people living there. For example the introduction of bird tables and the development of wildlife garden outside the conservatory and making one of the rooms a quiet room. We noted that the format of the activities calendar was large and pictorial which meant that people were more likely to understand the information about what was on offer. We were told that planned outings for the coming months included Hollingsworth Lake; the war memorial museum and Bury Market. We found at this inspection that staff provided additional activities in the absence of the activities co-ordinator. We noted that night staff were involved in organising activities such as gardening. We were also informed that some members of staff had completed beauty therapy courses before working on the home and these skills had been utilised. We found through looking at the notes from staff minutes that staff have received advice and guidance about the importance of talking to people and spending time with them. They have been informed that they have a responsibility to make sure that people continue to have an interesting life in the absence of the activities coordinator. The operations director informed us that the Southern Cross has identified a person to Dignity in care Champion; their role is to ensure that staff understand the different ways to ensure that people have a dignified life, is currently working at Heywood Court. This person receives additional training and information which she then cascades to all staff and monitors what is happening and reports back to managers. It has been identified that dignity includes taking an interest in what people do from day to Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 21 day and promoting their social and emotional well being through providing a stimulating and interesting environment. The expert by experience noted some improvements since the previous inspection, she said: ’Activities appear to be active mornings and afternoons according to the daily agenda. One resident, who appeared to suffer from dementia, was delighted that her nails had been painted that morning. There were photographs on the wall showing details of a baking session, gardening and skittles. Trips out are organised with residents being able to make a choice by looking at photos and a vehicle is available.’ People who were spoken to said that from what they saw activities in the home were varied. People said: ‘They have parties for birthdays and make an effort for main celebrations- they had a valentines party and mum really enjoyed that.’ Although in the main we saw that interaction between residents and staff was gentle appropriate and effective we noted that there might be room for improvement as the ex-by-ex observed: ‘Interaction between staff and residents appeared pleasant, but I feel that staff need more training to produce a realistic approach to friendliness and concern to residents. I.e. I feel that some “over the top” phrases were used in attempts to show what should be a natural concern.’ We found however that staff were receiving training and guidance in this aspect of their job because posters were on display in the home showing situations and scenarios concerned with how people should be treated. We also found that people were complimentary about staff interaction with the people living at Heywood Court they said: ‘Staff really show affection they give the residents physical contact- people need cuddles and reassurance- they are not impersonal.’ We saw that people that people could visit whenever they wanted and that they were made welcome. People who commented said: ‘Visiting is not a problem and they keep us well informed.’ We found that the home continues to provide four-weekly menus which are nutritionally balanced through a programme called “nutmeg menus”. The menus included a good range of meats and fish and many of the desserts were milk and fruit based and all items were homemade. On the day of the inspection the lunch meal was cheese and broccoli bake or salad and chips, followed by fruit salad and ice-cream or cream. All the food Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 22 was home made. We observed that people did eat the meal however it did look a little bland on the plate. The ex-by-ex had her meal with people at lunchtime. She commented: ‘I had a small mixed salad with a small portion of chips. The mixed salad was not very “mixed”. The other main dish was a cheese and broccoli dish, but appeared to be made mainly of mashed potato, which a resident, was rather put out by this.’ Generally, however, lunchtime was a pleasant experience. The dining room is beautifully decorated, clean and comfortable. The tables properly laid with condiments and napkins which all makes for a pleasant dining experience. As previously stated we found that the menu is varied and we also found that weight charts confirmed that people generally put on weight when they live at Heywood Court, but if they loose weight remedial steps are quickly taken. We were told that: ‘The food is good- they take time to feed her- and there’s a good variety.’ We noted that staff did sit with people and spend time encouraging people to eat their meals. We observed that people were offered tea at lunchtime and cold drinks were available throughout the day in jugs that were placed around the home. Over all we noted a definite improvement in the management of mealtimes the expert by experiences reported that: ‘Biscuits were offered for elevenses. The dining room was excellent, very light, feeling like a nice restaurant. Menus were available on the tables, but could possibly be in larger print, or pictures. It was good to see a pot of tea, jug of milk and bowl of sugar given to each individual who preferred tea, when they sat down at the table…… I was pleased to see that a wheelchair bound resident was helped to a chair to sit at the dining table.’ Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 23 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are effective complaints and adult protection procedures in use at Heywood Court so that people feel listened to and their views taken seriously. EVIDENCE: We noted that that the complaints procedure is clearly displayed in the reception area. And the operations manager had stated that this was the case in the information she returned to us. The manager also told us that all complaints are sent to head office to be analysed and if common issues are identified this might influence changes in how the home operates. We received a phone call detailing areas of concern and complaint and one safeguarding alerts concerning people living in the home since the last Key Inspection. We found through looking at the training matrix that that all staff had received Protection of Vulnerable Adults (POVA) training. And the newest staff received this training as a part of their induction. We also found that adult protection training is provided on a rolling programme. Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 24 We looked that the areas of concern detailed in the phone call by conducting a Random Inspection on 25th November 2008. We found that that some of the concerns were unfounded and other aspects needed to be dealt with by the management of the home. The full details are outlined in the Random Inspection dated 25th November 2008. The safeguarding investigation was conducted by Rochdale Metropolitan Borough Council. We found that the managers initial response demonstrated that the safeguarding and dealing with accidents policy had been used. The outcome of this investigation was the development of a ten point strategy to try and reduce the risk of a similar accident occurring again. This included additional and more in-depth moving and handling training to all staff, and changing the rules about using hoists and lifting equipment depending on the number of staff on duty. We looked at the logging of complaints and found that this continues to be satisfactory and the records indicated that complaints received had been logged and responded to in writing. We found that staff who were interviewed were clear and confident about their responsibility in protecting residents from harm. Comments from staff included: ‘There are all different forms of abuse, physical, mental, money and talking things. I would go straight to the manager - yes they would listen- I’m not afraid to say something and we have received training and a booklet about protecting people.’ We discussed with the manager staff training and understanding of the Deprivation Of Liberty safeguards (DoLs) guidance. We were informed that the manager was in the process of applying to Rochdale training partnership for training. The manager stated, however, that this training would only be provided after people completed the Mental Capacity Act training. We were told that currently two senior staff had completed the Mental Capacity Act training and the manager has completed both courses. The manager was aware of the need for staff to have some information about both the Mental Capacity Act and the DoLs guidance. She stated that she had arranged for a Lead Community Nurse from the Primary Care Trust (PCT) to provide some training. We agreed that this training needed to be a priority particularly considering that the majority of people living at Heywood Court experienced some degree of dementia. People who commented said that they would talk to the manager if they had any concerns and that in the past their complaints had always been taken seriously and dealt with in fairness. Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 25 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment at Heywood Court provides comfortable, clean and accessible accommodation for the people living there. EVIDENCE: We found that access to the home had improved substantially since the previous key inspection as the barrier had been removed and people were able to get into the foyer without undue restrictions. The ex-by ex noted the change and wrote: ‘In 2008, I accompanied Inspector Haller to this same location, it very difficult to get through gates and attract attention to be able to gain access. This time there were no locked gates, and I gained access through usual security keypads without a hitch and was made to feel very welcome and offered a coffee.’ Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 26 We noted that at the front of the home was a courtyard area. We had a look round the home. All communal areas were looked at and a number of bedrooms were also inspected. On entering the home there was no evidence of malodour. The home looked nicely decorated and refurbished. We saw that the windows and doors were opened to allow air to pass through rooms. We noted that all areas of the home looked clean. Furniture was new and clean and carpets also looked clean. The corridors are decorated in natural colours effective signage that would help people to recognise different rooms. We saw that the signs used were large and clear pictures and these were fitted to the bathroom and toilet doors and used to indicate different rooms such as the different lounge areas and the dining room. We saw that people could find their way around the home without constantly asking where they were and feeling lost. We noted that the bedroom doors were different colours with nameplates, letter boxes and memory boxes holding personal effects hung outside. This made the room more easily recognisable for the individual. We noted that pictures were often of people in their younger days because some people no longer recognise their older selves. We looked inside a number of bedrooms at random. We saw that they were clean and in good decorative order and well furnished. Large en-suite toilets were adapted for people with physical disabilities. Specialist flooring had been installed in the rooms where it was assessed that this would meet people’s hygiene needs better. We saw that many of the bedrooms has been personalised with family photographs, ornaments and their own furniture. A number also had televisions and radios. The bedrooms that were entered did not smell unpleasant. The expert by experience report about the environment said: ‘The whole place appears to have had a “makeover”, which includes very relaxing colours of décor both in corridors and personal rooms which have entrance doors that are identifiable front doors with letter boxes and knockers, plus, to the side, photographs of the person who lives there. Both staff and residents appeared to have been uplifted. The garden area was most inviting and residents were encouraged to be involved in small gardening exercises i.e. planting and watering if they wanted to. Bird watching and squirrel watching was on the agenda for relaxation.’ We assessed that the environment was homely and provided sufficient spaces so that people can have different degrees of privacy. There is a dividing wall Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 27 at the entrance making a separate entrance hall that visitors or residents can use as an alternative sitting area. There are a number of lounge/dining areas. Throughout the visit, the atmosphere within the home was generally peaceful. We assessed that all areas of the home were comfortable to use and decorated in a way that would prompt people to recognise the purpose of the area. We observed people moving around the home easily and appropriate aids and adaptations were fitted in bathrooms, toilets and corridors so that residents could remain as independent as possible. We found that all bathrooms that were entered during the inspection were clean and warm. We observed effective infection control practice meal times when staff changed into blue disposable aprons. They wore white disposable ones when assisting with personal care tasks. The store cupboard held a good stock of disposable gloves, and liquid soap and paper towels were seen in the bedrooms entered. However the ex-by-ex did not a possible problem with the way in which choice was offered at meal times. We were told that: ‘The home was always clean and staff are always cleaning.’ Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 28 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28.29 and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff at Heywood Court have access to a comprehensive training programme and are employed in sufficient numbers to meet residents’ needs. EVIDENCE: We found on the day of inspection that there were 15 people living at Heywood Court and there were four care staff on duty. The duty roster indicated that was usually the number throughout the day. At night the roster indicated that there were usually three staff on-duty. We found that additional staff on this day included the manager, domestic, laundry, kitchen, maintenance and administration staff. We believe that this staffing compliment met the needs of the people living at Heywood Court on the day of inspection. We looked at the training matrix and this showed that staff training provided since the previous key inspection in 2008 included: fire safety; food hygiene; moving and handling; protection of vulnerable adults; infection control; nutrition; safe handling of medication; continence care and dementia care training called ‘Yesterday Today and Tomorrow. Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 29 We found that staff who where interviewed were enthusiastic about working at Heywood Court. They told us: ‘The way staff interact with people and each other is good. The moving and handling training was amazing the best form of training since I’ve worked in care. And the fire safety training was good too.’ We noted that new recruits continued to complete workbooks and induction continues cover the topics required by the Skills for Care guidance on induction into social care. We noted that topics covered included: introduction to home; principles of care; organisational responsibilities; expectations in relation to the General Social Care Council code conduct; health and safety issues; communication; adult protection; fire-safety and personal development. The operations director gave us a letter of support provided by the person assessing the staff going through National Vocational Qualifications. This assessor was very complimentary about the change in culture he has noted at Heywood Court and continued staff education. We looked at staff files and found that each contained a copy of the application form, two references that had been followed up with phone calls when needed and evidence that protection of vulnerable adult (POVA) and Criminal record (CRB) declaration and checks had been completed before people worked in the home. We found that the staff we talked to confirmed that they were not able to take up their post until the POVA had been returned. One person was still awaiting the return of the CRB certificate but stated that they had completed a disclosure form and the references had been returned. We were able to verify this through checking this person’s employment file. We found through looking at supervision records that staff performance was closely monitored and if additional guidance was needed this was provided and so their practice improved. In the information she sent to us the Operation Director confirmed that 11 out of the 20 staff employed have achieved the National Vocational Qualification (NVQ) in Care level 2 or above. Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 30 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of Heywood Court is open and accessible, a quality assurance system is in place and people living at the home can comment and their views can influence how the home is run. EVIDENCE: We found that the management of the home has undergone continual change in the past 12 months. We found at this key inspection that the home was been managed by Southern Cross Operations Director and the newly appointed manager who had been in post for three weeks. Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 31 We found, despite the changes in management that improvements had taken place in the running of the home and particularly in the quality of health and personal care achieved with the people living at Heywood Court. We were informed in the information provided to us that the manager has achieved NVQ level 4 in management and has attained the Registered Managers Award. We were also assured that this person had already submitted the forms to CQC to become the registered manager for Heywood Court. We found evidence of continued improvements within the service. We found through records and notes from meetings that staff continue to receive regular supervision one to one supervision and day to day guidance as they go about their work. We found that the Operations Director was directly managing the home on the day of inspection. And we found that she was very keen to mould the service into one that could provide specialist support needed by people living with dementia. This would be achieved by carefully considering the changes to the environment and staff training. We found that the corporate quality monitoring and assurance system continues and the manager is given feedback from the information provided. We discussed issues as they arose with the management team and they were keen to demonstrate that all matters were been looked at dealt with quickly and in a manner that promoted the best interests of the people living at Heywood Court. We looked at the accident and incidents record. We noted that the number of falls in the home seemed high considering the number of residents living at Heywood Court and the fact that there are no stairs or steps connecting communal areas. These falls were mostly at night. We were informed that accident statistics were collated at Southern Cross Head Office and also a monthly review of falls was submitted. We found that people were more closely monitored and a falls chart put in place so that appropriate equipment can be put in place or changes in support made. We were given copies of the homes quality auditing questionnaires which were returned by relatives. Six had been returned and the responses from the residents were very positive. We found that people were asked to comment about the standard of personal care; the environment; communication; finances; catering; activities and laundry and other services. We found that comments were positive and that people were able to identify improvements in the running of the home for example one person wrote: ‘Staff are very pleasant and friendly ….room is always nice and clean, before clothes always went missing now things have improved.’; Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 32 ‘Since current activities coordinator has been in place activities have increased and to a high standard.’ And ‘We live in Hungary but still find the communication first class for example email and the phone.’ We found that since the previous inspection the management team have encouraged other people involved with the home to comment, for example the NVQ assessor who visits the home to work with staff who are completing their NVQ awards. We found that relatives meeting continue to be organised and we found that three people attended the pervious meeting. Topics discussed included: future plans for the home; activities- there is a plan to introduce flower arranging; meals and the role of the Dignity in Care champion. We found that the service holds small mounts of cash as money is spent receipts are then submitted to the person so that the company is reimbursed from the resident’s bank account. A running total of the amount that is banked for each person is available. We were informed that all income and outgoings were listed on the computer and print-outs were given to residents and/or relatives upon request. We were informed that due to the mental capacity of the residents, their relatives or advocates managed their financial affairs and regularly liaised with the administrator to check that sufficient money was held at the home to pay for hair, chiropody, etc. We found that the Southern Cross organisation has detailed health and safety policies and procedures in place which are reviewed and updated as needed. We were provided with Information in the Annual Quality Assurance Assessment (AQAA), returned to us in June 2009, which showed that the required maintenance checks had been carried out. Staff training in most areas of health and safety has been adressed and staff received ‘Health and Safety’ training in spetember 2008 and May 2009. We noted that the training records indicated that fire-safety training and fire drills had been conducted at least four times in since the previous key inspection 2008. Staff commented that this training was very good and practical. We looked at the information given to us about the maintance of equipment and noted that that everting was in order except for portable electrical equipment. This matter was discussed with the operations director. Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP38 Regulation 9 Timescale for action The registered person must 01/11/09 ensure that a suitable person is put forward for the CQC Registered manager process so that we can be sure that a person with the abilities to improve and sustain improvements for people living at Heywood Court. Requirement 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 OP10 Good Practice Recommendations The registered person should ensure that staff commence conversations with people by using their names, this will show that staff see people as individuals and is also more respectful. The registered person should prioritise to ensure that senior staff understand their role in respect of the DS0000049296.V376953.R01.S.doc Version 5.2 Page 35 2. OP10 Heywood Court Care Centre Deprivation of Liberty Safeguard guidelines as soon as possible so that people are not restricted illegally. Heywood Court Care Centre DS0000049296.V376953.R01.S.doc Version 5.2 Page 36 Care Quality Commission North West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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