Care Home: The Heathers

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What the care home does well The home had very good descriptions of the service and provisions. Their Service user`s guide was updated regularly and summarised all information for potential service users.In addition, prospective users were shown the home during their preadmission visit. Excellent pre-admission assessment helped the home and the users to match the offers and the assessed needs. Service users` documents, such as care plans, risk assessments and daily records were accurate, reviewed regularly and showed the involvement of service users or their relatives in care planning. The observed process of care and daily life of service users showed that the relationship between staff and service users was built on trust, respect, and created a safe and comfortable environment for service users in the home. The staff team was, in particular, well organised: everyone knew what they were doing and service users benefited from a well-structured daily routine. Protection of service users was emphasised and promoted through daily life. Clear procedures and the excellent atmosphere in the home helped the home offer very good protection. The excellent management of the home gave clear directions to staff and organised life in the home so that service users felt comfortable and safe, enjoying the benefits of a friendly and respectable atmosphere. What has improved since the last inspection? The home had their own processes for identifying areas for improvement. Their wellorganised quality assurance process and constant monitoring clearly identified what could be better. A new shower increased the choice for service users to have a bath or shower. The home reported improvements in their self assessment, AQAA: "The menu has been modified to include more home cooked food. New attrcative activities were introduced. We have purchased equipment for in-house training and increased the number of training for staff." What the care home could do better: The home identified areas for improvement by talking to the service users, their relatives, listened to staff suggestions and analysed their own progress. They plan to: introduce quality assurance surveys for service users twice a year, to buy a minibus to ensure more outings for service users and to provide more relevant training for staff. The inspection did not identify any particular shortfalls that needed to be specifically addressed in the requirements and recommendation in this report. Key inspection report Care homes for older people Name: Address: The Heathers 50 Beccles Road Bradwell Gt Yarmouth Norfolk NR31 8DQ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Dragan Cvejic     Date: 0 5 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: The Heathers 50 Beccles Road Bradwell Gt Yarmouth Norfolk NR31 8DQ 01493652944 F/P01493652944 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Shereen Arunthathi Jesudason care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 45. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling into any other category - Code OP Physical disability - Code PD Date of last inspection Brief description of the care home The Heathers is a single storey extended property situated in the village of Bradwell, on the outskirts of Great Yarmouth. 45 older people can be accommodated in 31 single and 7 double rooms (32 have en-suite facilities). Most of the bedrooms open out on to a patio area and garden which is mainly laid to lawn with small flower beds and attractive containers arranged on the patios. In addition there are three communal rooms including a dining room which service users Care Homes for Older People Page 4 of 25 0 45 Over 65 45 0 Brief description of the care home and their families can access. There is ample off street parking space to the front of the premises. The fees is presented in the homes induction documents. There are additional charges for personal toilet requisites, newspapers, hairdressing and chiropody services. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 stars. This means the people who use this service experience excellent quality outcomes. After revieving the service through an annual service review last year, the home continued to provide very good service for people that were cared for and supported in the Heathers. This was an unannounced inspection. It was carried out by the link inspector Dragan Cvejic who also provided this report. This site visit lasted for 7 hours and the inspector spoke to three case tracked service users, to two more users, to the staff members, a cook and three carers and to the manager who had just completed her night shift. We spoke to one of the proprietors who was present in the home during the site visit. Documentation related to three case tracked service users was checked, as well as three staff files. Care Homes for Older People Page 6 of 25 A self-assessment form was filled in by the home and was used to inform this report. The comments from some relatives, visitors, were also considered when the evidence was collected. Ten comment cards were returned to the CSCI giving direct anonymous comments from service users and their families. Care Homes for Older People Page 7 of 25 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not only excellent access to information about the home, but also appropriate assessments and evidence of meeting users needs determined the excellent rating of this group of standards. Evidence: An up to date Statement of purpose and Service users guide provided clear information about the home to service users,allowing them to make an informed choice. The existence of the waiting list here and the fact that the neighouring home had vacancies at the same time, demonstrated that the home had a very good reputation in the local community. The initial assessment, carried out by the manager was excellent, as it identified all areas that needed to be addressed in care plans and risk assessments. The manager was in the process of training another senior staff member to conduct the assessment to the same excellent standards. The home was particularly good in making arrangements to meet individual needs. Care Homes for Older People Page 10 of 25 Evidence: The cook reported: We bake individual pies for Mr X, who likes it with more onions, for Mrs Y who prefers it with less meat, for Mrs Z who likes it more crusty... Two staff members were observed helping a service user walk through the corridor, about 20 yards, for a full 4 minutes, allowing her to keep her slow pace, while they were talking to her, smiling and laugh all the way, making her relaxed and happy. A service user was moving in on the day of the site visit. Three staff welcomed her into her new room and were shifting furniture to make the room to her liking. They already knew her basic, assessed needs. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users healthcare needs were appropriately assessed, recorded and met in an organised, excellent way that promoted their well being, independence and with full respect for their dignity. Evidence: All three service users files checked contained detailed and up to date care plans. Care plans were clearly related to initial assessments. Service users spoken to confirmed that they knew their set goals. They look after us very well, stated a user spoken to. her nephew who visited her added: the healtcare in excellent. The files checked showed how the users pressure sore on admission was treated and improved within a week, demonstrating improvements by photos taken. The manager explained that the home asked a G.P. to help the home change the dressing, otherwise not available on NHS, from the private supplier when no other dressing helped. Medication storage and procedure was checked for 3 service users. Records were appropriate, accurate, the procedure observed was appropriate and ensured safe medication procedure, thus ensuring protection of service users. Privacy and respect for dignity exceeded minimum standards. New shower was Care Homes for Older People Page 12 of 25 Evidence: installed after several users expressed their preference to have a shower rather than bath. New staff induction emphasised the respect for dignity. Kitchen staff knew exactly who liked what and ensured that service users wishes were respected without their special request each time. A birthday cake was cut by the user who was on liquidised meals. The cook arranged to liquidise the slice of the cake cut by a celebrity, so that she also could enjoy her birthday cake. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users wishes were respected and helped the home organise daily life according to users preferences, while maintaining an appropriate level of support and care that ensured the safety and well being of service users. Evidence: Daily routine in the home was created as service users wished. Several users explained: We quite like to get up early. We have breakfast and then enjoy a cup of tea together. Two users sat in one bedroom and chatted. They explained that they are very good friends and like spending time together. A staff member knew their routine and popped in to the room and offered them a cup of tea. Recording service users preferences went a step ahead of the basic, for example it stated: Asked to reduce visits to the day centre temporarily, while not well, but to resume when better. When we talked to her she confirmed that staff respected that and arranged two instead of four day visits to the day centre. The home reported in their AQAA: because of service users diverse capabilities of taking part in activities, we offer such a variety of activities to ensure that each resident is offered something suitable. One of the checked files, of a user who was bedridden, stated in the activities section that regular reminiscence talk was provided for her. Care Homes for Older People Page 14 of 25 Evidence: Autonomy was highly promoted. Staff showed patience, realising that users needed much longer to complete tasks that would normally require less time, but that users conditions dictated the speed and pace of completing the task. A care assistant is assigned twice a week to provide manucures, the AQAA reported. The home arranged for service users to go out shopping with staff escort. This maintained their connection and involvement with a local community. Meals and meal times were really special. The kitchen staff knew users, their preferences and arranged meal times to be really enjoyable, as was observed at breakfast, at lunch and at the afternoon party on the day of the site visit. All people spoken to stated: The food is excellent. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users were well protected from abuse by clear working practices, preventative measures and a clear complaints procedure. Evidence: A complaints procedure was included in the service users guide. It had a clear time scale. The home recorded complaints in their complaints records. They recorded 7 received complaints, 6 verbal and one written. All but one related to the laundry. As a result, new name tags were introduced and attached to users clothing. Since then there were no complaints or concerns. When spoken to users confirmed that the laundry is now good. A full investigation conducted of the complaint was supported by the local MP. External healthcare professionals submitted their statements to ensure that the complaint is not only properly investigated and resolved, but to ensure that the procedure is adapted so that reoccurances are minimised. The manager stated that service users were offered a proxy vote on the last elections and decided themselves how to exercise their voting rights. The manager reported that there were no allegations of abuse, or referrals to the Protection of Vulnerable Adults register. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was safe, comfortable and bright and service users were free to go to any part of it, but also benefited from the layout of the home on one level that made it easier for orientation, especially for users affected by dementia Evidence: A tour through the home provided evidence of a comfortable, safe and homely environment. A closed back garden and lovely garden furniture were provided for service users to enjoy in nice weather. There were no restrictions for service users concerning on going out to the garden. A separate area of the garden was allocated for those that wanted to smoke. Quality furnishing also created a homely environment. The laundry room was equipped with semi-industrial washing machines and a tumble drier. The home also had an effective infection control policy and procedure that was reviewed in May this year. In their AQAA the manager spoke about the improvements regarding the environment and special adaptations that made the home appropriate for service users conditions: Nearly all bedrooms have patio doors leading directly to the garden. We have 38 bedrooms of which 31 are single and 32 have en-suite facilities. All service users have lockable facilities to keep their valuables. One nurse has been appointed an infection control link nurse and participate regularly Care Homes for Older People Page 17 of 25 Evidence: in training and passes on relevant information to the staff. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Competent staff provided reassurance to service users that their needs, wishes and preferences would be respected and met. Organisation, team-work and staff effectiveness were commendable. Evidence: Staffing was a real asset to this home. Well-trained, experienced, knowledgeable and caring staff members worked as a team in an organised manner that created a supportive and caring atmosphere in the home. An open atmosphere also was seen when staff approached senior staff for support and clarification when they were not sure what to do. The staff rota was created according to a daily routine and users needs. Three staff files checked showed that the robust recruitment procedure was followed and ensured better protection of service users by detailed checks carried out on all staff. Training offered to staff expanded from mandatory subjects to the subjects related to service users conditions and successful management. The latest included management action to put all staff through re-designed induction training. The effective management of the home and the outcomes could be seen in thevery organised and effective staff work. Seventy seven percentage of staff were NVQ qualified and this standard exceeded the minimum. Staff spoken to stated that they were happy with a firm but fair manager and the Care Homes for Older People Page 19 of 25 Evidence: support they received. Kitchen staff were commendable for their work and deserved to be paid incentive higher pay. All staff present on the day of the site visit deserved incentive, performance related pay. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The effectiveness of the management team, which contributed to a high level of safety and welfare of service users, determined the excellent scoring of management that ensured satisfaction and respect for service users. Evidence: The manager was studying towards a Diploma in management at level 5, apart from holding her nursing registration. She demonstrated her competence to run the home so successfully that both staff and residents were completely satisfied.The slogan used in the home stated: Residents are not here for us, we are here for them. The exceptional atmosphere in the home exceeded standards by influencing service users to feel respected, encouraged and positive. This resulted in recent opening of the homes fete, that was opened by a 101 year old service user. Although quality assurance was effective, the management decided to increase the surveys from once to twice a year, so that users wishes could be respected and implemented more frequently. Most service users had some small amounts of money with them, thus retaining the Care Homes for Older People Page 21 of 25 Evidence: feeling of being financially autonomous. All staff were supervised 6 times a year and received annual apparaisal. Certificates of indemnity insurance, gas safety records, water temperature records and other health and safety documents were in health and safety folder. The records were accurate and up to date. Incidents and accidents were appropriately reported and analysed within the home in order to prevent re-occurrence and improve the safety of service users. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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