Care Home: The Heathway

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What the care home does well People thinking about moving into The Heathway are able to have a look around before deciding if it is a good home for them. If they cannot visit people close to them have had a look around instead.There continues to be an assessment of peoples` needs before they move into The Heathway so they can be confident that the service is able to meet their needs. Staff is respectful, polite and patient to people needing help or requesting help, they make time to sit and talk and reassure people, especially where they are confused. The Heathway provides a pleasant, safe, and well-maintained place to live. People have the specialist equipment they need to meet their needs. The staff work very hard and maintain high standards of cleanliness, a fact commented upon by both the people who live there and their relatives; `everywhere is kept immaculately clean the staff work really hard, it`s lovely`. The staff has worked there for quite a long time and know how to look after the people living there. People visiting were made welcome and felt able to talk to staff about any concerns. What has improved since the last inspection? Due to the re provision of services, The Heathway is due to close in 2009/2010. The manager has made the necessary changes to the statement of purpose to inform people of this. This means people have the information they need before they make a decision to move into the home. A number of improvements had been made to risk assessments. These now show when someone is at risk of developing pressure areas, or likely develop health conditions because of their weight and nutrition. These now show what staff must do to keep people healthy. Checks have been made to make sure that the homely remedies people need are checked with their doctor, this means there are no complications with taking other medicines at the same time. The manager has demonstrated that she can successfully address the shortcomings noted in the service provision this must now be maintained. CARE HOMES FOR OLDER PEOPLE Heathway, The 70 Reddicap Heath Road Sutton Coldfield West Midlands B75 7EN Lead Inspector Monica Heaselgrave Key Unannounced Inspection 10:30 13th and 14th July 2008 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heathway, The Address 70 Reddicap Heath Road Sutton Coldfield West Midlands B75 7EN 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) 0121 329 2222 0121 378 1878 None Birmingham City Council (N) Indira L Surju Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. That the home is registered to accommodate 26 adults over the age of 65 who are in need of care for reasons of old age and may include mild dementia That minimum staffing levels are maintained at 4 care assistants plus a senior member of staff throughout the waking day of 14.5 hours Additionally to the above minimum staffing levels, there must be 2 waking night care staff and a senior on waking or sleeping-in duty Care manager hours and ancillary staff should be provided in addition to care staff Registration category will be 26 (OP) Date of last inspection 17th July 2006 Brief Description of the Service: The Heathway is a large, purpose built Local Authority care home for 26 elderly people. The home is located in Sutton Coldfield in a mainly residential area close to the Falcon Lodge estate. Sutton Coldfield centre is approximately one mile away where numerous community facilities are located. Public transport is available from outside the home. The building comprises of three floors but living accommodation is provided on the first and second floors. The ground floor provides office space for the management of the home together with an age concern co-ordinator, community psychiatric nurses and a day centre. Also on the ground floor is the main kitchen and laundry. The two upper floors are a mirror image of each other in design and comprise of two lounges, a dining room, bedrooms and small kitchenettes. There are bathing and toilet facilities fitted with appropriate equipment to meet the physical needs of the people who live at The Heathway. The accommodation was generally well decorated, comfortable with evident high standards of cleanliness. A sensitivity garden with ramped access, smooth brick surfaces and raised flowerbeds is at the rear of the home and provides a pleasant, sheltered environment in which people can enjoy the warmer weather. There is parking to the front and side of the home. The fees payable are dependent on the assets of the people being admitted to Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 5 the home, which are assessed by social workers. Heathway, The DS0000033584.V367870.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 stars. This means the people who use this service experience good quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and a questionnaire about the home. The questionnaire is called the Annual Quality Assurance Assessment (AQAA). The visit took place over one and a half days and staff and people who live at the home did not know that we were coming. Four people who live at The Heathway were “case tracked” and this involves discovering individual experiences of living at the home by meeting or observing them, discussing their care with staff, looking at medication and care files and reviewing areas of the home relevant to these people, in order to focus on outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files and health and safety records were reviewed. A tour of the building was undertaken to make sure that it was warm, clean and comfortable. There were some concerns identified during the visit. The manager made sure that these were put right at the time of the visit to make sure people stayed safe and well. What the service does well: People thinking about moving into The Heathway are able to have a look around before deciding if it is a good home for them. If they cannot visit people close to them have had a look around instead. Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 7 There continues to be an assessment of peoples’ needs before they move into The Heathway so they can be confident that the service is able to meet their needs. Staff is respectful, polite and patient to people needing help or requesting help, they make time to sit and talk and reassure people, especially where they are confused. The Heathway provides a pleasant, safe, and well-maintained place to live. People have the specialist equipment they need to meet their needs. The staff work very hard and maintain high standards of cleanliness, a fact commented upon by both the people who live there and their relatives; ‘everywhere is kept immaculately clean the staff work really hard, it’s lovely’. The staff has worked there for quite a long time and know how to look after the people living there. People visiting were made welcome and felt able to talk to staff about any concerns. What has improved since the last inspection? What they could do better: Risk assessments must show the action to take to minimise the risk of falling and the type of support needed for walking. This will safeguard people living in the home. Care plans must be extended to include details about the person’s dementia and how it affects them so that staff has guidelines to support people. These should be reviewed to ensure the changing needs of individuals are met, and ensure continuity of care. Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 8 The social interests of people should be explored so that they have a plan that provides opportunities for stimulation, particularly those people who has dementia. The system for medications should be monitored to identify any errors and ensure people get the correct medications. The record of complaints needs to show that the complaints were being looked into and to make sure that the person who made the complaint was told what had been done about it. This would make sure that the person would know that what they said had been taken seriously. Some areas in the Home needed improvements to ensure a more homely environment for the people living at The Heathway. Hot water temperature checks must be carried out regularly to make sure there is no risk of scolding. The temperatures of fridges must be recorded regularly to make sure they are not above safe levels, this will ensure people are not eating food that could be contaminated. There has been a lot of changes to the staff team so it is important that there is a profile to show what training the team has, this will ensure they have the skills necessary to meeting the needs of the people they care for. A system for making sure that people are happy with the quality of the service they receive needs to be put into place. It should be possible to see clearly how their views guide the way in which the service is developed. Monthly visits by the people who own the Home must take place so that someone is overseeing the conduct of the care home with a view to improving the service offered. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 9 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 Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. 1 and 3. This judgement has been made using available evidence including a visit to this service. The Heathway is down for a planned closure in 2009/2010. It was very encouraging to note that the manager has made the necessary changes to the statement of purpose to inform people of this. The home continues to ensure an assessment of needs is undertaken so that people thinking of moving into The Heathway can be confident that the service is able to meet their needs. EVIDENCE: Due to re provision of services, The Heathway is due to close in 2009/2010. The service user guide and statement of purpose need to be updated to include the changes that the re provision will entail. This is so that people considering moving into the Home are made aware that they will have to move in the next couple of years. This was not done at the time of the inspection but when requested the manager made the necessary changes to the statement of purpose and sent Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 11 this to the Commission. This now accurately informs any potential new people to the service that The Heathway is down for a planned closure in 2009/2010. Although the documents that help people to make decisions were not up to date, it was very encouraging to note that the manager has actively informed people of this change to support them in their decision-making. The Relative of an individual recently admitted to The Heathway was visiting on the inspection day. The relative spoke very positively about the home, saying it was very welcoming and very informative about how it could meet individual needs. They said the home provided all the information needed to make an informed choice, including giving them information about the planned closure of the Home and how this may affect their decision. They were happy they had the information they needed. There was evidence to show that the home received an assessment from the placing authority, and carried out their own assessment before the individuals moved into the home. Assessment information on the files sampled gave information about the person’s preferred daily routines as well as their health needs. This helps to make sure that care is given in a way and at a time to suit the individuals needs. Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Healthcare needs are not always clearly recorded in each persons care plan, although their health care needs are met positively. Risk assessments need developing further to ensure they include sufficient detail to enable the needs of the people living in the home to be met. Medication is administered and recorded more satisfactorily than at the time of the last inspection but needs to be monitored regularly so that any mistakes can be rectified. EVIDENCE: Each person has a care plan which is called an Individual Service Statement (ISS). The ISS covered different areas of need such as social interaction, personal care, religion, continence monitoring, mobility, mental health, and so on. There was some good information regarding personal routines such as time to get up and going to bed, and when someone likes to have a cup of tea. Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 13 The ISS for four of the people were looked at. One was for someone who had recently moved into the home, and one for someone who’s needs had changed significantly, the other two Individual Service Statements (ISS or care plan) looked at related to two people who had lived in the Home for a while. The ISS was hand written, the use of a computer would enable care plans to be printed in large print making them easier for people who use the service, to read them. For some people, due to their dementia the use of easy read or picture format may assist with understanding. The ISS did not always include sufficient detail as to how health needs are to be managed, for example the care needs of one person had changed resulting in her being cared for in her bedroom. The ISS had not been updated to show what arrangements had been put in place to care for the lady whilst she was in her bedroom, this is important so that she has staff time and attention to avoid isolation. A discussion with the relatives identified that whilst they were happy with the care that had been provided, they were concerned about possible isolation and deterioration due to the lack of contact with her peers. It is important plans are reviewed and updated to ensure changing needs are met. The review forms the basis for the new plan so that it is current and in line with the changed needs. A discussion with another relative identified that their relative had health care needs. The ISS did not identify this need. This would make it difficult for staff to ‘pick up’ on signs of failing health. Another person with vertigo, and who suffers from sensitive eyes, had an ISS that detailed the steps to be taken to keep them comfortable. None of the four plans looked at gave any detail as to how the persons’ dementia affected their wellbeing. This is very unfortunate as observation showed that the staff has specific skills in coaxing, prompting and encouraging people who have dementia, to undertake everyday tasks. This was evident in supporting a lady to mobilise she responded well to the approach adopted by a second member of staff who had come to assist. An improvement that the home could consider is to include a short profile of the individuals to go alongside the ISS this would give the staff a brief overview of their health history, and social background. This would enable staff to develop the ISS in a more person centred way so that the plan is personal to them, and that it clearly specifies how their dementia may be impacting on their health and what staff can do to support this. The fourth ISS looked at did not include sufficient detail as to how to support a person who had mobility difficulties. Discussion with individual staff showed some inconsistencies in how they supported the lady when she was walking. Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 14 An observation carried out on the second day showed that staff supported this person safely using the correct manual handling procedures, and hoist to transfer her from her chair to the wheel chair. The assistance she requires when walking and transferring must be detailed in her ISS so that all staff is consistent in meeting this need. Nutritional needs were well recorded one individual was prescribed a build up drink and the ISS detailed the importance of this and regular weight checks to ensure the person remained in good health. The weight record showed a healthy weight increase. A tissue viability assessment showed a lower risk of developing pressure sores and pressure care aids had been removed. Medication records showed that the build up drink had been regularly administered as prescribed. It was positive to see that the health care issues raised at the previous inspection regarding nutrition, healthy skin and weight monitoring have been addressed ensuring that people presenting these health needs can be confident they will be monitored. Discussions with some of the people who live at The Heathway, their relatives and the records looked at showed that people have access to and care from health professionals where this is needed. Relatives were particularly complimentary in this area. ‘The staff are very good, any sign of not feeling well and they bring the doctor in straight away, and they always look after mom so well when she’s poorly.’ Visits from health professionals took place privately in people’s bedrooms. The management of medicines in the home was looked at. There were photographs of each individual with their Medication Administration Record (MAR) and on the drug cassette and copies of the prescription from the doctor. This is good practice and ensures that each person’s medication is clearly marked and identified to avoid mistakes. The staff administering medication had undertaken training to do so. Medication was secure, and observation of the administration of medication showed that staff undertook this professionally, ensuring people had their medication on time, and in the correct manner. An audit of the medicines showed some inconsistencies, in one instance there were two tablets more than there should have been in the pack. Another instance there appeared to be an error in booking in the tablets as the amount booked in and signed for were different. Seven peoples’ medication was looked at; in all the other instances the medication was correct. Staff must ensure that they follow the correct procedures when administering medication, specifically to sign the MAR records only after medication has been given. A regular audit of medication would help to identify and rectify any errors. Following the inspection the manager and her staff improved the level of detail in those ISS and risk assessments highlighted. These now provide staff with clear guidelines on how to support people safely. The system for medication has been reviewed and guidelines provided to staff so that everyone is aware Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 15 of the correct procedure when giving medication. This will ensure that people receive the correct medication. The information provided to the Commission indicated that the health care issues raised above had been addressed. No requirements have been made as a result of these standards. However it is recommended that Individual Service Statements be reviewed to ensure they contain sufficient details regarding health care needs and how they are to be met. Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at The Heathway enjoy flexible routines to enable them to make some choices. The care plans need improvements so that social activities and individual choices are planned for and met, particularly where people have dementia. The meals are balanced and nutritional and cater for the varying dietary needs of the people using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home continues to support people who need a relatively high amount of support and help, through mental and physical frailties, as well as people who are relatively independent. There has recently been a number of staff who have left the service to take up other posts in the new care centres as part of the re provision of services for older people. The Heathway has 200 care hours vacant, these are being Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 17 covered by the use of both agency staff, and existing staff working extra shifts on a casual basis. During this time of change staff continues to work hard to support the people they care for, however records indicate that there has been some slippage in ensuring regular activities are planned for. Some of the people spoken with showed a limited awareness of planned activities whilst others said they had on occasions enjoyed dominoes, exercises, bingo, happy hour, painting, and visiting church services. Relatives spoken with said they had enjoyed a recent planned barbeque, and had seen people enjoy a game of bingo. Relatives provided a lot of information as to the social interests people had enjoyed prior to living at The Heathway, but the records for this person only showed two occasions when doing them. Each person has an ISS and activity sheet. The records for five people were looked at. The previous months entries gave little information about what activities people had engaged in, the majority of entries related to ‘watched T.V.’ or ‘had a visit from family’. There was a notice board on the wall but this was in the stairwell, as the majority of people use the lift this would not be seen by them There is a nice level courtyard type garden with raised boarders. There is ample sitting areas and out door furniture, and lots of nicely planted hanging baskets and flowerbeds. During the course of the two days only one person was seen in the garden. Observation of the people living at The Heathway indicated that due to their dementia and or physical needs, they would need support from staff to access the garden area from their accommodation, which is on the first floor. The ISS does not have sufficient detail of the activities people enjoy, it does not have measurable outcomes, that is there is no means of knowing from the ISS how frequently activities are planned for the person or how often these take place. The ISS focuses on physical care needs and routines but little social planning. As mentioned previously, the ISS was not updated to show how the social and emotional needs of one lady being cared for in her bedroom, were to be met to avoid isolation. The Commission has since the inspection, received an updated plan which now specifies the times and activities that are being built in, to meet the needs of this individual during the period she is incapacitated. The minutes of the staff meetings indicated that there was not a lot of activities taking place. Discussion with staff and observation of the morning routines showed that they are busy in meeting the physical needs of the people they care for. Staff endeavours to do activities in the afternoon when it is a little quieter. An improvement that the home could consider is to include a short profile of the individuals to go alongside the I.S.S. that would give the staff a brief Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 18 overview of their social background, and social history. This would enable staff to put in place a personal activity plan with measurable goals to support people in having a plan that is personal to them. This will ensure people have meaningful daytime activities of their own choice and according to their individual interests. This is particularly important where people have a degree of dementia and need support in planning and having some control over their lifestyle. Several meal times were observed and people appeared to be enjoying their meal. Staff was sensitive to the needs of those people who find it difficult to eat and gave appropriate support and assistance. People spoken with said that they enjoyed the food, which on the days of the visit was well presented, nutritious and tasty. It was positive to see that where people needed additional support to include food intake monitoring, this was being done. This ensured people had the nutrition they needed, including ‘build up’ drinks to supplement their diet. Weight records demonstrated that where concerns were evident regarding losing weight, staff ensured this was reported to the G.P. Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live at The Heathway say that they are happy with the service provided, and feel safe. The views and concerns of people have been listened to and improvements made. The recording of complaints needs to improve to reflect their good practice. Staff has the skills necessary to protect people from abuse and know when incidents need to be reported. There are positive attitudes amongst the staff team and this ensures vulnerable people are protected. EVIDENCE: The complaints log was seen. There were no complaints recorded in this. A record of monthly ‘returns’ indicated that there had been ‘nil’ returns for the month. Staff meeting minutes was looked at for the same time period some concerns had been raised in these meetings such as no steradents or toothpaste being available to an individual, Hearing aids going in the wash. One entry related to a complaint made by a relative. This had not been recorded in the complaints logbook and the AQAA stated that no complaints had been received by the Home. Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 20 These issues were discussed with the manager. Whilst it was positive to see that staff are picking up practice areas that need to improve records must show details of the investigation and any actions taken. This will demonstrate how the Home manages complaints to ensure a better outcome for the people living at The Heathway, and that complainants have some feedback as to what was done to resolve the concern. Relatives spoken with all said that they had no complaints, and that if they did they would raise them with staff or the manager. Details of the complaints procedure are available in the home, and feature in the service user’s guide. People living in the Home continue to be complimentary about the home, and especially about the staff. The home has copies of the Birmingham multi-agency guidelines on adult protection. Information taken from the AQAA informs us that there have been no referrals of an adult protection nature since the last inspection. A number of staff has received adult protection training and this is ongoing. Due to the turnover of staff it was not possible to establish accurate information as to the training undertaken, however it was evident that a core number of staff have this training and understand the steps to be taken to identify and respond to any protection matters, this ensures people living at The Heathway are protected from abuse. Those staff spoken with showed a good awareness of when incidents should be reported to protect people. Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been improvements that have addressed many of the issues raised at the last inspection. The Heathway provides a physical environment that is a pleasant, safe, and well-maintained place to live. People have the specialist equipment to meet their needs. The evident hard work by cleaning staff ensures the Home is clean and hygienic. Consistency of safe water temperature and food temperature records could compromise an otherwise safe environment. EVIDENCE: At the last inspection the environment was undergoing some improvement work. The majority of this has now been completed providing a pleasing environment for the people who live at The Heathway. Information provided in the AQAA matched that seen during the tour of communal areas. Each unit has been decorated, with new curtains, furniture and floorings providing a pleasant and comfortable environment for the people who live at the Heathway. It is Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 22 positive to see that despite the planned closure, there have been continued improvements in proving a nice living environment. Accommodation is provided on the first and second floors of the Home. The garden areas are accessible via the lift or the stairs. The majority of people would not be able to initiate the trip to the garden without staff support due to their frailty or dementia. During the time spent in the Home only one person was seen enjoying the garden, as he was able to independently access it. This is a shortfall of the Home, they have a lovely level garden area with raised flowerbeds, which were well maintained but most people need assistance to access this. The bathrooms have been refurbished providing facilities that meet with the needs of people who require assistance and the use of hoist equipment. These were fresh, immaculately clean and spacious. Some bedrooms were sample checked these were individual in style, had lots of personal affects and were spacious enough to allow the equipment people needed such as hoists. It is a credit to the staff that all areas of the Home were spotlessly clean, homely and comfortable. People who live at The Heathway commented, ‘It is always spotless, staff work very hard for us’. Relatives spoken with shared this view they said that on their visits everything is clean, and people are comfortable. Bedrooms are lockable and where people chose not to utilise this, the reasons are noted in their care plan. At the previous inspection the hot water temperature thermostatic valve did not appear to be working. The engineer rectified this at the time. Records of water temperature checks were viewed at this visit, these were not consistently maintained, on one unit they were regularly tested and recorded up till 12th July but this was a ‘tick’ chart and when asked the staff member did not know what the ‘safe’ temperature should be. The other unit last water checks date was 29th February 2008. Clearly there is variation in this practice. This was discussed with the manager, who was required to test water temperatures and maintain a record of this to ensure temperatures did not exceed 43 degrees centigrade and pose a risk of scolding. The manager has since provided to the Commission the engineers report, which showed water outlets are operating within the required safe temperature. The manager must now ensure that water temperature is tested and recorded consistently on each unit of the two units. Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The re provision of the service has created staffing difficulties, it was positive to note however that people who live at The Heathway and their relatives remain confident of the attentions of a staff team they rate highly. Staff is knowledgeable about the specific needs of people whom have dementia, staff training is enhancing the already good levels of care they are providing. EVIDENCE: Staff provided care and support to people in a relaxed and professional way throughout the two days. Staff spoken with showed a good knowledge of the needs of the people they were caring for, and a commitment to meeting those needs. Observation showed staff responding promptly to the needs of people and always supporting and helping them in a patient, respectful manner. This fact was commented on by visiting relatives, “Staff are very good they are particularly good at letting me know when dad is ill’. ”Staff are always good with her health, they look after her really well, I have no complaints at all on that level”. “ Staff are very kind and work hard, they do some activities and the place is immaculate.” “It’s a really friendly welcoming place, staff are approachable.” Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 24 When undertaking specific tasks, such as toileting, staff were heard to be informing people what was happening and why. This is important where people have dementia so that they understand what is happening and this can lesson any distress. Rotas showed a sufficient number of staff on duty during the day and at night to meet the needs of the people living at The Heathway. Due to the re provision of the service, a number of staff have recently left to take up posts elsewhere. The manager advised that currently there are 200 care hours vacant, which are being covered by both agency staff and existing staff doing extra shifts. On the morning of the inspection the manager herself had worked the night shift to cover for someone who was ill. Staffing levels are generally two staff on each floor plus a senior and sometimes the manager. However at times to maintain staffing levels the senior staff work alongside the care staff which in turn takes them away from some of their administrative tasks. Staff spoken with said “When it’s casual staff we know the needs of the people and their routines and characters, but an agency staff member may not always know this so we spend time helping them so that they understand peoples’ needs and are consistent with their routines”. Although this is not an ideal situation it is positive to see that staff remains committed to maintaining consistency and that the manager tries to ensure that the same agency staff are booked to maintain consistency for the people who live at The Heathway. Comments from relatives showed satisfaction with the numbers and availability of staff, with no adverse comments concerning there not being staff available. The AQAA information advised that over 50 of the staff employed at the home had NVQ level 2 and two managers has NVQ level 5, which is to be commended. However with the recent staffing turnover it is likely that this level has changed since the AQAA was completed. Staff spoken with stated that they received the required training on an ongoing basis. The training matrix for the home is not now an accurate reflection of the staff teams training because there are staff vacancies. However a core group of staff have undertaken the required regulatory training including, fire procedures, manual handling, protection of vulnerable adults and health and safety. Training specific to the needs of older people has also been undertaken to include Mental Health Act training, Dementia care, and safe medication. Nominations were also seen for other training courses. It is positive to see that staff members undertake training in subjects beyond the basic requirements this ensures a skilled, trained workforce care for the people who live at The Heathway. Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 25 At the previous inspection staff files sampled had appropriate employment checks and references, including satisfactory Criminal Records Bureau checks. This ensures that robust recruitment checks are undertaken to protect vulnerable people in the Home. Recruitment information was not examined at this visit, as there had been no new staff. Staff meetings took place in February, May and June. The minutes of these showed that there is a focus on improving outcomes for people using the service. Staff supervision sessions have not been regular senior staff said that in order to maintain staffing levels, some of their management tasks such as supervision has been affected. This is unfortunate as during this time of change for the service it is important that staff have a regular platform in which to focus on improving outcomes for the people using the service. Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home is generally good, although a lack of consistency in closely monitoring its own practice, both internally and externally could compromise the health, safety, and welfare of people using the service. There needs to be means of showing how the views of people living at The Heathway shape how the service is improved. EVIDENCE: The Registered Manager has worked in care of older people for a number of years and has completed the Registered Managers Award. She has a diploma in management of care. These mean that she has the qualifications and the experience to manage the home effectively. The manager has worked hard and successfully in addressing the majority of shortcomings noted in the previous inspection. Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 27 The current shortfalls relate to the lack of effective monitoring which appears to relate to the staffing difficulties that have occurred. A significant number of staff has moved on to the new care centres, leaving The Heathway to operate with 200 care hours short. Whilst the manager has managed this situation by covering the staffing shortages with the use of casual and agency staff, this has not been ideal. Discussion with the manager and senior staff shows that their main priority has been staffing the home, and this has led to some of their management tasks ‘slipping’. It has been a difficult time with staff turnover being a significant feature affecting the ability of the management team to manage effectively. There is little evidence of recent organisational monitoring by the provider. Records of monthly visits and reports known as Regulation 26 visits showed that the last one was over a year ago. Effective and regular support from external managers is required to ensure there is a review of the systems and practice within the Home. The Heathway has other monitoring tools and reports of these were sampled, the last one was April 2008, which was an internal audit carried out by a manager from another home. There should be a subsequent action plan showing how the views of people living in the Home and significant others are helping to inform the running of the Home. Some amounts of personal monies are looked after on behalf of people where this is requested. Records showed money is recorded accurately and safely secured. The AQAA detailed all necessary health and safety checks as being up-to-date. The maintenance and inspection of equipment used is regularly undertaken, the exception being the lack of testing and recording of safe water temperatures and fridge temperatures. At the previous visit the fridge temperatures in the small kitchens showed that the fridges were operating above the 8 degrees centigrade required and the 5 degrees recommended. Fridge temperature records viewed at this visit showed that these are tested and recorded every three to four days but all the readings show temperatures above those required or recommended. This could mean that food becomes contaminated. This was discussed with the manager who has since the visit informed the Commission that she has implemented a record for fridge temperature recordings. These must now be maintained on a regular basis to identify and rectify any shortfalls. Whilst the management of the Home is good, it is evident that senior staff has had little opportunity to monitor their practice, particularly ensuring records are updated as needed. This is related to the staffing difficulties that are currently affecting The Heathway. Management must ensure that records are up to date to reflect the otherwise good practices in the Home. The manager Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 28 has demonstrated that she can successfully address the shortcomings noted in the service provision this must now be maintained. Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X X X 2 2 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 30 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. OP25 Standard Regulation 13(4)(c) Requirement Hot water temperatures must be recorded regularly to ensure safe temperatures, and avoid the risk of scolding. Where fridge temperatures exceed the recommended level action must be taken to ensure food is stored at the correct safe temperature and avoid the risk of contamination. Timescale for action 30/08/08 2. OP38 13(3) 30/08/08 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 OP7 Good Practice Recommendations The ISS should be extended to provide a short social profile and health history. This should include details about the person’s dementia and how it affects them so that staff has guidelines to support people. Regular internal audits of medications should take place to identify any errors and ensure people get the correct medications. DS0000033584.V367870.R01.S.doc Version 5.2 Page 31 2. OP9 Heathway, The 3. OP12 The ISS should detail the social interests people has so that opportunities for stimulation, particularly those people who has dementia, is given consideration. The ISS should show how people are supported to exercise control and choice over their daily lives. The record of any complaints should clearly detail how and when complainants are notified of the outcome of any investigations and if they are satisfied with the response, so that they are confident that they have been listened to and that action has been taken. It is recommended that those environmental improvements identified at the last inspection are carried out, namely lighting throughout the home should be domestic in character. Flooring in the corridors should be replaced. That people are able to control the temperature of radiators in their bedrooms. These improvements will ensure a more homely environment for the people living at The Heathway. It is recommended that staff explore how people can access the garden on a regular basis. This will enhance the opportunities for stimulation. It is recommended that the home develop an up-to-date training matrix. This will ensure a team of staff who have the necessary skills to do so safely cares for the people living in the home. 4. 5. OP14 OP16 6. OP19 7. OP19 8. OP30 9. 10. OP33 OP37 The results of the quality assurance audits should be published to show how improvements to the service offered to the people living in the home have been made. Visits by the Providers representative must take place monthly and a report relating to that visit must be available for inspection. This will ensure someone is overseeing the conduct of the care home with a view to improving the service offered. Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Heathway, The DS0000033584.V367870.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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