We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards.

Transcription

1 Inspection Report We are the regulator: Our job is to check whether hospitals, care homes and care services are meeting essential standards. Halden Heights Care Community Ashford Road, High Halden, Ashford, TN26 3BP Tel: Date of Inspection: 18 June 2014 Date of Publication: July 2014 We inspected the following standards as part of a routine inspection. This is what we found: Consent to care and treatment Care and welfare of people who use services Cooperating with other providers Safeguarding people who use services from abuse Cleanliness and infection control Supporting workers Assessing and monitoring the quality of service provision Inspection Report Halden Heights Care Community July

2 Details about this location Registered Provider Registered Manager Overview of the service Halden Heights Ltd Mrs Anna Marie Cunningham Halden Heights Care Community is a purpose built home which provides accommodation, personal and nursing care for up to 59 people. Accommodation is provided on three floors, with passenger lifts to enable access between floors. The ground and first floors are for people who live permanently in the home and who need nursing care. Some people may also have dementia. The second floor provides rehabilitation services for up to 20 people. These beds are contracted out from local NHS hospitals, and are for people who need short term care and rehabilitation after illness or injury. The rehabilitation treatment is provided by NHS employees whilst personal and nursing care is provided by Halden Heights Care Community staff. Type of service Regulated activities Care home service with nursing Accommodation for persons who require nursing or personal care Treatment of disease, disorder or injury Inspection Report Halden Heights Care Community July

3 Contents When you read this report, you may find it useful to read the sections towards the back called 'About CQC inspections' and 'How we define our judgements'. Summary of this inspection: Page Why we carried out this inspection 4 How we carried out this inspection 4 What people told us and what we found 4 More information about the provider 6 Our judgements for each standard inspected: Consent to care and treatment 7 Care and welfare of people who use services 9 Cooperating with other providers 12 Safeguarding people who use services from abuse 14 Cleanliness and infection control 15 Supporting workers 17 Assessing and monitoring the quality of service provision 19 About CQC Inspections 21 How we define our judgements 22 Glossary of terms we use in this report 24 Contact us 26 Inspection Report Halden Heights Care Community July

4 Summary of this inspection Why we carried out this inspection This was a routine inspection to check that essential standards of quality and safety referred to on the front page were being met. We sometimes describe this as a scheduled inspection. This was an unannounced inspection. How we carried out this inspection We looked at the personal care or treatment records of people who use the service, carried out a visit on 18 June 2014, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and received feedback from people using comment cards. We reviewed information given to us by the provider and reviewed information sent to us by other authorities. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. What people told us and what we found The inspection was carried out by one Inspector over seven and a half hours. During this time we talked with 14 people who were living in the home, and observed staff carrying out care duties with other people. We talked with 13 staff and met other staff briefly; and talked with three relatives, three health professionals and a visiting GP. The manager and deputy manager were present throughout the inspection and assisted us by providing documentation for us to view. We looked at the answers to five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led? Is the service safe? We viewed all areas of the premises and saw that they were well maintained and visibly clean in all areas. We talked with housekeeping staff and found there were daily cleaning programmes in place and deep cleaning programmes to ensure that good infection control practices were maintained. A relative told us that they were "Always struck by the cleanliness of the home." We talked with people on each floor and spent time carrying out an observational inspection on the first floor. The Short Observational Framework Inspection (SOFI) is a method for observing people's care when they are unable to give clear verbal feedback. We saw that staff were kind and attentive, and treated people with respect and dignity. We found that the home had comprehensive procedures in place to check that people had consented to the care and treatment provided for them. People who lacked the mental capacity to make decisions about where they lived or the care that they needed had been Inspection Report Halden Heights Care Community July

5 appropriately supported by their family members or advocates, and by health and social care professionals, to make decisions on their behalf and in their best interests. The manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This meant that people who lacked full mental capacity were appropriately represented by people who knew their previous wishes and decisions. We saw confirmation that all of the staff had been trained in safeguarding vulnerable adults. We spoke to staff who gave clear explanations of the different types of abuse to be aware of, and who knew the action to take in the event of any suspicion of abuse. The manager and senior staff were informed about their responsibilities to report any safeguarding concerns, and liaised with the local authority safeguarding team for any support or advice. Is it effective? We viewed care plans on each floor and saw that people or their representatives had been involved in all aspects of their care planning. The care plans covered all aspects of people's care and treatment, and had associated risk assessments. We saw that people's preferences were recorded and were adhered to in regards to their individual care. The home included a floor for people receiving rehabilitation and short term care after being in hospital. This floor had NHS staff as well as nursing and care staff employed by the home. The NHS staff were health professionals who carried out physiotherapy and occupational therapy; and Social Services care managers who arranged for people's placements or return home after their period of rehabilitation. We saw that the staff liaised with each other throughout the day so that there was good communication between them about people's care. The staff appropriately arranged for referrals to other health and social care professionals for people who were receiving long term care. We viewed training records and saw that staff kept up to date with required training courses, and carried out other training which was relevant to their individual job roles. This meant that they were able to provide effective care and support. Is the service caring? All of the people that we spoke with, and relatives, spoke highly of the staff and the care they received in the home. People's comments included, "The nurses and care staff are outstanding. They have to deal with all sorts of things. It is very good here"; "It's very, very good, the staff are lovely"; and "The care has been brilliant. The staff are excellent. I am so pleased with the progress I have made." We saw that care plans identified people's own preferences, such as the name they preferred to be called by. We observed that staff offered people a variety of choices in regards to food and drinks; and in where they wanted to go, and what they wanted to do. We saw that staff took time to listen to people and did not rush them for answers. They included people who appeared withdrawn in the activities going on around them, and drew them gently into conversations so that they did not feel isolated. Is the service responsive? The home employed an activities co-ordinator who arranged for a variety of different activities to be available. We saw that care staff also took part in assisting people with activities during the day of our visit. This included people joining in with games and quizzes; and taking some people outside to sit in the garden. Inspection Report Halden Heights Care Community July

6 We saw that there were on-going assessments and care plan reviews to ensure that people's changing needs were identified and addressed. This was especially important on the second floor, as people having rehabilitation often made daily progress, which changed their care planning. We saw that the health professionals gave clear directions, so that nursing and care staff knew how to assist people with their mobility and daily living tasks. People said that if they had any concerns they were able to raise them with the manager and the staff. The manager and deputy were available throughout the week, and people said that they were confident that if they had any concerns or complaints that these would be dealt with appropriately. A relative said that the staff always informed them of any changes in the person's care plan, and would contact them if they had concerns about their health needs. People's views were obtained through using questionnaires and through residents and relatives' meetings. We saw that the responses were collated, and action was taken to address any issues raised. The results were given to people at the next meeting. Is the service well-led? Staff said that they worked well together as a team and were supported by the management structure. We saw that they interacted well with each other as well as with the people living in the home. Each floor had a nurse on duty who provided an overall lead for the floor. The manager and deputy manager provided daily support working alongside the nursing and care staff. Staff had individual supervision with their heads of department, which enabled them to discuss any training needs or raise any issues. They were also supported through yearly appraisals and monthly team meetings. We saw that the manager provided a clear lead for the other staff in the home. There were systems in place to monitor the home's progress, which included weekly and monthly audits for areas such as medication and care plans; and other audits for infection control; health and safety; staff training; housekeeping; laundry services and kitchen management. We saw that there was a yearly audit for how well people living in the home were involved in the running of the home, and this had scored 100 per cent at the last review. You can see our judgements on the front page of this report. More information about the provider Please see our website for more information, including our most recent judgements against the essential standards. You can contact us using the telephone number on the back of the report if you have additional questions. There is a glossary at the back of this report which has definitions for words and phrases we use in the report. Inspection Report Halden Heights Care Community July

7 Our judgements for each standard inspected Consent to care and treatment Before people are given any examination, care, treatment or support, they should be asked if they agree to it Our judgement The provider was meeting this standard. Before people received any care or treatment they were asked for their consent, and the provider acted in accordance with their wishes. Reasons for our judgement Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. We viewed eight people's care plans with some from each floor. We found that there were clear procedures in place for obtaining people's consent to their care and treatment. People were assessed for their mental ability to make their own decisions, in accordance with the Mental Capacity Act People who lacked capacity were appropriately supported by a family member or an advocate to work with nursing staff and other health professionals to make decisions on their behalf and in their best interests. We saw that "best interest" meetings were recorded and showed that they were held when complex decisions needed to be made for people who lacked the ability to do so. We observed staff interacting with people throughout the day, and saw that they obtained verbal consent from them for the things they wished to do. For example, we heard staff asking someone if they would like a shower; and we heard staff asking someone "Would you like to go to the lounge now?" We saw that people's care plans included consent forms, including a form for consent to care and treatment. Consent was obtained for people's confidential personal information to be shared with other health professionals, and with the person's next of kin if appropriate. People could also choose if they wished for their confidential information to be shared with other friends or relatives. We saw that responses from service user questionnaires confirmed that people were involved in their care planning. We saw that consent was discussed for photographs to be taken for the purposes of confirming people's identity, for the medication records, and for the home's literature. We saw that photographs were taken of people's wounds so as to show the progress of the wound healing. The provider may find it useful to note that only verbal consent was obtained for photographs of wounds and not written consent. The manager took action during the inspection to amend the consent form to include this. Inspection Report Halden Heights Care Community July

8 Some people had forms in their care plans for "Do Not Attempt Resuscitation" (DNAR). (These forms are in the event of the person having a sudden collapse or heart attack). We saw that the DNAR forms had been appropriately completed by the person's GP or consultant and nursing staff, and had been discussed with the person concerned for them to express their own wishes. People were asked separately to share their views about their preferred end of life care, such as if they preferred to stay in the home for any treatment or care, or if they would wish to go to hospital. We saw that appropriate discussions were carried out, and the plans were correctly signed and dated by the different parties. This showed that people's specific wishes were taken into account for the end of their lives. Inspection Report Halden Heights Care Community July

9 Care and welfare of people who use services People should get safe and appropriate care that meets their needs and supports their rights Our judgement The provider was meeting this standard. People experienced care, treatment and support that met their needs and protected their rights. Reasons for our judgement People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We viewed care plans for eight people, with some care plans from each floor. People on the second floor who had been admitted for rehabilitation had set time frames given to them for their recovery. This was for three weeks if they could weight bear, or eight weeks if they were non weight-bearing. Detailed assessments were carried out in hospital to ensure that they were suitable to receive short term treatment. We saw that their care plans were more compact than those for people receiving long term care, but contained all the required information. People were given an explanation before they left hospital that rehabilitation meant working with health professionals for their recovery in a set period of time, and a proposed date of discharge was set when they were moved into the home. Some people made a recovery more quickly and went home early; whilst others did not make the hoped for recovery and were assessed for care packages at home or for long term placements. We saw that people receiving rehabilitation had assessments from health professionals, such as a physiotherapist or occupational therapist shortly after their admission, and had a programme put in place to aid their recovery. This included exercises, and practice in movements such as standing, transferring from bed to chair, or walking up and down stairs. The floor included a kitchenette where the occupational therapists could assess people's safety and ability in using kitchen equipment, and in carrying items from one room to another. The occupational therapists carried out visits to people's own homes where this was indicated (for example, people living alone), to ensure that they would be able to manage at home, and had any necessary equipment put in place before going home. We saw that nursing and care staff worked with the health professionals to help people with their mobility and dexterity. The care plans contained clear on-going details from the health professionals to show how people were progressing, and for staff to know how to assist people according to their individual needs. We attended a weekly meeting in which the management, health professionals, care managers and GP discussed each person's progress each week, and put in place the different requirements for each person. Inspection Report Halden Heights Care Community July

10 We saw that care planning for people with long term placements was very comprehensive and covered all aspects of daily living. The care plans included assessments for people's mental capacity, moving and handling needs, continence, nutrition, mental health, falls risk, and pain assessments. People were assessed for their skin integrity to see if they were prone to pressure sores. We saw that pressure-relieving equipment including air mattresses and pressure-relieving cushions were used effectively as part of prevention or treatment for pressure sores. A member of the care staff demonstrated how they checked the air mattresses to ensure they were on the correct setting for the person concerned. The care plans were implemented according to people's individual needs. These covered topics such as their personal hygiene care, mobility, communication, medication and elimination. We saw that these were written to relate to the person concerned and had clear instructions. For example, we saw that one person had a care plan for keeping safe which had included the use of bed rails to prevent falls when the person was in bed. The staff had found that this did not work in practice, as the person tried to climb over the bed rails, which increased their risk of falling. The care plan had been amended to show that the person did not have bed rails used; that the bed was put on to its lowest setting at night, and a pressure alarm mat was placed by the bed which alerted staff if the person started to get out of bed. This promoted the person's safety. Night care plans contained details such as "X likes to wear pyjamas; likes to have a wash and brush teeth before bed; ensure call bell is in reach; likes to go to bed about 9pm." We saw that care plans contained people's life histories, which helped the staff to get to know their likes and dislikes, their hobbies and their previous occupation. This was especially important for people with dementia if they became confused or disorientated. The staff knew the things they liked to distract them if they were upset, such as classical music, a walk in the garden, or a cup of tea. The staff wrote daily reports for people for each shift, and we saw that these contained suitable information about the person's mood, health needs, personal care, eating and drinking and any concerns. They used charts to document hourly checks for each person in the home, which showed where the person was and what they were engaged in. Other charts were used as necessary to record people's food or fluid intake and positional changes. The charts that we viewed had been accurately completed. Some people had wound care for wounds or pressure sores. We noted that some people had more than one wound, and sometimes the wound assessments for different wounds had been made on the same chart. This meant that it was not easy to follow the progress of each wound as it healed. We discussed this with the manager who said that she would ensure that each wound was assessed on a separate form. People were encouraged to go where they wanted to and to take part in group activities if they wished to do so. The home employed an activities co-ordinator who carried out group activities on the ground and first floors each day. People were able to move between floors to attend activities. People on the second floor were often tired due to the rehabilitation processes, and so group activities were not held on this floor. We saw that some people liked to stay in their own rooms, and read newspapers, watched TV or carried out hobbies, such as knitting. The home had library books available. A relative told us "X has settled in really well, and it feels like home for him. He is happy here, and the staff are very, very good." Group activities were discussed with people at residents' meetings and reflected their choices. They included games such as quoits and skittles; arts and crafts; sing-alongs; Inspection Report Halden Heights Care Community July

11 exercises to music; and quizzes. Monthly entertainment was brought in from outside entertainers; and a church service was held each month for people who wished to attend. The activities co-ordinator told us that there had been an increase with involvement in the community, such visits from local schoolchildren. People were able to go out for walks, or out with friends and relatives as they wished. We saw that the home had a very relaxed and friendly atmosphere. People said "The staff are magnificent here! I don't want to go home"; and "I am very well looked after; the food is fine; I go out sometimes if the weather is good." A relative said "The staff are extremely gentle with X and very kind." Inspection Report Halden Heights Care Community July

12 Cooperating with other providers People should get safe and coordinated care when they move between different services Our judgement The provider was meeting this standard. People's health, safety and welfare was protected when more than one provider was involved in their care and treatment, or when they moved between different services. This was because the provider worked in co-operation with others. Reasons for our judgement People's health, safety and welfare was protected when more than one provider was involved in their care and treatment. People who were receiving rehabilitation treatment were referred from local NHS hospitals. We saw that thorough assessments were carried out to ensure that they were suitable to receive rehabilitation treatment; and where possible, to be able to take a full part in the process of their recovery. Some people had had falls or accidents which had caused a fracture, such as a broken leg or hip; other people had been in hospital with illnesses such as pneumonia, and had become frail or found it hard to manage their own care and welfare. The rehabilitation processes provided a set length of time for people to make a recovery and, as far as possible, to return home. This meant that the staff employed by the home liaised constantly with NHS staff and with Social Services care managers. The home had a full time physiotherapist, occupational therapists and two care managers employed by the NHS who were allocated to the home to work alongside the staff employed by the home. Some people needed care packages when they returned home, for example to support them with personal hygiene care or meal preparation. The care managers arranged for care agencies to be involved with people's care at home; and supported people who did not make a sufficient recovery to return home, and who required long term placements in nursing or residential homes. Some people were admitted with wounds following surgery in the hospital, or with pressure sores. Care plans showed that the staff liaised with the ward staff, and with tissue viability nurses in the hospital and in the community. This provided a continuity of wound care to aid healing of the wounds. The home had arranged for a local GP to visit the home each week, and most people chose to register with this doctor for their on-going care. He supported people in the short term who were receiving rehabilitation, as well as people with long term placements. A weekly meeting was held with all of the health professionals involved with rehabilitation. Inspection Report Halden Heights Care Community July

13 One of the health professionals said "This is the best nursing home I have ever been in." We found that people with long term placements were appropriately referred to additional health and social care professionals as needed. These included dieticians, speech and language therapists, community mental health team, psychologists, dentists and opticians. Inspection Report Halden Heights Care Community July

14 Safeguarding people who use services from abuse People should be protected from abuse and staff should respect their human rights Our judgement The provider was meeting this standard. People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening. Reasons for our judgement The provider responded appropriately to any allegation of abuse. We viewed staff training records and saw that all staff had been trained in safeguarding vulnerable adults and had been given regular refresher courses. Staff that we spoke to demonstrated a good understanding of the different types of abuse, and how to report any incidents of concern. The manager was familiar with local safeguarding protocols and contacted the local authority safeguarding team to provide them with information about any incidents, or to ask for any advice. Staff confirmed that they had been trained in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The manager told us that there had not been any need to apply for any Deprivation of Liberty orders, but knew the procedures to take if an application was required. People told us that they felt secure in the home. One person said "I like being here, I feel safe." We saw that this was also evidenced in recent satisfaction surveys where 100 per cent of people had ticked to confirm that they felt safe and secure in the home. We saw that when people moved into the home, the staff recorded an inventory of their clothes and possessions. This meant there was a clear record of the things that each person owned, which provided clarity for when people returned home. The home did not store any money for people receiving rehabilitation, and most items such as hairdressing and chiropody were invoiced to people or the person acting on their behalf. We saw that the home occasionally looked after small amounts of pocket money for people receiving long term care. There was a system in place to keep each person's money separately, and to retain all receipts. These were checked with the person or their next of kin at regular intervals. This prevented people from being subject to financial abuse. We saw that the manager had recently implemented an audit to check people's pocket monies. Inspection Report Halden Heights Care Community July

15 Cleanliness and infection control People should be cared for in a clean environment and protected from the risk of infection Our judgement The provider was meeting this standard. People were protected from the risk of infection because appropriate guidance had been followed Reasons for our judgement There were effective systems in place to reduce the risk and spread of infection. We viewed all areas of the home and saw that it was visibly clean and there were no unpleasant odours. We spoke to some relatives who said "We are frequent visitors, and the home is always clean. The domestic staff are all very polite and kind; the cleaning is very thorough." There was a member of the domestic staff to clean each floor each day. One of the cleaning staff told us that they cleaned each bedroom every day, and cleaned the communal areas. This included cleaning the dining area at the beginning of the morning, and after lunch. All of the bedrooms had en-suite showers and toilets. We saw that there were programmes in place for cleaning bathrooms after use, and the records were displayed on each bathroom wall. The senior housekeeper told us that there was an extra 'job of the day' for domestic staff, which included tasks such as high rise dusting or cleaning skirting-boards. There were also systems in place for routine washing of the curtains. All of the floors were hard floors which were vacuumed and mopped each day. Domestic staff confirmed that they had colour-coded equipment for different areas, and that they had been trained in use of the different chemicals. The home employed a maintenance man who deep-cleaned each floor each month using a steam cleaning system that did not require chemicals. There was a rota for deep cleaning each room, either monthly or when rooms were vacant. We saw that communal toilets included liquid soap and paper towels; and alcohol hand-gel was in strategic places around the home to promote good hand hygiene and infection control. The home had a laundry person on duty seven days per week, who managed all of the laundry in the home, including bed linen, tablecloths and people's personal laundry. We saw that the laundry area was well organised, and included a designated hand washing sink. There was a system in place for the management of soiled linen, using a red alginate bag system which promoted good infection control. Inspection Report Halden Heights Care Community July

16 We saw that there were appropriate systems in place for waste disposal and removal of sharps; and the home had approved contractors in place for managing this. We found that the manager was familiar with the Department of Health's "Code of Practice for health and social care on the prevention and control of infections and related guidance". There were six-monthly checks as part of the home's auditing processes to review the infection control management against this guidance. We saw that the home's own infection control audit covered appropriate details, including safe handling and disposal of waste and sharps; disinfection; wearing of uniforms and dress codes; hand hygiene; and to check that standard infection prevention and control procedures were in place. Inspection Report Halden Heights Care Community July

17 Supporting workers Staff should be properly trained and supervised, and have the chance to develop and improve their skills Our judgement The provider was meeting this standard. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Reasons for our judgement Staff received appropriate professional development. We viewed four staff training files for staff working in different areas of responsibility. These confirmed that staff had been given a comprehensive induction, which followed the nationally recognised "Skills for Care" training. Staff told us that they had carried out shadow shifts when they first started work, and had felt supported through this process. We talked with staff about their training and they said that they had carried out all of the required training when they had commenced employment, and had regular refresher courses for these subjects. We looked at the home's staff training matrix, and this confirmed that all staff were up to date with required training, such as fire safety, moving and handling, infection control, health and safety and safeguarding vulnerable adults. We saw that other relevant training was carried out, such as food hygiene, first aid, dementia care and equality and diversity. Staff were encouraged to take formal training qualifications, and we found that all of the care staff had completed training for National Vocational Qualifications (NVQ)/diplomas for health and social care, to levels 2 or 3. This meant that care staff were confident in their roles and able to deliver care appropriately. We saw that other staff completed qualifications in their different roles, such as an NVQ in administration for an administrator. Nursing staff were enabled to develop their skills and competencies in areas such as venepuncture (taking blood); catheterisation; and "PEG" feeding (Percutaneous endoscopic gastrostomy (PEG) is a method of feeding people via a tube passed through their abdominal wall into the stomach, for people who have swallowing difficulties). Staff said that there were clear lines of accountability in the home, and they knew who to go to if they had any questions about the delivery of care or any concerns. Each staff member had a line manager who gave them individual supervision, approximately every two months. Staff also received support through daily handover meetings between shifts; and through regular staff meetings. We saw that a staff meeting had been held the previous week, and the minutes showed that staff felt able to voice their opinions about the subjects under discussion. We saw that staff had been given encouragement by the Inspection Report Halden Heights Care Community July

18 manager where they were making progress with new areas of responsibility. Inspection Report Halden Heights Care Community July

19 Assessing and monitoring the quality of service provision The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care Our judgement The provider was meeting this standard. The provider had an effective system to regularly assess and monitor the quality of service that people received. Reasons for our judgement People who used the service, their representatives and staff were asked for their views about their care and treatment and these were acted on appropriately. We saw that staff interacted well with people and invited their comments and feedback throughout the day. Staff usually worked on the same floors, so that they got to know people well. This meant that for people with dementia or old age confusion, the staff were able to identify any changes in their usual mood or behaviour and identify if they might be unwell. People and their relatives were informed at the time of admission that the manager had an open door policy and was available for people to ask any questions or raise any concerns. We saw this in practice, as visitors spoke to the manager and deputy manager throughout the day, and were relaxed in sharing their views. Relatives that we spoke with had only positive comments to make, such as, "We can go to any of the staff to ask about any changes in X's care, and they always know what is going on. X has a named nurse and a keyworker allocated if we want to speak to them, but all of the staff are informed about his needs." Another relative said that they were always made welcome in the home, and that staff had offered them to stay as long as they liked when the person they were visiting had been unwell, and had offered them drinks and meals during their time in the home. We saw that the complaints policy and procedure was provided in a Perspex box outside each person's bedroom door. This meant that it was easily available to people. The provider may find it useful to know that this included the whole policy which was very lengthy and in small print, rather than a straightforward procedure in larger print, and easier to follow. People's views were obtained through satisfaction questionnaires, and we viewed the results for two questionnaires carried out in March One of these contained general questions such as, "How do you rate the quality of care provided by the home?" and "Do you feel safe and secure in the home?" The other survey was for food satisfaction. We saw that the manager had collated the results, and had taken action in regards to people's comments. For example, people had said that they would appreciate more activities. The Inspection Report Halden Heights Care Community July

20 manager had responded by employing an activities co-ordinator for increased hours over five days per week instead of the previous three; and had increased the range of activities and entertainment available. We saw that the manager had systems in place to carry out weekly and monthly audits for monitoring the progress of the home. These included care plan audits; monitoring of accidents and incidents; medication audits; nutrition audits and monitoring of people's weights; and pressure sore/wound care audits. This meant that any trends were quickly picked up, and action was taken to address any issues identified. The manager also carried out yearly audits for every area of responsibility in the home. We saw that the yearly audit had been carried out in March 2014, and had included infection control, medication, admission and discharge procedures, nutrition, maintenance, health and safety, housekeeping and laundry management. The home had had recent visits from the Social Services contracting department; and from the commissioning body for rehabilitation beds, and had increased the contract from 15 beds to 20 beds. This showed that they were confident in the rehabilitation care that was being delivered. Inspection Report Halden Heights Care Community July

21 About CQC inspections We are the regulator of health and social care in England. All providers of regulated health and social care services have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations We regulate against these standards, which we sometimes describe as "government standards". We carry out unannounced inspections of all care homes, acute hospitals and domiciliary care services in England at least once a year to judge whether or not the essential standards are being met. We carry out inspections of other services less often. All of our inspections are unannounced unless there is a good reason to let the provider know we are coming. There are 16 essential standards that relate most directly to the quality and safety of care and these are grouped into five key areas. When we inspect we could check all or part of any of the 16 standards at any time depending on the individual circumstances of the service. Because of this we often check different standards at different times. When we inspect, we always visit and we do things like observe how people are cared for, and we talk to people who use the service, to their carers and to staff. We also review information we have gathered about the provider, check the service's records and check whether the right systems and processes are in place. We focus on whether or not the provider is meeting the standards and we are guided by whether people are experiencing the outcomes they should be able to expect when the standards are being met. By outcomes we mean the impact care has on the health, safety and welfare of people who use the service, and the experience they have whilst receiving it. Our inspectors judge if any action is required by the provider of the service to improve the standard of care being provided. Where providers are non-compliant with the regulations, we take enforcement action against them. If we require a service to take action, or if we take enforcement action, we re-inspect it before its next routine inspection was due. This could mean we re-inspect a service several times in one year. We also might decide to reinspect a service if new concerns emerge about it before the next routine inspection. In between inspections we continually monitor information we have about providers. The information comes from the public, the provider, other organisations, and from care workers. You can tell us about your experience of this provider on our website. Inspection Report Halden Heights Care Community July

22 How we define our judgements The following pages show our findings and regulatory judgement for each essential standard or part of the standard that we inspected. Our judgements are based on the ongoing review and analysis of the information gathered by CQC about this provider and the evidence collected during this inspection. We reach one of the following judgements for each essential standard inspected. This means that the standard was being met in that the provider was compliant with the regulation. If we find that standards were met, we take no regulatory action but we may make comments that may be useful to the provider and to the public about minor improvements that could be made. Action needed This means that the standard was not being met in that the provider was non-compliant with the regulation. We may have set a compliance action requiring the provider to produce a report setting out how and by when changes will be made to make sure they comply with the standard. We monitor the implementation of action plans in these reports and, if necessary, take further action. We may have identified a breach of a regulation which is more serious, and we will make sure action is taken. We will report on this when it is complete. Enforcement action taken If the breach of the regulation was more serious, or there have been several or continual breaches, we have a range of actions we take using the criminal and/or civil procedures in the Health and Social Care Act 2008 and relevant regulations. These enforcement powers include issuing a warning notice; restricting or suspending the services a provider can offer, or the number of people it can care for; issuing fines and formal cautions; in extreme cases, cancelling a provider or managers registration or prosecuting a manager or provider. These enforcement powers are set out in law and mean that we can take swift, targeted action where services are failing people. Inspection Report Halden Heights Care Community July

23 How we define our judgements (continued) Where we find non-compliance with a regulation (or part of a regulation), we state which part of the regulation has been breached. Only where there is non compliance with one or more of Regulations 9-24 of the Regulated Activity Regulations, will our report include a judgement about the level of impact on people who use the service (and others, if appropriate to the regulation). This could be a minor, moderate or major impact. Minor impact - people who use the service experienced poor care that had an impact on their health, safety or welfare or there was a risk of this happening. The impact was not significant and the matter could be managed or resolved quickly. Moderate impact - people who use the service experienced poor care that had a significant effect on their health, safety or welfare or there was a risk of this happening. The matter may need to be resolved quickly. Major impact - people who use the service experienced poor care that had a serious current or long term impact on their health, safety and welfare, or there was a risk of this happening. The matter needs to be resolved quickly We decide the most appropriate action to take to ensure that the necessary changes are made. We always follow up to check whether action has been taken to meet the standards. Inspection Report Halden Heights Care Community July

24 Glossary of terms we use in this report Essential standard The essential standards of quality and safety are described in our Guidance about compliance: Essential standards of quality and safety. They consist of a significant number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations These regulations describe the essential standards of quality and safety that people who use health and adult social care services have a right to expect. A full list of the standards can be found within the Guidance about compliance. The 16 essential standards are: Respecting and involving people who use services - Outcome 1 (Regulation 17) Consent to care and treatment - Outcome 2 (Regulation 18) Care and welfare of people who use services - Outcome 4 (Regulation 9) Meeting Nutritional Needs - Outcome 5 (Regulation 14) Cooperating with other providers - Outcome 6 (Regulation 24) Safeguarding people who use services from abuse - Outcome 7 (Regulation 11) Cleanliness and infection control - Outcome 8 (Regulation 12) Management of medicines - Outcome 9 (Regulation 13) Safety and suitability of premises - Outcome 10 (Regulation 15) Safety, availability and suitability of equipment - Outcome 11 (Regulation 16) Requirements relating to workers - Outcome 12 (Regulation 21) Staffing - Outcome 13 (Regulation 22) Supporting Staff - Outcome 14 (Regulation 23) Assessing and monitoring the quality of service provision - Outcome 16 (Regulation 10) Complaints - Outcome 17 (Regulation 19) Records - Outcome 21 (Regulation 20) Regulated activity These are prescribed activities related to care and treatment that require registration with CQC. These are set out in legislation, and reflect the services provided. Inspection Report Halden Heights Care Community July

25 Glossary of terms we use in this report (continued) (Registered) Provider There are several legal terms relating to the providers of services. These include registered person, service provider and registered manager. The term 'provider' means anyone with a legal responsibility for ensuring that the requirements of the law are carried out. On our website we often refer to providers as a 'service'. Regulations We regulate against the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations Responsive inspection This is carried out at any time in relation to identified concerns. Routine inspection This is planned and could occur at any time. We sometimes describe this as a scheduled inspection. Themed inspection This is targeted to look at specific standards, sectors or types of care. Inspection Report Halden Heights Care Community July

26 Contact us Phone: Write to us at: Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA Website: Copyright Copyright (2011) 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. Inspection Report Halden Heights Care Community July