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Inspection on 28/07/09 for Highbury Nursing Home

Also see our care home review for Highbury Nursing Home for more information

This is the latest available inspection report for this service, carried out on 28th July 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Information is collected about people`s needs before they are admitted and this helps the home write plans to meet their needs and minimise risks to them. People have checks made on admission on for example their weight and blood pressure and where necessary referrals are made to health professionals. This means that any health concerns can be looked at quickly. People have care plans written about the care they need and how any risks to them can be minimised. Where possible people are spoken to about their care and arrangements made to give the care in the way the person wants. A health professional said that the home was good at maintaining a person`s privacy and dignity when they called and that they support people with their lifestyle choices. Staff spoken to were clear about what they need to do maintain people`s privacy and dignity. Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 People said about the home `They try to cater for all the individual needs of us residents. Our carers look after us with kindness and consideration.` `They take care of my needs and they are there for me if I need them. The home could do nothing better.` `I would recommend this place to anyone.` Relatives commented: `(The home) answers phone promptly and can speak to the responsible person easily and questions are answered knowledgeably.` `Highbury did their best to facilitate visits with a meal with the patient and a relative (relative as also being cared for).` `They take care of my (relative) they are very polite and very friendly to us all. They could do nothing better.` `The home takes exceptionally good care of (my relative`s) physical and medical needs and she is well fed.` People are supplied with good, wholesome and nutritious meals. The chef gets to know the people and what they like; he likes to check that they are not losing weight. If they are losing weight he consults with the person and the care staff about fortifying meals. Staff are recruited well and all checks are done before people are employed and this helps to keep people safe. Staff receive appropriate training with 70% of the staff having a National Vocational Qualification level 2 in care or higher. This means staff are trained to understand the needs of older people. People are invited to residents meetings on a regular basis to say what they think of the home. There are regular maintenance, checks and inspections for Fire, electrical, gas, and lifting equipment safety.

What has improved since the last inspection?

The home has better risk management plans for people that have mental health difficulties, such as dementia, that may result in challenging behaviour. These plans include any triggers or signs that this behaviour may happen and what may help to divert the person. People that have a tendency to fall out of bed are assessed for what is the most suitable method of keeping them safe. People and staff thought that activities that were available were improving and some residents were now assisted in going out of the home on occasions. New activities since the last inspection included pub lunches, internet access and Benson, a petting dog, visits. The environment continues to improve. Since the last inspection changes have been made by putting curtains and increasing the lighting in the lounge areas. Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Some decoration has been undertaken. The kitchen has been retiled and new fridges have been bought. More signage has been developed and people with dementia are being assisted to recognise their rooms with photographs of themselves being placed on their room door. The home`s Annual Quality Assurance Assessment states that the improvements are expected to continue. The staff team has become more stable and staff spoken to said that the staff team were working well together. There is a Quality Assurance system and the manager and a representative from the company have been assessing the home`s performance and are developing plans to improve the service.

What the care home could do better:

The home has information available about the service they provide but this is not given out before people are admitted and this does not help them to decide whether the home would suit them. Although the administration of medication is generally good and safe the ways of recording that medication has been refused, or refused and destroyed are not good enough to ensure that all tablets can be accounted for. Medication carried forward from the last 28 day cycle must be recorded on the Medication Administration Record (MAR). A copy of one medications prescription was found that was not recorded on the MAR and there was no information about the medication being discontinued or what happened to the prescription. Although the recording of complaints is improving the collection of small comments both good and bad would assist the home in making further improvements and identify where the home any recurring problems.

Key inspection report CARE HOMES FOR OLDER PEOPLE Highbury Nursing Home 199/203 Alcester Road Moseley Birmingham West Midlands B13 8PX Lead Inspector Jill Brown Key Unannounced Inspection 08:35 28 & 29th July 2009 th DS0000024854.V377315.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highbury Nursing Home Address 199/203 Alcester Road Moseley Birmingham West Midlands B13 8PX 0121 442 4885 0121 449 7855 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) Flintvaleltd@btconnect.com Flintvale Limited Elizabeth Anne Evans Care Home 38 Category(ies) of Dementia (38), Old age, not falling within any registration, with number other category (38) of places Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 38 Old age, not falling within any other category (OP) 38 The maximum number of service users who can be accommodated is: 38 29th July 2008 2. Date of last inspection Brief Description of the Service: Highbury Nursing Home is purpose built and is located on the edge of Moseley Village, a suburb of Birmingham. The home provides residential and nursing care for up to 38 persons who are aged 65 years or above who may suffer from dementia. Bedroom accommodation includes both single and shared rooms, some of which have en-suite facilities. Bedrooms are situated on three floors; these are accessible via stairs or a shaft lift. All of the communal rooms are linked by well glazed partitions, which helps staff to observe people. The main lounge leads on to a smaller lounge, which leads onto the main dining area. There are two smaller rooms; one is used as a lounge and the other as an extra dining area. Communal toilets and bathrooms are within easy access of all areas of the home. The home has enough specialist equipment and hoists to assist with the care of people. There is a secluded and well laid out garden and patio area. A large unused grassed area is situated to the side of the garden and a car park is also located at the rear of the premises. The fees for the home are between £538.50- £700.05 per week. People who are social-services funded a top up fee of between £32.31 and £86.16 per week is charged. There are additional charges for hairdressing, toiletries and chiropody. Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. We visited the home without notice on a day in July 2009 and spent about 12 hours in the home over 2 days. During the inspection one persons care was case tracked. This case tracking involved looking at all the records and information about them, looking at their medication and their rooms and observing their care. This assists us to make a judgement about the care given. We also looked at parts of the care records of a further five people. We received six comment cards from people living in the home, four from their relatives, three from health professionals and five from staff telling us about the service. Other documents about the running of this home were examined and parts of the building were looked at. We also took into account of information we had received from all sources about the home since the last key inspection. Services are required to complete an Annual Quality Assurance Assessment (AQAA) on a yearly basis; information from this was used in this report. During the inspection we spoke with six people living in the home, the manager, deputy manager and a representative of the company and 7 staff. What the service does well: Information is collected about peoples needs before they are admitted and this helps the home write plans to meet their needs and minimise risks to them. People have checks made on admission on for example their weight and blood pressure and where necessary referrals are made to health professionals. This means that any health concerns can be looked at quickly. People have care plans written about the care they need and how any risks to them can be minimised. Where possible people are spoken to about their care and arrangements made to give the care in the way the person wants. A health professional said that the home was good at maintaining a persons privacy and dignity when they called and that they support people with their lifestyle choices. Staff spoken to were clear about what they need to do maintain peoples privacy and dignity. Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 6 People said about the home They try to cater for all the individual needs of us residents. Our carers look after us with kindness and consideration. They take care of my needs and they are there for me if I need them. The home could do nothing better. I would recommend this place to anyone. Relatives commented: (The home) answers phone promptly and can speak to the responsible person easily and questions are answered knowledgeably. Highbury did their best to facilitate visits with a meal with the patient and a relative (relative as also being cared for). They take care of my (relative) they are very polite and very friendly to us all. They could do nothing better. The home takes exceptionally good care of (my relatives) physical and medical needs and she is well fed. People are supplied with good, wholesome and nutritious meals. The chef gets to know the people and what they like; he likes to check that they are not losing weight. If they are losing weight he consults with the person and the care staff about fortifying meals. Staff are recruited well and all checks are done before people are employed and this helps to keep people safe. Staff receive appropriate training with 70 of the staff having a National Vocational Qualification level 2 in care or higher. This means staff are trained to understand the needs of older people. People are invited to residents meetings on a regular basis to say what they think of the home. There are regular maintenance, checks and inspections for Fire, electrical, gas, and lifting equipment safety. What has improved since the last inspection? The home has better risk management plans for people that have mental health difficulties, such as dementia, that may result in challenging behaviour. These plans include any triggers or signs that this behaviour may happen and what may help to divert the person. People that have a tendency to fall out of bed are assessed for what is the most suitable method of keeping them safe. People and staff thought that activities that were available were improving and some residents were now assisted in going out of the home on occasions. New activities since the last inspection included pub lunches, internet access and Benson, a petting dog, visits. The environment continues to improve. Since the last inspection changes have been made by putting curtains and increasing the lighting in the lounge areas. Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 7 Some decoration has been undertaken. The kitchen has been retiled and new fridges have been bought. More signage has been developed and people with dementia are being assisted to recognise their rooms with photographs of themselves being placed on their room door. The homes Annual Quality Assurance Assessment states that the improvements are expected to continue. The staff team has become more stable and staff spoken to said that the staff team were working well together. There is a Quality Assurance system and the manager and a representative from the company have been assessing the homes performance and are developing plans to improve the service. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 8 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 Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3, People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information whilst available is not given at a time to help people decide whether the home will suit them. Detailed information is collected about peoples health and personal care needs and this means the home can plan to meet these needs. EVIDENCE: We looked at the information provided to people in the statement of purpose which includes information expected in the service user guide. We found that the information was clear about the service the home provides. Approximately half of the comment cards from people and their relatives indicated that not enough information was available before people were admitted. The home did not keep a record of the statement of purpose being given to people before Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 10 they were admitted. The home has identified that a shorter version of the information with perhaps pictures is needed as many of the people are ill at the point of choosing a home and find a lot of information difficult to take in. The homes residential agreement shows what is not included in the costs of the home. The information about the cost for people who have higher health needs was not clear enough for people who are self funded. The homes certificate of registration was on display and this helps people visiting the home to know whether their needs can be met. We looked at the records of admission for 2 people who had recently been admitted and talked to one person about this. A good level information was collected about people before they were admitted and this helps the home decide whether they can meet the persons needs. Information was collected about peoples health conditions, equipment needed, medicines prescribed and personal care needs. This helps the home write plans about how the care is to be given and how risks to them can be minimised. Further details were collected about peoples ethnic background, religion, food dislikes and likes and what the person can do for themselves. These details can be incorporated into a persons care plan to ensure that the care is given in the way the person wants and that people maintain their independence and their beliefs. On the day of admission people are checked to see whether they have health issues that need quick action. Both people whose admission records were looked at were referred to differing specialists the day after they were admitted. Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 &10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home have good care plans to meet their current lifestyle and health needs. People are treated with respect and this means that generally people are happy in the home. EVIDENCE: We looked at the care records for one person fully and looked at parts of the care records for another five people. We found that all the people had care plans to meet the needs identified during the assessment or identified later. Care plans and risk assessments were well organised and information was easy to find. This means that staff have information about how the care is to be provided. Staff spoken to about the care of some of the people were knowledgeable about the individuals needs and knew what care they should be giving. Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 12 We looked at some of the monitoring charts for people who need assistance to ensure that they drink or need turning in bed and these were completed well. Care plans were reviewed on a monthly basis and this helps to ensure that any slow changes in peoples health can be identified. There was evidence on care plans that people were talked to about the care they need. Risk assessments were completed to identify problems with maintaining good skin condition, moving and handling, nutrition and the risk of falling. Where risks were found these resulted in plans being made to minimise the risks. Where a person displayed behaviour that challenges there were plans that looked at any triggers for the behaviour or any signs that the behaviour was about to occur so staff could redirect and minimise the effect for the person and other people living in the home. Risk assessments were in place for people that needed bed rails or other measures to ensure their safety at night and appropriate checks were being made about their fitment. Heath professionals commented about the home Good, detailed person centred care plans. Prompt response when faced with a problem in seeking outside help and advice. Provide a high quality of care to residents. People have checks on their health such as weights and blood pressures completed monthly; these do not have the day of the month recorded when they are completed. This should be noted as it helps to determine how serious any changes may be. People have access to health care professionals such as opticians, dentists and chiropodists on a regular basis and this helps to maintain peoples overall health. People appeared to have their personal hygiene needs met during the inspection. People were observed to have their nails and hair attended to, and people were dressed appropriately. People said about the care given to them They try to cater for all the individual needs of us residents. Our carers look after us with kindness and consideration. They take care of my needs and they are there for me if I need them. The home could do nothing better. I would recommend this place to anyone. We looked at the medication records for three people and found the following. The home has an appropriate procedure for managing peoples medication. These covered receipts of medications, storage, risk assessments for people who wanted to self administer medication, health and special arrangements for administering medication, security of and disposal of medication and what to do if there was an error when medication is wrongly given. Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 13 The home has made arrangements to ensure that medication is stored at the correct temperature. Most medication comes into the home in a monitored dose system which means that each tablet is set up for the time and day it should be given to the person and this makes it easier to spot any mistakes. Medication administration in this system looked at was correct. There were no gaps in the medication administration record (MAR) which shows that nurses take care when giving medication. We found a copy of a prescription for a person that was not recorded on the Medication Administration Record. We were told that the medication had been discontinued; we could not find a record of where this script had been returned to the GP or destroyed. One medication did not match the record and the person may have had more medication than they should. There was not enough distinction on the (MAR) when a medication had been refused and destroyed, rather than just refused and this made it difficult to audit one medication looked at. All other medications were correct except for one medication where the in stock medication had not been carried over. The staff member spoken to was knowledgeable about medication and its effects. One person spoken to about their medication said I always get medication not like the previous place I stayed. Audits have been undertaken to ensure that medication is correct but these may be useful later in the 28 day cycle. A health professional said The home organises the medication well and responds quickly to any queries regarding medication. The home is well organised in ordering and administration of medication. Staff spoken to about peoples privacy, respect, cultural and diversity needs were able to say how these needs could be met. We observed good interactions between staff and residents during our inspection. A health professional indicated on the comment form that the home was good at maintaining a persons privacy and dignity when they called and that they support people with their lifestyle choices. We are aware that the home operates within the gold standard framework for people who are receiving terminal care. However the people whose care we looked at, at this inspection, either did not have these needs or did not wish to discuss these needs with the home at the present time. Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home have an opportunity to be involved in activities and have some time out of the home if they wish. Activities enhance peoples lives. Relatives are made welcome in the home and this means that people receive visitors. People have meals prepared that they like and that are nutritious and this can improve their health. EVIDENCE: Information is collected about the interests people had prior to coming into the care home and what they like and dont like. An assessment is made about their strengths in interactions with people and their mood is assessed monthly. From this information activities are looked at. The home has an activity coordinator who works 25 hours per week, she tries to ensure that activities are available for people who spend time in the lounges and those people who like to spend time in their rooms. We observed during our time at the home people watching TV, listening to music, having their nails done, being assisted to knit, playing snakes and ladders and reading. Records showed that recently some people had enjoyed a pub meal; some people had a trip to the local shops and to the Botanical gardens. The home has had a visit from Benson, a dog petting Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 15 service, and this has been enjoyed by a number of people. The home has a singer come once a month and this according to resident meetings is looked forward to. Comment cards from people suggest that are usually enough activities, one relative thought more individual time would be beneficial and another thought that more use needs to be made of the garden. The homes Annual Quality Assurance Assessment detailed further developments they are considering to help people become more involved with the home such as undertaking tasks of laying tables. This can help people especially people with dementia. They also intend to set up a newsletter. The home has internet access and there is a visiting artist who attends the home. Staff in the home felt that this was an area where the home was improving. We received 4 comment cards for relatives and they said (The home) Answers phone promptly and can speak to the responsible person easily and questions are answered knowledgeably. Highbury did their best to facilitate visits with a meal with the patient and their relative (relative as also being cared for). They take care of my (relative) they are very polite and very friendly to us all. They could do nothing better. The home takes exceptionally good care of (my relatives) physical and medical needs and she is well fed. People are able to spend time in their rooms and generally are able to move around from place to place unrestricted. Some people do have times when this is not the case but in these circumstances the home can show that the risks to the person are very high. A person said I can get up when I want and go to bed when I want. People on admission to the home are seen by the chef who tries to determine what meals the person likes. One person said The food is good the cook comes up and asks me what I want and we have a laugh and a joke. The chef states that care staff make him aware of people who are of low weight so he can look to fortify their food. He also monitors any changes. There are printed menu plans for a number of weeks however these are changed should people want a change. Families can bring favourite foods in they wish but the chef will also try and get the recipe so he can reproduce it. Staff were able to tell us about peoples specific diets, lifestyle choices about food and the importance of presentation of food. There were adequate amounts of food available on the day and this was all stored appropriately. The home has several deliveries of food during the week so there is a good turnover of food supplies. Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in this home can be assured that their concerns are being listened to and this assists the home to ensure that they meet peoples needs. Procedures are in place and staff are aware of their responsibilities and this helps to ensure that people remain safe as possible. EVIDENCE: The home has a complaint procedure and a shortened version of this procedure is displayed in the reception area. Complaints are documented in a complaints log and this shows what happens to them, and the actions the home has taken if necessary. There are residents meetings and people are asked about their concerns and people have individual time where they can raise issues if they wish. The Homes Annual Quality Assurance Assessment stated that this is an area that they would like develop and are considering having a video to show people living in the home how they can raise their concerns. Although the record of complaints is better and more responsive than at the last inspection further could be done to capture all comments positive and negative about the home. People we spoke to who were able to say said they had no difficulty about raising concerns. Comment cards suggest that people are more aware that they can speak to people if they have concerns. Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 17 We are aware of an incident that has been referred to other agencies as part of safeguarding procedures. The outcome for this has yet to be determined. Staff spoken to on the day of the inspection were aware of their responsibilities under Safeguarding and Whistle blowing procedures. Staff are recruited appropriately and this helps to keep people safe. The majority of staff have had training on abuse, challenging behaviour and awareness training was to be undertaken on the Mental Capacity Act and Deprivation of Liberty. Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25,26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment was clean fresh and homely and this means people have a pleasant place to live. EVIDENCE: We looked around the home on the morning of the first day and at times throughout the inspection. We found that the home was clean and fresh. The decor in the home varied from room to room, some rooms had been decorated more recently than others. The manager said the home tries to ensure that rooms are redecorated as they are vacated. Consideration should be given to those people that have lived in the home for some time. There have been improvements to the home since the last inspection in July 2008 these improvements have been undertaken to try and make the home Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 19 more homely, with curtains replacing blinds in the main lounge, increasing the lighting in the lounge and pictures showing how Birmingham used to look adorning some of the corridors. The signage in the home had improved and a number of peoples bedroom doors had photographs of when they were younger, this helps people with memory difficulties remember which room is theirs. A person commented that better use could be made of the garden and that there needed to be more seating in that area. We looked in six bedrooms and found that these were clean and the equipment in place varied to the health needs of the person. The home ensures that equipment is checked to ensure that is still safe to use and the manager takes note of any national alerts where faults in equipment have been found. We found that people could bring in items that were important to them making the rooms more personalised. People that spend time in bed or in their room looked comfortable and well supported. We looked at some bathing areas and found these to be clean and useable areas. One bath temperature appeared to be too hot on examination. This was thought to be because of the changing pressure as the home has had new hot water tanks fitted very recently and this was dealt with immediately by the home manager and the homes maintenance person. The home had a good report when audited by the Health Promotion Agency and the recommendations made had been acted upon. The kitchen had been retiled and new fridges had been bought as part of the homes refurbishment programme. We had some comments that the laundry service needed to be improved to be consistently good. Staff spoken to were aware of the measures they needed to undertake to ensure that there is good infection control in the home. The management of the home had plans of what they wanted to achieve and this means that people can expect further improvement. Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home have the benefit of well trained and recruited staff in enough numbers to ensure peoples needs are met in a safe way. EVIDENCE: We were told that the home has on duty six care staff from 8 AM to 2 PM and two nurses, there are also ancillary staff including a person undertaking laundry, two housekeepers, a kitchen assistant and a chef. An administrator, an activities co-ordinator and a handyman work during the week. In the afternoon there are 5 care staff and 2 nurses on duty with a tea cook and at night there are 3 care staff and one nurse. Rotas looked at confirmed this staffing level. People spoken to and comment cards received showed that people generally got help when needed, we observed that the call alarms were responded with a reasonable time. We received one comment card that said people sometimes had to wait. Currently the home has 70 of staff trained to National Vocational Qualification level 2 in care or above. This means that most care staff have received training in how to care for older people. Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 21 We looked at 2 recent recruitments to the home and found that all the necessary checks were undertaken before staff were employed. This included application forms being completed, references being taken up, checks via the Criminal Records Bureau and the Protection of Vulnerable adults list this helps to ensure that people living in the home are safe from abuse. New staff started attending training courses shortly after starting work and this helps to ensure that they in key areas such as moving and handling people safely. We looked at the training of number of long standing members of staff and spoke to six staff. They had a wide range of job specific training and training about Health and care issues that may affect older people. A health professional commented There is a stable team of nurses and carers. They are always pleasant and helpful. Relatives and residents (where appropriate) report positive care experiences at this home. Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home want to continually improve the service and this means that people can be assured that their best interests are considered. EVIDENCE: The manager of the home became registered with us in 2008. She is a registered general nurse and has a specialist qualification in elderly care. She is also a National Vocational Qualification assessor and has completed the Registered Managers Award (The recognised qualification for managers of care home). She demonstrated at the inspection that she has kept her knowledge current including being aware of the new Mental Capacity Act legislation. Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 23 People spoken to were happy with the management of the home. For example one person said I came here on respite my home carers said they couldnt continue to care for me, I was so glad when Liz (the manager) said I could stay here. Staff commented that the management was supportive. The home has purchased a quality assurance system and is using this to assess their performance. There had been 6 residents meetings this year where activities, food and complaints had been discussed with people that attended. No concerns had been raised. The home had surveyed some visitors to the home in May 2009 and got 6 responses. These surveys showed that the home was rated as mostly good or excellent in all areas. Staff were having meetings and records showed that these meetings covered a range of topics intending to improve the service the home delivers. The home undertakes audits of equipment and issues such as falls. We looked at the audits of falls and accidents for 2009. We found that the home checked monthly where accidents and falls happen, at what time they happened, if equipment was or specific people were involved and what could be tried to lessen the chances of these accidents and incidents recurring. People are assisted if they need help with managing their money. Some people have their money held by solicitors or social services and the home requests money when needed to meet peoples hairdressing, clothing and chiropody needs etc. Some peoples relatives bring in money for them; some people manage their own money. We look at 3 records. Receipts were seen when money was spent. Generally the money was well ordered but we suggested that when money is audited there is a sign on the account record to say that the money is correct at that point to make it easier to spot any errors. We looked at some health and safety records for fire, gas, electrical and lifting equipment safety and found that the home had ensured that routine maintenance, checks and inspections had been carried out. Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action 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 OP1 Good Practice Recommendations The home should develop ways of providing information that is appropriate to the needs of the people considering the service and this should be given in a timely way to assist people making this choice. Further clarity is needed on the RNCC determination funds and what this means to full fee payers. Where peoples weights or other routine monthly check is being recorded the full date should be recorded this is to ensure that importance of any changes can be assessed. Medication still in stock at the end of the 28 day cycle should be carried forward on the next medication administration record unless returned to the pharmacy. A system must be put in place to ensure that medication that is refused and destroyed and medication that is refused and retained can be accounted for this to ensure medication can be audited. DS0000024854.V377315.R01.S.doc Version 5.2 Page 26 2 3 4 5 OP1 OP8 OP9 OP9 Highbury Nursing Home 6 7. OP9 OP36 Details about what has happened with prescriptions that have not been dispensed should be kept. Supervision of staff should be planned so that each member of staff giving care has supervision no less than 6 times a year. Not inspected on this occasion. Highbury Nursing Home DS0000024854.V377315.R01.S.doc Version 5.2 Page 27 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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. 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