Inspection on 01/09/06 for High Peak Nursing Home

This inspection was carried out on 1st September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

High Peak Nursing Home 09/05/07

High Peak Nursing Home 09/02/06

High Peak Nursing Home 22/08/05

High Peak Nursing Home 28/02/05

High Peak Nursing Home 26/07/04

High Peak Nursing Home 08/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE High Peak Nursing Home High Peak Nursing Home Main Lane Kenyon Warrington Cheshire WA3 4AZ Lead Inspector Wendy Smith Key Unannounced Inspection 10 am 1 September 2006 st X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Peak Nursing Home Address High Peak Nursing Home Main Lane Kenyon Warrington Cheshire WA3 4AZ 01925 764081 01925 768888 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) European Care (UK) Limited Lisa Marie Astley Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: The home is registered for a maximum of 41 service users in the category OP (old age not falling within any other category). Date of last inspection 9th February 2006 Brief Description of the Service: High Peak is a nursing home for older people set in a rural area between the towns of Warrington and Leigh. The home is registered for 41 older people, however a maximum of 35 places are now provided, all in single rooms, most of which have en-suite facilities. The building combines an adapted three storey country house with a two storey, purpose built extension. The building is spacious and is set in its own grounds. Bedrooms are on all three floors, with access to the upper storeys by staircases, passenger lift and stair lift. Staff areas, including the kitchen and laundry, are on the ground floor. The dining room and the main lounge are on the ground floor and there is also a sitting area on the first floor. The home provides good car parking space but is not accessible by public transport. Weekly fees are from £450 to £590. High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection process for High Peak included a site visit to the home on 1st September 2006 which was unannounced and was completed in five hours. Time was spent talking with the manager, staff and residents, and observing the day to day routines of the home and care staff as they provided support. The building was looked at to assess its suitability to provide a comfortable, homely and safe environment. A sample of care plans and other records was looked at and the arrangements for medicines were reviewed. Before the visit, comments cards were sent to the home for residents and relatives to complete, but only two were returned. Comments cards were also sent to GPs and other professionals who visit the home and positive comments were received from two GPs. The home manager provided written information prior to the visit. The home promotes equality by treating people as individuals and ensuring that diversity needs such as impaired mobility and gender are appropriately met. People who use the service confirmed that care staff are kind, caring and responsive to meeting individual’s needs. The home had 33 residents, the majority of whom were receiving nursing care. All rooms were singly occupied although some may be used as a shared room for two people by choice. What the service does well: What has improved since the last inspection? High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 6 Records are maintained to show that staff have attended regular fire drills. The manager is now registered with the Commission for Social Care Inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 7 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 High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have a full assessment before admission to the home to ensure that their needs can be met. High Peak does not provide intermediate care but does offer short stay places. EVIDENCE: Information provided by the manager indicated that 23 residents have been admitted to High Peak in the last 12 months. The home offers short stays as well as permanent places, and eleven rooms are contracted to the local Primary Care Trust. The manager or deputy goes out to assess prospective residents and details of the assessments were contained in their care plans. The care plans also contained pre-admission assessments that had been provided by social workers. High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 9 At the time of this visit one resident was very agitated and it was difficult for staff to pacify her. Her behaviour was disturbing for some of the other residents. Discussion with the home manager, and documentation in the resident’s care plan, showed that support and advice was being accessed from mental heath professionals to resolve the situation and ensure that this person can receive the care that she requires in an appropriate setting. There was evidence that close family were also involved in decision making. High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health needs of residents are monitored and provided for and this is recorded in their care plans. EVIDENCE: Each resident has a care plan that details their needs and how their needs are to be met. The care plans are lengthy and very comprehensive but had been kept up to date with a monthly review. The manager and deputy audit a sample of the care plans each week. At the time of the visit there were no ill residents and all were able to be out of bed for at least part of the day. Specialist chairs were used to provide support for residents who are frail and to enable them to spend time in the lounge with others. A small number choose to remain in their own room throughout the day High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 11 Two residents had pressure damage to their skin; one was almost completely healed. One resident has a pressure sore that is not extensive in size but is long-standing and proving difficult to heal. Her care plan showed that appropriate pressure relieving equipment was in use and that the tissue viability nurse had provided advice about dressings. Comments cards were received from two GPs who visit the home. One considered that High Peak is a ‘good friendly well run nursing home’ and that ‘on my visits there I am impressed with helpfulness of all staff’. The other rated the home as ‘probably better than average’. There is adequate storage for medicines and medicines are handled only by registered nurses. Medicine administration records indicated that residents receive their prescribed medication at the correct time, however the recording of the application of prescribed creams and ointments needs to be improved. Some old stocks, including controlled drugs, need to be disposed of without delay as they should not be kept in the home. An oxygen warning notice is needed on the medicine room door to comply with fire regulations. High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to exercise choices in daily living and can join in social activities if they wish to and are able. EVIDENCE: The home employs a social activities organiser in the afternoons and various trips and activities are provided for any residents who wish to join in. A minibus is available for trips out and is used regularly. An area of the lounge is set aside for activities and on the day of the visit one resident was enjoying a game of dominoes with a member of staff and another was doing artwork. The main lounge is very large and it is not conducive to residents and visitors being able to have private conversations. The manager is considering rearranging the communal areas to make two lounge/dining rooms instead of one very large lounge and separate dining room. This would give a greater choice to residents and create some quieter sitting areas. Visitors are welcomed at all times of day. High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 13 The daily menus do not detail a choice of main course however the manager confirmed that the cooks are always able to provide an alternative for any resident who does not want to have the meal on the menu and gave examples of residents who have particular food preferences. A relative said that the meals are excellent and the lunch served during the visit was enjoyed by residents. High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints and concerns are addressed and responded to but not all staff have attended adult protection training. EVIDENCE: The home has a complaints procedure and records are kept of any complaints or concerns expressed. The records showed that no serious complaints had been received but two issues raised by a relative and a neighbour were taken seriously and addressed by the manager. A relative commented that she had asked for a meeting with her mother’s key worker and felt that her concerns had been listened to. The provider, European Care, does not provide any adult protection training and it is the responsibility of the home manager to access outside training for staff. However the manager does not have an allocated budget to fund the training. Some staff have attended adult protection training but the more recently recruited staff have not had this opportunity. High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In general the accommodation is of a good standard but the company has not addressed issues identified as requiring attention. EVIDENCE: The interior of the home is generally in good condition and is comfortable, clean and safe for residents. Residents spoken with were very happy with their bedrooms. There is a spacious well-stocked garden at the back of the home that is accessible for residents to enjoy. During visits to the home in August 2005 and February 2006 it was identified that two of the home’s bathrooms are out of use and awaiting repair/refurbishment. There has been no progress in restoring the bathrooms. The large bathroom on the ground floor is also in poor condition and does not provide a pleasant environment for residents to enjoy a bath. High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 16 The floor is badly marked and there was an unpleasant smell of urine. The manager said that this bathroom always has an unpleasant smell as it is the only room that is big enough for a hoist to be used when taking residents to the toilet and a large number of continence pads are changed and disposed of in this bathroom. During previous visits to the home it has also been noticed that some windows are in a poor state of repair/decoration and there has been no progress in address this. During recent wet weather, water had been leaking in through a ceiling at the top of a staircase. Staff said that water had been ‘pouring in’ and had caused the smoke alarm to keep activating. The water has also affected an adjacent light fitting, presenting a fire hazard. The manager was trying to obtain authorization for repairs to be carried out but it appeared that there is a lengthy process of authorization by a number of senior staff before the roof can be repaired. High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Enough staff are provided to meet the needs of residents and good recruitment practices are followed, however European Care does not provide training for staff to ensure that they are able to work competently and safely. EVIDENCE: The home employs ten nurses, 22 care staff and eleven anciliary staff. Staffing rotas showed that there is always a registered nurse on duty, usually two in a morning. There are five or six care staff in a morning, four or five care staff in an afternoon/evening and three at night. A relative commented that there are always plenty of staff on duty but that the staff seemed to all disappear for a meal break at the same time. This was discussed with the manager who said that staff go for their breaks in two groups so that there is always a minimum of two staff on the floor however they may be in a bathroom or a resident’s bedroom. Eight care staff have a national vocational qualification in care, four are currently working towards this and eight are waiting for places. Training for new staff is provided by experienced senior carer staff. The home has the opportunity to access the induction training provided by Warrington Borough Council free of charge but the manager said that she is not able to pay staff for the time spent attending the training. High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 18 The supervision records for three staff employed at the home for about six months showed that they had all requested training in moving and handling and other important topics. A training matrix prepared by the manager showed the training that staff have received over the last year. It showed that 31 staff had not received moving and handling training for more than a year, and this is not acceptable. All kitchen staff, and some care staff have completed food hygiene training. Some, but not all staff, have attended infection control and adult protection training. Records available showed that all staff working in the home have an enhanced Criminal Records Bureau disclosure and new staff are not employed until satisfactory references are received. High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 37 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has a registered manager but the manager is not always supported to ensure that the home is run in the best interests of service users. EVIDENCE: The manager has been in post for almost a year and is now registered with the Commission for Social Care Inspection. She is a registered nurse with limited previous management experience but she has not yet started working towards a management qualification. She said that this is due to funding difficulties. High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 20 The manager is supernumerary to the staff rota and the deputy manager is also allocated some management time to carry out auditing. A sample of care plans is audited each week and there are also medicines audits and food hygiene audits. Residents and relatives meetings are arranged three times a year but are poorly attended despite trying different times of day. Regular staff meetings are held and there had been meetings for all staff groups within the last five weeks. A system of staff appraisal and supervision is in place. Satisfaction surveys are sent out each month to a sample of residents but few are returned. An administrator is employed to deal with day to day financial procedures in the home. Residents are able to keep small amounts of personal spending money in safekeeping and the administrator keeps satisfactory records of this. A full health and safety audit of the home was carried out in December 2005. This highlighted windows in need of attention and causing draughts. The manager has prepared a list of repairs, equipment and services needed in order of priority and has submitted this to European Care. The list includes moving and handling training, refurbishment of bathrooms, outside painting and repairs to windows, redecoration of the reception area, deep clean of the kitchen, a new dishwasher, a special chair for a resident, more pressure mattresses, and a medical fridge. These are all necessary, not luxury items, but it appears that there is a significant delay in agreeing finance which is very frustrating for the manager. Three requirements made following the last visit to the home have not been addressed due to funding not being made available. The training matrix that 31 staff had not received moving and handling training for more than a year, and this is not acceptable. Health and safety records were inspected and showed that equipment in the home is regularly serviced and maintained. The fire log book showed that weekly alarm tests and emergency lighting tests are carried out by the home’s maintenance person. Regular fire drills are carried out and a list of staff attending is kept. The manager has completed a fire risk assessment and intends to check this with the fire trainer, who is booked to carry out fire safety training for all staff in October 2006. Not all serious accidents and untoward incidents had been notified to the Commission for Social Care Inspection. This was discussed with the manager and addressed immediately. High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 1 3 X 2 2 High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP21 Regulation 23(2)( j) and (n) Requirement Bathing facilities must be provided to meet the needs of residents. (Timescale of 30/11/05 and 30/04/06 not met) Some windows need to be repainted and repaired. (Timescale of 30/04/06 not met) Moving and handling instruction must be provided for staff by a suitably qualified person. (Timescale of 30/04/06 not met) Timescale for action 31/12/06 2. OP19 23(2)(b) 31/12/06 3. OP38 13(5) and (6) 31/12/06 4. 5. 6. OP9 OP19 OP30 13(2) 23(2)(b) 18(1)(c)i Dispose of unused medicines in a 30/09/06 timely manner. Repair the leaking roof Ensure that new staff receive the training they require to do their work. 30/09/06 30/09/06 High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 23 7. OP31 18(1)(c)ii Ensure that the manager has suitable assistance to achieve a management qualification. 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations High Peak Nursing Home DS0000005170.V299596.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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