Inspection on 09/05/07 for High Peak Nursing Home

This inspection was carried out on 9th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 01/09/06

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 Main Lane Kenyon Warrington Cheshire WA3 4AZ Lead Inspector Wendy Smith Unannounced Inspection 11:30 9th May 2007 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.V332803.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.V332803.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Peak Nursing Home Address 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 Stephen Gartside (proposed) 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.V332803.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 41 service users in the category OP (old age, not falling within any other category). 1st September 2006 Date of last inspection 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 34 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 and is set in its own grounds. Bedrooms are on all three floors, with restricted access to the second floor. The home is within easy reach of the motorway network but is not accessible by public transport. Weekly fees are from £515 to £554.80. High Peak Nursing Home DS0000005170.V332803.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place on 9th May 2007 and took three and a half hours. The home had 24 residents, all of whom are older people. A tour of the building, including all communal areas and some bedrooms, was completed. A sample of records was looked at and time was spent in conversation with the home manager, residents, staff and a visitor. Some of the information contained in this report is taken from the preinspection questionnaire that was completed by the manager. Comments cards were provided by the Commission for Social Care Inspection for residents, visitors and visiting professionals to give their views about the home but none were returned. What the service does well: What has improved since the last inspection? The large lounge and the dining room have been re-arranged to provide two lounge/dining rooms that are more homely and give greater choice to residents. The ground floor windows have been re-painted. A new bath has been installed in the first floor bathroom and the ground floor bathroom was cleaner, tidier and less cluttered. High Peak Nursing Home DS0000005170.V332803.R01.S.doc Version 5.2 Page 6 Some decorating had taken place and this had made the corridors lighter and brighter. Staff have had training relating to the protection of vulnerable adults so that they are aware of how to protect residents from abuse. Management records were kept in better order. 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. The summary of this inspection report can be made available in other formats on request. High Peak Nursing Home DS0000005170.V332803.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.V332803.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. 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. People who are interested in going to live at High Peak have an assessment of their needs to determine whether their needs can be met in full at the home. EVIDENCE: On 9th May 2007, 26 residents were living at High Peak; all were older people. The home offers short stays as well as permanent places and eleven rooms are contracted to the local Primary Care Trust. High Peak does not provide intermediate care. 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.V332803.R01.S.doc Version 5.2 Page 9 Information provided by the manager in a pre-inspection questionnaire indicated that fourteen residents have dementia, however it was evident that these people also had needs due to physical frailty. This was discussed during the visit and the manager considered that there were no residents who presented difficulty for staff in managing their condition at the present time, although there had been a recent incident of concern relating to two residents who lacked mental capacity. The manager said that European Care (who own the home) are currently reviewing the way forward for this service. Registration for the provision of dementia care may be necessary if the home continues to accommodate a high proportion of residents with dementia-related needs. High Peak Nursing Home DS0000005170.V332803.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. 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 and personal care 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 comprehensive but were kept up to date with monthly reviews. The manager and deputy audit a sample of six of the care plans each week. During the staff handover it was clear that the nurses are very familiar with the needs of the residents. At the time of the visit no residents were very ill and all were able to be out of bed for at least some of the time. 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.V332803.R01.S.doc Version 5.2 Page 11 Four residents had pressure damage to their skin; care plans showed that appropriate pressure relieving equipment was in use and that the tissue viability nurse or district nurse had provided advice about dressings. The recording of progress could be more detailed to include a full description of the wound at each change of dressings, and photographs would be helpful so that all staff can be aware whether healing is taking place or whether the treatment needs to be reviewed. 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. Some old stocks of controlled drugs need to be disposed of without delay as they should not be kept in the home. High Peak Nursing Home DS0000005170.V332803.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. 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 who are able can exercise choices in daily living and join in social activities if they wish. Residents enjoy a good standard of meals. 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. The large lounge and the dining room have been rearranged to provide two combined lounge/dining rooms. This has given a greater choice to residents and created smaller, more homely sitting areas. In general the residents have a high level of need including more than 50 who have dementia. Residents in the lounges seemed mainly to be unoccupied and there appeared to be little engagement between residents or between residents and staff. The manager said that he was working to introduce a more person-centred approach to their care and move away from fixed routines. High Peak Nursing Home DS0000005170.V332803.R01.S.doc Version 5.2 Page 13 Visitors are welcomed at all times of day. A visitor spoken with said that she visits her friend every week and has lunch with her. She considered that her friend was well cared for. The daily menus do not detail a choice of main course however the cook said that she is always able to provide an alternative for any resident who does not want to have the meal on the menu. A relative said that the meals are excellent and the lunch served during the visit was enjoyed by residents. High Peak Nursing Home DS0000005170.V332803.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place and are followed to ensure the protection of residents. EVIDENCE: The home has a complaints procedure and records are kept of any complaints or concerns expressed. One complaint had been received since the last visit and this had been recorded by the previous manager. Adult protection training was provided for all staff in April 2007. A recent adult protection incident was dealt with by the manager following the correct procedures. High Peak Nursing Home DS0000005170.V332803.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. 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. Residents live in a generally comfortable, clean and safe environment but issues previously identified as requiring attention have not all been addressed to ensure the comfort of residents. EVIDENCE: The interior of the home is generally in good condition and is comfortable, clean and safe for residents. The manager has arranged for a decorator to repaint the corridors and those that were completed looked very attractive, with brightly-coloured pictures and new curtains making these areas look light and bright. Residents spoken with were happy with their bedrooms. There is a spacious well-stocked garden at the back of the home that is accessible for residents to enjoy. High Peak Nursing Home DS0000005170.V332803.R01.S.doc Version 5.2 Page 16 The second floor bedrooms are accessible by stairs or by a stair lift and none of these rooms were occupied at the time of this visit. During visits to the home in August 2005, February 2006 and September 2006 it was noticed that two of the home’s bathrooms were out of use and awaiting repair/refurbishment, and a third bathroom was in poor condition. The large bathroom on the ground floor has now been cleaned and tidied, and a new bath, that is fully adjustable and can be moved in the room, has been installed in the first floor bathroom. Tiling and decorating work was not yet completed but residents were able to use the bath. Staff said that this had been a great improvement. The third bathroom remains out of use and the manager said that he intends to have it converted to a shower room. During previous visits to the home it has also been noticed that some windows are in a poor state of repair/decoration. Ground floor windows have now been repaired and repainted but the first floor windows remain in need of attention. A full health and safety audit of the home carried out in December 2005 highlighted windows in need of attention and causing draughts in some bedrooms. A large flat roof is covered with moss and also requires attention. All parts of the home, including the kitchen, were very clean. High Peak Nursing Home DS0000005170.V332803.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough qualified and experienced staff to meet the needs of residents. EVIDENCE: The home employs 13 nurses, 21 care assistants and ten ancillary staff. Eleven of the carers have a national vocational qualification in care and three more are working towards a qualification. Staffing levels have been maintained despite current low occupancy. In a morning there are two nurses on duty with either four or five carers. In the afternoon and evening there is one nurse and four carers and at night one nurse and three carers. On weekdays there are either two or three housekeepers on duty with one at the weekend, and there is a laundry assistant each day. Recruitment records for the two most recently employed staff were looked at. These showed that good procedures had been followed and included Criminal Records Bureau disclosures and two references. High Peak Nursing Home DS0000005170.V332803.R01.S.doc Version 5.2 Page 18 The manager said that he has spent a long time sorting through staff training and supervision records and trying to get them in order. He intends to develop a matrix to show what training is due for each member of staff. Moving and handling training was provided for all care staff in December 2006. The home does not have an in-house trainer for moving and handling which means that new staff may have to wait a while before they have this training. They should not assist residents with mobility difficulties until they have been trained how to do this safely. One of the more experienced carers said that she was working as mentor with a new member of staff. She was working through the company’s induction programme with the new person, who was making good progress. European Care is planning to provide a development programme for nurses. A questionnaire has been sent to each of the nurses employed asking them about their training needs. It is a positive development that the company is taking a more active role in staff training. High Peak Nursing Home DS0000005170.V332803.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an experienced manager who is committed to taking the service forward for the benefit of residents. EVIDENCE: A new manager was appointed in November 2006. He is a registered nurse with previous experience as a home manager. He has completed a national vocational qualification level 4 in management and has applied to be registered with the Commission for Social Care Inspection High Peak Nursing Home DS0000005170.V332803.R01.S.doc Version 5.2 Page 20 The manager said that he has identified a number of areas where the service can improve. Work was in progress to re-decorate communal areas, new care plans are to be introduced, and record keeping was improving. He considered that he received good support from head office and had been able to buy any equipment needed for the care of residents, including four new nursing beds this year. The manager has held meetings for all groups of staff and has a monthly wine and cheese evening for residents and their families to come and share their views. As part of a recent satisfaction survey, eight questionnaires were sent out but only one was returned. Monthly visits to the home are carried out by the area manager and a comprehensive report follows each visit. Each week six care plans are audited and there are also regular audits of accidents, medicines and pressure sore. Accident records showed no serious injuries and no areas of concern. 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. Information provided by the manager indicated that all plant and equipment is regularly tested, serviced and maintained in good order. Fire alarm testing is done weekly and a fire drill is held every two months at different times of day. A record is kept of which staff attended. High Peak Nursing Home DS0000005170.V332803.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 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 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 3 X 3 X 3 X X 3 High Peak Nursing Home DS0000005170.V332803.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes High Peak Nursing Home DS0000005170.V332803.R01.S.doc Version 5.2 Page 23 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 OP19 Regulation 23(2)(b) Timescale for action Some windows need to be re- 31/07/07 painted and repaired, in particular those that cause bedrooms to be draughty. (Timescales of 30/04/06 and 31/12/06 not met) Requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Care plans should contain a detailed record of the progress of any wounds requiring dressings so that all of the nurses are able to measure whether healing is taking place or whether the treatment needs to be changed. Unused controlled drugs should not be kept in the home and must be disposed of without delay. Ensure that new staff receive moving and handling training before they provide care to residents with mobility difficulties. 2 3 OP9 OP30 High Peak Nursing Home DS0000005170.V332803.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: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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