Inspection on 20/06/05 for Highbeech Care Home

This inspection was carried out on 20th June 2005.

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

Other inspections for this house

Highbeech Care Home 08/10/08

Highbeech Care Home 07/11/06

Highbeech Care Home 06/01/06

Highbeech Care Home 14/12/04

Highbeech Care Home 06/07/04

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

CARE HOMES FOR OLDER PEOPLE Highbeech Care Home 124 Dorset Road Bexhill on Sea East Sussex TN40 2HT Lead Inspector Niki Palmer Unannounced 20 June 2005 10:20 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 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. Highbeech Care Home H59-H10 S14054 Highbeech V230168 200605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Highbeech Care Home Address 124 Dorset Road Bexhill on Sea East Sussex TN40 2HT 01424 221034 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Galleon Care Homes Ltd Mrs May Care Home (CRH) 26 Category(ies) of Dementia - over 65 years of age (DE(E)) 26 registration, with number of places Highbeech Care Home H59-H10 S14054 Highbeech V230168 200605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only residents who have a dementia type illness are to be accommodated. 2. Residents should be aged sixty five (65) years or over on admission. 3. That no more than twenty six (26) residents are to be accommodated. 4. That one named resident can be accommodated who is under sixty five (65) years of age. Date of last inspection 14 December 2004 Brief Description of the Service: Highbeech is a care home registered to provide care for 26 older people with dementia. It is owned by Galleon Care Homes, who also own two other homes in the area. The home is situated in a residential area of Bexhill on Sea close to local shops, churches, pubs and other community facilities. The building was refurbished approximately two years ago and is purposely designed and planned for older people. It provides a well-decorated, spacious and bright accommodation. Residents bedrooms are on three floors, with the dining room and lounge on the lower ground floor. A shaft lift is provided which enables residents to access all floors. The home comprises of 20 single bedrooms and three shared. There is a large garden and patio to the rear of the property, which is well-maintained and accessible to residents. Highbeech Care Home H59-H10 S14054 Highbeech V230168 200605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Highbeech Care Home will be referred to as ‘residents’. This unannounced inspection took place on a Monday between 10.20am and 2.30pm. The inspection began with discussions with the registered provider of the care home (in the absence of the registered manager) in respect of progress made since the last inspection, followed by the examination of six care records. In order to gather evidence on how the home is performing, individual discussions took place with two residents, whilst others commented on their care during lunchtime, the inspector having been invited to join them for a meal. In addition, four care staff were spoken with during the visit, and also visiting relatives. A detailed inspection of the premises and its facilities took place. 25 residents were accommodated at the time of the inspection. What the service does well: What has improved since the last inspection? The previous inspection report highlighted poor practices in relation to the recruitment of staff. Since this time the home has worked to improve their procedures to safeguard the welfare of residents. Highbeech Care Home H59-H10 S14054 Highbeech V230168 200605 Stage 4.doc Version 1.30 Page 6 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. Highbeech Care Home H59-H10 S14054 Highbeech V230168 200605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Highbeech Care Home H59-H10 S14054 Highbeech V230168 200605 Stage 4.doc Version 1.30 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 standard(s) 1, 3 and 6. Prospective residents and their families are provided with detailed information to support their decision to move to the home. The home needs to improve its pre-admission assessment process. EVIDENCE: Both the Statement of Purpose and Service User Guide were found to be very detailed and comprise the service user and relatives’ information folder, which is on display in the entrance hall. This file also contains details of the home’s complaints procedure, most recent inspection report, terms and conditions of contract, information on local health services and visitors comments. One of the relatives spoken with during the inspection said that she found this information ‘very useful’ when choosing a home for her relative. Highbeech Care Home H59-H10 S14054 Highbeech V230168 200605 Stage 4.doc Version 1.30 Page 9 One of the relatives confirmed that her relative was assessed by the registered manager prior to his admission at his previous home. On the day of inspection access to some records was difficult as the registered manager is currently on long-term sickness and the acting manager was on annual leave; therefore it was not possible to locate a sample of the home’s most recent pre-admission assessments. Only one was found, which was not considered to be detailed enough. Details of the individual’s mental state and cognition had not been recorded, which is imperative of a care home providing nursing support to residents with a dementia type illness. In addition the pre-assessment seen did not provide a risk assessment for falls, or details of how the home could meet their assessed needs. Intermediate care is not provided. Highbeech Care Home H59-H10 S14054 Highbeech V230168 200605 Stage 4.doc Version 1.30 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 standard(s) 7, 8 and 9. The assessed needs of residents are met by the homes care planning procedures, however detailed information regarding other aspects of healthcare need to be clearly recorded. EVIDENCE: Four individual care plans were seen during the inspection. Long-term care needs had been identified and a number of risk assessments were in place, including the prevention of falls and use of bed rails. There was evidence that professional advice is sought on an individual basis from the local Community Mental Health Team and district nursing team, however it was not clear from the care plans what their level of input was or why it was required. It was concerning to note that there was no record of the cause of death of a recently deceased resident or that there was any evidence of any subsequent contact with the family. In addition there was no evidence to confirm that care plans are shared with residents or their relatives. Highbeech Care Home H59-H10 S14054 Highbeech V230168 200605 Stage 4.doc Version 1.30 Page 11 The homes medicine storage and administration system was viewed. The home uses a monitored dosage system provided by the local pharmacy. All medicines were found to be stored appropriately and clearly labelled, however handwritten entries on the medication administration records had not been signed or countersigned. The home has clear policies and procedures in place regarding the use of homely remedies and controlled drugs. There were no prescribed controlled drugs in the home on the day of inspection. Recent medication training has been provided to all staff. Highbeech Care Home H59-H10 S14054 Highbeech V230168 200605 Stage 4.doc Version 1.30 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 standard(s) 15. The home offers residents a variety of food that is balanced and nutritious, however care staff need to ensure that additional support is given to those that need it. EVIDENCE: Two part-time cooks are employed by the home and have devised a four weekly rotational menu. Alternative options are available on request such as salads, omelettes or jacket potatoes. On the day of inspection residents were misinformed by care staff regarding the lunchtime meal as the weekly menu had not been changed in the dining area. The dining area was found to be rather busy and quite disruptive on the day of inspection; one particular resident found it difficult to settle and continually got up from the table to wander, consequently only eating a small amount of the food provided. Two of the residents required one to one support from care staff. It was concerning to note that they were kept separate from the other residents and were assisted to eat in the conservatory area in inappropriate seating. A requirement has been made in respect of the mealtime arrangements. Highbeech Care Home H59-H10 S14054 Highbeech V230168 200605 Stage 4.doc Version 1.30 Page 13 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 standard(s) 16 and 18. Although the home has adequate policies and procedures in place, Adult Protection training is required for all staff to ensure that residents are safeguarded from the risk of abuse, harm and neglect. EVIDENCE: The home has a very detailed complaints procedure in place, which is provided to all residents and their relatives on admission. This was confirmed by one of the relatives spoken with. A copy of the procedure is kept in the home’s information folder. A record of all complaints received by the home are stored centrally, however on inspection records did not clearly identify what the nature of the complaint was or how it was dealt with. The home last updated its Adult Protection and Whistle blowing policy in September 2004. It was found to be thorough and contained details of different types of abuse and reporting suspected abuse. Staff spoken with said that they had not received any Adult Protection training. A requirement has been made in respect of this. Highbeech Care Home H59-H10 S14054 Highbeech V230168 200605 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19, 20, 21, 24, and 25. Highbeech provides residents with a safe, comfortable and well-maintained place to live. EVIDENCE: Highbeech is maintained to a good standard throughout. All residents spend their days in either one of the two lounges, conservatory area or garden on the lower ground level. One of the relatives spoken with stated that she liked the layout of the home, as all stairways are inaccessible to residents and therefore prevent them from wandering or falling down the stairs. Fourteen of the bedrooms have en-suite facilities. In addition there are 12 toilets for communal use plus seven bathrooms, including assisted baths and a portable hoist. It was noted in one of the bathrooms that the tiles surrounding the bath appeared worn, and in addition no blinds or curtains are in place in any of the bathrooms. It was concerning to note in another of the bathrooms that an older style bath that is no longer in use is being used to store buckets and mops. Highbeech Care Home H59-H10 S14054 Highbeech V230168 200605 Stage 4.doc Version 1.30 Page 15 A large number of the bedrooms were seen on the day of inspection. All were pleasantly decorated and reflected residents individual personalities, however one room was noted to be odorous. The vast majority of residents had their own furniture including: a television, video recorder, chairs, lamps and clocks. Gas fired central heating is provided throughout the home. All windows are restricted and all radiators are guarded to ensure the health and safety of residents. It was concerning to note that a number of personal toiletries were kept unsecured in many of the en-suite bathrooms. Highbeech Care Home H59-H10 S14054 Highbeech V230168 200605 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 29. This home has adequate recruitment procedures in place to safeguard the welfare of residents. EVIDENCE: Since the last inspection the home has worked hard to develop it’s recruitment procedures. Four staff recruitment files were seen, and all were found to contain photo identification, two suitable written references, a Criminal Record Bureau (CRB) and Protection Of Vulnerable Adults (POVA) check. In addition application forms and job descriptions were seen. On the day of inspection an agency carer was on duty who said that she has worked at the home on a number of occasions and that she finds the standard of care to be ‘high’. Highbeech Care Home H59-H10 S14054 Highbeech V230168 200605 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31. In the absence of the registered manager the home have maintained acceptable levels of managerial input and management of the day-to-day running of the service. EVIDENCE: The current registered manager has been in post since 1998. She is currently signed off from work due to ill health. Details of the current arrangements in place to manage the home in her absence are on display in the entrance area for visitors and residents to see. The home has employed an experienced person to cover this period; unfortunately she was on leave on the day of inspection. The registered persons of the home are always actively involved in the day-to-day concerns of the home and are available to deal with any query or concern. Highbeech Care Home H59-H10 S14054 Highbeech V230168 200605 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 1 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 1 COMPLAINTS AND PROTECTION 3 3 1 x x 3 2 x STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 3 x x x x x x x Highbeech Care Home H59-H10 S14054 Highbeech V230168 200605 Stage 4.doc Version 1.30 Page 19 NO Are there any outstanding requirements from the last inspection? 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 OP3 Regulation 14(1)(2) 17 Schedule 3. Requirement That the homes pre-admission assessment record is reviewed and amended to include further details of individual needs. These must be stored appropriately and made available for inspection. Care plans must detail all care and nursing interventions, provide evidence that they have been shared with residents/relatives and record details of all contact with relatives. Handwritten entries must be signed and countersigned on the homes medication and administration records. Weekly menus need to accurately reflect the food that is offered. All residents must be supported at mealtimes in an inclusive and relaxed atmosphere. The home must maintain detailed records of all complaints made to the home, investigation and any action taken. Adult Protection training needs to be provided to all staff. Timescale for action 20/09/05 2. OP7 15(1)(2) With immediate effect. 3. OP9 4. 5. 6. OP15 OP15 OP16 13(2) 17 and Schedule 3. 12(1)(2) 16(2)(i) 17(2) and Schedule 4. 13(6) With immediate effect. With immediate effect. With immediate effect. With immediate effect. 20/09/05 7. OP18 Highbeech Care Home H59-H10 S14054 Highbeech V230168 200605 Stage 4.doc Version 1.30 Page 20 8. OP21 23(2)(b) (d) 9. OP21 10. OP25 That tiles are repaired/replaced in one of the bathrooms and that curtains or blinds are supplied in each. 13(3) That all buckets and mops are removed from bathrooms and stored appropriately and hygienically. 13(4)(a-c) All toiletries must be stored appropriately to safeguard residents. 20/09/05 With immediate effect. With immediate effect. 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. 2. Refer to Standard OP15 OP21 Good Practice Recommendations That care staff support all residents during mealtimes at the dining table. That the older style bath no longer in use is removed from the bathroom. Highbeech Care Home H59-H10 S14054 Highbeech V230168 200605 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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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