Inspection on 06/01/06 for Highbeech Care Home

This inspection was carried out on 6th January 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

Highbeech Care Home 08/10/08

Highbeech Care Home 07/11/06

Highbeech Care Home 20/06/05

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 Inspection 6th January 2006 10:00 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 Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 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. Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Highbeech Care Home Address 124 Dorset Road Bexhill On Sea East Sussex TN40 2HT 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) 01424 221034 Galleon Care Homes Limited Mr Ashdown Mrs May Care Home 27 Category(ies) of Dementia - over 65 years of age (27) registration, with number of places Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Only service users who have a dementia type illness are to be accommodated Service users should be aged sixty five (65) years or over on admission That no more that twenty seven (27) service users are to be accommodated That one named resident can be accommodated who is under sixty five (65) years of age. 20th June 2005 Date of last inspection Brief Description of the Service: Highbeech is a care home registered to provide care for 27 older people with a dementia type illness. It is owned by Galleon Care Homes, who also own two other homes in the area. The home is situated in a quiet residential area of Bexhill-on-Sea close to local shops, churches, pubs and other community facilities. The building was refurbished approximately three years ago and is purposely designed and planned for older people. It provides well-decorated, spacious and bright accommodation. Residents bedrooms are located over 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 21 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 when the weather permits. Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 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 will be referred to as ‘residents’. This unannounced inspection took place on Friday 06th January 2006 between 10:00am and 3:45pm. The inspection began by having discussions with the Registered Manager of the home in respect of progress made since the last report, followed by an inspection of the premises and its facilities. In order to gather evidence on how the home is performing, individual discussions took place with three visiting relatives/friends and two care assistants. A small number of residents were spoken with over the lunchtime period, the Inspector having been invited to join them for lunch, although because of the difficulty many residents at the home have in relation to comprehension and understanding, not all residents were able to fully express their views about the home and the service provided. 25 residents were accommodated at the time of the inspection. Other records and documentation inspected included: three individual care records, medication procedures, the provision of food, home’s complaints procedure and systems in place for the protection of vulnerable adults, quality assurance systems, staffing levels, staff recruitment files, the management of residents’ finances and a sample of health and safety certificates. In order that a balanced and thorough view of the home is obtained, this inspection report should to be read in conjunction with the previous inspection report carried out on 20th June 2005. What the service does well: Highbeech is a well-managed service that provides a high standard of care to the residents accommodated at the home. It is adequately staffed by experienced and suitably trained care assistants. The environment is exceptionally well maintained, which one of the visitors said makes it ‘a cut above the rest’. Visitors are made welcome by the home throughout the day, without restriction. The provision of food and activities are also managed well. There is evidence that feedback from residents and others is sought and acted upon. Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 Page 6 What has improved since the last 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. Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 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 Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 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. All residents are assessed by the Registered Manager prior to admission; this helps to ensure that no one is admitted to the home whose needs cannot be met. EVIDENCE: Two of the relatives/visitors spoken with said that friends had initially recommended the home to them. They both had the opportunity to visit the home informally on an unannounced basis in order to have a look around. One visitor commented that her first impression was good. She found the Registered Manager to be approachable, honest and open and the overall environment to be ‘impeccably clean’ and ‘a cut above the rest’. Three individual pre-admission assessments were seen on the day of inspection, all of which had been completed by the Registered Manager. It was pleasing to note that since the last inspection, the home has amended the forms in order to allow for thorough detailed information to be recorded in relation to individuals’ mental health state and cognition. It was noted however that one of the assessments had not being dated; it was therefore Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 Page 9 unclear as to whether the assessment had actually taken place prior to admission. It is also required for the Registered Manager to record details of those present at the time of the assessment. This will help to provide evidence that there has been appropriate consultation with the prospective resident and/or a representative. Intermediate care is not provided. Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 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, 9 and 10. Whilst residents’ personal care needs are mostly met by the home’s care planning procedures, they fail to provide specialist guidance for those with additional healthcare needs. This has the potential to place residents at risk. All residents are treated with kindness, dignity and respect. EVIDENCE: Staff confirmed that the home currently uses a keyworker system. This means that each resident has an identified person who is responsible for devising his or her plan of care and ensuring that it is regularly updated. The home uses a recognised care-planning format (Nursing Standex). Long-term care needs assessments were complete and were found to provide staff with sufficient information and guidance to follow in relation to providing personal care. During conversation with one of the care assistants on duty, it emerged that three of the residents living in the home have epilepsy, yet staff were unable to describe the different types of seizures, individual seizure patterns, medication use or emergency procedures. In addition there was no record of these issues being highlighted within individual care plans. This was discussed at length with the Registered Manager, who promptly arranged for epilepsy Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 Page 11 training. This is due to take place at the end of January 2006. The home is required to devise clear epilepsy guidelines for each of the named residents. Although on the whole the current care-planning format is adequate to meet the assessed needs of residents, they are more suited for residents in need of nursing care. Discussions took place with the Registered Manager in respect of reviewing the current arrangements in order to make the care plans more resident focussed and individual to each person. This may encourage residents and their relatives to become more involved in the care planning process. The home’s medicine storage and administration systems were viewed. The home uses a monitored dosage system, provided by the local pharmacy. Whilst all medicines were found to be stored appropriately and clearly labelled, it was noted that two tablets had been removed from one of the blister packs, presumably in error, yet there was no record of this. The home is required to have a medication error policy and procedure in place. This should encourage staff to report any errors no matter how minor. This will help to support the home to identify any faults in their current procedures and training needs for staff. In addition it was disappointing to find that handwritten entries are still not being countersigned on the medication administration records. This is outstanding from the previous inspection report. All staff were observed to treat residents with kindness, dignity and respect from care assistants to housekeeping staff. Relatives and visitors to the home spoken with said that they always find this to be the case; residents are always dressed appropriately in their own clothing and are discreetly supported to have all personal care needs carried out in the privacy of their own rooms or bathrooms. Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 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. Residents are provided with a variety of stimulating and meaningful activities and are supported to maintain contact with family and friends. A varied, wholesome and nutritious diet is provided by the home. EVIDENCE: It was pleasing to note that each of the visitors commented very positively of the provision of different activities for residents. One commented that residents are always doing something such as: knitting, sewing listening to music, or going out and that staff always make an ‘extra effort’ for residents’ birthdays. An activities coordinator is employed to work for Galleon Care on a full-time basis. She shares her time between each of the homes. Leading up to the Christmas period, local carol singers visited the home and the home held a Christmas fair. In addition a number of residents were taken to a local pantomime. Visitors, staff and residents said that friends and relatives are always made to feel welcome at the home. There is no need to inform the home in advance, they just turn up. This was apparent on the day of inspection. They said that staff are always welcoming and never turn visitors away. Some family members visit daily. Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 Page 13 Residents spoken with said that they could get up and go to bed when they wanted. Their preferred routines and choices were recorded within their plans of care. Staff said that although the home has a bathing rota in place, times are flexible dependent on the needs and preferences of each resident. Two part-time cooks are employed by the home and have devised a four weekly rotational menu in place, which is changed on a seasonal basis. Alternative options are available on request such as sandwiches, omelettes or jacket potatoes. Menus are on display within the dining area, however are quite difficult to read and due to the cognitive abilities of the vast majority of residents are rarely ever read. A recommendation has been made for the home to consider using large, brightly coloured photos/pictures of food alongside the written menus. This may help to inform residents and help them to recognise what the choices are for lunch. All residents are encouraged to dine in the pleasantly decorated dining area. It was pleasing to find that since the previous inspection, the home has reviewed its staff lunch breaks to ensure that there are suitable numbers of staff on duty to support residents as necessary. The lunchtime period was found to be relaxed and staff were seen to offer discreet support to residents where needed. The Inspector spoke with staff regarding some of the difficulties that are often encountered in trying to encourage a person with a dementia type illness to maintain a healthy diet. A recommendation has been made for the home to seek advice from a community dietician in relation to this. Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 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): 18. The home has good systems in place to ensure that all residents are protected from harm, neglect and abuse. EVIDENCE: Concerns were raised during the previous inspection regarding the level of detail that was (or was not) being recorded in relation to complaints made to the home and the action that the home had taken to address any matters. It was pleasing to note that no complaints have been made to the home since the last inspection, however this will be followed up at subsequent inspections. Adult protection training was provided to a large number of care assistants in October 2005. Staff spoken with said that they found this to be helpful and informative. They appeared to have a good understanding of what constitutes abuse and the actions that they would take in the event of reporting suspected abuse. No alerts have been raised since the last inspection. Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 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, 21, 25 and 26. The standard of the environment within this home is exceptionally wellmaintained, thus providing residents with an attractive and homely place to live. EVIDENCE: Highbeech is maintained to a high standard throughout. All residents spend their days in either one of the two lounges or conservatory area on the lower ground level. In December 2005, the home converted an office on the top floor in to a bedroom with en-suite facilities. This increased its registration numbers from 26 to 27. A great deal of work has been carried out by the home to refurbish a number of bathrooms and shower facilities since the last inspection. Two have been converted in to shower rooms, whilst the medi-bath on the first floor has been removed and replaced with an assisted bath. All bathrooms have been completely retiled and updated. Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 Page 16 A small number of bedrooms were seen during the inspection. It was pleasing to note that all toiletries are now kept securely in residents’ bathrooms to prevent the unnecessary risks to the health or safety of residents. All visitors to the home commented on how clean and tidy the home is always kept. Carpets and upholstery are cleaned regularly. It was evident on the day of the inspection that housekeeping staff work tremendously hard to maintain a clean, safe and hygienic home. Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 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. Adequate numbers of suitably trained staff are employed to meet the assessed needs of residents. The procedures for the recruitment of staff do not ensure the safety of residents living in the home. EVIDENCE: The Registered Manager normally works Monday-Friday 8am-5pm. Staffing rotas confirmed that there is usually one senior carer on duty with an additional three care assistants in the morning and one senior carer with two care assistants in the afternoon. In addition to this there is usually a laundry person on duty, housekeeping and kitchen staff and a maintenance person. Of the 15 care assistants employed, six are trained to at least NVQ level 2 in care, whilst two are currently working towards this. One of the visitors spoken with said that they are ‘always impressed with the numbers of staff on duty’. Two staff recruitment files were checked on the day of the inspection. Whilst satisfactory documentation was in place for one newly appointed care assistant, it was concerning to note that another who had been appointed as a senior carer, was still awaiting a Criminal Record Bureau (CRB) check, yet was working unsupervised on the day of the inspection. It was reaffirmed to the Registered Manager that care staff who have received a Protection of Vulnerable Adults (POVA) First Check can only be employed subject to the induction and supervisory arrangements stipulated in the Care Standards Act 2000. An immediate requirement was issued. Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 Page 18 Care staff informed the Inspector that they have attended a number of training sessions since the last inspection including: fire training, manual handling and adult protection. Certificates of training were seen on the day of inspection. Further training due to take place between January and March 2006 includes: epilepsy, challenging behaviour in dementia, infection control and risk assessments. Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 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): 33, 34, 35 and 38. Highbeech is a well managed home that is run in the best interests of residents. EVIDENCE: Residents’ and relatives’ questionnaires were given out by the home in November 2005. The questionnaire covered the following areas: the overall care provided, staffing arrangements, the provision of activities and food, privacy and dignity and care planning. Whilst the results were published and made available for visitors to the home to see, they are organised in the form of a numerical list, which are not easy to read or understand. This is unfortunate as the outcome of the questionnaire is very positive for the home. From this survey, responses to questionnaires sent to staff members and a report carried out by the Registered Manager, Galleon Care have devised a draft development plan for the home for 2006. Copies of this can be requested from the home. Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 Page 20 Only one resident’s finances are managed by the home for purchases such as hairdressing, toiletries and outings. Only the Registered Manager has access to these. Clear written records for each transaction are kept including receipts. These were viewed and found to be in order. A number of the home’s health and safety checks and certificates were seen. It was pleasing to note that all equipment is regularly maintained and serviced. Certificates seen included the homes: gas safety record, servicing reports for laundry equipment, hoist maintenance, emergency lighting and fire alarm testing. An overdue test of the boiler is planned to take place within the next two weeks. Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 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 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 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 X 17 X 18 3 3 X 3 X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 3 3 X X 3 Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 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 OP3 Regulation 14(1)(2) Requirement That the date, time, place and those present at the time of the pre-admission assessment are recorded. That epilepsy guidelines are in place for all named residents who have epilepsy. These should be devised in accordance with advice sought from individual’s GP’s. That a medication error policy and procedure is implemented within the home and adhered to. Handwritten entries must be signed and countersigned on the homes medication and administration records [THIS IS OUTSTANDING FROM THE PREVIOUS INSPECTION REPORT] That supervisory arrangements are in place for staff working in the home with the minimum of a POVA First check [IMMEDIATE REQUIREMENT]. Timescale for action 06/01/06 2. OP7 15(1&2) 31/03/06 3. 4. OP9 OP9 13(2) 13(2) 17 & Sch 3 31/03/06 06/01/06 5. OP29 19 & Schedule 2 06/01/06 Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 Page 23 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. 3. Refer to Standard OP7 OP15 OP15 Good Practice Recommendations That the current care-planning format is reviewed in order to make them more resident focussed and individual to the person. That large brightly coloured photos/pictures of food are used in conjunction with the daily/weekly menus. That advice from a community dietician is sought in respect of working with older people who have a dementia-type illness. Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection East Sussex Area Office 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. Extracts may not be used or reproduced without the express permission of CSCI Highbeech Care Home DS0000014054.V276643.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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