CARE HOMES FOR OLDER PEOPLE
Highbury House 580/582 Lytham Road South Shore Blackpool Lancashire FY4 1RB Lead Inspector
Mr Kevan Royston Unannounced Inspection 15 August 2007 09:00 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 Highbury House DS0000009750.V343056.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. Highbury House DS0000009750.V343056.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Highbury House Address 580/582 Lytham Road South Shore Blackpool Lancashire FY4 1RB 01253 344401 01253 402475 david.moseley@lineone.net 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) Mr David Moseley Mrs Barbara Selina Moseley Karen Carter Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Highbury House DS0000009750.V343056.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 30/08/07. Brief Description of the Service: Highbury House is situated in the south area of Blackpool close to Highfield Road shopping centre and near Blackpool airport and local bus routes. The home is registered for 28 older people of both sexes. The home is a large detached building with two lifts to access the second floor. There are garden areas to the front and rear of the property with seating provided for residents. The home provides en suite facilities and all but one room single occupancy. The bathroom and toilet facilities are situated for easy access for residents and aids and adaptations are fitted where required. The communal areas consist of two lounges with a conservatory and separate dining room. The fees for the home range from £326.50-£375.73. There are additional charges made for hairdressing and chiropody, which may vary. There is a statement of Purpose/Service user Guide, which is given to all prospective residents. This written information explains the care service that is offered, who the owners and staff are and what the resident can expect if he or she decides to live at the home. Highbury House DS0000009750.V343056.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit that took place on the 15/08/07 over a period of approximately 6.5 hours. We spoke to the homeowner six residents, the manager in charge, five members of staff, three people visiting and a group of residents sitting in the lounge to get their views of the home. As part of the inspection process we talked to people using the service and asked staff about those peoples needs. We also looked at their rooms, care plans, medical records and daily notes this is called case tracking. Other residents are invited to pass their opinions to us if they wish. The response from surveys sent to residents, GP surgeries and relatives for there views on how the home is run is good, seven completed questionnaires received from residents, three from relatives and five from doctors. Most comments were positive about the standard of care and support provided by the people working at Highbury House. We looked at records of two staff members. We walked around the building and watched people living and working to see how everyone supported and talked to each other. Looking at documentation, policies and procedures formed the basis of the inspection process. What the service does well:
Highbury House has achieved the “Investors In People Award” which means the service is run and operates to a high standard with good quality care provided to the residents to ensure they are well looked after and supported. The manager spoken to said, “Yes we have achieved the award and worked hard to get it”. There is a settled staff team with only one new staff member employed since the last inspection, enabling relationships to develop between staff and residents and provide a better understanding of resident’s wishes and needs. Staff spoken to said, “We have a very good staff team”. And, “Only one new member of staff everyone seems happy here”. A resident spoken to said, “They don’t change much staff”. Other comments from residents and relatives visiting said, “Caring staff”. And “They know my mums needs because they have been here together for a while which helps”.
Highbury House DS0000009750.V343056.R01.S.doc Version 5.2 Page 6 Watching staff helping and talking to residents was good, with staff members joining in with a sing-along in the lounge, which helps provide a good atmosphere in which to live in. Residents spoken to said, “Its nice when they join in”. And “We sit and get along with each other”. One member of staff said, “We can spend more time and chat to the residents”. We examined training records and talked with staff and the management team and found there are excellent training opportunities for all staff to attend and access courses in relation to their job role. This ensures the development of all staff and provides the skills and competencies required to support and provide good care for the residents. Staff spoken to said, “Yes I have done my National Vocational Qualification (NVQ) and thought it worthwhile”. Also “We are always encouraged to attend training courses”. The manager spoken to said, “We are putting forward senior carers to complete level 4 NVQ and the Registered Managers Award (RMA)”. What has improved since the last inspection? What they could do better:
Photographs of staff should be on record to ensure proof of identity of those staff employed at the home. One of the resident’s records we looked at did not have a recent photograph for identification purposes they should be done and kept on file.
Highbury House DS0000009750.V343056.R01.S.doc Version 5.2 Page 7 Monthly reports provided by a representative of the Company are required by regulations. These must be completed and kept on file for examination during inspections to ensure there is an overview of the management of the home. The reports can also show any developments that are taking place and comments made by residents on the running of the home. 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. Highbury House DS0000009750.V343056.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Highbury House DS0000009750.V343056.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. 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. The admission and assessment procedures were clear and precise to ensure the needs of the residents are met. EVIDENCE: We looked at four residents care records and found they had full assessment information recorded in detail. Residents funded by social services had been assessed by social workers with information on file for the management team to carry out there own assessment to develop a care plan and ensure all health, welfare and social needs are identified and recorded. One staff member spoken to said, “We try and make sure all social work assessments are in place”. A relative who sent in a survey said, “We were provided with enough information and went through my mothers care needs with the manager before she came in”. Standard 6 was not assessed, as the home does not provide intermediate care.
Highbury House DS0000009750.V343056.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. Promotion of health is taken seriously. Resident’s welfare is closely monitored and health needs are identified and met. EVIDENCE: Records of resident’s looked at, were accurate and had good information about their health, welfare and social care needs that supported the staff to maintain and promote each individuals daily needs. Care plans were up to date and regular reviews taking place with involvement of the residents and relatives where possible with good information of care provided ensuring the welfare and general wellbeing of residents is continuously monitored. Risk assessments were in place and had been updated in one case when a residents needs had changed. One member of staff said, “Risk assessments are looked at periodically however they are changed if a person needs have”. One resident spoken to said, “Once a month we go through issues about my health”. A relative survey commented, “Always kept informed about my mothers care”.
Highbury House DS0000009750.V343056.R01.S.doc Version 5.2 Page 11 We examined and observed medication records and medicines given out at lunchtime and found practices were good ensuring resident’s health is properly monitored and medicines administered are correct. Medication procedures have been updated to ensure medicines being administered are accurately identified to trained staff to provide safety and protection for the residents. One member of staff said, “Only trained staff give out the medication”. A resident said, “They are very careful with my medication”. We saw resident’s respect and privacy being observed by staff knocking on bedroom doors and supporting them to lounges to make sure all residents are treated properly. A survey returned by a relative commented, “Cares and looks after clients with dignity”. Resident’s comments included, “Nothing to much trouble”. And, “The staff all treat you with respect”. A member of staff said, “It’s not hard to be polite and respectful to residents it’s important”. Highbury House DS0000009750.V343056.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 and15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities and meals are both well managed, creative and provide daily variation and interest for people living in the home. EVIDENCE: Lunchtime meals were seen being prepared, and were wholesome, home baked with fresh produce used providing a nutritious meal. The cook was spoken to and said, “Yes we do some home baking”. Comments from residents and surveys completed confirmed the food to be good. Comments included, “Lovely food”. And, “Yes if I don’t like something they will always offer me something I do like. Meal times are set although flexible enough to accommodate preferences. One resident spoken to said, “I have my food in my room”. The cook spoken to said, “I have done my Food an Hygiene course”. Activities are centred on each individuals preferences ensuring flexibility and residents can enjoy their own personal interests, which are recorded on their care plan. One resident spoken to said, “ I like the sing- along in the lounge”. A member of staff spoken to said, “We have entertainers coming in regularly”.
Highbury House DS0000009750.V343056.R01.S.doc Version 5.2 Page 13 One resident said, “In the afternoon a member of staff will take me out if I want to”. There is a visitor’s policy, which allows friends and relatives to come any time of the day. One resident confirmed this and said, “Any time my son comes to take me out”. We Looked in some resident’s rooms and found personal belongings are allowed into the home so to create a homely atmosphere. One resident spoken to in her own room said, “Its lovely and cosy with all my family photos around me”. Highbury House DS0000009750.V343056.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. The arrangements for recording and reporting of complaints are good ensuring people feel listened to. The management team and staff have good knowledge and understanding of adult protection issues, which safeguards residents from abuse. EVIDENCE: There is a detailed complaints procedure, which is made available to all residents on admission and written in the Statement of Purpose and Service User Guide to ensure they feel protected. Residents and relatives in surveys returned confirmed all are aware of the complaints procedure and who to complain to. Comments included, “Yes but never had to”. And, “I would speak to the manager”. Staff spoken to said, “Complaints policies are given to us when we start work”. There have been no complaints since the previous inspection. We examined records and found there is a procedure and policy for dealing with allegations of abuse and safeguarding adults to protect people living at the home. One member of staff spoken to said, “My NVQ training covered issues and all kinds of abuse”. Highbury House DS0000009750.V343056.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 good. This judgement has been made using available evidence including a visit to this service. The environment is safe and clean maintained to a good standard providing comfortable surroundings for the residents. EVIDENCE: We had a walk around the building and found it to be very clean and tidy and maintained to a good standard ensuring residents live in a pleasant clean home. A comment from a relative visiting the home, “Always smells nice the place is kept clean”. One resident spoken to said, “The home is always kept clean”. We spoke to two domestic staff on duty and one said, “We keep on top of the cleaning”. There is a programme of maintenance and records are kept, one of the management team said, “Any problems are reported daily and acted upon promptly”.
Highbury House DS0000009750.V343056.R01.S.doc Version 5.2 Page 16 Some of the resident’s bedrooms have been redecorated and refurbished to improve the living accommodation for the residents. One resident spoken to said, “Its nice and clean my room its just been painted”. There are policies and guidance for laundry processes and for the control of infection ensuring the home is kept clean, pleasant and hygienic. Highbury House DS0000009750.V343056.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. The procedures for the recruitment of staff are good ensuring the safety and protection of the residents by ensuring only suitable staff are employed. Training for staff is good and enables them to have the skills and competencies for their roles. EVIDENCE: Observation of staff working at the time of the visit, examination of rotas and discussion with the manager and staff confirmed there were sufficient numbers on duty to ensure the resident’s needs are being met. One member of staff spoken to said, “ There is more than enough care staff on duty”. Residents spoken to said, “There is always someone to talk to if you want.” And “The girls always have time for me”. A comment from a GP from a survey returned said, “Plenty of staff very caring”. Examination of two staff files confirmed the recruitment procedures of the home are good ensuring the protection of the residents is maintained. Staff records include, application forms, Criminal Records Bureau (CRB) disclosures, Protection of Vulnerable Adults (POVA) disclosures and references, all in place prior to employment. However not all photographs of staff were on record. They should be put each staff member file for identification purposes.
Highbury House DS0000009750.V343056.R01.S.doc Version 5.2 Page 18 Records show training is ongoing and there is over 90 of care staff that has completed National Vocational Qualification (NVQ) level 2 in care. Discussion with staff confirmed training is accessible and the management team encourage staff to attend courses to develop their skills. Records are kept of staff training and the manager said, “We are now putting forward senior carers to complete their RMA and level 4 NVQ”. A member of staff said, “I don’t have a problem to access any courses I feel would help me the manager is supportive”. Highbury House DS0000009750.V343056.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): 31,33,35,37 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 is managed well, with systems and policies in place for the protection and safety of staff and residents. EVIDENCE: The manager has the necessary skills and experience required to support the staff and residents and enable the home to meet its stated purpose and objectives. Surveys returned from residents and relatives commented on how well the home is run, comments included, “Nothing is to much trouble” and “The place
Highbury House DS0000009750.V343056.R01.S.doc Version 5.2 Page 20 runs smoothly”. A member of staff spoken to said, “The manager has always got time for you”. We examined records of residents and found they are comprehensive, well written and up to date ensuring the correct information is available and health and welfare needs are continuously monitored. Records show the management team has good systems to gather staff, residents and relative’s views to enable ongoing improvements to the home. Staff and resident meetings are held and records confirm they take place on a regular basis ensuring there views are listened to and implemented if agreed it would improve things. Relative surveys are sent out annually for there views and opinions on how everything is run and to ensure they feel the home operates smoothly, any suggestions for improvements are put in writing. Monthly reports provided by a representative of the Company are required by regulations. These must be completed and kept on file for examination during inspections to ensure there is an overview of the management of the home that can show any developments that are taking place and comment on the running of the home. We looked at records and found regular tests to emergency lighting, fire procedures, electrical appliances, the lift and fire extinguishers had been carried out ensuring the safety of residents and staff is maintained. Highbury House DS0000009750.V343056.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 2 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 Highbury House DS0000009750.V343056.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP37 Regulation 26 Requirement A responsible person must undertake monthly unannounced visits to the home, with a record of the outcomes of the visit kept in the home for inspection purposes. Timescale for action 30/09/07 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 OP29 OP7 Good Practice Recommendations Photographs of staff should be on record to ensure proof of identity and safeguard residents. Photographs of residents should be on their care records for safety reasons. Highbury House DS0000009750.V343056.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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
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