Inspection on 13/06/06 for Highbury House Nursing Home

This inspection was carried out on 13th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Highbury House Nursing Home 21/09/07

Highbury House Nursing Home 07/12/05

Highbury House Nursing Home 13/07/05

Highbury House Nursing Home 12/01/05

Highbury House Nursing Home 21/05/04

Highbury House Nursing Home 28/08/03

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Highbury House Steyning Road Rottingdean Brighton East Sussex BN2 7GA Lead Inspector Elizabeth Dudley Key Unannounced Inspection 13th June 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 Highbury House DS0000013999.V295482.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 DS0000013999.V295482.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highbury House Address Steyning Road Rottingdean Brighton East Sussex BN2 7GA 01273-309447 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) Mrs Zeenat Nanji Dr Tasneem Osman Benitha Siziba Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service users should be aged sixty-five (65) years or over on admission The service can provide up to thirty (30) nursing places and twelve (12) personal care places The maximum number of service users to be accommodated is thirty (30) That no more than four (4) service users who are terminally ill can be resident in the home at any one time. This is to include service users who are already resident within the home and become terminally ill 7th December 2005 Date of last inspection Brief Description of the Service: Highbury House provides accommodation with nursing for up to 30 older people, it may also accommodate 12 older people who need only personal care and assistance. Situated in Rottingdean, all rooms have pleasant views, some with a sea view and there are well-maintained gardens which are accessible to service users who use wheelchairs. Highbury House provides a pleasant environment and one which service users are encouraged to treat as home’. Public transport passes within walking distance of the home and there is restricted parking in the area of the home, however unrestricted parking is available in roads around the home. Then fees currently charged are in a range of £350-£700 depending on both the residents needs and the room to be occupied. There are charges for extra services such as hairdressing, chiropody, toiletries and newspapers. Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 13th and 14th June 2006. During the course of the inspection a tour of the home was undertaken, documentation including care plans, personnel files, health and safety and catering records were examined and members of staff, visitors to the home and residents were spoken with. Prior to the inspection some relatives were spoken with by telephone and viewpoints of GP’s and other health care professionals gained. The care of six residents was looked at in depth, this included examination of their care, and the documentation relating to this, and talking with the residents or their relatives. Variable comments were received from residents and visitors including ‘it is a good home’, ‘the attitude of the home is open and transparent’, ‘there are some things that could be better’, and ‘there is room for improvement’. Positive comments were received from health care professionals who visit the home. The inspection was facilitated by Mrs Benitha Siziba, the home manager and Mrs Zeenat Nanji, the home owner. Thanks are extended to Mrs Siziba, Mrs Nanji and all residents, staff and residents representatives for their help and courtesy in this inspection. What the service does well: Highbury house provides a good standard of care within a comfortable home. The staff are encouraged to undertake training relevant to the work that they do. Residents are able to make choices about their lifestyle to the limit of their abilities and staff provide some activities. These have included outings for tea in the village and some lunches out. Birthdays are celebrated and cream teas in the garden take place. There is a resident’s representative who will represent residents at meetings, and suggests changes to be made within the home. There has been a change of manager in the past year, and staff and residents spoke very positively about the changes that have occurred. Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 6 Staff turnover is low, and many of the staff have been working at the home for a number of years. Eleven members of staff have their NVQ 2 and some of the registered nurses have attended training on Palliative care. The home has recently been enrolled to undertake training in the Liverpool Care Pathway, a study of care for people who have a terminal illness. Staff were enthusiastic about the amount of training offered and one said that ‘if you show an interest in anything about the care of residents, they will help you to follow it up’. The home has bi-monthly staff meetings to which relatives and representatives of residents are invited, residents being represented by the ‘service user representative’. The service user representative, who is one of the relatives of a resident, is in contact with other relatives and friends of the residents. A quality monitoring system, which seeks the views of residents, staff and relatives, is in place. Information received by this method is used to change practice in the home and improve the service offered. Comments from residents were received and these stated that ‘We are well looked after’, ‘Staff come in and talk to me’ and ‘the staff are very nice’. Other residents said that they could take part in activities if they wanted to do so and that ‘The staff always tell me what is going on’. Residents spoke very positively about the home made cakes that are offered at teatime and most residents stated that they enjoyed the food. The variety of food shown on the menu is good. The gardens around the home are well maintained and many bird feeders are in place. Residents are encouraged to use the garden and many spoke about how much they enjoyed this and how they liked watching the birds. The manager and provider always respond positively to the CSCI and meet any of the requirements made at inspections. What has improved since the last inspection? The home now employs a full time maintenance person and the standard of maintenance within the home has improved. Gradual redecoration is taking place and new carpets are being provided, this has made a great difference to the home and residents said ‘How nice it is looking’, ‘Have you seen our new carpets and curtains?’, ‘They have made my room lovely’. The standard of cleanliness in the kitchen has improved and this will continue to be monitored by the providers. Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 7 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. Highbury House DS0000013999.V295482.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 DS0000013999.V295482.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5 Quality in this outcome area is good; this is based on the available evidence including a visit to this service. Prospective residents receive sufficient information to enable them to make an informed decision over whether to make Highbury House their home. EVIDENCE: The statement of purpose and service user guide meet the standard and comply with the regulations. All service users receive a copy of the service user guide, with the manager taking copies of all documents with her when she goes to meet and assess the prospective resident. All residents receive a copy of the terms and conditions, which meet the standard, on their admission to the home. All residents and their representatives spoken with said they had received a contract or terms and conditions on their admission to the home, and evidence of this was seen at the inspection. Prior to accepting any resident into the home, the manager visits the resident to assess them and ensure that the home can meet their needs. The preadmission assessment addresses the physical, psychological and social needs of the prospective resident and forms the basis of the care plan. Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 10 Staff were made aware of the specific needs of new residents prior to the resident being admitted, and registered nurses appeared to be aware of any complications that could arise due to specific resident’s conditions and were aware of how to deal with these. Some registered nurses have attended recent training in palliative care at the local hospice and the manager said that they are commencing the Gold Standards Framework for the care of the terminally ill resident. There was evidence of on going staff training across all areas, with carers attending in house training as well as being encouraged to undertake study for the NVQ 2. All residents are admitted on a month’s trial basis to ensure that their needs can be met by the home. Prospective residents and their representatives are encouraged to visit the home prior to admission, to meet residents and staff and to look around the home. Several residents spoken with said that either they or their friends and relatives had come to look around the home prior to their admission. Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 Quality in this outcome area is good; this is based on the available evidence including a visit to this service. The quality of care received by the residents is good. The administration of medication practice and associated policies and procedures ensure the safety of the residents. Some issues around privacy during care and laundry management may impact adversely on the dignity of the individual resident. EVIDENCE: The initial care plan is formed from the preadmission assessment, and all care plans addressed the physical, psychological and nutritional needs of the resident. The majority of the care plans included a nutritional assessment, with evidence of residents being weighed on a monthly basis. The majority of care plans had been reviewed on a monthly basis and showed evidence of the residents or representatives involvement. Risk assessments were present in all care plans. All information relating to resident was in place including hospital visits, records of wound care and there was evidence that general observations such as blood pressure and blood sugar testing were in place. Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 12 The standard of care planning was reasonable, in some instances good. The main criticism was the lack of detail in some care plans, which would not give sufficient in depth information to enable consistency of care. Consent and risk assessments for the use of bedrails were in place. There was evidence of the involvement of other health care professionals, physiotherapists; older persons nurse specialists and the wound care nurses One GP attending the home on this day said that ‘the care is good and I am satisfied that I am called out when needed’. Feedback cards received from a doctor stated that ‘the staff do an excellent job. Many admissions are via the local hospital and have multiple problems and needs’. Very positive feedback was received from a health care professional that visits the home on a regular basis. She commented that ‘the manager was really addressing the care needs’ and was ‘requesting training in areas that staff stated they required’. A recent training session was on MRSA (methicillin resistant staphylococcus aureas) and this was aimed at the care staff as opposed to the registered nurses. The manager had asked for this as several of the care assistants were concerned about this The majority of the residents and relatives spoken with stated that the care within the home was good, that the staff received advice from other health care professionals as required and would access the GP if they needed to see a doctor. However two relatives said that they had to ask for a doctor to visit on one occasion. The majority of the relatives or representatives said that they were kept informed of any concerns relating to their relatives. Dentists are accessed for residents as required. Medications had been signed for following administration but prescribed creams and ointments must be signed for rather than ‘ticking’ the boxes. All controlled drugs were stored and recorded correctly. All dressings and medications were within their expiry dates and batch numbers of catheters are written in care plans. A range of medicine policies are in place but individual risk assessments for residents who self medicate should be kept with the MAR charts or care plans in order that they can be referred to and reviewed. There was evidence of records of the drug fridge, clinic room temperatures and equipment being checked, and relevant information relating to medications including the British National Formulary and Medical Alert bulletins were in place. Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 13 Residents spoken with said that they were addressed by their preferred name and that staff were polite and caring. There were some concerns raised by relatives about the laundry system, in which the ironing was often of a poor standard and one relative said ‘Sometimes my mother is wearing clothes that are not hers, when she has lots of clothes of her own, and that upsets me’. Whilst another resident said that the ‘Laundry is not always up to standard’. Dignity was also compromised by the provision of protective aprons rather than napkins for some residents at meal times and this has been addressed in National Minimum Standard 15. One of the GP’s that visit the home expressed concern that ‘examinations were frequently initially suggested in communal areas’. Although on the day of inspection it was seen that medical examinations were taking place in the residents own room, and a visiting health care professional stated that dressings were seen to always take place in their rooms, the manager must be vigilant to ensure that staff always take a resident to their rooms when any personal examinations or treatment, including chiropody or dentistry, is to take place. A requirement has been made relating to this. The majority of residents made positive comments about the care received. ‘They call a doctor when I need one’, ‘I was well looked after when I felt so ill’ and ‘Staff come quite quickly when I call them’. All rooms were equipped with call bells and staff response to these appeared prompt. There was no-one undergoing palliative or terminal care at this inspection but the staff have attended study days at the hospice. The home has recently attended training on the Gold Standards Framework (a framework addressing the care of the resident requiring palliative care). Letters held in the home made positive comments about the home’s care of the dying resident, and there was evidence that staff have received training in this and that extra staff are put on duty to care for these residents if required. Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 14 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 5 Quality in this outcome area is adequate, this is based on the available evidence including a visit to this service. Activities provided by the home have improved the quality of life for residents. Well-balanced menus are in place but poor presentation and serving of food may have an adverse effect on resident’s nutritional health. EVIDENCE: Most residents spoken with stated that they had the choice of what time they get up and go to bed and most knew about the activities on offer. There is an activities programme displayed on all notice boards and residents said that they are informed of activities that are taking place. At the present time the deputy manager and one of the carers takes responsibility for the programming of activities although the carers implement these. Activities on offer show that two residents are taken out in the afternoons for afternoon tea, cream teas are given in the garden or the home, horse racing takes place in the home and musical entertainment takes place. There has also been a wine tasting event, sing-along, St George’s day celebrations and birthday parties, musical entertainment is also provided at birthday parties. Some residents have been taken out to lunch at a local public house. Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 15 Residents talked about the activities on offer although one said that ‘I am not really interested as I prefer staying in my room’ and another stated that she found it difficult to participate at times because of wheelchair access - there is wheelchair access throughout the home. All residents are able to choose their preferred lifestyle according to their abilities, and are able to manage their own finances if able. The home has a ‘service users representative’; she said that the home is doing far more in the way of activities and that it has improved a lot in this area. The home has an open visiting policy with visitors being welcomed at any time. Visitors to the home were seen to have an open and friendly relationship with staff and they said that they were always offered beverages when they arrive, and that they can have meals with the residents if they so wish. Ministers of religion visit the home and services are held. The manager can access advocates for residents as required and residents can remain responsible for their own affairs as long as they feel able. Financial advisors and solicitors can be accessed for residents if they so wish. The menus provided to the home are varied and show a good choice of food. However there were few vegetables in season evident and one resident said that she wished that there were more variety in the vegetables provided. Cakes and puddings are homemade. Residents spoken with said that the food was variable, the majority saying that they liked the food ‘most of the time’. All residents said that they have a choice of food and this was evidenced in the records kept in the kitchen. Staff raised concerns about the quality of food and said that ‘the food provided to those who need feeding looks awful, there is not a lot of choice of desserts and diabetics only get one choice of puddings’, ‘the presentation of food is poor, boiled egg with the shell on has been sent out to a resident that can’t use their hands’ and ‘Concerns about the food have been mentioned at staff meetings, sometimes it is good but sometimes it is really bad’. One lady who had a soft diet had the wrong diet sent to her and the inspector had to point this out to the staff. Her lunch was brought in twice when she was having her hair done. Pureed food seen given to residents was not presented separately but with all ingredients mashed together. One resident said she did not like her meal and gave it back and was not offered a suitable alternative. The general presentation of food was poor, with trays being carelessly laid up and some residents being offered cups of tea without saucers. The standard of setting up the tables for meals could be improved, and trays do not have tray cloths or salt and pepper. Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 16 One service user in a wheelchair was not pushed to the table, neither was a table provided beside him, the care staff sitting with the plate on her lap assisting him. Many residents were wearing protective aprons. Discussions were held with the provider regarding the provision of napkins to maintain resident’s dignity. Some residents who had used their tables in their rooms for books etc, did not have a table from which to eat their meals and discussions were held with the manager relating to providing an alternative table for meals. The meal of the day was braised pork or corned beef or potato bake and tuna or corned beef salad. Bananas and custard or diabetic jam sponge followed this. One diabetic resident spoke of his frustration at being offered something on the menu and then being told that he could not have it because he was diabetic. The manager is asked to check with the dietician for current practice for diabetic residents. Cleanliness in the kitchen has improved but this must be monitored. The home is following the hazard analysis programme supplied by the environmental health authority and all kitchen staff have their food hygiene course. All fridge, freezer and hot and cold food temperatures have been recorded. Some dried food was not been kept in containers. All kitchen staff and some care staff have undertaken the food hygiene course. Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 and 18 Quality in this outcome area is good, this is based on the available evidence including a visit to this service. Residents are protected by the manner in which complaints are addressed, and staff training in the protection of the vulnerable adult. EVIDENCE: The home has a complaints policy, which meets the standard, and this is available both in the entrance hall and in the service users guide. One complaint was made to the home recently, and made to the inspector in response to the inspection questionnaire sent to relatives - there was evidence that the home had dealt with this satisfactorily, and the provider had spoken to the complainant on the phone, to ensure that she was happy with the result. The documentation dealing with complaints is kept in a confidential file, however this needs to be kept in a secure environment to maintain confidentiality. Another relative of a resident stated that he had previously had to make a complaint and that this had been dealt with in a thorough and satisfactory manner. The majority of residents spoken with were aware of to whom to make a complaint, and would feel able to do so if necessary. Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 18 All staff have had training in the protection of the vulnerable adult and were aware of their responsibilities in this area. Senior staff have received adult protection training with the social services and were aware of the reporting protocols. Information is cascaded to other members of staff both by induction and other training. The residents are protected by the homes recruitment practices. Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 19 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): 19,20,21,22,23,24,25 and 26 Quality in this outcome area is adequate, this is based on the available evidence including a visit to this service. Attention to maintenance issues has led to some improvements within the home, which will add to resident’s comfort. EVIDENCE: The home has recently undergone some redecoration and re-carpeting, and this has improved the general environment. There are still some rooms in need of redecoration and some carpets that need to be replaced. General maintenance of the home has improved, minor repairs are now undertaken and all curtains, apart from one room, were in place. The home now employs a maintenance person on a full time basis. Both gardens back and front appeared well maintained with wheelchair access from the lounge and some rooms. Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 20 Some flagstones in the patio areas need to be reset as these could pose a safety hazard. There was an accumulation of discarded furniture in the area adjacent to the kitchen; the manager stated that a skip is ordered to dispose of this. On the day of the inspection, bathrooms were seen to be clean and uncluttered, and although previously staff have raised concerns about the storage of hoists etc making care difficult, no such concerns were brought forward on this day. Most rooms have an ensuite facility. All rooms were seen to be clean, but in some bed tables had become filled with personal possessions, leaving little room for residents to eat their meals. This was discussed with the provider who has agreed to provide extra tables for these residents. Resident’s rooms meet the recommended sizes with the exception of one room, which is slightly undersized. This has no ensuite facility. The resident in this room states that ‘I like my room although it’s a bit of a walk to the toilet, but it gets me up out of my chair’. All residents’ rooms have lockable doors and a lockable facility. Risk assessments relating to those residents who have keys to their rooms must be put in place. The majority of windows have window restrictors and radiator guards, one room and the first floor corridor required attention to their window restrictors. Although water temperatures to resident’s outlets have been recorded, some of the temperatures were outside the recommended parameters (48°C). This was discussed with the maintenance person who was not aware of the optimum temperatures, and he stated that he would go around and adjust the valves. Residents can bring in personal possessions following discussion with the manager and rooms were seen to be cheerful and homely. The home has been assessed by an occupational therapist and provides a selection of hoists and aids as required by residents. Some issues in rooms that needed addressing included one bed without a pillow case, duct tape on the foot of the bed, curtains in one room off their hooks and some carpets requiring replacing. These were discussed with the provider. Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 21 Cleanliness in the home has improved, no odours were apparent in any parts of the home, but all windows needed to be cleaned. Positive comments had been received from relatives i.e. ‘The home is always clean’ and ‘my mothers room is kept nice’. Residents, in the main, thought the standard of cleanliness was good. However some concerns had been raised from relatives. These included comments such as ‘cleanliness around the home could be improved’, ‘There is room for improvement’ and one relative had raised concerns relating to her father’s room and that it did not appear to be cleaned regularly. She also raised concerns about the standard of cleanliness of the windows. The kitchen cleanliness has improved, but still needs some work relating to them washing the tiles down and cleaning the freezers but most dried goods were now in containers. However the temperatures in the kitchen were very high, having no windows, and although here is a fly screen for the back door this was not operational. It is recommended that the provider address this. The carers were seen going into the kitchen without blue aprons when the relief cook was on duty. The home has a good selection of policies and procedures relating to infection control and training on prevention of MRSA is taking place. . Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate, this is based on the available evidence including a visit to this service. Quality in this outcome area is adequate. Staff training and the robust recruitment methods maintain residents safety. Lack of senior staff during some parts of the day could cause standards of care and attention to residents to fall. EVIDENCE: The staff rota showed that there were sufficient staff rostered to meet the needs of the residents. The manager will roster extra staff if these needs increase. Although the home provides 2 registered nurses during most mornings and afternoons, these are sometimes not provided at evenings and weekends. Relatives stated that they have problems finding staff, especially when some staff are on their breaks, they also voiced concern over the supervision of staff at weekends and after 4pm when the senior care staff go off duty. They were also concerns over the number of part-time staff on duty at weekends. One GP also stated it took him some time to find qualified staff when he is called into the home. There were several concerns raised over the perceived lack of supervision of staff and also that ‘we get the best service on the four days a week when there is someone in the office’. Relatives and residents also voiced concern that in the case of unexpected absence of staff there was no plan to provide cover. Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 23 Lack of staff supervision after 4pm, when there was no senior carer on duty, was noted on the day of the inspection. The possibility of providing an extra RGN on a Sunday morning and the provision of senior care staff after 4pm was discussed with the provider. The provider and manager must address these problems. Staff spoken with said there were enough staff on duty although one member of staff said that language barriers could be a problem. However staff spoken with on this day had a good standard of English, and all residents said that they could understand all the staff. All personnel files were in order and were good with all documentation in place including POVA first and CRB checks. There is a staff training programme and staff were seen to have had mandatory training and also ongoing updating training. There are a total of 11 staff with NVQ level 2 or above which is 39 of total staff and 7 other staff are undertaking the NVQ level 2. All staff undertake an induction course on commencing employment. Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37 and 38 Quality in this outcome area is good, this is based on the available evidence including a visit to this service. The management of the home promotes the safety of residents and staff. EVIDENCE: The manager, Ms Benitha Siziba is an RGN (level 1) and has been in post as manager for one year. Prior to this she worked in the home as an RGN for the past two years. She is now registered as manager with the CSCI and is undertaking the Registered Managers Award (RMA). Ms Siziba is commencing the Liverpool Gold Standards Framework training and is also undertaking training in maintaining a quality monitoring system. Discussions with staff, relatives and residents showed that the ethos within the home was good, with the manager and provider being approachable and available to answer queries and concerns. Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 25 There are bi-monthly resident meetings to which all relatives and residents are invited, with staff also attending. Relatives said that ‘these are informative and give us the ability to directly make any queries or concerns to the relevant staff’. All relatives spoken with were aware of the invitation to attend these meetings and minutes of these meetings were seen. These showed positive comments from relatives. It is recommended that those residents who are able to do so, be invited to attend these meetings. There is a quality assurance policy in place and this was seen to include feedback from residents and relatives. Questionnaires relating to the food and general life within the home have recently been implemented, and the response from these had been collated and will initiate any changes in practice within the home if required. Most policies and procedures have been reviewed recently. Some responses from relatives and GP’s identified that they were not aware of the inspection reports and the manager must ensure these are kept in an accessible place. Formal staff supervision has not always taken place at the times dictated by the standards but has now recommenced. Neither the manager or provider act as appointee for residents, some resident’s monies are kept in the home but the management of this is robust. The business plan and all relevant insurances were seen and are in order. All records relating to staff, residents and the business records of the home are kept securely and those seen were appropriate and up to date. All certificates relating to the servicing of utilities and equipment were in place and in date. All staff have had mandatory training apart from the maintenance person who is fairly new in post, who requires COSHH and manual handling training and the cleaners who require manual handling training. This is being arranged. Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 26 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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 2 2 STAFFING Standard No Score 27 2 28 2 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 4 3 3 3 3 3 Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation Reg 15(1) Reg 16(m)(n) Requirement That care-plans identify in depth of how the service users needs are to be met. All care plans to show evidence that social needs have been identified and how they are to be met. That staff ensure that any medical, nursing, or other health care intervention takes place within the privacy of the service users private accommodation. That reorganisation of the laundry service takes place to ensure service user dignity is maintained. That vegetables in season are included in the daily menu and that attention is paid to the presentation of all food including liquidised meals. That cleanliness in the home is monitored, and those areas identified in the main body of the report are addressed. That all water temperatures of outlets used by service users are maintained within the recommended parameters. That those window restrictors DS0000013999.V295482.R01.S.doc Timescale for action 30/07/06 2 OP10 Reg 4 (a) 30/07/06 3 OP15 Reg 16(1) 30/07/06 4 OP26 Reg 13(3) 30/07/06 5. OP25 Reg 13(4) 14/06/06 Highbury House Version 5.2 Page 28 6 OP27 Reg 18(1) 7 OP19 Reg 23(2)(b) identified in the main body of the report, are repaired. That management ensures that 30/07/06 there are sufficient senior staff on duty to supervise staff and that the deployment of staff ensures these are working at those times of day as identified in the report. That the maintenance issues 30/07/06 identified in the main body of the report are addressed. 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 OP38 Good Practice Recommendations That the manager contacts the community dietician for current information on diabetic diets. That measures are taken to ensure that there is sufficient ventilation in the kitchen. Highbury House DS0000013999.V295482.R01.S.doc Version 5.2 Page 29 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. 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