Inspection on 08/08/07 for Highbury Nursing Home

This inspection was carried out on 8th August 2007.

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

Highbury Nursing Home 29/07/08

Highbury Nursing Home 08/08/06

Highbury Nursing Home 01/02/06

Highbury Nursing Home 04/10/05

Highbury Nursing Home 17/03/05

Highbury Nursing Home 04/09/04

Highbury Nursing Home 03/08/04

Highbury Nursing Home 11/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Highbury Nursing Home 199/203 Alcester Road Moseley Birmingham West Midlands B13 8PX Lead Inspector Kath Strong Key Unannounced Inspection 8th August 2007 09:15 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 Nursing Home DS0000024854.V341852.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 Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highbury Nursing Home Address 199/203 Alcester Road Moseley Birmingham West Midlands B13 8PX 0121 442 4885 0121 449 7855 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) Flintvaleltd@btconnect.com Flintvale Limited Bernadette Farrell Care Home 38 Category(ies) of Dementia - over 65 years of age (38), Old age, registration, with number not falling within any other category (38), of places Terminally ill over 65 years of age (38) Highbury Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Nursing home for the elderly, old age, dementia and terminally ill That Mrs Farrell undertakes further training in the area of Dementia Care and notifies CSCI of the details. 8th August 2006 Date of last inspection Brief Description of the Service: Highbury Nursing Home is purpose built and is located on the outskirts of Moseley Village, a suburb of Birmingham. The home provides residential and nursing care for up to 38 persons who are aged 65 years or above who may suffer from dementia. Bedroom accommodation includes both single and shared rooms, some of which have en-suite facilities. Bedrooms are situated on three floors; these are accessible via stairs or a shaft lift. The communal areas are situated on the ground floor and have recently been extended. All of the communal rooms are linked by glazed partitions, which facilitates staff ability in observing people and the nurses’ office is adjacently situated. The main lounge leads on to a smaller lounge, which leads onto the main dining area. There are two smaller rooms within close proximity one is used as a lounge and the other as an extra dining area. Communal toilets and assisted bathing facilities are within easy access of all areas of the home. The home has adequate quantities of specialist equipment and hoists to assist with the care needs of residents. There is also a range of pressure relieving equipment for use by people who may be prone to developing pressure ulcers. During warm weather people frequently sit in the well laid out garden and patio area. A large unused grassed area is situated to the side of the garden and a generous sized car park is also located at the rear of the premises. The fee rate ranges from £349.86 to £380.46 for people who are funded by the local authority. The rate for those who pay themselves is £500.00. Further payments may be provided by the NHS for people who are assessed as requiring additional nursing care. There are three bands for this, low is £40.00, medium is £87.00 and high is £139.00. If someone is self funding and is assessed by the NHS as requiring extra funding, the amount is reimbursed to the individual. Highbury Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home did not know that the fieldwork visit would be carried out, this is to enable the inspectors to obtain a true picture of the standards of services provided. On the day of the visit, the home had 34 people living at the home. Assistance was provided throughout by the manager and deputy manager. At the conclusion feedback was given to the manager, deputy manager and the administrator. No Immediate Requirements were made. Information was gathered from speaking with people who reside at the home, relatives and staff. Care, health and safety and the arrangements for medications were inspected. Staff personnel files were checked and staff were observed whilst performing their duties. A partial tour of the premises was carried out. Two of the six care plans reviewed were case tracked. This involves obtaining information about individuals’ experiences of living at the home. This is done by meeting with or observing people, discussing their care needs with staff, looking at care plans and focussing on outcomes. Tracking peoples care needs and how the care is delivered helps us to understand the experiences of those people. One of the inspectors spent time in the lounge carrying out an assessment about how staff and other people spend time with people who live in the home. It included how staff and others communicate with them, what they did and how it affects the daily lives of people. This is referred to in the body of the report as SOFI (short observational framework for inspection) in the section concerning daily life and social activities. Prior to the visit the home had completed the annual quality assurance assessment and sent it to CSCI. The information within the document advised of what the home does well, improvements made during the last 12 months and what the home would like to further improve. This provided details that contribute to the inspection process and highlights areas that may be explored during the fieldwork visit. A number of people who live at the home were requested by the inspector to complete a questionnaire. These give personal opinions about the services provided and are included in this report. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is based upon the outcomes for people who live in the home and their views about the services provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and aspects of service provision that need further development. Highbury Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The home has commenced implementation of the gold standard framework. This ensures that all aspects of physical and mental health needs and equipment are provided to make the final stage of life as comfortable as possible for the individual. The home has increased staff training in adult abuse and dementia care to promote staff knowledge and skills in providing effective care. Newly appointed care staff will be expected to undertake an induction that includes all of the topics contained in the Skills for Care programme. This will provide new staff with the basic skills for working in the care home. Highbury Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 7 Reminiscence and activities boards have been introduced for people to use as part of the activities provided. This will provide stimulus and enjoyment for people. A new menu has recently been developed and daily menus are placed on each dining table. This will assist people who have difficulty in remembering recent choices made about meals. Some bedrooms have been supplied with new wardrobes and bedside cabinets to promote pleasing private facilities for people. Some rooms have been supplied with profiling beds to ensure that staff have safe access to provide personal care. A bath hoist has been replaced to provide safe transfers of people. Audits of the standards of the laundry service have commenced to ensure that peoples personal clothing is given back to them in an acceptable presentation for wearing and promoting a neat appearance. A second fish tank has been purchased and equipped to promote peoples pleasure whilst sitting in a lounge. The dining room and a few bedrooms have been re-painted to give a bright and hygienic effect. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Highbury Nursing Home DS0000024854.V341852.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 Nursing Home DS0000024854.V341852.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): 1, 2, and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are provided with sufficient written details about the home to assist them in making a decision about living in the home. The contract of terms of residency does not advise people of all of their rights whilst residing in the home. The home is failing to demonstrate when pre-admission assessments are carried out. EVIDENCE: A range of previous CSCI and the home quality assurance reports are on display in the reception are of the home. A copy of the statement of purpose and service user guide are also on display. Both documents provide people with adequate information about the services supplied. A contract of terms of residency was seen that had been supplied to a person who had recently been admitted and it was noted that it did not include the Highbury Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 10 room number that the individual occupies or details of the services that are not included in the fee rate. The document requires further development; this was made a requirement at the last inspection but has not been met. Pre-admission assessments of the most recent admissions were viewed and found to be satisfactory in content but one had not been dated or signed. Parts of another pre-admission assessment were found to be blank in respect of personal preferences and medications. The manager advised that hospital staff do not supply such information. The form fails to demonstrate that other areas have been explored to find the required information. The home provides respite care but not intermediate care. Highbury Nursing Home DS0000024854.V341852.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans were poorly documented and it was not possible to verify that all of peoples’ required healthcare needs were being met. All medications must be administered as prescribed by medical staff to promote peoples health and wellbeing. Observations of staff practices indicated that the privacy and dignity of people is being maintained. EVIDENCE: Each person has a written care plan. This includes assessments, staff guidance about how care needs to be delivered, personal preferences and regular monitoring to enable the home to make changes as required to ensure that all aspects of care are being provided. The home has introduced an initiative whereby full pictorial information is provided to staff about which type and sling size should be used for individuals. This was determined as being good practice and the home is commended for this. During the inspection carried out August 2006 the care Highbury Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 12 plans were assessed as being good. Since then the home has introduced a different means of care planning the majority of which involves the use of pretyped sheets. They do not permit adequate space for free text and staff had failed to ensure that they were individualised. Although the annual quality assurance assessment (AQAA) carried out by the home states that care plans contain detailed information about mental and physical health needs and personal preferences, the inspectors found that this was not the case. Numerous shortfalls found were as follows: • Moving and handling instructions need to include the type of hoist to be used • The form ‘Permission to Use Restraint’ includes the terminology ‘Cot Sides’. This is not acceptable practice as it fails to maintain peoples dignity • Many care plans seen were based on ringing or ticks of typed sections with lack of individuality • The files did not incorporate personal preferences regarding bathing such as bath or shower, how often or the preferred time of day • One care plan states preferred time of rising is 09:30 and retiring 20:30 but the night time routine states ‘goes to bed at 22:00 • A waterlow score on admission was 21 and had been changed later to 23 but had not been dated or signed • There was no indication that people were being assessed about their normal routines and habits about going to the toilet. Staff should attempt to find this information and develop the care plan accordingly. Staff instructions such as toilet every 2-3 hours demonstrates that the care plan has not been individualised. Another form had been pre-typed instructing 4 hourly toileting • A care plan regarding pitting oedema was compiled September 2006 and reviewed December but had not been reviewed since • A file states, ‘pressure ulcer found, grade three. This raises the question of whether staff are carrying appropriate checks or if the nurse has the ability to assess pressure ulcers correctly • People who remain in bed have repositioning charts for staff to complete but others who spend part of the day in bed as well as all night did not have them. The home should review the system, any person who requires changes of positions should have charts completed • A night time form for one person had not been completed at all • One pre-typed form concerned details about preferred method of shaving. It was part of the file of a female person • A care plan concerning poor appetite states weigh weekly, the nutritional assessment states weigh monthly • Staff should be given clear instructions in respect of catheter care. Later in the care plan it describes what staff need to do due for urinary incontinence although the person is catheterised • Another section of the care plan does not provide clear information about incontinence of stools and the type of pad required Highbury Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 13 • • • • • A recent admission had been identified as loosing weight and was due to be weighed 2nd August but this had not been done and does not state which food supplement that should be given Later in the day a person was observed who suffers with communication problems but there was no comprehensive care plan in place The file retained by the activities organiser that contains information about peoples life history, backgrounds, likes and dislikes needs to be available at all times to all trained and care staff. The information may provide staff with explanations about an individuals behavioural trends and are therefore important to care as well as activities A person who does not like spoons was having all foods liquidised but there was no evidence that a dietician had been consulted. Also states that weekly weights should be carried out but they were not being done Lack of short term care plans for conditions such as chest or urinary tract infections. The deputy manager stated that it would be recorded in the qualified nurse report. All recordings about a persons health must be retained in the individuals care plan. One resident was itching all the time. Carer said she had recently had treatment for scabies bit it was evident that the itch was distressing her. This was brought to the attention of the home manager. The lack of information in care plans and failure to individualise them does not demonstrate that peoples needs and preferences are being met. There also appears to be a failure to request a consultation by a dietician, this indicates that staff are not responsive the to all healthcare needs. Lack of comprehensive and appropriate staff guidance about how care should be delivered fails to demonstrate that all healthcare needs were being assessed, monitored and met. There is a need for all care plans to be reviewed and this matter should be given priority for the home to evidence that all healthcare needs are being assessed and met. Following in depth discussion with the manager and deputy manager the manager has agreed to develop a report about people who lived in the home previously and on completion by 31st August 2007, forward a copy to the inspector. Someone who lives in the home made the following comment, “I like some of living here, I have made some friends”. The medications of those persons whose care plans were seen were audited and the following shortfalls were identified: • Two signatures are required for any hand written MAR (medication administration record) charts to verify that the entries are correct Highbury Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 14 • • The practice of discarding unused medications down a sink must cease and the correct system adhered to It was found that a dose of an antibiotic had not been given. It is essential to give antibiotics as prescribed to maintain therapeutic levels Senior staff are not ensuring that people receive their prescribed medications and the appropriate method of disposal is not being adhered to. An audit of the system and staff practices needs to be carried out in order to prevent further inappropriate practices. Observations of delivery of care and staff interactions with people were not always respectful. Staff did not always use the preferred term of address. This fails to ensure that peoples dignity is being maintained. One person was overheard talking to a carer, she called the carer, “Darling”. This indicated her pleasure with the carer. Highbury Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People are not being adequately stimulated by both activities and staff interactions, this fails to promote people from experiencing a quality lifestyle. The meals provided offer variation, choices and a balanced diet and specialist diets are catered for. EVIDENCE: The home has a four week rolling programme of activities, which is on display in the reception area. The programme is varied and indicated that a good degree of physical and mental stimulus could be achieved. However the manager advised that due to staffing shortages the activities organiser had been carrying out care duties instead. Of the seven questionnaires received from people who live in the home there were some comments made about the lack of activities. An inspector observed some activities in one of the lounges but some people in another lounge were not offered any social stimulation. An activities organiser had commenced employment three days previous to the inspection visit. She was shadowing the carer who previously took on the role Highbury Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 16 and was observed trying to entertain people. She appeared to be gaining good attention. Peoples birthdays are celebrated and parties held for seasonal festivities such as Halloween and St Patricks day. Details of an annual fete were on display. There were lots of photographs on display to remind people of the festivities that have taken place. Here was some evidence of people going out into the community and to church services but there was no evidence of pre-arranged outings for people to enjoy. The home has a folder that contains details about peoples past and family life to give staff information about peoples preferences. These must also be available to trained and care staff as they may provide staff with explanations about an individuals specific behavioural trend. The files included likes and preferences. There was a separate page per person for recording if a person had participated with an activity or outing. It included only limited information about peoples enjoyment for the activity. These are needed to use as a tool to monitor changes and trends in peoples preferences. The home needs to demonstrate that people are given choices and influence the activities programme. Outings needs to be arranged and offered to provide external stimulus within the community. During the inspection we spent time in the lounge watching how the care staff interacted and looked after residents and also how residents spent their time. No interactions between residents and no visitors present Observations: (3 people observed) In the small lounge. No activities in here during the 2 hour period as residents not able to join in with group activity of bingo that was being played in the dining area by more able residents. The majority of staff interactions were good however there were a number of inappropriate/poor comments made by staff. For example, one carer said to someone “That’s a good girl”. Another carer made derogatory comment about a person who had a reduced appetite. No negative behaviours displayed by the three residents, mainly passive but also positive behaviours especially when music was on the radio (one resident was tapping her feet in time with the music, nodding her head. Moving her hands and mouthing the song and smiling). One carer spoke to a resident about her daughter visiting and the resident was smiling about this and all residents appeared to be enjoying choices. No staff present in small lounge for the majority of the observation period. With the exception of one staff member who came in to give out hot drinks and two carers that took residents to the toilet. (staff assisted residents with their Highbury Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 17 hot drinks in an appropriate manner). During the last five minutes of observation a carer came in and gave out choc ices and the new activity person began to talk to a resident until she was called away. No table available for one resident to put her cold drink down on so she put in on the floor! One resident was tapping on the table to get staff’s attention. The contents of the menu were reviewed. It provided information that suggested that well balanced and healthy meals were being provided. Although it did not include alternatives people were aware that they could request different foods from a separate alternative list. The menu did not indicate that ethnic meals were available. Snacks are available during the night. Lunch was observed being served, dining table were attractively laid. The meal was well presented and gravy boats were placed on tables for people to help themselves or staff to assist. Appropriate and discreet assistance was supplied by staff throughout the meal. Plate guards were being used by some people to promote their independence. People gave positive feedback about the meal. Highbury Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 18 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. People are aware of how to make a complaint and are confident that concerns raised will be listened to and dealt with effectively. The arrangements for adult protection serve to protect people from the risks of abuse. EVIDENCE: The complaints procedure was available in the service user guide at reception as well as on display. The complaints log suggested that the home has not received any complaints since the last inspection of August 2006. CSCI had recently received a complaint, which was investigated during the fieldwork visit. There was no evidence that the home had breached the Regulations. The adult protection policy appeared to have been updated January 2007 and provides staff with clear instructions about the action they need to take if abuse is suspected. Staff had received training in this aspect of care. This was evidenced during discussions with staff when they demonstrated good knowledge in respect of what action they would take if abuse was suspected within the home. Highbury Nursing Home DS0000024854.V341852.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a warm, comfortable and safe environment and are encouraged to make choices about their bedroom contents layout. EVIDENCE: The extended communal sitting and dining rooms are light and airy and homely in appearance. All of the rooms were fully utilised by people who live at the home and their visitors, they are also used for activities. People are able to choose where they wish to sit. The rooms are directly adjacent to each other and the large glazed partitions assist staff in providing discreet observations. Furniture, fixtures and fittings were of a good standard. The pleasant garden offers a place where people can sit during warm whether. The bedrooms were visited of those people whose care plans were seen. They were noted to be comfortable and offer a pleasant private place where people Highbury Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 20 can maintain their privacy and spend quiet time. They were personalised to the degree preferred by the occupant. Bedrooms were laid out to peoples personal preferences and were noted to be clean. The home was found to be tidy and hygienic in all areas visited. Housekeeping staff are employed who provide a service seven days a week to ensure that there is no slippage of standards. Staff appeared to be wearing protective clothing when required to prevent the risks of infection. Highbury Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 21 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 adequate. This judgement has been made using available evidence including a visit to this service. The home is failing to comply with working Time Regulations 1998 therefore is not ensuring that staff are fit for duty. Staff are supplied with the training to equip them with the knowledge and skills to meet peoples needs. EVIDENCE: Review of the staff rota suggested that staff are allocated in sufficient numbers for each 24 hour period. There are two trained staff on duty during daytime hours as well as a minimum of five care staff. Night times appeared to also be adequately covered. It was found that one member of staff was consistently working excessive hours and rarely taking a day off. This fails to comply with Working Time Regulations 1998 and to ensure that staff are fit to carry out their duties. The manager said she was aware of this and had raised it with the member of staff but had not taken appropriate action. The home employs in excess of 50 of carers who have successfully completed NVQ level 2 and three have completed level 3 in care. Highbury Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 22 Review of staff files indicated that the home operates a safe means of recruiting staff. All of the relevant checks and two satisfactory references are obtained before a post is confirmed. The home has recently introduced an induction programme that includes all topics of the Skills for Care programme to give staff the basic knowledge and skills for working in the care sector. Staff had received training in Fire Safety, Health and Safety, Food Hygiene, and other courses that cover the specialist needs of the current client group. Some staff had also had training in Dementia Care. It was noted that some staff were in need of refresher training in Safe Moving and Handling and it was evidenced that this had been arranged to take place in the near future. Highbury Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 23 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, 25 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is not fully overseeing the operations of the home and taking appropriate action to ensure that it is being effectively managed. Health and safety arrangements are not comprehensive in protecting people from risks of injuries. EVIDENCE: The manager has the experience and skills to oversee the day to day operations of the home and to make the necessary improvements. She is ultimately responsible for the safe management of the home. She had failed to ensure that a member of staff was working within legal limits. The deputy manager provides support and has specific tasks to carry out. Highbury Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 24 The home has a quality assurance programme whereby regular audits of the premises, fire safety equipment and emergency lighting are carried out. It is recommended that these and other audits that should also be completed are included in the annual report that is developed regarding peoples opinions about the services provided. The arrangements for the safekeeping and transactions of monies held on behalf of people who live in the home were found to be good. This prevents financial abuse. Regular staff meetings were being carried out and the agenda items were about staff practices, peoples welfare communications and the premises. Accident records were good and CSCI were receiving Regulation 37 reports about the welfare of people who live in the home. The fire alarm system was being tested weekly and the findings recorded. Regular fire drills were being carried out and the names of staff who had participated were being recorded in order to capture all staff within a period of one year. Checks and servicing of equipment were being carried out to ensure that they are fit for purpose. The majority of the procedures appeared to protect people from risks of injuries. It was evidenced that the emergency lighting had not been tested since January 2007, this procedure should to be carried out monthly. Highbury Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 25 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 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 X X 2 Highbury Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 26 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 OP2 Regulation 5(1)(c ) Requirement The contract of terms of residency must be further developed to include details of the room occupied and services that are not included in the fee rate. This is needed to advise people of their right whilst living in the home. Timescale for action 15/10/07 2. OP3 14(1) 3. OP7 15(1) Timescale of 31/10/06 has not been met and should be treated as a priority. Pre-admission assessments must 08/09/07 be comprehensive and include the date and signature of the author. This is needed because the home must ensure that it has enough information about the individual to demonstrate that the home is able to meet all of the needs. 15/10/07 Care plans must include all needs and care requirements: • The type of hoist needed must be recorded • The form ‘Permission to Use Restraint’ must not include inappropriate terminology DS0000024854.V341852.R01.S.doc Version 5.2 Page 27 Highbury Nursing Home • • • • • • • • • • • • • • • Highbury Nursing Home Ticks and circles on pretyped forms lack individuality Lack of peoples personal preferences Files must not include conflicting advise regarding times of retiring Changes of waterlow scores must be dated and signed Lack of toileting regimes to suit the individual A care plan about pitting oedema had not been reviewed Evidence of lack of staff ability to grade a pressure ulcer All people who require changes of positions must have turn charts Night time preferences should be recorded for all people A pre-typed form for shaving needs must be completed accurately taking into account the persons sex Instructions for weekly weights were not being carried out Staff instructions for urinary incontinence had been provided although the individual had been catheterised Staff must have clear instructions regarding incontinence of stools The weight of a recent admission had net been checked on the due date and the type of food supplement had not been recorded Those people who have Version 5.2 Page 28 DS0000024854.V341852.R01.S.doc • communication problems must have a comprehensive care plan developed Information about peoples life history and background must be available to all care staff because. These indicate that care plans fail to provide staff with information and accurate care needs and how they should be delivered and should be addressed as matter of urgency. 4. OP8 13(1)(b) The home must ensure that all health needs are fully met: • A person who does not like spoons was having pureed food but no professional advise had been sought • There was evidence of lack of staff knowledge in assessing a pressure ulcer • A care plan about pitting oedema had not been reviewed, it was not possible to evidence that the condition was being monitored • The practice of providing staff with instructions to toilet 2-3 hourly or 4 hourly fails to demonstrate that an appropriate system has been developed to reduce urinary incontinence. Staff must be responsive to all healthcare needs and ensure that appropriate action is taken to promote peoples health and wellbeing All handwritten instructions on MAR(medication administration record) charts must be signed by DS0000024854.V341852.R01.S.doc 15/10/07 5. OP9 13(2) 15/09/07 Highbury Nursing Home Version 5.2 Page 29 6. OP10 12(4)(a) 7. OP12 16(2)(n) 8. OP13 16(2)(m) 9. OP14 12(5)(b) 10. OP31 9(1) 11. OP33 26(2)(3) (4) trained nurses. All prescribed medications must be administered as instructed. This is needed to ensure that people receive their prescribed medication accurately to promote their health. Staff must not use inappropriate terminology. This is to ensure that peoples respect and dignity are maintained. A programme of activities must be provided to physically and mentally stimulate people and promote a quality lifestyle. Timescale of 30/11/06 has not been met and should be treated as a priority. Regular outings must be offered and arranged to people to assist them with access to the community and leisure pursuits. Timescale of 30/11/06 has not been met and should be treated as a priority Staff must attempt to have regular interactions with all people who live in the home. This is required to treat all people as an equal, to stimulate them and preserve their dignity. The registered manager must oversee the total running of the home and take appropriate action where shortfalls are identified. This is to ensure effective management of the home and peoples safety. The responsible individual must carry out unannounced monthly visits to the home, collate a report and supply a copy to the registered manager who must make it available for inspection. This is required to demonstrate that the manager is effectively managing the home for the DS0000024854.V341852.R01.S.doc 15/09/07 15/09/07 30/09/07 08/09/07 15/09/07 30/09/07 Highbury Nursing Home Version 5.2 Page 30 benefit of the people who live in the home. Timescale of 30/11/06 has not been met and should be addressed as a matter of priority. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The registered manager should give consideration to production of the service user guide and complaints procedure in large print and/or taped for the convenience of those people who have sight or hearing impairment. Consideration should be given to installing signage on the doors of all communal rooms and individuals bedroom doors. This would assist people in orientating and increase their independence. Staff hours of working need to be regulated to ensure they are fit for duty and working within legal limits. Consideration should be given in developing a more robust quality assurance system. Further audits should be carried out and all audits included in the report. The emergency lighting should be tested monthly and the outcomes recorded. This is needed to ensure that appropriate backup facilities are available when emergency situations occur. 2. OP20 3. 4. 5. OP27 OP33 OP38 Highbury Nursing Home DS0000024854.V341852.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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