CARE HOMES FOR OLDER PEOPLE
Highbury Rise 6 Highbury Road Hitchin Hertfordshire SG4 9RW Lead Inspector
June Humphries Unannounced Inspection 20th October 2005 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 Rise DS0000019424.V263209.R01.S.doc Version 5.0 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 Rise DS0000019424.V263209.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Highbury Rise Address 6 Highbury Road Hitchin Hertfordshire SG4 9RW 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) 01462 437 495 angela@benslow.co.uk Benslow Management Company Limited Angela Taylor Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (23) of places Highbury Rise DS0000019424.V263209.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 11th January 2005 Brief Description of the Service: The home was first registered with Hertfordshire County Council on 29th August 1985 and transferred to the National Care Standards Commission on 1st April 2002. The home is situated in a residential area of Hitchin, within easy walking distance of local amenities and shops. Accommodation is provided on three floors consisting of single occupancy rooms and one double. Each floor is served by a passenger lift. The home comprises of a main kitchen, two dining rooms one large lounge. The smaller dining area is also used as a sitting room by a small number of service users. The laundry is in the basement. There is limited parking to the front of the home and an average sized garden to the rear. The home provides the service of a hairdresser and chiropodist, for which an additional charge is made. The home also offers dementia care. Highbury Rise DS0000019424.V263209.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out by two inspectors over one day, starting at 10am.The inspectors spent a lengthily period examining records and discussing the requirements and recommendations made at the last inspection in January 2005. The registered manager has worked extremely hard to meet the requirements and recommendations, and was keen for the inspectors to see the positive care provided within the home. At the previous inspection there was a high level of maintance work being carried out at the property, and although staff worked hard to minimise disruption to service users, it was evident from speaking to staff that they felt the care provided was not seen at it’s best on that day. Four service users, and three staff were spoken to as part of the inspection process, of which one staff member was being newly inducted. The service users who live at Highbury Rise are older people of which many have very high needs, including dementia. Staff was observed during the inspection talking to, and supporting service users in a very caring manner. Mealtimes were seen to be unhurried and social and staff was attentive to individual need. Several service users needing, help or guidance with feeding. However due to the high needs of the service users it is imperative that care plans are fully completed and used as working documents to ensure standards of care are maintained. The manager has a high level of consistency within the staff team, not neceitating the use of agency workers, and rarely using bank staff. This cannot replace the need for up-to-date documentation. The registered manager must also provide a programme of dementia training, available to all staff; to meet the on going needs of the service users within the home. What the service does well:
Highbury Rise provides a good standard of service to 23 older people, excepting service users with high needs, including those suffering from dementia. The registered manager is committed to improving and developing the service provided within the home, as were the staff interviewed and spoken to on the day of the inspection. The majority of service users bedrooms were clean and tidy, and it was observed that many people had brought personal belongings from home making homely and personalised atmosphere. Highbury Rise DS0000019424.V263209.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
The registered manager has demonstrated her commitment in addressing the recommendations and requirements raised at the last inspection. This work was seen to be in progress. A package as been purchased by Benslow management company to begin the quality assurance progress, but there is no advocacy involvement within the home for service users who do not have relatives, and a quality assurance report as yet to be produced. Supervision and appraisal had recently taken place with all staff, but these processes appear to be new practices within the home. The registered manager must ensure that staff meetings and supervisions are offered regularly and recorded. Generally recording practices were seen to be limited, and need to be extended. The registered manager must introduce regular health and safety checks within the home. These must be recorded. Particular concerned was raised at this
Highbury Rise DS0000019424.V263209.R01.S.doc Version 5.0 Page 7 inspection with regard to the temperature of the hot water in service users bedrooms. Temperatures were not being checked, or recorded. The paving on the patio was observed to be slippery, and several pavings being up lifted which could cause a trip or fall. Service users are supervised throughout the day by staff, but these on going safety issues must be acted on as they arise. The home was seen to be clean and tidy on the day of inspection, but there was an unpleasant odour in the lounge area and several service users bedrooms. The registered manager must ensure that the home is free from offensive odours, unless there is a specific issue, which is addressed within an individual risk assessment. 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 Rise DS0000019424.V263209.R01.S.doc Version 5.0 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 Rise DS0000019424.V263209.R01.S.doc Version 5.0 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): 3,4,5 Perspective service users are now assessed prior to admission to the home. The format shown provides sufficient detail to ensure the staff can assess fully if the person needs can or cannot be met, within the resources which the home is able to provide. Opportunity for the service user and relatives to visit the home is available. The admission process is occasionally speeded up to take urgent admissions. This could result in inappropriate admissions and the practice should cease. EVIDENCE: The registered manager has introduced a pre-assessment form for perspective service users since the last inspection, and the inspectors saw several completed forms. From this document the service users needs can be identified, which must then be part of an individual care plan. Care records of service users were inspected and recordings generally are limited. Staff would benefit from training in this area. Highbury Rise DS0000019424.V263209.R01.S.doc Version 5.0 Page 10 The manager discussed how the information collected within the assessment process was now being used as part of the service users care plan. This was evident from the care plans viewed. The statement of purpose for the home should clearly set out the admission process. This process should not be shortened as a result of pressure to accept urgent asmissions. Highbury Rise DS0000019424.V263209.R01.S.doc Version 5.0 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 All service users have a plan of care on file, but further detail is needed. The documents must be fully operational and be easily accessed, to ensure that service users changing needs are being adequately monitored and recorded. Not all care plans and risk management forms are appropriately signed and dated by the service user, or representative. The staff assist and support service users with personal care, and hygiene within the home is of a good standard. Service users medical needs are being promptedly address via their G.P, and the district nurse being involved where necessary. The manger ensures that all medicines are handled in accordance with relevant legislation and guidelines from the Royal Pharmaceutical Society. EVIDENCE: The service users spoken to appeared satisfied with the level of care and support received. The staff appeared to know the service users well, and most had worked in the home for a lengthily period of time. This has influenced the speed in which the care plans have been completed, and from documentation
Highbury Rise DS0000019424.V263209.R01.S.doc Version 5.0 Page 12 viewed there is still work with regard to detail needed. Examination further showed, that some of the documentation had not been signed. The manager needs to include this as part of the process. It will possibly be a way of involving carers/representatives in the care being provided. Where there are no representatives, some form of advocacy within the home is required. There were three service users receiving care from the district nurse service at the time of inspection. Again the information was very limited on file, to the current condition and treatment. The staff were however observed talking to the district nurse and appeared involved in the service users care. The storage facilities for medication have been replaced, and medication reorganised, to ensure compliance with legislation in storing medication. The MAR recording sheets were also found to be well organised, and accurately recorded. The manager checks medication is being stored and administration correctly on a regular basis. Highbury Rise DS0000019424.V263209.R01.S.doc Version 5.0 Page 13 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): 14,15 The staff spoken to appeared committed, and supportive to meeting service users needs, but there was very limited evidence to show how the home actively consults and implements service users requests. Whilst acknowledging that the service users are elderly people who may find difficulty in expressing themselves, the manager must demonstrate that service users, carers and advocates are involved in the day to day running of the home. Documentation must clearly state how this is happening. The service users are offered a choice of food from a set menu. The manager has changed the format of how the menu is prepared, which includes pictures for ease of selection. There is also a whiteboard in place in the main dining room which is updated daily. EVIDENCE: Service users are able to make a choice of what they would like to eat from the menu and are offered drinks at set times throughout the day. The majority of service users had selected sausage toad for lunch, but a few had requested lamb chops. Meals are prepared in the main kitchen and served in the two dining rooms. We observed the meals to be wholesome and nicely prepared, and the service users interviewed said they enjoyed the food. Staff were observed supporting and assisting several people in a sensitive and
Highbury Rise DS0000019424.V263209.R01.S.doc Version 5.0 Page 14 professional manner. There appeared to be no facilities for service users to make their own drinks and snacks, this is something which should be offered and several of the service users spoken to said that they would like a selection of biscuits served with their hot drinks (tea and coffee). The old medication cupboard now stores a range of toiletries offered to service users should they run out of their own personal supplies. This supply was very limited, and was of a very basic range. Great care is required when making choice for service users and there is concern relating to possible irritation to the skin. This practice should be reviewed, and personal choice included in the care plan. Highbury Rise DS0000019424.V263209.R01.S.doc Version 5.0 Page 15 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): 16,18 The home has a complaints procedure in place, which is used in all Benslow homes. This appears adequate, in allowing service users and carers to feel their individual views are listened to, and acted on. EVIDENCE: The registered manager had received two complaints since the last inspection. One was on going. The documentation seen showed that the manager had dealt with the complaints in a practical and prompt manner. She had personally met with the carers, as well as responding in writing. The home does hold carers meetings during the year and all carers are invited to attend. There had been a recent case of abuse in the home, and the manager demonstrated that she understood how to protect vulnerable service users from abuse. A strategy meeting had been organised incorporating the relevant professionals, and the outcome was that staff had been made aware of the service users wishes. Only four staff had received training on adult abuse, and this essential training must be extended to the whole staff team. The registered manager must also ensure that the CSCI are informed of all incidents in accordance with Regulation 37. Highbury Rise DS0000019424.V263209.R01.S.doc Version 5.0 Page 16 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): 19,20,21,22,23,24,25,26 The home has a new refrishbuished kitchen since the last inspection, some further work is required. Each service users individual space (bedroom) is well decorated and maintained. Communal areas are also of a general good standard. There was however, an unpleasant odour in the communal lounge, and also several of the bedrooms. There has been much refurbishment within the home since the last inspection, and although there are a few outstanding requirements related to health and safety, the manager has worked hard to improve the over all facilities of the home. EVIDENCE: A hoist has been fitted, and is fully operational in the bathroom that was raised in the previous report. The bathing facilities are limited but all service users have commodes and washing facilities in their rooms. Some of the commodes do require replacement.
Highbury Rise DS0000019424.V263209.R01.S.doc Version 5.0 Page 17 The en-suite bathroom in room 10, is not currently accessible due to a chest of drawers blocking access. This is of concern as it makes cleaning of the facility very difficult and denies the service user access. The registered manager must also ensure that the water temperature on all wash hand basins does not exceed 43°C. A risk management plan must be put in operation until this is rectified. The home was found to be clean and tidy, but the home had an unpleasant odour in several of the bedrooms and the communal lounge area. The deputy manager explained the difficulties relating to the service users bedrooms, but this is not acceptable especially as one of the service users spends a great deal of time in their bedroom. Every effort must be undertaken to eradicate this difficulty, and if it continues to be an outstanding problem then it should be noted in the individual persons risk assessment. The home has a very pleasant garden, which is a nice facility for service users use. Service users are accompanied when outside, but the raised pavings and the slippery patio area could be a tipping hazard and must be rectified. The kitchen has been completely refruishbushed since the last inspection but requires greater ventilation as identified by the architect.Fly screens must be fitted to the large window which is presently providing the only ventalation to the kitchen. Highbury Rise DS0000019424.V263209.R01.S.doc Version 5.0 Page 18 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): 29,30 The recruitment process is in accordance with current legislation, including police checks and the protection of vulnerable adults (POVA). The manager has begun to implement a structure of induction, supervision and appraisal. EVIDENCE: The inspectors viewed records on the day. The records showed that staff have received supervision and appraisal within the last month. The management team do meet, but the manager needs to set out an agreed schedule of staff meetings. These must be formal staff, and management meetings with available minutes. There appears to be a high level of consistency in the care provided to service users, and staff have been employed at the home for a long period of time. The manager advised that agency staff are not employed in the home, and bank staff rarely used. However there are an increasing number of service users who appear confused, and some who have been diagnosed with dementia. This is a very specialised area of work and all staff must be trained in working with and understanding dementia. Staff stated that they were trying to meet the requests of service users by accessing the kitchen to collect, or provide alternatives to that served at lunchtime, they must be mindful of the policies and procedures for control of infection. Suitable clothing should be made available to all staff accessing the kitchen.
Highbury Rise DS0000019424.V263209.R01.S.doc Version 5.0 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,36,37,38 The registered manager was keen to demonstrate her commitment to developing and improving standards in the home. Service users and carers are invited to give their views, and influence the care provided in the home. Some care practices need to be addressed to ensure that service users and staff members are not put at risk, but generally the standard of care is good. EVIDENCE: Staff spoken to confirmed that the manager is supportive and approachable. From the documentation viewed supervision is in place, but staff and management meetings in the home are not structured, and furthermore not recorded. Verbal meetings, which the manager and deputy assured are taking place at present, need to be planned and recorded. Highbury Rise DS0000019424.V263209.R01.S.doc Version 5.0 Page 20 Health and safety issues relating to facilities inside the building (water temperatures) and outside (slippery pavement and lifted pavements) must be immediately addressed and action recorded. Evidence showed that issues of a similar nature from the last inspection were acted on promptly. When, where, and by whom is unclear. Again regularly checks relating to health and safety must be implemented and recorded. The registered manager has introduced an assessment format for service users to be fully assessed prior to being admitted to the home. She must not allow time schedules to impact on this assessment process. The home accepts service users with high needs. New referral documentation that was viewed, indicated that there has been an increase in referrals of service users with dementia. The registered manager must ensure that all staff are trained in this specialist area of work. The registered manger has begun work on developing a quality asssurrance system in the home, and must ensure that a report is produced for the CSCI to provide evidence of evaluation and review. Highbury Rise DS0000019424.V263209.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 2 2 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 3 x 3 2 2 2 STAFFING Standard No Score 27 X 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 2 2 2 Highbury Rise DS0000019424.V263209.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP4 Regulation 14 (2)(a) Requirement The Manager must be able to demonstrate the homes capacity to continously meet service users assessed needs. Regular reviews are required. The manager must ensure that service users care plans are reviewed and updated to reflect changing needs.Care plans must be accessiable to staff at all times. Service users so far as practical must be enabled to make choices in relation to products used for their own personal care. The registered person must ensure that hot and cold drinks and snacks are available at all times and offered regularly. The registered manager must ensure that all staff attend traning on the protection of vulnerable adults. The registered Manager must inform the commission without delay of any event in the home which adversly affects the well being or safety of any service
DS0000019424.V263209.R01.S.doc Timescale for action 31/10/05 2 OP7 15 (2)(b) 31/10/05 3 OP14 12 (2) 01/12/05 4 OP15OP15 16 (2)(i) 31/10/05 5 OP18 18 (1)(c) 01/12/05 6 OP18OP18 37(i)(e) 21/10/05 Highbury Rise Version 5.0 Page 23 7 OP19 23(2)(c) 8 OP19 13(4)(a) (b)&(c) 13(4)(a) (b)&(c) 9 OP19 10 OP25 23(5) user. A regular assessment of equipment, in particular commodes must be carried out. Any faulty equipment must be repaired, or replaced. A risk assessment must be submitted to CSCI in relation to restriction of access to the ensuite bathroom in room 10. Risk assessment s must be completed on hot water temperatures exceeding 43°C. Water temperatures must be tested and recorded on a weekly basis. The registered person must consult with the evironmental health authority with regard to ventalation and the use of open windows in the kitchen. The manager must ensure that the enviroment is free from offensive odours and where this is not possible be identified in the service users risk assessment. All care staff must receive specialist Dementia care training. The registered Manager must supply to the CSCI a copy of the annual quality assurrance report. Care staff must receive formal supervision at least six times per year and minutes should be taken. Staff must wear appropriate protective clothing when entering the kitchen. Paving slabs on the patio area must be made safe, and slippery surfaces must be eradicated. The registered Manager must implement regular health and safety montioring throughout the home, and records must be
DS0000019424.V263209.R01.S.doc 01/11/05 01/11/05 21/10/05 31/10/05 11 OP26 16 (2)(k) 01/11/05 12 13 14 OP30 OP33 OP36 18(1)(c) (i) 24(2) 18(2) 01/12/05 03/02/06 03/02/06 15 16 17 OP38 OP38 OP38 13(4)(c) 13(4)(a) 23(2)(b) 13(4)(a) (b)&(c) 21/10/05 21/10/05 31/10/05 Highbury Rise Version 5.0 Page 24 available for inspection. 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 OP5 OP7 Good Practice Recommendations The manager should ensure that whereever possible every effort is made to faciicate a visit to the home prior to admission. Care plans should be available in an accessiable format and signed by the service user whenever possible and or their representatives. Highbury Rise DS0000019424.V263209.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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