CARE HOMES FOR OLDER PEOPLE
Highbury Rise 6 Highbury Road Hitchin Hertfordshire SG4 9RW Lead Inspector
Patricia Rogan Unannounced Inspection 3rd May 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 Rise DS0000019424.V292707.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Highbury Rise DS0000019424.V292707.R01.S.doc Version 5.1 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.V292707.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th March 2006 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 accommodates older people, including people with a diagnosis of dementia. It 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 charges for the home range from £450-£594 per week. There is an additional charge for hairdressing and chiropody. Highbury Rise DS0000019424.V292707.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. One day was spent in preparation. One full day was spent in Highbury Rise, speaking in privacy with residents and staff and examining documents. In addition to the inspection of key standards, studies were made of care plans, medication and risk assessments of four residents who had a history of one or more falls. This themed inspection looked at what measures were in place to minimise the risk of falls for these residents. A further day was spent asking some relatives and social and health care professionals for their views of the care provided at Highbury Rise. Feedback from those consulted was favourable. Residents appeared to be at ease with the manager and the care staff. There have been some improvements since the last inspection and further work is ongoing. Some standards were not met and requirements have been made. What the service does well: What has improved since the last inspection?
Many of the requirements from the previous inspection have been addressed. Although they have not all been completed, the Manager has given serious consideration to finding the correct format for care plans which should incorporate all aspects of the residents individual care and social needs. The manager and at least ten of the staff are having in depth training in the care of people with dementia. The manager has already identified some changes, which could be made to the home to provide more effective dementia care. There has been partial redecoration and some new furniture in the communal areas. There are plans to replace other furniture in the near future.
Highbury Rise DS0000019424.V292707.R01.S.doc Version 5.1 Page 6 There has been a full medication audit and some members of staff have taken a medication administration course. 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 Rise DS0000019424.V292707.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Highbury Rise DS0000019424.V292707.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (key standard 6 is not applicable to this service) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is aware of the importance of completing a comprehensive assessment of the prospective resident’s needs. The manager involves the prospective resident and their representatives in this assessment. EVIDENCE: Examination of some resident’s files showed that a pre-admission assessment had taken place. Discussion with one resident and a relative of another resident shows that they were involved in the assessment and were given information about the home prior to admission. Highbury Rise DS0000019424.V292707.R01.S.doc Version 5.1 Page 9 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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of the residents were being met. The care plans regarding the social care needs of the residents lacked detail and although the manager is developing new care plans, care staff would benefit from training to understand the importance of individualised care plans. Staff appeared to be friendly and helpful towards residents but not all staff were seen to be discreet when attending residents. EVIDENCE: There is a good working relationship with the medical professionals and there has been a quality audit of the medication and ‘medication administration and recording’ training has been given to some staff. Staff showed that they understood the importance of ensuring that residents were given meals and were appropriately dressed and were helped with personal care. However, it was evident that few staff knew the previous life history or what life was like for individual residents when they were younger, even when this was on file. This is particularly important with such a large
Highbury Rise DS0000019424.V292707.R01.S.doc Version 5.1 Page 10 number of residents with a diagnosis of dementia, whose long term memory may still be intact. The manager and several staff are taking training in dementia care and it is to be hoped that this shows a marked improvement. Not all staff were seen to use the ‘knock and wait’ policy and one resident commented that staff knocked but didn’t give her a chance to reply or cover herself if she was on the commode, before walking into her room. During the inspection, one staff member was heard to call out to a resident to ask, ‘are you ready to go to the toilet?’ Another carer was heard to say ‘oh, dear, you’ve had an accident. Come on, lets go and get changed.’ Carers should be reminded to approach the resident and speak discretely to give the resident more privacy and dignity. Highbury Rise DS0000019424.V292707.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement is made using available evidence including a visit to this service. There is a friendly atmosphere in the home, which reassures the residents. There was a limited amount of appropriate activities to reflect the individual interests and abilities of the residents. One relative wrote that the resident ‘was happier when she has a job to do, she doesn’t like doing nothing.’ Those residents who have dementia need support and time to identify what activities would provide stimulation and an interest. Visitors commented on the welcoming atmosphere when they visited. Some residents said they are helped to make choices on a day-to-day basis. There is a varied menu with seasonal changes. Choices are offered and dietary needs are met. EVIDENCE: Re-arrangement of the communal rooms was taking place during the inspection but residents were seen to sit unoccupied for considerable periods of time and only stirred when age appropriate music was played for a while and when it was mealtime. Staff were seen to work hard, and appeared to have little time to sit and chat with residents on an individual basis or small groups. Meal time was observed and residents obviously enjoyed their meals. Staff served the meals in a cheerful manner and ensured that those unable to feed themselves were given the assistance they needed.
Highbury Rise DS0000019424.V292707.R01.S.doc Version 5.1 Page 12 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 and 18 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. The manager is proactive in promoting an open door policy to enable residents, relatives and staff to make a complaint. There are clear policies and procedures in place and staff have been trained in the Hertfordshire Protection of Vulnerable Adults. EVIDENCE: When there has been a complaint, this has been investigated and responded to appropriately. One relative said she had had a complaint and that the manager ‘spoke to me personally and resolved the matter without any fuss.’ Discussion with staff show that they have had training and on-going supervision, which includes the emphasis that all residents will be protected from abuse. Highbury Rise DS0000019424.V292707.R01.S.doc Version 5.1 Page 13 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 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The hot water temperature in some rooms exceed safe limits and this has been an ongoing concern during more than one inspection. Bed rails were in use but uncovered. There has been some redecoration and some furniture has been replaced. However, some areas were in poor decorative order and in some rooms, walls and surfaces were bare and lacked a homely appearance. Minor repairs are usually carried out soon after they are highlighted but a tour of the building by the inspector and discussion with the manager shows that not all staff take responsibility for reporting any item which requires repair or replacement. The majority of the home was clean but some rooms were still malodorous after cleaning had taken place. In four bedrooms, used continence pads had been left in the waste basket. Highbury Rise DS0000019424.V292707.R01.S.doc Version 5.1 Page 14 EVIDENCE: Weekly records of the water temperatures and recordings taken by the inspector show that the water was excessively hot in some rooms, putting residents at risk of harm. Those residents who have a visual or cognitive impairment may not be able to understand the warning notices about the excessively hot water and are even more at risk. Covers specifically made for bedrails are needed to prevent the resident from becoming trapped. If for any reason a bumper is not used on the bedrail, the person who has given this advice must do so in writing and a risk assessment completed. The manager has a redecoration plan but there are several areas which are used very frequently, such as the toilet next to the communal room and these are in need of attention. A tour of the building by the inspector highlighted some minor necessary repairs such as light bulb needing replacement but these had not been reported to the manager. Some rooms had a strong odour in them, despite recent cleaning. This adversely affects the dignity of the resident. If, with advice from the District Nurses and the Continence Advisor, no solution can be found to effectively manage the resident’s continence, then it would be more appropriate to have non-porous, non-slip flooring which is domestic in appearance. Staff must be reminded of the correct way to dispose of continence pads. Highbury Rise DS0000019424.V292707.R01.S.doc Version 5.1 Page 15 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 for this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The personal and health care needs of the residents were being met but there did not appear to be sufficient numbers of staff to provide the residents with the opportunity to take part in individual or group activities. There is an induction programme and on going training for all staff. The home’s recruitment policy and practice is monitored and reviewed regularly. EVIDENCE: An examination of the rotas and the tasks that staff carry out appear to leave little time for more social interaction with the residents. This is particularly important for those residents who lack the confidence or cognitive ability to engage with others in order to instigate an activity, which interests them. Most staff do not have in depth training in dementia care. This is being addressed and approximately ten members of staff are studying the latest methods of providing the best care and environment for people with dementia. Recruitment policy protects service users and training needs are identified during observation and discussion at supervision.
Highbury Rise DS0000019424.V292707.R01.S.doc Version 5.1 Page 16 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, 33, 35 and 38 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. The manager is qualified and demonstrates a commitment to the well being of the residents and feedback from residents, staff and relatives was positive. She was conversant with the policies and procedures required for a care home. Service user’s finances are safeguarded by stringent policies and procedures and lockable drawers are available to each resident. The manager recognises the importance of staff development and has a training programme in place. EVIDENCE: The manager has an open door policy for residents, relatives and staff and respects the need for confidentiality when it is appropriate.
Highbury Rise DS0000019424.V292707.R01.S.doc Version 5.1 Page 17 In those rooms where the hot water exceeded a safe temperature, the manager had tried to safeguard the residents by putting warning notices above sinks where the water was too hot and she had also reported this on several occasions. During discussion with the manager, it was evident that she was open to new ideas and demonstrated her keen interest in the dementia care training, which she and several members of staff are undertaking. The manager had already identified areas where practice and / or the environment could be changed in order to provide more appropriate support for those residents with a diagnosis of dementia. Highbury Rise DS0000019424.V292707.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 1 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Highbury Rise DS0000019424.V292707.R01.S.doc Version 5.1 Page 19 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 OP26 Regulation 16(2)(k) Requirement To protect the dignity of residents, effective action must be taken to keep the home free from malodours. If necessary, non-porous, non-slip flooring which is domestic in appearance must be used after discussion with the resident and family. This requirement has been carried forward from the previous inspection. Hot water temperatures in some rooms exceed 43°F and puts residents at risk of harm. This must be remedied. This requirement is outstanding from the previous inspection. The manager must ensure that staff are discrete when speaking to residents about personal hygiene matters. Bed rails must have appropriate covering whenever they are used to prevent the resident from becoming trapped. Bed rails must have appropriate covering whenever they are used to prevent the resident from becoming trapped.
DS0000019424.V292707.R01.S.doc Timescale for action 30/06/06 2 OP19 13(4) 30/06/06 3 OP10 12(5) 30/06/06 4 OP28 13(4) 30/06/06 5 OP38 13(4) 30/06/06 Highbury Rise Version 5.1 Page 20 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 OP24 Good Practice Recommendations Some residents’ bedrooms are rather bare. If those residents do not have any family to provide a few ornaments and pictures or photographs, the manager should ensure the resident is helped to select a few items. The variety of activities made available should take into account the individual hobbies, interests and life history of the residents so that residents feel more involved. The manager should identify appropriate training for care staff to raise their awareness of how a dementia affects sufferers and how staff should support these needs. The manager should identify appropriate training for care staff to raise their awareness of how a dementia affects sufferers and how staff should support these needs. The manager should identify appropriate training for care staff to raise their awareness of how a dementia affects sufferers and how staff should support these needs. 2 3 4 5 OP12 OP7 OP27 OP14 Highbury Rise DS0000019424.V292707.R01.S.doc Version 5.1 Page 21 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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