Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 12/05/08 for Highcliffe House Nursing Home

Also see our care home review for Highcliffe House Nursing Home for more information

This inspection was carried out on 12th May 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Highcliffe House offers a friendly and welcoming atmosphere with a homely environment. We saw staff greeting visitors and helping them in a courteous manner. This confirmed comments made by relatives that the staff were always very pleasant, helpful and friendly.Meals are prepared to a high standard, with alternatives to the main dishes always advertised on the menu. Residents have a choice of where they take their meals. Comments from local GPs and community nursing staff expressed the opinion the Highcliffe House provided nursing care of a high standard. The home is kept clean and odour free, as residents and relatives confirmed. There are good procedures to prevent the spread of infection, by staff using protective clothing, the use of hand sanitizers and hygienic laundry procedures.

What has improved since the last inspection?

The home has been registered for an additional five rooms, and has extended the Wisteria lounge, moved the laundry, provided an additional toilet on the ground floor, added a conservatory and refurbished the dining room. These developments have improved the appearance and comfort of the home for residents, and given them more choice on where to spend their day. Pre-admission assessments are now routine for all new referrals, to evidence that the home is able to meet the needs of those admitted. Some progress has been made in reviewing care plans on a regular basis to ensure that any changes in the care needs of residents are identified and their care modified as necessary. New staff are not appointed until two references have been received to ensure that residents are cared for by staff who have been recruited safely. Some improvements have been made in the ordering, receipt, administration and recording of medications in line with the requirements of the Statutory Notice. These have increased the safety of residents and protection from harm through poor medication practices, although more improvements are required.

What the care home could do better:

The manager must make further improvements to the medicine administration system in order to safeguard residents. For example, records must show that residents have received the medication prescribed for them, and the management should regularly audit its medication system and practices. These measures will ensure that residents` courses of medication are strictly followed, and that all medication is properly accounted for. Residents should be able to feel assured that their care will be delivered in accordance with their care plan, by competent staff and respecting their privacy. For this to happen, there should be regular reviews of all care plans to re-assess care needs and to adjust the care plan appropriately. Staff should be supervised formally to identify training needs and monitor care practices, toensure that residents` changing needs can be met. How care plans are stored should be reviewed to ensure that they are secure, up-to-date and maintained in accordance with statutory requirements.

CARE HOMES FOR OLDER PEOPLE Highcliffe House Nursing Home 10 Cobbold Road Felixstowe Suffolk IP11 7HQ Lead Inspector John Goodship Unannounced Inspection 12th May 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Highcliffe House Nursing Home DS0000024414.V364164.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. Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highcliffe House Nursing Home Address 10 Cobbold Road Felixstowe Suffolk IP11 7HQ 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) 01394 671114 01394 671298 alison@highcliffehouse.com www.highcliffehouse.com Highcliffe House Limited Mrs Bridget Bone Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th November 2007 Brief Description of the Service: Highcliffe House is registered as a care home with nursing, providing care for a maximum of 32 older people. The home is privately owned by Highcliffe House Limited and is managed by Mrs Bridget Bone. Highcliffe House is a large Edwardian building situated in a residential area of Felixstowe within walking distance of the sea front and local amenities. It is a detached building with gardens to the front of the property and parking at the rear. Accommodation is over three floors with communal rooms located on the ground floor. Access to the upper floors is by stairs or passenger lift. Fees range from £380.00 to £700.00 per week depending on the level of care needed and the accommodation occupied. The fees do not include the cost of toiletries, hairdressing, chiropody or newspapers. Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key unannounced inspection took place on a weekday and lasted four and a half hours. The registered manager was on leave but the director who deals with the administration of the home was present as well as the deputy matron. At the key unannounced inspection on the 5th June 2007 the home was found to provide poor outcomes in health and personal care in relation to poor medication practice. The Commission’s Pharmacy Inspector undertook an inspection on 4th September 2007. As a result of the inspection a Statutory Requirement Notice was issued in relation to poor medication practice. A further pharmacy inspection on 18th December 2007 found that some improvements had been made and the Statutory Notice was withdrawn. The Pharmacy inspector undertook an inspection on the 9th May 2008 to check that there was continuing compliance with the Statutory Notice. A record of their findings is included in this report. This report has been compiled using information available prior to the inspection, and evidence found on the day. The manager had completed an Annual Quality Assurance Assessment (AQAA) for the Commission in October 2007. Questionnaire surveys were sent out by the Commission to residents, relatives and staff. Two were returned from residents, six from relatives and seven from staff. The results of these surveys, and comments made on them, have been used where appropriate in the report. We toured the home, and spoke to two residents in detail, and chatted to others. We also talked to two members of staff at length, as well as observing how staff went about their work. One relative was visiting at the time and we were able to talk to them about the care of their family member. We also looked at three residents’ care plans, two staff files and other records kept by the home such as maintenance records, fire logs, staffing rotas, and policy documents. What the service does well: Highcliffe House offers a friendly and welcoming atmosphere with a homely environment. We saw staff greeting visitors and helping them in a courteous manner. This confirmed comments made by relatives that the staff were always very pleasant, helpful and friendly. Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 6 Meals are prepared to a high standard, with alternatives to the main dishes always advertised on the menu. Residents have a choice of where they take their meals. Comments from local GPs and community nursing staff expressed the opinion the Highcliffe House provided nursing care of a high standard. The home is kept clean and odour free, as residents and relatives confirmed. There are good procedures to prevent the spread of infection, by staff using protective clothing, the use of hand sanitizers and hygienic laundry procedures. What has improved since the last inspection? What they could do better: The manager must make further improvements to the medicine administration system in order to safeguard residents. For example, records must show that residents have received the medication prescribed for them, and the management should regularly audit its medication system and practices. These measures will ensure that residents’ courses of medication are strictly followed, and that all medication is properly accounted for. Residents should be able to feel assured that their care will be delivered in accordance with their care plan, by competent staff and respecting their privacy. For this to happen, there should be regular reviews of all care plans to re-assess care needs and to adjust the care plan appropriately. Staff should be supervised formally to identify training needs and monitor care practices, to Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 7 ensure that residents’ changing needs can be met. How care plans are stored should be reviewed to ensure that they are secure, up-to-date and maintained in accordance with statutory requirements. 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. Highcliffe House Nursing Home DS0000024414.V364164.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 Highcliffe House Nursing Home DS0000024414.V364164.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): 1,2,3. Standard 6 is not applicable to this home. Quality in this outcome area is good People who use this service can expect to have sufficient information to make an informed decision and can be assured that they will have an assessment of need prior to being offered a place in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined the statement of purpose and service users guide which contained all the information required about the service offered by Highcliffe House. They covered the organisation of the home and its staffing structure, the admission criteria, the range of care offered, the qualifications and training of staff, and the daily living arrangements regarding meals, activities, laundry, and access to a GP. Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 10 Examples of letters giving information about fees were shown to us. These detailed how the NHS nursing element was to be paid, the net figure required from the resident or their family, and any top-up agreed between them and Social Care Services if appropriate. The letters also made clear what was chargeable in addition to the fees. Items such as hairdressing, private chiropody, telephone, newspapers and toiletries were listed. Residents or their representatives were asked to consent formally to the home paying for these items and recharging them on a monthly basis. We examined the care records for two residents admitted since the last inspection which contained a full pre-admission assessment. This covered areas of support required for the activities of daily living such as communication, eating and drinking, personal hygiene, continence, mobility and night needs. There were also details about social interests, religion and family involvement. Highcliffe House Nursing Home DS0000024414.V364164.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): 7,8,9,10. Quality in this outcome area is adequate. People who use this service can expect to have their health needs met and be treated with respect but they cannot be assured that their care plan will be reviewed regularly to reflect all their care needs. They cannot be assured that they will be fully protected by the policies and procedures for medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following a requirement in the previous report that care plans must address all the care needs of each person and be regularly reviewed, we examined three residents’ care plans. An assessment on admission in each file seen included the reason for the need to be admitted, a past medical history, current medication, any known allergies and a little social history. There was a tick list to show the level of support required in walking, standing, sight, hearing, skin integrity and mental state. Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 12 The care plans seen had basic information and limited interventions under headings such as maintaining safety, eating and drinking, mobility, personal hygiene and communication. There was still no evidence that monthly reviews of care needs were being carried out for all residents. We noted that the most recent nursing assessment for one person had been signed and dated. There had not yet been a review for a resident admitted seven weeks previously. However another resident had been reviewed and changes made to their care. Their wound care was regularly reviewed. The dietitian was monitoring their PEG feeding regime. They had decided to take the resident off this and put them onto a strict oral feeding regime. This was detailed in the care plan with clear alerts to staff about monitoring their care. We saw the record book for the monthly weight checks on each resident, taken with the use of a weighing chair. We noted that no resident’s weight was causing concern at present. Bathing records were also recorded separately from the care plans. The care plan records would be easier to follow if these two aspects of care were also recorded in those plans. They were usually recorded in the Daily Evaluation Report but this would not easily identify changes of care needs or provide an overall picture of care given, for example when conducting a review. Some of the entries in this daily report were scanty, while other entries gave a full picture of what the resident had accomplished during the day, for example in terms of what they did, whether they had a good lunch, if they had visitors or took part in activities. Nursing interventions were however recorded fully. The daily report should give a rounded summary of the resident’s day and night to enable an holistic picture to be available to assess against their care plan, and to identify changing needs both nursing and social. We examined the record of a resident who had recently died after transfer to hospital. This showed that symptoms had been promptly reported and recorded and vital signs recorded regularly during each day. The GP had been called at the appropriate time and their instructions recorded and followed. Observations were made regularly up until the district nurse, acting for the GP, had decided the resident should be transferred to hospital. The inspection of the medication standard was conducted by the Commission’s pharmacist inspector on 09/05/08. Overall he found that there had been some improvement in the home’s management of medicines; however, the system of medicine administration could be streamlined to improve safety. There were some medicines available in two container types which could cause confusion. Some medicine containers were not synchronised with the start of the monthly medication records. There were some residents’ photographs missing which are used to assist in safe medicine administration. Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 13 There had been improvements in the home’s record-keeping practices. At the time of arrival for inspection, records of medicines already administered in the morning had been completed. However, for many medicines there was still found to be no system in place to enable medicines to be accounted for. Where they could be audited and a sample examined there were six medicines satisfactorily accounted for and one discrepancy where it could not be determined from the records that the medicine was being given in line with prescribed instructions. The manager confirmed that the home was still not conducting internal audits to account for medicines. The handling of ophthalmic medicines which are of limited life on opening (28 days) was discussed, as there were containers of eye drops that were dated as opened 23/03/08 but were still available for use. It was requested that these containers were immediately disposed of and replaced by new containers. Nursing staff said that residents who regularly refuse medicines or have problems taking them are referred back to the prescriber for review but there were not always records available to confirm this. Where there were records, they had been documented in residents’ daily care notes and not on separate healthcare professional intervention records so were difficult to find and refer to. We observed staff knocking on doors before entering bedrooms and bathrooms. Relatives said in their surveys that staff were always pleasant and “very friendly and helpful to patients and visitors.” One relative said that a resident was given “effective and sympathetic support following a bereavement.” The care plans of each resident were kept on an open shelf at the nursing station, which was a small area at the side of the dining room. These files were only identified by the name of the room occupied by the resident. (All rooms were named after different flowers). However there were times when this area was unattended therefore not fully ensuring the privacy of personal data. Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is good. People who use this service can expect to be offered activities relevant to their interests, be encouraged to maintain contact with family and friends and have a well balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All the files we saw contained some details of the resident’s social needs. Contact details of the next of kin and anyone important to the resident were recorded. Some daily records showed when residents had had visitors. Visitors were seen to come and go during the day and were welcomed by staff. Many thank you cards on the notice board made comments about how welcoming the staff had always been. The home employed a therapeutic practitioner for 3 days a week. This person had started a programme of assembling life histories for each resident with help from their families. Some had a full life history written by the resident. All new admissions had one and the practitioner was working through the other residents. They had also developed a therapeutic assessment form for each Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 15 resident, to record their interests and ideas about things they would like to do. Each resident had an individual record of activities which was kept in their care plan. The practitioner told us that they noted which residents did not or could not take part in activities, and they visited and talked to them on a one to one basis. These sessions were also recorded in their care plan. The notice board in the hall listed activities for that day. There was a DVD showing for ‘Early Risers’, the gardening club in the conservatory, and musical reminiscence in the Wisteria lounge. The practitioner listed other activities that were put on, such as musical entertainers, bingo, and dominoes. The mobile library visited the home, and residents were able to borrow talking books as well as reading books. One resident told us that they were taken out in a wheelchair by their relatives if the weather was suitable. The practitioner told us that once a year the home tries to book a day at the community centre on the front to take some residents for the day. Relatives commented on their survey forms that “the information and care for friends and families is superb.” We noted visitors coming to the home during the inspection. One person said that they visited their relative most days. Most residents chose to have breakfast in their room. At lunch, six people were eating in the dining room, eight were eating in one of the lounges, and the others were eating in their rooms. Lunch consisted of pork casserole with sauté swede and herby potatoes or an alternative of marrow Provencal. Dessert was semolina pudding and jam. A cup of tea and fruitcake was offered at teatime, and supper was spinach soup, and omelette or sandwiches. We spoke to four residents who all said that they enjoyed the meals. One said that they had been given too big a portion which was why they had not finished the plate. Another said: “The meals are exceptional and very appropriate for my generation.” A relative commented that “ the food and hygiene standards could not be improved”. The planned menus were seen and showed that a fish dish was served each Friday and a roast every Sunday. Staff were observed in one of the lounges supporting two residents to eat their lunch. This was done in an unhurried and friendly way. A relative was also supporting their family member to eat. The homeliness of the dining room was somewhat marred by the presence of the nursing station in an alcove at the side of the room. This led to staff coming in and out of the room to access information or documents while people were having their lunch. Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 16 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): 16,18. Quality in this outcome area is adequate. People who use this service can expect to have complaints taken seriously but cannot be assured that they will be fully protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This inspection took place during the week when the Commission was conducting a national thematic probe into safeguarding. The director on site was advised of this and an outcome record was completed for the home. The areas covered were staff recruitment, quality assurance, training, and effectiveness of systems. We examined the complaints policy which was included in the statement of purpose. There were a large number of complimentary thank you cards on display in the entrance hall. Residents spoken with were clear about the procedure for raising any concerns. Four of the six relatives who replied to the survey said that they knew how to make a complaint. We were shown the policy on the protection of vulnerable adults. This was taken from a model template. It was not specific to the procedures agreed in Suffolk. It did not clarify how and to whom safeguarding referrals must be made. This was surprising as the manager and previous manager had Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 17 completed a trainer’s course with Suffolk Adult Care Services and provided the in-house training. Following this training, the home had decided to cease using an outside training provider and do all their safeguarding training in-house. The home had a policy on whistle blowing to protect staff who may raise issues. Staff we spoke to were clear about their duty of care and were able to identify hypothetical instances of abuse. They were clear that they had to report any incidents or concerns to the manager on duty. They said they had received updated POVA training within the last year. Training records confirmed training had been given in July and August 2007. However the deputy manager was not able to tell us how they would action a safeguarding referral if they were the senior person on duty or on call. The home had been the subject of an investigation by Suffolk Social Care Services in January 2008 after they had received allegations about medication and care practices. The medication issues were already under investigation by the Commission for Social Care Inspection. The other allegations were not substantiated. The home had received one complaint from a relative since the last report. This had been investigated by the manager and a response sent to the complainant within the required timescale. Recruitment checks were carried out for new staff with full application forms, identification documents, POVA list and Criminal Records Bureau checks. This was to ensure the safety of residents. These checks are detailed under ‘Staffing’. The home did not manage any personal monies for residents. The director explained that incidental items were paid for by the home and invoiced monthly. This was agreed formally by the resident or their representative. Otherwise residents could keep money in a lockable drawer in their room. Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 18 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): 19,26. Quality in this outcome area is good. People who use this service can expect to live in a clean, homely environment which is well maintained and has hygienic procedures for the protection of residents’ health. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Following the completion of an extension, the home was registered for five additional places in January 2008. The rooms met the requirements of the National Minimum Standards regarding size, facilities and contents. The door leading to each of the five rooms was a normal width 800 mm and there was an extension panel to allow a wider area to be opened in the case where a stretcher had to be manoeuvred in and out of the rooms. The door could be Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 19 locked and the side panel was secured with a bolt and adhered to the fire safety regulations. The rooms were in excess of the minimum 12 square metres ranging between 13.7 and 15.7 square metres to allow sufficient space for nursing care to be delivered each side of the bed and for the movement of hoists and wheelchairs. An ensuite was located off each of the bedrooms and had all the appropriate equipment and facilities, for example toilet, washbasin, heater, cabinet and handrails. Inside each of the bedrooms there was appropriate furniture and furnishings. The rooms’ facilities had been designed to allow the bed to be placed in one of two positions according to the preferences of the occupant. The consequential and other works had been completed, including the upgrading of the dining room with new window frames, a new laundry and a new conservatory leading to a courtyard garden with a protected pond. A small extension had been added to the Wisteria lounge with double doors leading to the front garden. An additional disabled toilet had been created on the ground floor. When we toured the home, it was clean and tidy. We spoke to two residents who said that the home was always clean. We noted staff using protective aprons and gloves for personal care tasks. There were hand sanitizers on the walls to complement hand washing, reducing the risk of cross-infection. A member of staff working in the new laundry confirmed that it was a much better working environment. There were two washing machines with sluicing programmes, and two tumble driers. Soiled linen was transported to the laundry in red alginate bags, which were placed directly in the machine. This reduced the need for handling soiled items and helped to prevent the spread of any infection. Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 20 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): 27,28,29,30. Quality in this outcome area is good. People who use this service can expect to be supported by adequate numbers of suitably trained staff who have been recruited properly to ensure their safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We inspected the duty rotas which showed that there was a trained nurse on duty throughout the twenty-four hours. Six carers in the morning shift, six carers during the afternoon and evening and two carers overnight support them. There was a cook and breakfast assistant in the kitchen and four housekeeping staff including a laundry worker. The home employed a maintenance person and a part time therapeutic practitioner. A physiotherapist attended the home weekly for assessments and routine exercise work with the residents. The home had no staffing vacancies at the time of our inspection. We saw staff working in a calm and friendly way. Residents and relatives who replied to the survey all felt there was always or usually sufficient staff on duty. Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 21 Five carers had achieved an NVQ level 2 or above with seven more working towards the award. When the training is completed the percentage of carers with the qualification will be 66 , which exceeds the recommended 50 of standard 28 of the national minimum standards (NMS). This target is set to ensure that residents are in safe hands at all times. The files for two recent appointments were examined, one a nurse and the other a care assistant. Both contained application forms with no gaps, together with the required identifying documents and photos. The nurse’s registration had been confirmed with the Nursing Council. Two references had been received for each person. The home had received confirmation that neither was named on the Protection of Vulnerable Adults (POVA) list. These were received before they started work. One Criminal Records Bureau (CRB) disclosure certificate had been received on the starting day; the other had not yet been received. We spoke to two staff in detail about their work and training, one male, one female. They confirmed the training they had received, including fire training, POVA, and health and safety. They also confirmed that they had received training in the moving and handling of residents. This training was given by the visiting physiotherapist. Both the staff said there were enough staff on each shift to meet residents’ needs and that the team was very supportive, working well together. They told us staff meetings were held quarterly, but supervision sessions had not been undertaken. The home employed four male carers out of a total of sixteen carers. The male member of staff told us that residents were offered a choice of gender to support them in personal care tasks. He told us that currently there were no residents who had expressed a wish not to be cared for by a male member of staff. Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37,38. Quality in this outcome area is adequate. Residents can expect the home to be run in their best interests. They cannot be assured that they will be protected by the proper supervision and monitoring of staff competence and practices, or by the auditing of medication procedures to ensure the safety of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The present manager had been in the post two years having achieved a promotion within the service. They were a trained nurse and had a number of years’ experience in caring for older people. They held an ENB skills assessor and an NVQ assessor awards. Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 23 The home did not manage any personal monies for residents. The director explained that incidental items were paid for by the home and invoiced monthly. This was agreed formally by the resident or their representative. Otherwise residents could keep money in a lockable drawer in their room. The home had issued a Patient Quality of Care survey in March 2008. 22 replies were received. We saw these waiting to be analysed. However we were able to see that the majority of matters were rated as satisfactory. Two people had asked for changes to the menu. The director told us that the cook had been asked to action this. The majority of the surveys had been completed with the help of a staff member, often the therapeutic practitioner. Several residents had stated that they did not know whom they should speak to if they were unhappy. The staff member completing the form had written on it that they had explained to them what this meant and what they should do. However the two residents who completed our survey said they did know who to raise concerns with. No evidence was shown to us of how the management ensured that staff were properly supervised, to monitor their care practice and to identify training needs. We examined the accident records for staff and for residents. We noted that one person had sustained several falls in a four-week period. The director told us what action had been taken to reduce the risk of further falls. The pharmacist inspector identified that a number of shortfalls in medication procedures were due to a lack of management auditing and monitoring. The absence of audit trails for prescribed medicines put residents’ health and welfare at risk. We inspected the fire log and the fire risk assessment. All tests and inspections of equipment were up-to-date. The assessment had been written by an external adviser. The temperatures of hot water outlets were tested monthly by the maintenance man. We checked one bathroom and confirmed that it was within the safe range. The local authority environmental health officer had inspected the kitchen in May 2008. No action had been required. Hoists were checked every six months, the sticker on one showed the last inspection was on 30 April 2008. These tests and checks contributed to the health, safety and welfare of residents and staff. Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 1 2 2 Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement Improvements must be made to the medicine administration system to ensure confusion is avoided by removing second containers and medicines no longer in use. Medicines of limited life on opening including ophthalmic preparations must be safely handled and removed when their expiry time has been exceeded. Medication record-keeping practices must demonstrate that all medicines have been administered in line with prescribed instructions. The Adult Safeguarding policy and procedure must specify how referrals are made in Suffolk so that allegations are dealt with in a timely and correct manner to safeguard residents. Staff must be appropriately supervised, on a regular and DS0000024414.V364164.R01.S.doc Timescale for action 10/06/08 2. OP9 13(2) 12/05/08 3. OP9 13(2) 10/06/08 4. OP18 12(1) 30/06/08 5. OP36 18(2) 10/07/08 Highcliffe House Nursing Home Version 5.2 Page 26 recorded basis to ensure that residents are cared for competent staff following the home’s policies and practices. 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 OP7 OP9 Good Practice Recommendations An audited system of monthly care reviews should be introduced to ensure that the home’s policy is implemented. It is recommended that monitored dosage system containers are synchronised with start dates on medication records. It is recommended that resident-identifying photographs are obtained for all residents to assist in safe medicine administration. It is recommended that regular audits of medication are conducted in the home to enable medicines to be accounted for. It is recommended that the home improves its recordkeeping practices relating to external healthcare professional interventions for medicines. A programme of regular supervision sessions should be drawn up to ensure that staff’s skills and competencies are monitored. The security of the place where care plans are kept should be reviewed to ensure that the home meets the requirements of data protection legislation. 3. OP9 4. OP9 5. OP9 6. 7. OP36 OP37 Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. Extracts may not be used or reproduced without the express permission of CSCI Highcliffe House Nursing Home DS0000024414.V364164.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!