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Inspection on 26/07/05 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 26th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

The care given for physical health needs is good. There is input and support from a number of specialised professionals from the community who advise and train staff for specific health care. The residents are given choice about how they spend their time and their privacy is respected. The meals and choice of food is good and residents can take their meals where they like. Communication between staff about residents is appropriate and handovers include carers and trained staff. The inspector was told that there are regular staff meetings, trained staff meetings and night staff meetings.

What has improved since the last inspection?

Pre admission assessments seen were comprehensive and allowed for the development of an individualised care plan. There was evidence of Moving and Handling risk assessments in residents files. There was evidence in staff files that supervision has begun to take place more formally. Although the level of dependency in the present resident group is high there is no recorded incidence of pressure sores. The Waterlow assessment score for people `at risk` is used and there was a wide selection of pressure relieving equipment available.

What the care home could do better:

Care plans for physical care needs were detailed but there were no interventions for psychological or social care needs. The policy folder lacks an accurate policy on Protection of Vulnerable Adults, the Complaints policy needs to be more detailed in the process of responding to a complaint and there is no policy for Infection Control. Some risk assessments had been undertaken but there were areas for individual residents that needed to be risk assessed to protect the service and the resident. Administration of medication must follow the Nursing and Midwifery Council (NMC) standards for administration of medicines.

CARE HOMES FOR OLDER PEOPLE Highcliffe House Nursing Home 10 Cobbold Road Felixstowe Suffolk IP11 7HQ Lead Inspector Jane Offord Unannounced 26th July 2005 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 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 I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 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 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 None Highcliffe House Limited Mrs S Filmer CRH 27 Category(ies) of TI - 1, OP - 27 registration, with number of places Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 21/1/05 Brief Description of the Service: Highcliffe House is registered as a care home with nursing offering accommodation to twenty seven older people. The accommodation is over three floors with the communal rooms located on the ground floor. Access to the upper floors is by stairs or a passenger lift. Highcliffe House is in a residential area of Felixstowe with views of the sea and within walking distance of the local amenities. The house is a large detached Edwardian building with attractive gardens to the front of the property and parking to the rear. Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on a weekday beginning at 9am and finishing at 16.00. The matron and deputy matron were available throughout the day to assist with questions and queries. During the course of the day five residents, the administrator and two care staff spoke with the inspector, three staff files and three residents files were seen. The Medication Administration Records (MAR sheets) were inspected and the Controlled Drug record and medication storage were seen. Several of the home’s policies were also seen. The atmosphere in the home on the day of inspection was relaxed and friendly. Visitors were observed arriving and being welcomed during the day. Residents and staff were open in their conversation with the inspector and spoke highly of the level of care given. A tour of the premises was undertaken and all areas seen were clean and tidy. The communal areas were suitably furnished and the gardens were lovely. Most of the previous requirements had been complied with but an immediate requirement in regard of correct completing if MAR sheets was left. What the service does well: What has improved since the last inspection? Pre admission assessments seen were comprehensive and allowed for the development of an individualised care plan. There was evidence of Moving and Handling risk assessments in residents files. Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 Page 6 There was evidence in staff files that supervision has begun to take place more formally. Although the level of dependency in the present resident group is high there is no recorded incidence of pressure sores. The Waterlow assessment score for people ‘at risk’ is used and there was a wide selection of pressure relieving equipment available. 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. Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 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 standard(s) 1, 3, 4, 5 People who use this service can expect that they will be given information about the service and how their needs will be met prior to their admission. They can also expect that they and/or their family can visit the home before the decision to live there is made. EVIDENCE: On the day of inspection the matron made a phone call to a prospective new resident and was planning for them to visit. They were also told that they could bring a specific chair for their room if they chose to come to the home. There was evidence in the residents’ files that were seen, of pre admission assessments covering areas of need such as, personal hygiene, diet, communication, mobility, sleep pattern and past medical history. One resident said that they had talked of moving into Highcliffe House, because of its local reputation, before the need arose and then after they were in a convalescent placement they were able to move in permanently. Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 Page 9 Another resident said they had been unable to choose the home themselves as they were in hospital prior to admission to the home. Two family members had visited on their behalf and been impressed with the home and the staff attitude to them. Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 Page 10 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 standard(s) 7, 8, 9, 10, 11 People who use this service can expect that their health needs and final wishes will be fully met with respect, but they cannot be assured that their care plans will address their psychological and social needs or appropriately risk assess their choices, or, that they are protected by the home’s medication administration procedure. EVIDENCE: There was documented evidence in residents’ files of appointments with health professionals such as the GP, chiropodist, optician, diabetic support worker and physiotherapist. Residents confirmed that they attended such appointments with family or staff. One resident talked of specialised care from Macmillan nurses and a review of their medication for pain relief by a doctor from the hospice. They also saw the physiotherapist regularly who gave them exercises to help them remain comfortable. Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 Page 11 The matron had indicated to the inspector at the beginning of the inspection that there was a resident who was terminally ill and suggested that that room was not visited during the tour of the premises to respect the privacy of the resident and their relatives. There had been the death of a resident some days earlier and the funeral was taking place, some staff members attended to represent the home. Residents’ personal files that were seen recorded their final wishes and who the next of kin was for notification in an emergency. Care plans detailed physical care needs but not psychological or social ones. One resident had clear reservations about selling their home to move into the home permanently but there was no intervention for anxiety on their care plan. Another resident demonstrated difficulties with their sleeping pattern and some strategies to help were recorded in the daily records but nothing on the care plan. Medication was stored correctly and the Controlled Drug (CD) count tallied. Temperatures recorded for drug refrigerators were within safe limits for medication storage and there was evidence of individual prescriptions for common drugs such as lactulose and paracetemol. MAR sheets that were checked showed correct use of code letters for doses that were not given and ‘as required’ (PRN) medication indicated the amount administered. However there were signature gaps on several sheets where medication should have been administered, some of these were for CDs. Residents said that they had a choice of male or female carers to undertake their personal care. Staff were observed knocking on doors prior to entering residents’ rooms. Interactions between staff and residents was friendly and appropriate. Some care plans and personal records recorded that bed rails were in place but there was no evidence of there being a risk assessment for this equipment. No risk assessments had been generated for other areas of concern such as one resident wandering at night or two residents who had chosen to remain in bed for a period of days. Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 Page 12 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 standard(s) 12, 13, 14, 15 People who use this service can expect to be supported to choose how to spend their time, what they would like to eat and whom they would like to maintain contact with. EVIDENCE: It was evident on the day of inspection that residents had chosen where they wanted to spend their time. Some residents were in the main lounge but some had remained in their room, one or two had decided to take advantage of the sunshine and sit in the garden. On resident said they had freedom to choose when or whether to get up in the day. They spent time in their room or the garden but always joined other residents for the lunchtime meal. They said the food was ‘excellent’ and they always found something they liked. Another resident said there was a menu to choose from each day and the food was always well cooked and hot. At lunch time one resident was served a meal with more gravy on it than they liked, the plate was returned to the kitchen and replaced with one with less gravy. Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 Page 13 Two residents, for different reasons, had chosen to remain in bed for the day. The staff respected this decision and meals were supplied to their rooms. All the residents spoken with said their family and friends were welcome at any time and there were visitors arriving and leaving during the day. One resident whose physical health had deteriorated making some leisure activities difficult said they had ‘a lot of visitors to help pass the time’. Residents talked about activities and outings that had taken place. One resident had been to Colchester Zoo with a friend recently. There was an outing planned for the following week which would include a ‘fish and chip’ lunch. The home regularly takes part in Felixstowe in Flower competition, which accounts for the lovely gardens. A young relative of one resident was playing a prominent part in the local carnival and a group of participants in full costume were due to visit everyone during Carnival week. The home had televisions and music in the communal rooms with one ‘quiet’ lounge with a choice of books and jigsaw puzzles. Residents said they could bring in their own televisions and music centres for their rooms. Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 Page 14 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 standard(s) 16, 18 People who use this service can expect that any complaints or concerns they have will be taken seriously and resolved, however although staff were aware of Protection of Vulnerable Adults their training was not recent so residents cannot be assured that they will be protected from abuse. EVIDENCE: Neither the home nor CSCI have received any complaints since the last inspection. The Complaints policy was seen and adequate although to assist in an investigation trail there should be a written response to all complaints outlining the steps taken to resolve any issue. Residents and relatives were all able to say whom they would speak to if there was a concern. Staff spoken with were able to describe what constituted abuse but one staff member gave a procedure for dealing with an abusive situation which would have compromised further investigation. No member of staff has had recent training in Protection of Vulnerable Adults so the existing policy is not in line with up to date guidelines. Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 Page 15 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 standard(s) 19, 22, 24, 26 People who use this service can expect to live in a well maintained, clean environment with their own belongings around them but they cannot be assured that the home’s procedures will protect them from infection. EVIDENCE: All areas of the home seen on the day of inspection were clean and tidy. Residents’ bedrooms were furnished with some of their own belongings and a lot had photographs and personal ornaments on display. There was evidence of specialised equipment to assist residents with moving, bathing and protecting skin integrity. There were hoists to help people into chairs. One resident who could no longer walk said that being hoisted was not ‘scary any more’ as they had got used to it. Two residents who were in bed both had specialist mattresses to protect them from developing pressure sores. There was an assisted bath in the down stairs bathroom. Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 Page 16 There were ramps or level access to the outside and doors were all wheelchair accessible. A passenger lift gives access to the first and second floor for residents who are unable to manage stairs. On the day of inspection there were no offensive odours present. The laundry area is small and not easy to manoeuvre in but the matron said there are plans to upgrade the area. The washing machines have a sluicing programme and residents said that the service for personal clothing was good with items very rarely missing. Personal laundry was observed being delivered back to resident’s rooms and looked clean and pressed and was hung carefully in the wardrobe. There was evidence of staff using gloves and linen bags in the course of their work. However there was no written Infection Control policy to give overall guidance of managing soiled linen or preventing cross infection. Consideration needs to be given to managing a resident with an acquired infection such as MRSA. Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 People who use this service can expect to be cared for by staff who are trained for the work and in a skill mix suitable to meet their needs but they cannot be assured that the present recruitment checks made by the service will protect them. EVIDENCE: On the day of inspection there was a mix of trained staff and carers on duty throughout the day. They were supported by the manager and deputy manager who were both supernumerary on that day. In addition there were kitchen staff and domestics working in the home and an administrator to deal with the telephone and visitors. Care staff and residents all said that the staffing levels were sufficient to meet the level of need at that time in the home. Residents said buzzers were answered quickly. Staff said that if the number of residents or the level of need fell or rose then there was the opportunity to discuss and review staffing levels. Staff training is an ongoing process with a monthly programme of training sessions which include subjects such as, tissue viability, care of the dying, Dementia care and stoma care. Staff and residents spoke of specialist input being available for specific care needs such as advice from Macmillan nurses or Hospice from Home. Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 Page 18 Four staff files were seen during the inspection. Three of them contained all the checks required such as two references and Criminal Record Bureau disclosure (CRB). One file only had one character reference and a CRB check for a different post. This was discussed with the matron on the day and a further CRB for that member of staff will be sought. Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 36, 37, 38 People who use this service can expect it to be led and managed by a person well qualified for the post who supervises the staff team appropriately and safeguards residents’ health and welfare however they cannot be assured that all the present policies and procedures will protect them. EVIDENCE: The matron has been in the present post for two years and had previously qualified as a Registered Mental Nurse and undertaken a Certificate of Higher Education in Nursing. They have also had nine years experience in administration in the Metropolitan Police. There was documented evidence of supervision taking place for staff. Matron supervises trained staff and the deputy matron supervises carers. Staff spoken with felt that supervision was giving them the opportunity to discuss issues and the support they needed in the job. Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 Page 20 The staff undertake an annual Moving and Handling update to give them the knowledge and skills to help residents safely. There is a fire-training programme ongoing. There was evidence that food hygiene regulation for storage of food was being correctly observed. Temperatures for freezers and refrigerators were within safe limits for food storage and food was labelled with ‘use by’ dates. There has been no recent training for staff on Protection of Vulnerable Adults (POVA) and the policy needs reviewing in line with the most up to date guidelines. There was no Infection Control policy in the folder seen on the day. This omission must be addressed to protect staff and residents. Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x 3 x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 3 3 x x x 3 3 2 Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 Page 22 yes 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 7 Regulation 15 Requirement Residents care plans must be comprehensive and include psychological needs and the interventions required. Mar sheets must be correctly completed to show medication has been administered or an accepted code to indicate the reason why not. This is a repeat requirement. Training for staff on Protection for Vulnerable Adults must be undertaken and the POVA policy updated to reflect most recent guidance. The information required in Schedule 2 must be obtained when recruiting staff and kept in personal files. This is a repeat requirement. A policy for Infection Control must be developed and implemented. Timescale for action 31/10/05 2. 9 13 (2) immediate. 3. 18 13 (6) 31/9/05 4. 29 19 Schedule 2 13 (3) immediate 5. 38 31/8/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 Page 23 No. 1. Refer to Standard 16 Good Practice Recommendations The Complaints policy should reflect that each complaint will have a written response and record of investigation to allow an audit trail if required. Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 5th Floor, St Vincent House 1 Cutler Street Ipswich Suffolk, IP1 1UQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Highcliffe House Nursing Home I54-I04 S24414 Highcliffe House V241352 050726 Stage 4.doc Version 1.40 Page 25 - 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. 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