Inspection on 30/04/09 for Highcliffe House Nursing Home

This inspection was carried out on 30th April 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Highcliffe House Nursing Home 12/05/08

Highcliffe House Nursing Home 27/11/07

Highcliffe House Nursing Home 05/06/07

Highcliffe House Nursing Home 31/05/06

Highcliffe House Nursing Home 06/12/05

Highcliffe House Nursing Home 26/07/05

Highcliffe House Nursing Home 21/01/05

Highcliffe House Nursing Home 26/07/04

Similar services:

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Claremont House

Oak Ridge

Sun Court Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Highcliffe House Nursing Home 10 Cobbold Road Felixstowe Suffolk IP11 7HQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jill Clarke     Date: 0 1 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 38 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Highcliffe House Nursing Home 10 Cobbold Road Felixstowe Suffolk IP11 7HQ 01394671114 01394671298 alison@highcliffehouse.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Highcliffe House Limited care home 32 Number of places (if applicable): Under 65 Over 65 32 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 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 £625.00 to £700 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. Fees for Respite/Convalescent care are from £100 per day, and weekend breaks can Care Homes for Older People Page 4 of 38 Brief description of the care home also be arranged (from Friday afternoon to Monday morning) at a cost of £300 per person. The home also provides Day Care, although this is not regulated by ourselves. Please contact the home direct for a copy of their Statement of Purpose, which gives further details on fees, and what the home is able to offer. Care Homes for Older People Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Please note as from 1 April 2009 the duties of CSCI was taken over by the Care Quality Commission, the new independent regulator of all health and adult social care in England. For more information please visit the Care Quality Commissions website at www.cqc.org.uk We (The Commission) visited the home unannounced on the 30th April 2009, to carry out a key inspection, where we focused on assessing the outcomes for people living at the home, against the Key Lines of Regulatory Assessment (KLORA). In undertaking this, it helps us get an idea, from a residents viewpoint, on what it is like living at the home, and gain feedback on the level of care they receive. As we did not manage to complete all our work on the first day of the inspection, we made arrangements with Care Homes for Older People Page 6 of 38 the home to return the following day. The report has been written using accumulated evidence gathered prior to, and during the inspection. We last inspected the home on the 12th May April 2008. A Selection of our surveys were sent to the home in October 2008 to give out. This gives an opportunity for people using, working in, and associated with the service to give their views on how they think it is run. At the time of writing this report we had received surveys back from 9 residents, 5 relatives, 1 healthcare professional and 2 staff. Comments from which have been included in this report. Prior to the inspection the home was asked to complete an Annual Quality Assurance Assessment (AQAA). This provides us with information on how the home is meeting/exceeding the National Minimum Standards. It also provides us with any planned work they are intending to undertake during the next 12 months. Comments from which have also been included in this report. We spent time talking to 2 residents in the privacy of their bedrooms, as well as gaining general feedback whilst meeting residents during the day and joining in with a reminiscing session. We looked at a sample of records held at the home which included care plans, staff recruitment paperwork, minutes of meetings, training records, menus, incident forms and medication administration records. By doing this we can see whether staff are keeping their records up to date, and reflect current practice, to ensure the safe running of the home. Everyone we met during the 2 days (residents, staff, and visitors) was very helpful and participated in the inspection by giving us feedback, and providing information when asked. What the care home does well: What has improved since the last inspection? What they could do better: With 2 reportable medication errors since our last inspection, and finding records showing a tablet had been signed as being given when it had not, during our visit, it shows that the medication monitoring systems and practices at the home, are improving, but still not sufficient to prevent mistakes happening. Care Homes for Older People Page 8 of 38 Information in residents care plans still concentrates on giving staff more guidance on supporting people with their physical and nursing requirements, then their emotional and social welfare. For example, when a new resident first moves in, besides just giving information on what care they have received, such as a bath, the records should also give information how they are feeling, and adjusting to the move, to ensure they are supported with any anxieties they may have. Where residents have mental health, as well as physical needs, staff should be given clear guidance on what to do to support the person when they become anxious. The staff must make sure that the bed-rails they are using are fit for purpose, so people using can feel confidant that if they lean against them, they will keep them secure in bed. Where there is an incident or accident the home needs to provide written evidence on what action they have taken to investigate, and where applicable, steps taken to reduce, or stop, the situation occurring again. When staff are applying for a job at the home, the management needs to ensure that they have given their full employment history, including the reason for any periods of time they were not employed. The management will then be able to identify any periods of employment where the person has worked with vulnerable people, and take steps (where possible) to confirm with that employer, that the applicant did work for them, and the reason why they left. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 38 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be given sufficient information to help them decide if the home offers the level of care, support and environment they are looking for. Evidence: The homes registration certificate is displayed in the hallway, so people can see that the home is registered to care for up to 32 frail older people. A copy of their Statement of Purpose and Service Users Guide is also made available (on a shelf in the signing-in area) for people to read if they wished. We asked for a copy of their latest Statement of Purpose to take away, which consisted of separate information sheets, held in a cardboard wallet, which has coloured photographs of the home and details on how to find it, printed on it. The file contains up-to-date information on fees, and other services provided by the home Care Homes for Older People Page 11 of 38 Evidence: such as Day Care (not regulated by ourselves), Weekend Breaks, and Respite/Convalescent Care. By offering day and short-break care it enables people to gain an insight into what it would be like living at the home, and if it will meet their needs. People we surveyed all answered, yes when asked if they had received enough information about the home, to help them decide if it was what they were looking for. With 1 person telling us that my family visited a few homes in the area before we chose Highcliffe. People moving into the home are given information on what is included in the fees, and any extras they will need to pay for. It also informs prospective residents of any administration charges, for tasks undertaken on behalf of residents. For example when a person has been assessed for funded nursing care, people are informed that the company will pay the relevant funding directly to the patient every four weeks. A fee of £2.50, per cheque issued is payable. Where people are being funded by Adult Care Services, information is sent on how much the local authority will be paying, and how much the person receiving the service will need to pay, to cover the fees charged by the home. Discussion with the administrator showed that they are not always receiving the correct information before a new resident moves in. This can result in the home having to approach the resident, asking for back-dated/increased top up money to cover their fees. We were told that the management is pursuing the matter with Adult Care Services. Where the contract is made directly between the home and people paying privately for their care, they are given a copy of their contract of residence. This gives information on what they have agreed to pay for, and when they need to pay it. There is also a section for the next-of-kin to sign, to pay any arrears of fees on behalf of the resident. Further information to ensure people are make aware of what is included in the fees, is given in the homes terms of Business booklet. All the people we surveyed told us that they, or their family on their behalf, son dealt with it had received a contract therefore knew how much their care was costing. The AQAA tells us under what we do well encourage informal visits. Update brochures and Service Users guide. Advertise on Internet. We looked at the web page, which gives people a lot of the information covered in their Statement of Purpose, along with extra photographs of the home and staff, plus details on how to contact the home. We did not find any feedback given from the people using the service, or examples on how they can meet peoples specialist needs in their Statement of Purpose or Web page, which would also be informative to the reader. To see what work is undertaken by the home, prior to new residents moving in, we Care Homes for Older People Page 12 of 38 Evidence: looked at 2 new peoples pre-admission paperwork. It showed that a trained member of staff had visited the potential resident, to assess their health needs prior to them moving in. By staff visiting, and assessing peoples needs before they move in, supports staff in identifying if they are able to meet a persons health, environmental and social needs - prior to offering them a place. It also enables the prospective resident, to meet staff, which if they are unable to visit the home beforehand, could be their only contact before moving in. The homes own admissions policy is to try and have the member of staff who visited and carried out the pre-assessment on duty, when the new resident is admitted. This so they have contact with someone they know straightaway, to help relieve any anxiety. However, a relative contacted (see complaints section of this report) us to say that this is not always the case. They told us when they arrive with their next-of-kin; no one at the home expected them. This resulted in the new resident waiting in their transport whilst the nurse contacted the management, who was not on duty at the time, who was then able to confirm that the person was being admitted that day. The home has since apologised (verbally and in writing) for their oversight, and lack of communication. We asked nursing staff what the normal procedures were, they told us that information is put in the Nurses Day Diary, of any expected admissions that day, and the pre-assessment is made available for them to read. This information forms the basis for the new residents care plan, and then the Nurse will verbally give a handover about the new residents needs to the other staff on duty. They were aware of the incident we were talking about, and confirmed that the situation would not happen again. We spoke with 2 residents about their experiences before they moved in, and asked if a member of staff had visited them, their feedback included my daughter did it all and yes I think they did visit. When we asked if the home was living up to their expectations, and is able to meet their needs, their comments included I like it here, and rather be in our own home, but they do their best, Ill give 9 points out of 10 - no one is ever perfect. Residents surveyed, when asked if they receive the care and support they need, 6 replied always and 3 usually, with 1 resident telling us that it can be a problem if there are staff shortages. This reflected the feedback we received from relatives surveyed, when we asked if they felt the home is able to meet their next-of-kins needs, 3 replied always, and 2 usually. A relative, who had replied usually, said they felt this can be a problem when there are staff shortages. Care Homes for Older People Page 13 of 38 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to have their privacy and dignity respected, and their health needs met. People with mental health needs, cannot be assured that they will be fully identified and recorded in their care plan to ensure their indidvual needs are met. People cannot be assured that they are fully safeguarded by the homes medication practices and procedures. Evidence: When we asked the residents surveyed, if they receive the medical support they need, all but 1 person (who said usually) replied always. The homes own survey feedback showed that residents had all replied yes, when asked if they felt they are well cared for, saying absolutely, yes - no complaints, reasonably yes and Yes they are very good. To gain a view on the level of care and support being given since we last inspected, we tracked the care of 3 residents (which included past and present). Tracking involves looking at the information written in their care plan, where able spending time talking Care Homes for Older People Page 14 of 38 Evidence: with the resident (or if unable to their next-of-kin) to hear their views on the level of care they receive. We also spoke with staff about the level of care they give, and their individual knowledge of the residents needs, to see if it reflects what is written in the care plan. Each resident has a care plan, which provides information on how their physical and nursing needs are being met, and monitored. The Statement of Purpose does not give any information about the use of care plans, but does state patients may have access to their medical records held at the home. Written daily records and nursing plans, showed that residents physical health is being monitored, and that they work closely with other healthcare professionals, to ensure appropriate action is taken, when a resident becomes unwell. However, daily records gives very limited information about the persons social, emotional and mental wellbeing, which is equally as important to the nursing needs, to ensure a good quality of life. For example, 1 care plan mentioned that the resident had been very aggressive, hitting out at staff - language a lot to be desired, there was no further reference as to whether anything had triggered the resident to react in this way, and what action was being taken by staff to support them. Instead, the following day it just focuses (negatively) on what had not happened no aggression or offensive language noted at this time, rather than how the person was feeling. Informative information about the resident as a person, is included in the residents memory diary, which gives the reader a good insight of the persons life and interests, which is undertaken by the Therapeutic Practitioner (see next section of this report). In 1 residents care plan, staff had written that if the resident wakes at night they can become very anxious and has previously hallucinated. There was no clear guidance written in the care plan on how the situation needs to be managed/prevented, to ensure the safety and wellbeing of the person. Night reports showed that they are taking some time to settle, but does not give an insight on what they did, and what they found worked well (and what didnt), when trying to settle the person. The care plan showed that the resident had been assessed as needing cot sides (used to stop the person rolling out of bed), however, there was no record of what had led to this decision, or of it is being reviewed following them falling out of bed, after the cot side came off completely (see Environment and Management sections of this report). Discussions with staff identified that Nursing staff complete the daily records, therefore at times are writing 3rd party information, they have received from care staff. From discussion with staff, there appeared to be an acceptance that it is the Nurses job to write in the care plan, and carers did not see it as their role - rather than them not Care Homes for Older People Page 15 of 38 Evidence: being allowed to write in them. With care staff not recording their own observations when they have provided the hands on care, could lead to the risk of information not being given accurately. Feedback from a relative and staff, identified that communication is an area which the care service can improve in. The home has a nutrition policy, which includes undertaking a risk assessment, to identify if a resident is malnourished on admission. The policy informs staff that the residents weight should be recorded on admission, where practical, and then on a monthly basis. We found care plans did not always show people classed as high risk being weighed monthly. However the policy states it may not be possible, as the residents condition may not allow them to sit on the scales to weigh them. We saw no evidence of other nutritional tools being used, which are not reliant on the resident needing to be weighed, which would support staff in monitoring residents most at risk, such as long term bed rest. Our last inspection identified that there was still no evidence that monthly reviews of care needs were being carried out for all residents. The AQAA informs us under how we have improved in the last 12 months, that they have allocated extra time for care plan reviews. Out of the 2 current residents care plans we looked at, 1 had not been at the home long enough to have their care plan reviewed. The second persons care needs had been looked at monthly in November, December 2008, but not again until March 2009. Staff surveyed confirmed that they are being given up-to-date information about the needs of the residents they are looking after. Relatives told us that staff always kept them updated on any important issues affecting their next-of-kin. Their comments included I feel Highcliff sees to the peoples individual needs and staff all work hard towards making everyone comfortable despite having some difficult service users. During our last inspection, shortfalls were found in the homes medication systems (see key Inspection report dated 12 May 2008), and the management were required to complete an improvement plan, which they sent us when requested. The plan gives us information on what action the management have/are taking to address our concerns. To assess if the work the home said they would be undertaking to address our concerns have been followed through, we spent time with the duty Nurse, looking at the homes medication system. We found staff are now following safe practise by writing the date when the bottle of eye drops was first opened, so they know when to dispose of the drops). Information given in the improvement plan, also told us that all nurses are to sign MAR (Medication Administration Records) after medication has been Care Homes for Older People Page 16 of 38 Evidence: taken by the patient. However, we found a tablet (which is important to relieve the symptoms of Parkinsons Disease) was still in its blister pack, which staff had signed as being taken. We checked the residents other care records to see if there was any reason why the medication had not been given. We tried to carry out a sample audit of 2 packets of tablets that had not been dispensed in a blister pack (special packs which give a 28 day supply of individual drugs), but had problems undertaking this. This was due to the written quantities of medications received into the home, not being recorded correctly. We thought another medication had not been given, but found the day labelling on the blister pack, did not correspond with the others used by the home, as it had come from another pharmacy. The nurse took action straight away to re-label the pack, to stop any further confusion. The home has systems in place to ensure residents medication are ordered on a monthly basis, so they do not run out. When we checked the fridge we found that staff had continued ordering insulin for 2 residents, even though they had plenty of stock. This included 14 ampoules (small bottles) of insulin, the oldest dated November 2008, and newest March 2009. As part of the homes improvement plan, we were informed that the management would be undertaking regular audits to check that staff are giving out medication, and completing MAR charts correctly. Discussions with nursing staff identified that regular meant monthly, however this was not happening. For example there was no audit sheets available for March and April 2009. Since our last inspection, we have been notified of 2 errors when giving out medication, 1 of which was giving a resident the wrong medication. In both cases, nursing staff took action to ensure the safe welfare of the residents involved, by consulting with their GP. We checked the amount of controlled medication held for 2 residents, and the amount held, agreed with the homes records. The nurse on duty went through the procedures they have in place for getting rid of any medication, which is no longer required, to ensure that it is safely disposed of. Time spent talking to the Nurse demonstrated their knowledge about the different medications residents are taking, and why they are on them. The locked room used to store medication can get very warm, so there is an airconditioning unit located in the room, to help keep the temperature to an acceptable level, to ensure the medication stored in the room does not deteriorate. When we Care Homes for Older People Page 17 of 38 Evidence: checked the temperature of the room, it was already at 25 degrees, any higher would have been too warm. Daily checks are being undertaken by staff to ensure that the secure fridge holding medications is being kept at the right temperature. As part of ensuring residents privacy and dignity, good practise was seen with the use of lights located outside the bedroom doors, which staff switch on, to indicate that a person is receiving personal care, and not to enter. Time spent with residents in the communal lounge, showed staff treated people with respect, addressing residents by their preferred name. Feedback given by residents in the homes own survey, identified that they felt staff are ensuring their privacy is respected, comments included quite good and certainly do. Care Homes for Older People Page 18 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to be offered a range of activities, be encouraged to maintain contact with family and friends, and offered a well balanced diet. Evidence: Relatives surveyed, when asked if they felt the residents are given the support to live the life they choose, 1 had ticked always and 1 usually. The homes own quality assurance survey asked residents if they would like to be more involved in decisionmaking within the home, all but 4 people had said No. Their comments included not at the moment, no rather leave it to the management, I dont know it depends on the decisions and would like more information. When we asked a member of staff, if there was a set routine for ensuring a certain number of residents are in bed/or got up by a certain time, they replied no. They went on to say some residents prefer to get up early in the morning, but it was their choice as they dont need to get up if they dont want to. This was further reflected later in the morning whilst we were observing activities going on, when a resident who had just got up and came to join us, was greeted warmly by a member of staff, enquiring if they were having a lazy day as that is what they liked to do on their day off. Care Homes for Older People Page 19 of 38 Evidence: When we asked (surveys) residents if there are activities arranged by the home that they can take part in, 1 ticked always, 7 usually, and 1 sometimes. Comments included mostly prefer to remain in room, I do not personally take part, preferring own company, if I am feeling well enough and yes but Im not usually able to attend. A relative surveyed told us I feel the home does a very good job, but I wish they could take people out (for short walks, to the shops, in a mini bus, a bit further a field) and provide stimulating activities/entertainment that are appropriate. The homes own survey feedback showed that all but 1 resident had replied yes when asked if they felt suitable activities were being provided by the home. Comments included like particular in the summer getting outside, sometimes I like the live entertainment, yes I enjoy them, yes - feel they are suited to the age group. The home in their AQAA had identified that an area they could do better in was by providing more excursions, and would be investigating the possibility of more excursions during the next 12 months. During our inspection residents told us how much they had enjoyed a recent trip to the Red Cross hut on Felixstowe sea front, where they had enjoyed a fish and chip lunch. Staff also said that they had noticed, where some residents are continuously asking to go to the toilet, during the outing they were not asking to go, due to the distraction of enjoying their day out. The AQAA also tells us that the therapeutic activities they provide includes professional performers, 1:1 sessions, spiritual, reminiscence, physical activities, introduction of library service, coffee club and gardening club. So residents and visitors know what is happening daily/weekly, information is provided on a notice board. A resident told us that there is nearly something going on each day, when we asked if they joined in with the Snakes and Ladders activity which was being advertised, they said it was quite good, makes a change from sitting in here. We also saw residents enjoying a reminiscing session with a member of staff whilst we were sitting in the lounge. If residents do not want to join in, or prefer to get away from the television, there is another lounge, and conservatory residents and their visitors can use. The home employs a professionally qualified therapeutic practitioner to provide their activities service. The positive role they undertake includes meeting new residents soon after admission, seeing how they have settled in, and producing a life history and memory diary with them. Through these sessions they identify what kind of activities the resident prefers to join in with, including if they prefer group or 1 to 1 sessions. The activities therapist completes a log of what activities each resident has undertaken/joined in with. The resident whose care we were tracking showed that this was happening for them 2 to 3 times a month. On the first day of our inspection, the information board gave details of the days Care Homes for Older People Page 20 of 38 Evidence: menu. The lunch menu was Beef in Black Bean Sauce, Spring Onion mash and a selection of vegetables. Residents surveyed when asked if they like the food provided, 3 people ticked always, 5 usually and 1 sometimes. Comments included they are very good, would like more choice, and I would enjoy the food more if small portions used nicely presented and HOT. The last comments made, were also reflected in the homes own quality survey feedback, which also evidenced what the management was doing to address them, which was further confirmed by a member of staff on duty. When we visited the second day, we joined 2 of the residents who were just finishing their lunch, to ask their views on the quality of the meals. Their comments included that they enjoyed the chocolate pudding and all that goes with it, that meals are chosen with the family in mind and these are quality fish and chips. It was a warm day when we visited, and we noticed that residents in the lounges and in the bedrooms we visited, all had drinks within easy reach. Care Homes for Older People Page 21 of 38 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. When using the homes complaints procedure, people can expect their concerns to be listen to, and appropriate action taken to address them. Evidence: When we asked residents do they know who to speak to if they are not happy, all but 1 (who said usually) replied always. Comments included if not sure would ask and not always sure who to speak to. Residents told us they knew how to make a complaint with 1 person saying, shout loud enough! Thats my opinion and how I have always complained if necessary. Relatives were also aware of the homes complaints procedure, with 1 person telling us that when they did have cause to approach matron at about a particular issue, it was dealt with promptly and efficiently. Since our last inspection we were contacted directly by a relative, over care and management issues concerning admission procedures, money going missing, laundry system, end of life care/discharge arrangements. We referred the complaint back to the home, asking them to investigate using their complaints procedure, which they did. The management met with the complainant, and we were provided with a letter, showing the outcomes of the complaints, which they upheld, offering their sincere apologies, and giving information on what action they were taking to ensure the situation did not happen again. Care Homes for Older People Page 22 of 38 Evidence: During our last inspection we identified shortfalls in the homes policies and procedures for reporting any safeguarding concerns, as it did not reflect the local policy for Suffolk. This has since been addressed by the home, by updating their policies, and keeping their knowledge updated by accessing the Suffolk safeguarding website. In the office we also noted that the home has down loaded copies of the safeguarding newsletter, for staff to read. Training records for new staff showed that they receive training on safeguarding vulnerable people as part of their induction. This is to ensure staff are aware of the different types of abuse which may occur, and know what action to take if they have any concerns. A member of staff told us that as part of their safeguarding training they watched a DVD which they discussed, and completed a worksheet. The AQAA informed us that under plans for the next 12 months, staff are to undertake training via the internet on Safeguarding Adults. Staff surveyed, when asked do you know what to do if a person raises any concerns about the home, both replied yes, with 1 saying well I believe that we direct them to the Matron. As we mentioned in our last report the home does not hold monies in safe keeping for residents, instead the resident can be invoiced for any purchases (which there is a small charge), or residents can keep money in a lockable drawer in their room. In response to concerns raised by the relative making the complaint, that money had gone missing from a residents bedroom, the home told the complainant that the missing money was not an isolated incident, and that the police had been informed and this is now a matter for their investigation. The relative told us that they had mentioned this to staff at the time, but we had not received any formal notification from the home over monies going missing, or the outcome of the police investigation. Discussions with staff during the inspection, seem to indicate that there was not enough evidence to go any further, and that they are encouraging people not to keep money in their room - unless it is kept locked away. Since our last inspection there has been 1 Safeguarding Referral made to the Vulnerable Adult team, which is still under investigation. As part of the homes procedures for protecting the interests of the residents, we asked if they had written policies and procedures for staff concerning using their own mobile phones whilst at work, taking into account privacy and dignity issues, and were told not at the present time. Care Homes for Older People Page 23 of 38 Evidence: Prior to staff being employed, the home asks applicants to supply information to validate they are - who they say they are, and checks are undertaken by the home to ensure staff are cleared to work with vulnerable people. A new member of staff we talked to told us they started once their Criminal Bureau Records (CRB) check had come back. Displayed in the home is an attendance certificate to evidence that the manager has attended training on the Deprivation of Liberty safeguards for the home manager, in February this year. As the manager was not available during the inspection we were unable to discuss how they will be implementing the safeguards, (including the mental Capacitiy Act) within the service, and will look at this during the next inspection and information supplied in their next AQAA. Care Homes for Older People Page 24 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Highcliffe house provides a clean, comfortable, homely environment , located close to the sea front. However, people cannot be confident that bed-rails will be used in a way that ensures their safety. Evidence: Although we did not look at the Fire emergency planner during this visit, it was on a shelf in the hallway, so staff has easy access to the file, in the event of a fire breaking out. The Statement of Purpose informs us that the home has a full time handyperson who helps with the general maintenance of the home. Included in their routine tasks is to check the bed rails (which the home refers to as cot sides), which are attached to the bed, to prevent a resident accidentally rolling out, are working correctly. The file recording all the checks undertaken showed that they were last checked on the 27 April 2009, and before that on the 17th April 2009. On the 28 April 2009, the care records for the resident whose care we were tracking, stated that they were found lying on the floor in the early hours of the morning, after they reached for something in their drawer resulting in the bed rail coming off completely and was lying beside them. The maintenance records showed that the clamps required tightening, on the 17 April. Information given in the incident book showed that there had been another Care Homes for Older People Page 25 of 38 Evidence: incident, with a different resident when the cot side was off on the floor in March. Records showed that the Handyperson is checking and tightening any clamps they find loose in different residents bedrooms, but they are still becoming loose again. The Statement of Purpose also informs the reader that their maintenance person is quite willing to help people to settle into their rooms by way of hanging pictures/photograph etc, or any other little jobs to personalise their room. Time spent visiting and talking to residents in their bedrooms, showed that they were personalised, and received a thumbs up when we asked a resident if they liked their room, and importantly if their bed was comfortable. When asked if the home is kept fresh and clean, all but 1 (who said usually) of the residents replied always. Their comments included good standard, Housekeeping staff are efficient and clean as appropriate e.g. clean under bed and the laundry is very efficient and the cleaners are good. This reflected our findings on the day; with areas we visited being clean and fresh, and housekeeping staff busily cleaning residents bedrooms and communal areas. Staff told us that there are always enough aprons and gloves for staff to use as part of their infection control procedures, to reduce the risk of infections being passed on. A certificate displayed in the home shows that the Manager in December 2008 attended a Suffolk County Council The essential of safe, clean, care homes training day. Time spent talking to the member of staff responsible for Manual Handling training, identified that they are going to introduce disposable hammock slings which fit on to the hoists (used to transfer residents who are unable to walk), so each person will get their own. This will help prevent the transfer of any infections around the home. When we spoke to a relative earlier in the year, they raised concerns that the home was not getting stains out of clothing. Information supplied by the home showed that there has been problems with de-staining laundry items. To address the situation we were informed that the equipment has been inspected, amendments made, and the dosage of detergent has been increased, so they no longer have these problems. This reflected another relatives comments who felt the laundry is most efficient and that the cleaning is of a high standard. On the first day we visited, the home also received a visit from the Environmental Health Officer, who was carrying out a routine inspection of the kitchen. They found no problems with the cleaning and cleanliness of the kitchen, however the home was asked to address 2 shortfalls. The first was due to a fridge being overloaded, (which can cause problems maintaining the fridge at the right temperature), and for the home not to use photocopies in their food safety logbook. Staff told us to address the Care Homes for Older People Page 26 of 38 Evidence: situation they would be looking at how food is stored/loaded - and looking to get an extra fridge. They were also ordering new refills for their food safety folder, to replace the photocopies currently being used. We came across a toilet upstairs, which was being used as a storeroom, and the toilet itself had no seat, therefore unusable. Housekeeping staff informed us that the toilet is no longer used by residents in that corridor, as either they used a commode in their bedroom, or had their own en-suite facilities. To ensure that residents/visitors did not accidentally go and try and use the facilities, they said they would look to having the sign on the door removed. In the homes AQAA, under how we have improved in the last 12 months, they tell us they have refurbished the dining room, provision of conservatory, internal laundry, pond/patio area and herb garden, additional patio to front of home, sun awnings. Their plans for the next 12 months is to replace all televisions in patients rooms with LCD TVs, which feature freeview, which will give the patient a greater choice of programmes/radio stations to view. A relative told us we were very impressed when a large sunshade was brought so that my (next-of-kin) could be protected, when they sat by the little pool. Time spent talking to the residents, confirmed that they make use of the communal rooms, and when the weather permits enjoy sitting outside in the well maintained gardens. Care Homes for Older People Page 27 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect staff to receive training to support them in their role, and the managements recruitment procedures includes checking to make sure they are allowed to work with vulnerable people. Evidence: Residents surveyed told us that staff are always/usually available when they needed them. Comments included generally speaking and can be a problem when staff are off. When we asked staff surveyed if they felt there are sufficient staff on duty, to meet the individual needs of the residents, they replied usually or sometimes. Discussions during our inspection, identified that the decision on how many staff should be on a shift, is determined by the number of people living at the home, instead of looking at the dependency needs of the residents. For example when there is 29 residents, the cover at night will be 2 carers and 1 Nurse, increasing by another carer when occupancy reaches 30 residents. By working on numbers and not dependency levels, staff confirmed that they find some shifts can be too heavy. We were told that the staffing levels for the day time, is normally 6 in the morning, 4 to 5 in the afternoon. Where the home has staff calling in sick at the last minute, the home is not always able to cover, which reduces the staffing levels. When this happens staff assured us that residents physical care needs are met, but can result in staff feeling that they were unable to spend enough time with everyone. This reflected a Care Homes for Older People Page 28 of 38 Evidence: comment made by a relative, in response to being asked how do you think the care home can improve told us availability of relief staff during time of sickness and holidays, as they felt it can affect the quality of care given. We also asked relatives if they felt the home is able to meet the different needs of the people they look after, 3 replied always, and 2 usually. Comments included some staff need to be more aware that speaking quickly and indistinctively and sometimes with strong regional or national accents can cause problems for the hard of hearing, and I can only comment on the excellent care given to my mother and I am not aware of any problems at their meeting the needs of others. Relatives when asked do they feel that the care staff have the right skills and experience to look after their next-of-kin properly 4 replied always, and 1 usually. The AQAA tell us that the home provides adequate numbers of staff who are well trained and meet the needs of the patients. We provide a flexible induction period. Staff surveyed gave mixed views about their induction, when we asked if it covered everything they needed to know to get them started in their job, with 1 saying very well, and 1 not at all. Discussions with Nursing staff during the inspection, showed that this is an area that they have been focusing on, as they are aware of the importance of investing in staff training, to provide high quality care. Further information supplied, identified that staff are not always receiving manual handling training, to ensure they can assist residents to move safely, during their induction period. Discussion with staff on duty, identified that this could have been the case, as the home did not have a dedicated manual-handling trainer then. However, now they have, as the training is undertaken as part of new staffs induction, and they are also able to give on-going support to staff, to ensure they are moving residents safely. We spent time talking to a member of staff about their induction, which they informed us consisted of 3 days training which included manual handling - morning theory and afternoon practical. We asked if they felt this had provided them with sufficient training to undertake their role, and they felt it did. Which further evidenced that the homes induction programme has improved since the feedback we received. They then went on to tell us that they had worked 2 weeks, as supernumerary, which they said helped them get to know what peoples individual likes were. Feedback from staff, when asked if there are any areas they feel the home could improve in, 1 person felt better support in completing Induction folders, as sometimes they can be left to get on with it, and they felt by having a member of staff support them through the folder, would instill more confidence in new staff. Care Homes for Older People Page 29 of 38 Evidence: We looked at the recruitment records for 2 new members of staff, which held completed application forms, paperwork to validate their identity, references and proof that a Criminal Bureau Record (CRB) check had been undertaken. On 1 of the application forms, we identified that the person had not given their full employment history; therefore the management would not know if there had been any periods that they had not been working, and the reason why. Where the person had stated that they had worked previously in care, the home had not always taken steps to validate with that care provider the reason why they left. This led to discuss on the need to have a system in place to double check that this has been undertaken. The home had gained information for both applicants, to satisfy themselves that the prospective staff are both physically, and mentally fit to undertake their role. Following a successful interview, letters held on file showed that staff are offered a job, subject to them receiving their enhanced CRB check, and suitable references. They are also informed that they will be given a welcome pack, which contains information to help them settle in. Staff surveyed said they receive training, which helps them understand and meet the individual needs of the people they are looking after. We received mixed feedback when asked if the training they received was relevant to their role, and kept them up to date with new ways of working, where 1 member of staff felt it did, another felt it did sometimes. The homes staffing rota shows us that 9 out of the 20 care staff have achieved a National Vocational Qualification (NVQ) level 2 or above. The AQAA mentions that staff are well trained, but gives no further information to support the statement. The homes Statement of Purpose informs the reader that the home as an Investor in People, firmly believes that all staff should be encouraged to develop their skills, to ensure they have the skills and knowledge to undertake their role. They also tell us that as a statutory requirement all staff receive Fire, manual handling and Safeguarding training. However, it does not mention other training happening to support the individual needs of the people they are looking after, for example Parkinsons Disease and Dementia. It also does not mention specialist training Nurses may have undertaken, such as in monitoring nutrition and condition of residents skin, to ensure their professional knowledge is updated, to ensure they are following current best practice. Including this information in their Statement of Purpose, would be useful to support people identifying if the staff have the skills to provide the level of care they are looking for. Residents and visitors we spoke with during our visit, described staff as being helpful and friendly, with 1 resident telling us they have nothing but help and good feeling Care Homes for Older People Page 30 of 38 Evidence: from staff - all the way through. Care Homes for Older People Page 31 of 38 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can expect to be asked their views on the running of the home, and staff to be committed to working in their best interests. people cannot be assured that there is adequate monitoring in place, to reduce the risk of incidents/accidents happening. Evidence: The Registered Manager was on annual leave during the inspection, but did pop in to ensure we had the keys to access paperwork, such as staff training files, that we would need to look at during our visit. The Administrator and Nurse on duty were very helpful in providing any records we asked for, and answering any questions we had over the running of the home. Information booklets stored in the office, and copies of certificates showing their attendance at training days, evidenced that the Manager is keeping their knowledge updated. Staff surveyed were asked if the manager meets with them, to give them support and discuss how they are working, 1 person replied sometimes, another Care Homes for Older People Page 32 of 38 Evidence: often, telling us that the matron is usually available to discuss issues. Since the last inspection, systems have been put in place to ensure staff receive regular supervision and yearly appraisals. We looked at the homes supervision policy which informs staff that supervision encourages an informal meeting with the matron of the home every 12 weeks, this need not last longer than 10 minutes. It goes on to say that the aim of these meetings is to avoid escalation of problems arising from working practices and issues relating to the workplace. To receive feedback on what people think of the care and service they receive, the management send out their own quality assurance surveys. We looked at 20 completed survey forms, which have not as yet been formally analysed, so they can compare the results from 2009 with last years. The home is required to complete an Annual Quality Assurance Assessment each year, and informs us what work they have been/and planning to undertake, linked to the standards we assess during an inspection, and the outcomes of their last key inspection report. We found the AQAA sent to us gave very limited information, and if we had not visited the home, we would not have gained a good understanding of the service. For example when asked to provide information on what evidence they have to show they are doing well, in meeting the Health and Personal Care standards, they had just written documentary evidence, visual evidence. Which reflected the wording used in all the sections. It is especially important, taking into account their adequate rating, and shortfalls identified in their last report, that they should be providing more informative feedback on what action they are taking to ensure good outcomes in all areas of their service. Residents, relatives and staff who gave us feedback either through our surveys, or verbally during the inspection all praise the friendly, homely atmosphere, where people are made to feel welcome. This evidences that staff are working hard to create a homely atmosphere for residents. However with their practice of always referring to people as patients (even though on admission they sign a contract of residence), reflects a more clinical environment such as a hospital, rather then the more homely, domestic environment staff are promoting. Discussions with a member of staff during our visit also identified the positive ethos the home is working to, when they told us treat them (residents) how you want to be treated. The AQAA gives us information on the different policies and procedures the home has in place, to ensure the health, safety and welfare of people living and working in the home are being promoted and protected. This includes regular servicing of fire fighting Care Homes for Older People Page 33 of 38 Evidence: equipment, and hoists used to safely transfer residents. The home now benefits from having a qualified manual-handling trainer, who can carry out training and give advice as needed. When we tracked a residents care who had fallen out of their bed, and bruised themself following their bed rail, coming away from the bed, an incident form had been completed. However, this and other incident forms we looked at gave no information on what action staff were taking to ensure the situation did not happen again. Also looking at some of the accidents happening at the home, that affects a residents well-being or safety, such as money being taken, or a bedrail giving way, the home should be sending a formal notification (regulation 37) to ourselves. All the information is used to monitor how services are performing, in-between our visits. Also by being made aware, we can ask the home what action they are taking, if it has not been given in the notification. Care Homes for Older People Page 34 of 38 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 35 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Staff must ensure residents receive their medication as prescribed. To support residents with their health and well-being. 01/07/2009 2 22 23 The home must ensure that the bedrails fitted to the beds are fit for purpose. To ensure the safety of people using them. 17/07/2009 3 38 12 There must be systems in 17/07/2009 place to ensure all incidents/accidents are followed, and action taken to prevent it happening again. To ensure the safety of the people using and working at the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 36 of 38 1 7 The home should look at giving more individualised guidance in their care plans, on how staff are supporting residents with their behavioural needs. To safeguard the interest of vulnerable people, the home should look at producing guidance for staff on the use of mobile telephones, including phones which are able to take moving and still pictures. 2 18 Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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