Inspection on 13/02/08 for Highermead

This inspection was carried out on 13th February 2008.

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

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

Other inspections for this house

Highermead 01/08/07

Highermead 16/08/06

Highermead 05/10/05

Highermead 28/04/05

Highermead 20/10/04

Highermead 28/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Highermead College Road Camelford Cornwall PL32 9TL Lead Inspector Helen Tworkowski Unannounced Inspection 13th February 2008 10:25 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highermead Address College Road Camelford Cornwall PL32 9TL Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01840 212528 01840 211024 info@arkcare.co.uk Ark Care Services Ltd Vacant Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (22) Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to include up to 22 adults aged over 65 years with a mental illness (MD(E)) Service users to include up to 22 adults aged over 65 years with dementia (DE(E)) Total number of service users not to exceed a maximum of 22 1st August 07 (Key or full Inspection) and random or short inspections on 12th September 07, 21st September 07, 2nd October 07, 14th November 07, 16th January 08. Date of last inspection Brief Description of the Service: Highermead is a privately run home, which provides twenty-four hour personal care and accommodation for up to twenty-two older people who suffer with a mental disorder or dementia. Arc Care Services Ltd who operate Highermead have a second home in the North of England. Highermead is a large detached house on the outskirts of Camelford. Accommodation is provided on two floors. All of the bedrooms are single with the exception of one double room. There are two lounges, which provides a choice of where to sit. Stair gates restrict access between floors. A passenger lift is available. In good weather there is a courtyard garden area available for use. There is good car parking by the home. Information about the home in the form of a “Statement of Purpose” is available in the office. There is a copy of the Service User’s Guide in each bedroom. The fees charge are £400 to £488 per week and according to the Service User Guide are inclusive of colour TV and licence, transport to all local appointments, entertainment throughout the year, NHS optician and dentistry, pedicure and creams, food, accommodation, church service, laundry, individual diets, private telephone calls by arrangement. Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is zero stars. This means the people who use this service experience poor quality outcomes. This inspection included three site visits to the home on 13th February 08 from 10.25 am until 4.50pm and involved two inspectors, on 22nd February 08 from 7.45am until 4.20pm, and on 28th February 08 between 8.45am and 4.10pm. As part of these site visits we looked around the home, looked at records relating to care, safety, medication, and staffing. We interviewed seven of the care staff, and spent time talking with the manager. We spent time sitting and observing what was happening in the home, and recorded what we saw. This is part of a process that helps us to understand what life is like in the home particularly for people with dementia. We looked at the care records and then looked at how this related to the care that was actually provided. In addition to these site visits we also sent surveys out: we sent surveys to all of the people who live at Highermead, however the Manager said that only one person either was interested or was able to complete a form. Surveys were sent to relatives and also to visiting professionals. Relatives returned four surveys, one was returned by a visiting healthcare professional, none were returned by social care professionals, and seven were returned by care staff. The Commission also received an “Annual Quality Assurance Assessment” which contained information about the service, the Registered Provider completed this. The last Announced Inspection was carried out on 1st August 07, when concerns were noted about the poor standards of care offered. In mid September 07 the Commission was contacted by a visitor to the home and by staff working in the home. Because of the concerns we carried out a “random inspection” on 12th September 07. We found that there were serious concerns for the welfare of the Service Users, because of the lack of management in the home and poor quality of care. Further visits were carried out on 21st September 07 (as a result of a complaint), on 12th October 07, 14th November 07 and 16th January 08. Copies of these inspection reports are available on request from the Commission. The continued serious concerns raised in these reports resulted in the Commission issuing two enforcement notices in relation to the administration of medication and in relation to informing the Commission of Notifiable events at the home. Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? Staff now know about the needs of the people who live at Highermead, as these are now written down in Care Plans, which are generally read. The people who live at Highermead are generally provided with care that meets their needs. When the people at Highermead get up in the morning staff have sufficient time to ensure that they are properly dressed and that their hair is brushed. Three out of the four relatives who responded to the survey said that they felt that their relative’s needs were always met, whilst the fourth person thought that they were usually met. We observed that many of the interactions between staff and the people who live at Highermead were very positive, and that many were occupied in activities or engaged with what was happening around them. Some of the staff now have both the time and skills to relate to the people who live at Highermead, staff take the time to listen to what people have to say. The people at Highermead are now offered the opportunity to participate in activities, and staff said that more people are now joining in. Staff felt that there were usually enough staff to meet needs (four out of seven) and it was our observation that this was the case. Staff have recently received training in a number of areas of the work, some for the first time. Staff said that they felt that this had helped them to understand what was going on for the people at Highermead, and how best to approach situations. The medication system has much improved, the people at Highermead now get the medication that is prescribed, and staff are aware of when people should be given “as required” medication. Staff were observed giving medication and they did so in a manner that was both safe and respectful. Meal times have improved and the people at Highermead now get the help they need to eat. The dining room décor has been improved and meal times appear to be less rushed and more social occasions. There have been improvements in the hygiene in the home, the house is now cleaner and there are no offensive smells. Staff seem to have a better awareness of the use of gloves and aprons, and there is now soap and towels in the bathrooms and toilets so that staff can wash their hands. The recruitment of staff has improved although there are still areas where further improvement is needed. Checks are being made with previous employers and of whether they are suited to work with vulnerable people. Newly recruited staff are now receiving an induction and told us that they felt well supported. Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 7 The home now has a manager, though the person is not currently registered. Staff spoken to during this inspection said they communicate well with the manager, another person said that the manager was great, helpful to talk to and very supportive, and another one that the Manager was “on the ball”. Many of the staff commented on the improved atmosphere in the home, and said that they now look forward to coming to work. Staff felt that there was better communication with the “head office”, and that that this meant “head office” knew what was going on at the home and what the issues were. The Registered Provider has been visiting the home, as is required, to check on the running of the service. What they could do better: Improvements are still required to ensure that all the needs of each individual in the home are recorded in the care plan, this must include those in relation to diabetes. There are more activities going on in the home, however because there is no proper recording of what people do, it is not clear to what extent individuals are involved or participating. There is a system for dealing with complaints however the records of complaints in the home did not match other information provided. We also found that when concerns were raised these were not always dealt with appropriately. We also had concerns that in previous months the home has not managed issues where the people at Highermead might have been subject to abuse, properly. Social Services and the Commission have not always been advised of concerns in a timely manner. The general hygiene in the home has improved however there are still concerns that some of the practices could lead to infections spreading in the home. Also staff told us that it is difficult to get hot water in wash hand basins in bedrooms. The recruitment and training of staff has improved however further improvements are still needed in the recruitment process and further training is still required to ensure that staff to ensure that staff know what they are doing. The home is now better managed however the current manager has not been registered, and there has been no registered Manager in the home since August 2007. Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, and 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who are thinking about moving to Highermead may not be given accurate information about the home and what they can expect. They can be assured that the manager is aware of the importance of finding out about their needs before they move. EVIDENCE: No new people have moved to Highermead since the last inspection, therefore it has not been possible to look at how well the service manages such moves in practice. We asked the manager about how she would manage someone moving to the home. She said that she would be get to know the person, talk to any people involved in providing their care, and encourage the person to visit Highermead before they came to stay for a trial period. We looked at the information that is available to people who are considering moving to the home, this is contained in two documents, the Statement of Purpose and the Service User’s Guide. The Statement of Purpose does not Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 11 contain all the information that it should contain. The information about the number of bedrooms appeared not to be accurate, and the information on emergency admissions to the home seems to show that the home admits people for Mental Health assessments under the Mental Health Act, this is not the case. The Manager said that there were Service Users Guides in each bedroom, and this was seen to be the case when we looked around the home. These documents are important in that they provide information about what the home provides and to whom a complaint may be made. We asked to see copies of the contracts, these documents must be available in the home, and no documents were available for inspection. The Manager said that these contracts had been taken to the head office to be updated. Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people who live at Highermead are treated with respect. They can feel confident that they will receive their medication as prescribed. The care staff are aware of most of needs of the people at Highermead and these are generally, well documented in the care plans, though there are some areas where more information is needed to ensure that care is properly provided. EVIDENCE: Each person who lives in a home should have information on file that has been agreed with them or their representatives about how their care needs, and how they are to be met. These documents are important as they should ensure that staff know what the needs are and how to meet these needs in a manner that suites that individual. The Care Plans at Highermead have improved. They now contain more information about what the needs are and also give clear direction to staff, for example one care plan explains about how a person is to be helped at night if they wake up. There are still some gaps in care plans- for Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 13 example information about the diabetic needs of one person is focused on just their diet, and did not reflect other needs in relation to foot, skin or eye care. Some of the information that is needed to complete the care plans is not available at present as assessments that should be carried out by other professionals are awaited, for example in relation to continence. We were told that professionals had recently visited from to assess people and advise on how to prevent falls, additional aides had been provided; assessments of fall risk have been completed and the documentation is awaited. We looked at the accident book and falls were being recorded, and the Manager explained that she looked at all the reports before they were placed on file. The Manager told us that a visiting dentist and optician had recently been to the home. We asked staff about the Care Plans, and some staff had read and understood the documents. Other staff commented that they had not had a chance to read all of the plans. Six out of the seven staff who responded to the survey said that they were given up to date information about the needs of people, the seventh person said that they usually had this information. We looked at the standard of care provided and there had been significant improvements in this area, when we visited Highermead first thing in the morning the residents looked well dressed in clean clothes, their hair looked tidy. It was noticed that one person had been helped to wear some jewellery. Paying attention to how an individual looks is important not only to maintain their physical well being but also to maintain their sense of dignity and individuality. As part of the first day of inspection we spent time sitting and observing what happened in the lounges at Highermead and the way that staff and the people who live at Highermead spoke with each other. It was noted many of the interactions that staff had with the people observed were positive, these tended to be with people who were more able and who could converse well. A few interactions were identified as being poor and tended to be with people who were more disabled by their dementia. It was also noted that some of the individual staff were much more skilled in talking with people with dementia than others. They were able to assist individuals to go to the toilet without making it a public event. Other staff were clearly less skilled and clearly found it more difficult to talk or interact with the people who live at Highermead in any meaningful way. Some of the individuals who live at Highermead have alarm devices that alert staff if they get out of bed in the night. The use of such devices needs to be agreed with the individual, their representative and with relevant professionals. The use of a device for one person was recorded in the care plan, and the manager confirmed that this would be discussed at review meetings where professionals and relatives would be involved. The manager told us that they were awaiting advice in relation to one individual. We discussed various options with the manager that might be used in the interim to ensure the Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 14 individuals well being. Locks have now been fitted to bathroom doors to ensure privacy, however no suitable locks have yet been fitted to bedroom doors. Concerns had been raised at previous inspections that there was no clear guidance on how staff were to manage situations where individuals became distressed or upset, and could be “challenging”. There was now information on file from visiting specialists and this information and guidance had been incorporated into care plan. We spoke with staff about working with people, who presented challenges, and responses varied, but some staff showed a good understanding and were able to understand some of the difficulties that people at Highermead experienced. We looked at the way medication was managed as part of this inspection. We looked at the way medication was stored and the way the administration of medication was recorded. There have been significant improvements in the management of medication, there are now good records of medication being received into the home, and when it is administered. We observed staff administering medication, staff were careful to explain what the medication was for, to offer drinks with tablets, and not to hurry the person. On one occasion one person said that they did not want to take their tablets, the member of staff did not make a fuss, but left them for a little while before returning to see if they might have had a change of heart. Where one person had wanted medication to be left on the table, the member of staff had explained that this would not be safe. One particular concern has been “as required medications”, as there was no clear guidance as to when such medication should be given. During the visit we looked at the records for two people and found that there was information in the care plan as to when it should be given. There was also information in the file that indicated that one individual had been given the medication when it was needed. Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people at Highermead have the opportunity to take part in activities and staff have the time to sit and talk with them, though the record of participation in activities is not sufficient. People now have the opportunity to take part in religious services. Meals are well cooked and provide a varied diet however the timing of the meals is such that there is potentially an unnecessarily long gap between teatime and breakfast. EVIDENCE: We sat with the people who live at Highermead during two meals, breakfast and lunch. The décor in the dining room has been much improved, and further improvements are planned. We observed that the meals were relaxed, individuals were given a choice of what to eat, and were given time to enjoy the meal. People who needed assistance to eat were given the help that they needed. We have raised concerns at previous inspections that teatime is set at 4.30 pm. People are offered a supper later in the evening, however many people Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 16 tend to go to bed after tea, and this means that the evening is very long and that there is a long gap between tea time and breakfast the next day. We have raised this issue in previous reports. The manager said that this was a concern and that they were looking at the meal times and changing them. We looked at the record of meals eaten and people were offered a varied diet, and there was evidence of a choice being offered. We had previously been told that a 4-week menu was to be introduced, and that this would include food people at Highermead were known to like. However when we asked about this the cook said that she chose what was to be cooked each day. The information supplied by the home about the number of care staff who have received training in handling food shows that no one is trained. Staff regularly handle food at times when the cook is not in the home. We spoke to one of the cooks and she confirmed that her food hygiene certificate was out of date. We discussed with one of the staff how one of the people at Highermead had spent her formative years abroad, and it might be possible to provide some food that might remind her of this. We were told that activities were now being provided most afternoons, and staff confirmed that they had time to play games, play bingo, cook cakes, and to do some craft work. Staff also said that they now had time to sit and talk with people, and the Manager confirmed that she viewed this as an important part of the role of staff. Staff were observed spending time sitting and talking with the people who live at Highermead. We talked to staff about the times people got up and went to bed, they explained this was to suit the individual. When we looked at the information that had been recorded this reflected the choice that we were told about. One of the days we visited some people had got up early however others were having a later start. We looked at the care plan of one individual; this document said that the person should be given the opportunity to go for a walk four times a week. However when we looked to see if the person had been out, there was no record of this happening in the previous month. We spoke to staff about this and they said that the individual had been out, but they had not recorded it, or that the person had said that they did not want to go out on other occasions. It is important that such information is recorded as part of the daily notes. We were told that visitors were welcomed at any times that were convenient to the people who live at Highermead. The record in the visitor’s book showed that there were regular visitors to the home. During the final day of the inspection the local vicar visited the home, and the Manager explained it had been agreed that communion would be offered at Highermead every month, Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 17 and that arrangements were to be made for people to attend church, if they so wished. We looked at the money held by the home on behalf of the people who live at Highermead. There was a record of money being received and money being spent on such items as hair dressing and clothing. Receipts had been kept for such times. Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Complainants cannot confident that complaints or concerns will be acted upon. The systems for protecting people from abuse are not robust and allegations may not always be recognised as such or appropriate actions taken in a timely manner. EVIDENCE: Since the last major or key inspection in August 07, we have received a number of complaints regarding the care provided at Highermead. We received a complaint regarding the lack of management in September 07, and the resulting inspection found that there was no proper management of the home and that the standard of care provided was so poor that we referred the matter to Social Services to ensure that people were protected from harm. In late September 07 we received an anonymous complaint about recruitment of staff and the financial viability of the home, we looked into these matters and whilst the Commission had concerns about the recruitment of staff there was no evidence to support the specific concerns raised in that complaint. We have also received concerns from a visitor to the home and from an anonymous complainant; these matters were referred to the Registered Provider to investigate and to respond to. It was of concern that the home failed to take appropriate action to protect service users in the light of the Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 19 allegations. It was of further concern that confidential information about a resident of Highermead was sent to the complainant. A relative of a person who lived at Highermead has raised a further concern. This concern had been raised with the providers, who found no basis for the concerns relating to care. However when this matter was referred to the Commission and we looked at the relevant records, it was apparent that there had been omissions in the care provided. We therefore considered that this concern had not been properly investigated. The Complaint’s procedure is in the Service User’s Guide a copy of which is in bedrooms. There is a complaint’s procedure that is displayed in the hallway, however this is so high on the wall it would be unlikely that it would be noticed and would be difficult to read. The information sent by the provider shows that 6 complaints had been received in the previous 12 months. We looked at the complaints file with the manager; there was no record of all of these complaints. The record of complaints was kept so that any member of staff had access to it. We discussed with the manager that some of the information might be confidential and that consideration needs to be given to keeping information in a matter that reflects it’s confidential nature. The Commission requires that it be informed of a range of events in the home, this includes: allegations of misconduct by staff, events that effect the well being of service users, deaths and burglaries. It was identified at previous inspections that the Commission was not being notified as is required by law. An enforcement notice was served on the Registered Provider because of the concerns, since then the Commission has been informed of a number of events however not always in a timely manner. The Registered Provider also must report all allegations of abuse or suspected abuse to Social Services who have a duty to manage the investigation of such matters. Again, the Registered Provider has on occasions been slow to raise these issues. During this inspection we asked the manager about the information they had on reporting allegations of abuse. The information was that aimed at the general public rather than more detailed information that might be of use in a care home. We asked that manager about training and she said that staff were now booked on courses that were run by Social Services. At previous inspections we have found that money was not well accounted for, at this inspection we found that there were good records and that the cash held balanced with the amount shown on paper. Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 23, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Highermead provides comfortable and generally clean accommodation, however some of the ways things that are done to stop people catching infections are inadequate. Hot water in wash hand basins is not readily available for people to be able to wash. EVIDENCE: We looked around most parts of the building as part of this inspection. The bedrooms that we went into were clean and tidy, and there were no offensive odours. Some individuals had chosen to bring in items of furniture or ornaments. It is recommended that residents are provided with the option of having door locks fitted that would allow them to lock their room if from the inside and outside, if they so chose, and be overridden in an emergency. There are a number of bathrooms in Highermead, however only one of these is in use, as the others do not have a hoist or accessible shower. Door locks Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 21 have now been fitted to the ground floor bathroom and toilets. One item that staff raised as a concern was difficulties with the hot water in wash hand basins. Staff told the inspector that to obtain hot water they had to run both the hot and cold taps for a considerable time. It made helping a person to wash more difficult, and difficult for staff to wash their hands. We were told that hot water to the baths was not such a problem. We spent time in the lounges and in the dining room, and they seemed comfortable and suited to the needs of the people at Highermead. Thought had been given to the seating to try and make it more convivial. We were told that the flooring in the dining room is to be replaced. The people who live at Highermead do not have access to the dining room between meals. Improvements have been made in relation to the control of infection since previous inspections; liquid soap and paper towels are now available in bathrooms and toilets. Disposable gloves and aprons are now being more appropriately used, to protect both staff and the people who live at Highermead from infections. We were told that the Manager that they had not used the Department of Health guide “Essential Steps” to assess the current infection control management, this helps the manager to identify where there are concerns. We looked at the laundry, and there had been improvements in that foul laundry is no longer washed by hand. However the laundry is used to store clean items. Such systems can lead to the spread of infection. It was also noted that flannels are still being used. We discussed with the manager the importance of seeking expert advice and guidance to further improve the control of infection. The manager said that she was arranging for staff to attend control of infection courses. New handrails have been fitted to corridor areas, but they are too high to be easily used by the people who live at Highermead. Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are sufficient staff to be able to meet the needs of the people who currently live at the Highermead. The recruitment process, whilst much improved, lacks thoroughness in one area. Staff feel well supported and initial training is improving their understanding of the needs of the people with whom they work. EVIDENCE: As part of this inspection we spoke with seven staff working at Highermead. All of the staff who had worked at the home for more than a few months felt that there had been major improvements in the home. Staff commented that they now had more time to do their work properly, and to talk to people. One member of staff talked about the impact that this had had on one person, and how the resident was now talking and participating in activities. As part of this inspection we spent time observing the way staff interacted with the people who live at Highermead. Many of the interactions were very positive, staff were responsive and thoughtful in their interactions and responded in a way that suited that person. A few of the interactions were less positive, and were from staff who were far less skilled. This was discussed with the manager at the time of the inspection. We looked at the recruitment files for two staff who had recently been recruited to the home. These files contained application forms and there was Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 23 evidence that references had been taken and a check on criminal record had been initiated before the person had started work. It is required that any one who works in a care home must have a full employment history and any gaps must be accounted for. Neither of the application forms seen had a complete work history, as there were significant gaps. We asked to see the induction programme for the new workers and were told that they were with the individuals, however we were shown a blank version. We spoke to one of the new workers, and the person confirmed she was having an induction. The person explained that he/she was shown how to do things, and that the manager and seniors had been there to offer support. The person confirmed as part of the induction that they had read the care plans and had learnt about the backgrounds of the individuals. This is an improvement, as prior to this staff had not received any induction. Staff spoken with said that they were now receiving some training, this had included training in relation to first aid, dealing with anxiety, medication, and a half day training on dementia and challenging behaviour. It is also planned that staff will be attending training on Adult Protection/ or safeguarding. As has already been noted staff, including a cook, do not have up to date training in relation to food hygiene. The staff spoken with felt very positive about the training they have received in recent months, and spoke about how it had started to improve their understanding of the people at Highermead. We asked staff about whether there were sufficient staff, some commented that they felt that there was not always enough staff, the staff surveys showed that staff felt that there was usually enough staff on duty. When we observed the care provided, and the well being of the people who lived at Highermead, we considered that there were sufficient staff during this inspection. We spoke with staff about support and staff said that they felt that the manager was very supportive, that she was always there when you needed her. One member of staff talked about how everybody’s views were being respected and another said that now looked forward to coming to work. One person who responded to a survey said “ When I started to work at the home things were in a turmoil and I did feel I couldn’t work there. But now I have settled in very well the home has moved forward”. Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Highermead is generally well managed, however there is no Registered Manager at the home. Staff feel well supported and that there is good communication within the home and with the “head office”. Checks to ensure people are kept safe were being made. EVIDENCE: The current Manager has been in post since October 07, and said that she has now sent in an application to be registered as the manager by the Commission. The Manager said that she thought that it was important that some of her time was spent working directly with the staff and the people who live at Highermead. One member of staff said that the manager was always there, and was very supportive. Staff gave examples of when they had had problems, they had been able to contact her and get the sort they needed to resolve the difficulty. Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 25 We looked at the way staff communicated, and from the surveys and from what we were told staff feel that they know what is going on, we were told that staff keep each other up to date with handovers. We were told that there was now daily contact with the head office, and that this was not just the manager, but all of the staff were able to call. The Manager told us that the Registered Provider visits the home, the last visit being in January, and a further visit was now due. At previous Inspections it had been noted that the Commission had not been informed of incidents or events of a serious nature. Because of the concerns we had, an enforcement notice was served. The Commission has now been informed of a number of incidents, though not always in a timely manner. We looked at the organisation of the home, records were generally up to date, and when we asked for particular records staff were able to find these. We looked at the fire records that were kept in the ground floor office, however these were out of date. The current records were kept up stairs. We discussed with the manager the importance of ensuring that the current records are readily available to be inspected rather than historical records. We also looked at the way cleaning materials were stored. We found that they were stored securely and that there was guidance for staff on how these were to be used and what to do if there was an accident. We asked about the Quality Assurance system and were told that survey forms had been sent out at Christmas, though the results were not yet in. As has already been noted the records of money held on behalf of the people at Highermead were good. Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 1 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 3 x x 2 3 x x 2 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 3 Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 5 Requirement The Statement of Purpose must be up dated so that it contains the information that is required, and is accurate and up to date. Resident’s contracts must be available for inspection at the home. Service User Plans (Care Plans) must clearly say what each person’s needs are and how these are to be met by staff- this must include information in relation to the management of diabetes- where appropriate. Similar requirements have been made at previous inspections. There must be a record of any activities that people take part in, and where this has been specified in the Care Plan, there must be a record of any reason for it not happening. Meals must be available at times that suit the needs of the people who live at Highermead. This means that the times that meals are set must be reviewed. (A similar requirement was made at the inspection on 12/9/07) DS0000009188.V358810.R01.S.doc Timescale for action 01/05/08 2. 3. OP2 OP7 , OP8 Sch 3 (1) 15 01/05/08 01/05/08 4. OP12 16(n) 01/05/08 5. OP15 16(i) 01/05/08 Highermead Version 5.2 Page 28 6. OP16 22(3) 7. OP16 17 (2) Sch 4. 8. OP18 13 (6) 9. OP22 23(c) 10. 11. OP26 OP26 23(j) 13(3) 12. OP29 19 Sch 2 13 OP30 18(c) The Registered Person must ensure that all complaints are thoroughly investigated, and treated in a confidential manner as appropriate. The Registered Person must keep a record of all complaints and the action taken in respect of any such complaint. This must be available for inspection. (This requirement was made at previous inspections). You are required to ensure that service users are protected from abuse by ensuring that staff know what their responsibilities are, and any allegations of abuse are appropriately acted upon. (This requirement was made at previous inspections) Handrails fitted in corridors should be at a height suited to the people who live at Highermead. Hot water should be readily available in wash hand basins and sinks. The systems for controlling infection must be reviewed, this should include how laundry is stored and the use of flannels. No one may work at Highermead until a full employment history has been obtained, and any gaps in employment accounted for. A similar requirement was made at the Inspection on 1/8/07 to be met from 1/8/07, 2/10/07 to be met by 10/10/07. Staff must continue to receive training to ensure that they have sufficient competence and understanding to provide care and support for the people who live at Highermead. This should include training in relation to control of infection, protection of vulnerable adults, food hygiene, DS0000009188.V358810.R01.S.doc 01/05/08 01/05/08 01/05/08 01/06/08 01/06/08 01/06/08 01/05/08 01/07/08 Highermead Version 5.2 Page 29 14. OP31 8 and working with people with dementia and mental health needs. The Registered Provider must ensure that a Registered Manager manages the home. 01/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP10 Good Practice Recommendations All bedrooms should have suitable door locks for the people the home accommodates. Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Regional Office Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Highermead DS0000009188.V358810.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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