Inspection on 16/08/06 for Highermead

This inspection was carried out on 16th August 2006.

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

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

Other inspections for this house

Highermead 13/02/08

Highermead 01/08/07

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 Philippa Cutting Key Unannounced Inspection 16th August 2006 09:30 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.V306062.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.V306062.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 Ark Care Services Limited Mr Shaun Boundy 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.V306062.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 Date of last inspection 5th October 2005 Brief Description of the Service: Highermead is a privately run home, which provides care and accommodation for older people who have problems with their mental health, or dementia. Accommodation is provided on two floors, in single rooms in a large detached house in a quiet rural area in Camelford. There is good circulatory space on the ground floor so that service users can sit or wander in safety. Access between floors is safeguarded to prevent accidents. In good weather there is a safe garden area available for use. The home has recently completed an extension on the ground floor. There is good car parking by the home. Highermead DS0000009188.V306062.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place over two days and lasted 9.25 hours. During this time the inspector spent time with the service users observing interactions between them and the staff, reviewing records to see how the care needs identified in the care plans were reflected in the care provided and talking with staff and the registered manager as well as inspecting the premises. Relatives & friends who were visiting were also greeted. The atmosphere was good; staff were very much in evidence and spent time with service users. The registered manager said that they had just come out of a difficult period (new service users & staff changes coinciding) but staff had pulled together as all regarded the care of the service users as the top priority. The premises were generally in good order; the extension had fitted into the layout effectively; the rooms being occupied. There was minor disruption caused by the home waiting for new bathroom fittings to be installed. Fees range from £340.00 - £480.00 per week. What the service does well: What has improved since the last inspection? What they could do better: Not all records were up to date but this was acknowledged and steps were already in place to address this. Highermead DS0000009188.V306062.R01.S.doc Version 5.2 Page 6 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. Highermead DS0000009188.V306062.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Highermead DS0000009188.V306062.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5 These standards were judged as good – the home takes time and effort to introduce new service users and – as importantly – their families to Highermead, seeking & providing information and spending time, as needed, to help people make what can be a difficult transition. EVIDENCE: People moving into Highermead are usually too frail to make this decision for themselves; consequently the home liaises closely with families or significant other people. Information is sought from any referring professionals and the registered manager likes to visit people in advance wherever possible. The home’s reputation is such that relatives are frequently prompted to visit the home when making care choices. A relative visiting a recently admitted service user said that he had been given the information that he required about the home and had been impressed by the visits he made whilst looking at options. Highermead DS0000009188.V306062.R01.S.doc Version 5.2 Page 9 The home has good support from various members of the mental health team but it is rare for the home to find itself unable to care for even very challenging service users, as the staff are competent and experienced. The registered manager said that he prefers not to admit too many new service users at a time as people’s individual care needs need to be assessed and absorbed into the ‘service user mix’. There had been a number of vacancies recently following several deaths and for a period this had created considerable pressure with admissions and staff changes. Highermead DS0000009188.V306062.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 The health & personal care provided for service users is excellent and these standards are well met. People are cared for as individuals and given time and consideration according to need. Staff take time with people who are reluctant or unable to assist with their own care, seeking help from colleagues when necessary. Strategies are in place to identify trigger factors and the action to be taken if a difficulty arises. EVIDENCE: The home has introduced a new care plan format that is fuller than the previous one. It includes an assessment of a service user’s functional and personal activities of daily living as well as their mental & psychological needs. The recent influx of new service users has meant that not all the care plans were fully up to date but the registered manager & senior staff were aware of this. They said that their priority had been the care of the new service users, which in some cases had been challenging. Now that the routines in the home were becoming more settled, the care plans were being given precedence. It was noted that on the second day of the inspection progress had been made in Highermead DS0000009188.V306062.R01.S.doc Version 5.2 Page 11 this respect and the inspector was confident that all the records would be updated within two weeks. The general health of the service users is well cared for by the staff with good support from the local surgery & community nurses as well as psychiatric services. Medication is carefully managed by senior staff who have undergone courses in the safe handling of medication. The process for ordering, recording and returning any unused medication was discussed, seen to be satisfactory and in accordance with the home’s written procedures. An amendment to the controlled drugs book was recommended in order to make the inclusion of new supplies clearer. There were signed agreements in place regarding the administration of medication to certain service users where, after assessment and consultation, it had been agreed that the person’s health would be improved if medication could be given disguised in a drink if necessary. The dignity of all service users is respected at all times with staff addressing people courteously. Altercations between service users were seen to be handled swiftly and carefully although the staffs’ level of awareness meant that in many cases potentially difficult situations were averted. It is unusual for a person living at Highermead not to spend their last days in the home. Care is given to the service user & their families during the last stages of the service user’s life. Highermead DS0000009188.V306062.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The outcome for these standards is good. The routines in the home are planned around the service users’ needs and wishes where these can be expressed. Opportunities for people to be able to make choices are limited due to their diminished abilities but staff seek to provide these as much as possible. Relatives are involved in a person’s life as much as they wish to be. EVIDENCE: Routines are very flexible, as staff prefer to coax reluctant people into helping rather than provoke difficulties. Visits to and from families and friends are encouraged with some service users staying with their families for short breaks. If there are problems managing a person’s care relatives are included in any discussion to sort out the problems. The present service user group is more able to participate in activities than has been observed on previous inspections and it was seen to be part of the home’s routines, mainly in the afternoon, to offer activities such as simple art work, quizzes and music etc. Participation with the service users is seen to be an important part of their care and the staff all responded to situations which included giving comfort to someone who was upset, calming a person who was agitated and joining in a ‘dance’ with another. Highermead DS0000009188.V306062.R01.S.doc Version 5.2 Page 13 Meals are taken together with an additional small dining room set for four people who were more able and likely to converse or benefit from a more social setting. A choice is provided with staff knowing through experience which meal a person is most likely to prefer. Meals were served attractively on smaller plates as time has shown that the service users are more likely to eat all the meal if it does not look too overwhelming in size. Help is given with feeding if required but everyone appeared to manage well. People were encouraged to stay to finish their meal rather than leave the table quickly. One person who was asleep and reluctant to wake was left to sleep but offered a meal or other refreshments later when she woke. The home holds limited sums of money for service users as safekeeping. Any expenditure, which is usually modest (hairdressing, newspapers etc), is recorded. Highermead DS0000009188.V306062.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 These standards are well met with staff alert to the prevention of abuse & training provided. Concerns are taken seriously and addressed. EVIDENCE: The complaint policy & procedure is provided to all relatives and available in the home, as in reality none of the service users are likely to instigate it on their own behalf. A questionnaire completed by relatives indicated that families were very satisfied with the care that their relative received. There were a few comments made – these included thoughts about activities or minor issues. On speaking to staff they were aware of the risk of abuse to the vulnerable people in their care. Information about PoVA is available & places on seminars sought. Highermead DS0000009188.V306062.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25 The facilities provided at Highermead provide a satisfactory outcome with a homely environment that meets the service users’ needs. The home was seen to be clean & tidy with sufficient space to allow people to wander safely if they wished. People are encouraged to personalise their rooms. Personal dignity is helped by the location of toilets near the communal rooms. EVIDENCE: The home is well maintained. The extension has been completed with a few minor areas that need finishing off. The registered manager has planned to do these himself but admitted that there had been insufficient time recently to allow him to do so. The bits concerned are largely cosmetic but do need attention. Handrails in some of the longer passages could be of benefit to service users. A new bath that would help staff bathe people who needed more assistance was being installed. Some people are reluctant to bathe and it is hoped that Highermead DS0000009188.V306062.R01.S.doc Version 5.2 Page 16 this bath will make the experience more pleasurable for them and easier for staff. People’s rooms showed varying amounts of personalisation, some had many family photos with reminders as to whom everyone was. Generally all rooms were in good order although two rooms have odour problems that have been difficult to address satisfactorily. If a service user becomes frailer and needs closer observation the registered manager may negotiate a room change with another person to effect this. People are encouraged to spend the main part of their day in the communal rooms as they can wander freely between them as they wish. Access to the first floor is via a lift or stairs. Both are guarded to prevent accidents but if people choose to spend time in their own rooms this is not a problem. Externally there is a courtyard garden that is enclosed where service users can sit or wander. One person likes to go outside frequently, via an alarmed door. Staff responded by following her and walking a bit further round the outside before gently guiding her back indoors. This outing, although short appeared to satisfy the person concerned. Staff said they do take various people for walks when they can. Highermead DS0000009188.V306062.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The outcome for the standards relating to staffing was good. Some documentation was awaiting filing but the appointment of an assistant manager with dedicated time for paper work indicated that this would be addressed. Most importantly staff were seen to work together for the benefit of the service users. EVIDENCE: The staff in the home are enthusiastic and caring. They said that they enjoyed working with this group of service users and were seen to be spending time with them as people and not just looking after their functional needs. The care rotas showed that the staffing ratio is good which is one of the main factors in enabling the provision of good care for service users. Staff recruitment procedures were in place with Criminal Records Bureau checks & PoVA First checks being carried out by the responsible individual prior to anyone starting work. The registered manager said that the responsible individual forwards the documentation to him when it is complete. He had received a verbal message that a new staff member’s checks were satisfactory but had not yet received the paper copy. All new staff have an initial three-month probationary period followed by an appraisal before being offered permanent contracts, which were seen to be in place. Staff currently undertake a four-week induction programme; the Highermead DS0000009188.V306062.R01.S.doc Version 5.2 Page 18 responsible individual is considering how the new ‘Skills for Care’ induction will be introduced. All staff are encouraged to study for National Vocational Qualifications. Training opportunities are sought for courses that will improve staff knowledge and thereby benefit service users. Moving & handling is currently booked although no one needs a hoist at present. Regular ‘job chats’ take place between the registered manager & staff – these need to be fully recorded as supervision sessions as well as the annual appraisals. The staff handbook is available in the office for anyone to consult. It was comprehensive in nature. The registered manager commented that during a recent period when the home was trying to integrate several new service users and cope with some staff leaving, the staff who were on shift ‘were brilliant’ in providing cover for each other whilst maintaining the standard of care. Highermead DS0000009188.V306062.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,37,38 The home is managed in a proactive and dynamic way by the registered manager so that there are good outcomes for the service users and staff who said that they felt supported and valued. The importance of good record keeping is understood and maintained but the well being of the people for whom the staff care is always the first priority. EVIDENCE: The registered manager holds National Vocational Qualifications level lV & his registered manager’s award. He says he enjoys his work enormously which means that the staff and service users benefit from his enthusiasm. Outside agencies recognise the skills that this has brought about in the home. The home does not handle money for service users but will keep ‘pocket money’ in safekeeping, reminding or billing families periodically if a service user runs short of cash. Highermead DS0000009188.V306062.R01.S.doc Version 5.2 Page 20 The policies and procedures in the home are sound with the records required by statute kept. The registered manager said the responsible individual has been supportive over a past staffing problem and now visits the home on a more regular basis. She sends through information about Health & Safety to ensure that this is kept up to date. The required checks were seen to be in place. A questionnaire is circulated annually to families seeking their views on the service provided by the home. The responsible individual follows up any comments that indicate there could be a problem or where suggestions are made. Highermead DS0000009188.V306062.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 X STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 3 3 Highermead DS0000009188.V306062.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP9 Good Practice Recommendations New supplies of medication that needs to be stored as a controlled drug (CD) should be entered in the CD book more clearly, possibly in a different colour, to indicate clearly the total held. The provision of handrails in corridors should be considered. 2. OP23 Highermead DS0000009188.V306062.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Highermead DS0000009188.V306062.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!