Inspection on 05/10/05 for Highermead

This inspection was carried out on 5th October 2005.

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

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

Other inspections for this house

Highermead 13/02/08

Highermead 01/08/07

Highermead 16/08/06

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 Unannounced Inspection 5th October 2005 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.V251274.R01.S.doc Version 5.0 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.V251274.R01.S.doc Version 5.0 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 18 Category(ies) of Dementia - over 65 years of age (18), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (18) Highermead DS0000009188.V251274.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to include up to 18 adults aged over 65 years with a mental illness (MD(E)) Service users to include up to 18 adults aged over 65 years with dementia (DE(E)) Total number of service users not to exceed a maximum of 18 Date of last inspection 28th April 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, mainly due to 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 is currently building an extension on the ground floor. Highermead DS0000009188.V251274.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place between 9.45am & 3.30pm. Time was spent with the registered manager and records, especially those regarding staffing and administration, were inspected. Later the premises were toured with regard to the extension and communal rooms. Individual rooms were not visited on this occasion. The inspector talked with service users but many were unable to sustain a conversation. Relatives visiting the home were however very positive about the care their family member received. Staff were informative and very caring towards the service users and it was noted that they often had to stop a task (such as writing notes) to attend to a service user. Staff were alert to each other and would offer to assist or intervene if this was needed. The atmosphere within the home was calm and peaceful. What the service does well: What has improved since the last inspection? What they could do better: The registered providers have failed to meet their statutory requirements with regard to regular visiting and reporting in support of the registered manager. Highermead DS0000009188.V251274.R01.S.doc Version 5.0 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.V251274.R01.S.doc Version 5.0 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.V251274.R01.S.doc Version 5.0 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): 3,4,5, Information is provided for and sought about service users before accommodation is offered to ensure that a person’s needs and the home’s skills are compatible. EVIDENCE: The registered manager meets prospective service users (and their families) before offering accommodation in order to ensure that the services provided by Highermead are compatible with a person’s needs. A relative said that people who knew of Highermead had recommended it to her and she had heard good reports of its reputation. In general it is families who choose the home rather than the service user, as he or she is usually too frail to do so. The mix of existing service users is taken into account when a vacancy occurs. Highermead DS0000009188.V251274.R01.S.doc Version 5.0 Page 9 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 care provided for service users is tailored to meet their individual and family needs in a caring and considerate manner. EVIDENCE: Care plans detail each person’s needs. These also set out the problems that occur at different times of day. A new, more detailed care plan format is being introduced which provides for more input from families and important others. The registered manager reported that the home has excellent support from the community nursing services with referrals onto other agencies/professionals as needed. Medication is administered by the staff for all service users. The home’s philosophy is to use minimal medication. Staff who administer medication have received training and another course is being arranged. One senior member of staff has the designated responsibility for ordering and checking medication. The home has policies and procedures for all aspects of medication. A ‘returns’ book is maintained and signed by staff and the pharmacist. Highermead DS0000009188.V251274.R01.S.doc Version 5.0 Page 10 Medication is stored in a secure trolley in a locked room. Inspection of the trolley and other storage revealed that a controlled drug (CD), which was correctly stored, needed to be returned to the pharmacy, as it was no longer used. The tally in the CD book matched the CDs in storage. If CDs are required in future the home should purchase a Controlled Drugs Book with numbered pages in which to record them rather than use a notebook. An unlabelled but unused packet of tablets was found. It was surmised that this had been part of a supply but the labelled packet had gone. Staff are urged to check that all packets are labelled on receipt. If not, this should be raised with the pharmacist. The inspector was told that the current users are compliant when offered medication but syrups can be used if swallowing tablets presents problems. Medication is generally well managed. Observation showed that the staff treat each person with kindness and respect, offering help and assistance as needed. It is rare for a person not to remain in the home until their life’s end; support being offered to families etc. Highermead DS0000009188.V251274.R01.S.doc Version 5.0 Page 11 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 Service users and their families can be confident that the home will try to meet all expressed needs in a considerate and appropriate manner. EVIDENCE: The majority of service users are no longer able to participate in ‘organised activity’ but respond individually to attention and appropriate company. Routines are flexible, as people cannot necessarily accommodate a set timetable. Staff are very much in evidence throughout the home and understand fully that their role is to spend time actively engaged with service users, which they were seen to achieve successfully during the inspection. Visitors are encouraged and staff make time to talk to them about their relative. Meals are normally taken in the dining room as this provides a social element and it is easier for service users to manage when sitting at a table. Meals are provided before the main sitting for people who need assistance with their food so that they can receive attention in quiet, unhurried surroundings. The cook will cater for special diets – mainly diabetic although other preferences e.g. Highermead DS0000009188.V251274.R01.S.doc Version 5.0 Page 12 vegan have been provided. Food can be presented as a soft diet etc if this is needed. Highermead DS0000009188.V251274.R01.S.doc Version 5.0 Page 13 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): 16,17,18 The registered manager takes all issues concerning the rights and protection of service users seriously and will address any problems. EVIDENCE: The home’s complaints policy & procedure is about to be displayed within the home as a notice. It is currently incorporated in the service users guide but families had become unaware of this. There have been no complaints from service users or families since the last inspection. Information in service users’ records showed that people’s rights were addressed; advice from a solicitor would be sought or recommended where there are no suitable family advocates. The home has policies and procedures on the protection of vulnerable adults (PoVA) and on going training has been sought. Highermead DS0000009188.V251274.R01.S.doc Version 5.0 Page 14 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): 19,20,21,22,25 The home is maintained in a way that meets service users’ needs. Risk factors within the building have been taken into account which allow people the maximum of freedom. EVIDENCE: An extension is currently in progress. Precautions have been taken to prevent service users from straying into a unsafe area but a more detailed assessment of any risks and health & safety issues is being arranged whilst the work is in progress. The home appeared clean and free of odours. People are encouraged to spend their days in the communal rooms downstairs where they can be in constant contact with staff and other service users. One person expressed a wish to return to her room at the end of the afternoon and was helped to do so. Highermead DS0000009188.V251274.R01.S.doc Version 5.0 Page 15 The layout of the home enables people to wander in safety indoors between the communal rooms or in linking passages. There are areas where people can sit outside in good weather if they so wish. Equipment to assist with care needs is provided, many of which are to help maintain good skin integrity. The laundry was not inspected. Highermead DS0000009188.V251274.R01.S.doc Version 5.0 Page 16 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 Service users are cared for by a team of staff who demonstrated a good understanding of the client group. EVIDENCE: Staffing levels in the home are good so that service users can receive the attention that they need at all times. Staff were very positive about their roles and appeared to have an empathetic understanding of the service users. The required checks are obtained for all staff before they start work and training is encouraged. All senior staff hold an National Vocational Qualifications at level lll. The registered manager is aware of the new standards that are being introduced as the induction programme for new staff. The current induction documentation requires staff to sign that they have read/understood instructions rather than a ‘tick box’ system. Highermead DS0000009188.V251274.R01.S.doc Version 5.0 Page 17 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): 31,32,35,36,37,38 The management style of the home is open and inclusive. The registered manager is keen to include families in the care of the service users. EVIDENCE: The registered manager has completed his National Vocational Qualifications level lV & Registered Manager’s Award. He has a clear vision of the services that the home provides and is positive and enthusiastic about it. He reports that the registered providers are generous with their financial support. A questionnaire has been sent to service users’ families but this was not looked at on this occasion. A record of spending on behalf of service users is maintained as families leave appropriate sums for everyday needs such as hairdressing and toiletries etc. Highermead DS0000009188.V251274.R01.S.doc Version 5.0 Page 18 An appraisal form that is being used with staff was seen. The home’s system of supervision - ‘job chat’ - was good but has fallen into abeyance and needs to be restarted. This format is more suitable for on going supervision with existing staff rather than the form that demonstrates a carer’s knowledge and competence with caring skills and equipment. This latter form would be more useful as part of an induction, although periodic reminders could be indicated. The records required by statute are in place although the most recent fire test had not been recorded. However documentation showed that the system had been serviced as a fault had been identified at the last test. Staff receive updates with regard to moving and handling and infection control. Accidents are recorded in accordance with the requirements of the Data Protection Act 1998 and any violent incidents or aggressive episodes are also recorded. Health safety audits are being contracted out to a consultant firm whose visit is awaited. The registered provider has failed to comply with the statutory requirements of regulation 26 regarding regular reports of his/her visits and inspections. Highermead DS0000009188.V251274.R01.S.doc Version 5.0 Page 19 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 X X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 3 18 3 3 3 3 3 X X 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 X X 3 3 3 2 Highermead DS0000009188.V251274.R01.S.doc Version 5.0 Page 20 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 OP9 Regulation 13(2) Requirement The person checking in medication must ensure that all packets are labelled especially if the dosage is supplied in more than one packet. Timescale for action 01/11/05 2 3 OP36 OP37 18(2) Reg 26 Staff supervison must be 01/11/05 restarted on a regular basis comprisng at least 6 x per year. 01/11/05 (2) Where the registered provider is an organisation or partnership, the care home shall be visited in accordance with this regulation by - (a) the responsible individual or one of the partners, as the case may be;(b) another of the directors or other persons responsible for the management of the organisation or partnership; or(c) an employee of the organisation or the partnership who is not directly concerned with the conduct of the care home. (3) Visits under paragraph (1) or (2) shall take place at least once a month and shall be unannounced. (4) The person carrying out the visit shall - (a) interview, with their consent and DS0000009188.V251274.R01.S.doc Version 5.0 Page 21 Highermead in private, such of the service users and their representatives and persons working at the care home as appears necessary in order to form an opinion of the standard of care provided in the care home;(b) inspect the premises of the care home, its record of events and records of any complaints; and(c) prepare a written report on the conduct of the care home. (5) The registered provider shall supply a copy of the report required to be made under paragraph (4)(c) to - (a) the Commission;(b) the registered manager; and(c) in the case of a visit under paragraph (2) - (i) where the registered provider is an organisation, to each of the directors or other persons responsible for the management of the organisation; and(ii) where the registered provider is a partnership, to each of the partners. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP23 (2)(a) Good Practice Recommendations A bound and numbered CD book should be obtained if CDs are in use in the home. The provision of handrails in corridors should be considered to help service users when walking. Highermead DS0000009188.V251274.R01.S.doc Version 5.0 Page 22 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. 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