CARE HOMES FOR OLDER PEOPLE
Highfield Highfield The Common Marlborough Wiltshire SN8 1DL Lead Inspector
Malcolm Kippax Unannounced Inspection 1st February 2006 9:35 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 Highfield DS0000063586.V280769.R01.S.doc Version 5.1 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. Highfield DS0000063586.V280769.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Highfield Address Highfield The Common Marlborough Wiltshire SN8 1DL 01672 512671 01672 514283 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) Mr Anthony Leeson Andrea Leeson Vanessa Hillier Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Highfield DS0000063586.V280769.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th September 2005 Brief Description of the Service: Highfield is a privately run care home for up to 25 older people. The home overlooks Marlborough Common and has a large garden at the rear of the property. The original building has been extended over the years and facilities provided to meet the needs of older people. The period character of the house has been retained. The accommodation is on three floors. Bedrooms are on the ground, first and second floors. A passenger lift is available. There are 24 bedrooms in total, one of which may be used as a shared room. En-suite facilities are provided in all except two of the bedrooms. The communal areas include a dining room and a large lounge. The lounge provides a variety of sitting areas and outlooks onto the garden. Service users receive care and support from a permanent staff team. Highfield is not registered to provide nursing care and district nurses attend to the service users’ nursing needs. Highfield DS0000063586.V280769.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place between 9.35 am and 3.25 pm and focussed on those key standards that were not looked at during the previous inspection. The majority of service users were spending time in their own rooms. There were individual meetings with four service users. Their rooms were well personalised and with different outlooks. Other service users were met with in the lounge. Two staff members talked about their work and the training that they have received. Mrs Graham, assistant manager, was in charge as the home’s manager was having a day off. Mrs Graham was available during the inspection and the home’s Administration Manager also assisted with some of the record keeping and staffing matters that were looked at. Records, including care and assessment, staff training, quality assurance and the fire log book were examined. The medication arrangements were looked at on 2 February 2006 by a pharmacist inspector from the Commission. What the service does well: What has improved since the last inspection?
This was Highfield’s second inspection since the current owners and manager were registered. Much of the inspection concerned aspects of the home that have improved during this time, or are currently being developed. The requirements from the previous inspection have been met other than one, which is met in part. Highfield DS0000063586.V280769.R01.S.doc Version 5.1 Page 6 A new system of care planning means that there is better information about the service users’ needs and how these will be met. New medication facilities are in place and the pharmacist inspector has commented positively on the changes that have taken place. Regular staff meetings have been established, which have included training events with an invited speaker. A system of quality assurance is being developed, which looks very good. This includes an internal audit of standards which, together with the views of service users and others, will provide useful information about how well standards are being maintained and producing the right outcomes for service users. The home is commended for the developments that have been made in quality assurance. Service users like the new ‘hold-open’ devices that have been fitted to several bedroom doors. A new policies and procedures file has been set up which includes new areas of guidance for staff. This will help to ensure that service users receive consistent support from the staff team. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Highfield DS0000063586.V280769.R01.S.doc Version 5.1 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 Highfield DS0000063586.V280769.R01.S.doc Version 5.1 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 Service users’ needs are assessed and recorded before moving into the home. (Standards 1, 3 and 5 were looked at during the last inspection. Standards 1 and 5 were met and standard 3 was almost met). EVIDENCE: Standard 3 was not fully met at the last inspection because the manager’s preadmission assessment of a new service user’s needs had not been recorded. A service user has moved into Highfield since the last inspection. The records for this service user included a ‘Client Assessment Report’, which was carried out prior to admission. There was also a record confirming that the home could meet all the service user’s needs. Other information included a useful checklist for recording whether the service user had received the necessary information about the home, such as the Service User’s guide. This service user was away from the home at the time of the inspection. Highfield DS0000063586.V280769.R01.S.doc Version 5.1 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 and 9 Service users benefit from a new system of care planning, which gives good information about their needs and how these will be met. The home has good arrangements for the safe handling of medicines. (Standards 7, 8, 9 and 10 were looked at during the last inspection. Standard 7, 8 and 19 were met and standard 9 was almost met). EVIDENCE: A new system of care planning was being developed at the time of the last inspection. Examples of four care plans in the new format were looked at. Recommendations made at the last inspection have received attention. The care plans had been written in the last few months and are being reviewed each month. The care plans are updated using a ‘Changes to Care Plan’ form. The care plans include relevant sections such as ‘Expected outcome’ and focuses on a service user’s abilities and preferences, as well as their needs. This is good practice. The service users’ records also include an ‘Individual Reports’ form. In addition to being a record of daily events, these forms also
Highfield DS0000063586.V280769.R01.S.doc Version 5.1 Page 10 have a ‘suggestions/issues’ section. This appears to be a useful means of highlighting matters arising out of day to day events that may have an impact on the service user’s care plan or risk assessments. The medication is stored in new locked cupboards and a locked trolley is used to administer the drugs from a monitored dosage system. Printed medication administration records are provided by the pharmacy and photographs are included to aid identification. All staff administering medication undergo training and appropriate procedures are in place. All records are correctly maintained. Some residents retain some element of self-medication. This is risk assessed, but not reviewed with the care plan. Storage for medicines needing refrigeration should be reviewed as the current arrangements may not keep the temperature at the required level (2-8c). Highfield DS0000063586.V280769.R01.S.doc Version 5.1 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): 14 Service users can exercise choice and control within the home. (Standards 12, 13 and 15 were looked at and met during the last inspection. The home was commended in respect of standard 15). EVIDENCE: Each of the service users met with felt that they were able to exercise a good degree of choice and independence within their daily routines. Service users said that breakfast is brought to their rooms at a convenient time. One service user said that it could be earlier or later, if asked for. Lunch is at a set time, which the service users were happy with. Service users were also happy with the visiting arrangements and liked being able to have lunch with their visitors in a separate area away from the dining room that had been designated for this purpose. During the meeting with one service user, a staff member came to her room and nicely introduced a visitor who had arrived at the home. Staff also came to the service users’ rooms to ask about drinks to check on things. One of the service users met with was looking forward to her hundredth birthday later in the year. The service users met with had private telephones in their rooms and said that they received their post promptly.
Highfield DS0000063586.V280769.R01.S.doc Version 5.1 Page 12 One service user said that they like to be as independent as possible, in spite of some physical limitations. This preference was highlighted in the service user’s care plan. Other care plans seen included positive statements about what service users like to do, for example entertaining other service users in their room and taking communion. One service user’s wish to keep as mobile as possible was reflected in the ‘Action’ section of their care plan, which stated that the service user would walk one way when going between their bedroom and the dining room. Service users particularly like the new automatic closures that have been fitted to some doors. These enable service users to safely keep their bedroom doors open, as little or as much as they want. Other doors are to receive attention during the year. Highfield DS0000063586.V280769.R01.S.doc Version 5.1 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): 18 The protection of service users is receiving good attention and some further developments will be beneficial. (Standard 16 was looked at and met at the last inspection). EVIDENCE: A new policy and procedure has been produced covering P.O.V.A. and the prevention of abuse. This contains a lot of relevant information for staff and a detailed account of how an allegation of abuse would be responded to. The procedure for the reporting and investigation of an allegation appears to have come from an authoritative source, but it does not reflect the local arrangements and the involvement of the vulnerable adults unit in Wiltshire. It is important that the guidance accurately states the multi-disciplinary approach that is taken in the investigation of allegations, rather than pre-empting what the role of the manager might be as part of any investigation. Some other new policies have been produced in respect of whistle blowing and privacy & dignity. Staff members said that the subject of abuse had been touched on in a recent talk about dementia that they had attended. P.O.V.A. and the prevention of abuse were not included in the home’s record of staff training. Highfield DS0000063586.V280769.R01.S.doc Version 5.1 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): These standards were not looked at on this occasion. (Standards 19 and 26 were looked at and met at the last inspection). EVIDENCE: Highfield DS0000063586.V280769.R01.S.doc Version 5.1 Page 15 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): 28 and 30 Service users benefit from competent staff who are working towards the level of qualification that is expected. A programme of staff training is being well developed. (Standards 27 and 29 were looked at during the last inspection. Standard 27 was met and standard 29 was almost met). EVIDENCE: 11 staff members have achieved NVQ at level 2 and others are undertaking the qualification. One of the staff members met with said that she was starting her NVQ the next day. Progress is being made in reaching 50 qualified staff members within the staff team. The service users spoken with during the inspection were very complimentary about how staff members go about their work. The new owners and manager have been clarifying existing levels of staff training. Action in respect of training has been included as part of the home’s ‘Action and Improvement Planning Framework’. Individual staff training needs are to be identified through the appraisal process and new common induction standards introduced. A record of staff training is kept, which is in two parts under the headings of ‘Required Training’ and ‘Other Non-Statutory Training’. This gives a good
Highfield DS0000063586.V280769.R01.S.doc Version 5.1 Page 16 overview of the training undertaken. One of the staff members met with had been employed for about a year and had attended courses in First Aid, Food Hygiene and Fire Safety during 2005. Another member of staff had started more recently and completed her induction. She had not yet received training in moving & handling and first aid. The member of staff did not know what arrangements would be made for her to receive first aid training. Several other staff members had also not received training in moving & handling, although a notice in the office gave details of training that had been arranged for dates in March 2006. Another notice asked staff if they would be interested in attending a course in palliative care. The record of staff training had a column for planned training dates but did not show the priorities for training and timescales for attendance, for example how soon a new staff member will receive first aid training. This would help to ensure that staff members receive the training they need in a structured way, which meets their individual needs. In connection with standard 27, there was a requirement at the last inspection that the staff records show how staff are deployed during the night, e.g. whether on waking duty, or providing sleeping in cover and the times during the night when there is a change in these duties. The tasks and responsibilities of night staff in different roles have now been confirmed in a job description. This is being discussed with the registered persons. Highfield DS0000063586.V280769.R01.S.doc Version 5.1 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): 33, 35 and 38 Service users have provided good feedback for the registered persons, who have a positive approach to improvement and to providing ‘service user satisfaction’. A system for quality assurance is being well developed. Service users manage their own financial affairs with the support of people outside the home. Service users would benefit from more detailed risk assessments. (Standards 31, 32 and 38 were looked at during the last inspection. Standards 31 and 32 were met and standard 38 was almost met). EVIDENCE: Quality assurance was evident in the home’s ‘Action and Improvement Planning Framework’, under which improvement plans have been produced, based on an internal audit of standards. This appears to be a good exercise in
Highfield DS0000063586.V280769.R01.S.doc Version 5.1 Page 18 self-assessment and completion of the improvement plans will demonstrate a very positive approach to on-going development. The next review was due in July 2006. At the same time, questionnaires have been given out to service users and their comments collated and analysed. This has identified the service users’ satisfaction levels with different aspects of the home and been useful in obtaining individual feedback that will help the home with its development plans for the future. The Administration Manager said that the home had no involvement with the financial affairs of service users but there is agreement with some relatives for the billing of certain expenditures. Money is not normally looked after on behalf of service user although this had recently happened in connection with a relative who had left money. A record of this had been kept, which the relative had signed. The details of standard 38 were not inspected on this occasion although the requirements from the last inspection concerning fire precautions and risk assessments were followed up. Requirements concerning the fire precautions have received attention and the home’s fire log book was up to date. Risk assessments in respect of some bed aids used by service users have not been completed. It was also recommended at the last inspection that the service users’ moving and handling assessments are recorded on a separate form with more detail. Information about mobility is included on a ‘Client Risk Assessment’ form, although these forms give limited information about the service users’ moving & handling needs. The client assessment forms also refer to the risk of pressure sores. This, and other areas of risk would benefit from a more detail approach and from being recorded separately on individual forms. It was seen on one of the client risk assessment forms that the word ‘regular’ had been used to show that a service user requires support on a number of occasions throughout the day. A specific timescale, for example, every three hours, or a specific time would provide clearer guidance for staff about the frequency of the support that they need to give. Highfield DS0000063586.V280769.R01.S.doc Version 5.1 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 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 X 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 4 X 3 X X X Highfield DS0000063586.V280769.R01.S.doc Version 5.1 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. 2. Standard OP9 OP18 Regulation 13(2) 13(6) Requirement Timescale for action 03/02/06 3. OP18 13(6) 4. OP38 13 Risk assessments and arrangements for self-medication must be reviewed regularly. The protection of vulnerable 30/04/06 adults and abuse awareness must be included in the home’s programme of staff training. The policy and procedure on the 30/04/06 protection of vulnerable adults must be amended in order to accurately reflect the local arrangements and the multidisciplinary approach that is taken in the investigation of allegations. A risk assessment must be 31/03/06 undertaken in respect of the use of bed rails and similar aids. The risk assessments must be done on an individual basis (met in part since the last inspection). Highfield DS0000063586.V280769.R01.S.doc Version 5.1 Page 21 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 OP3 Good Practice Recommendations That the service users’ moving and handling assessments are recorded on a separate form which includes greater detail about their individual needs (recommendation outstanding from the previous inspection). Arrangements should be made to accommodate medicines requiring cold storage if they are prescribed. That the staff training plan is developed to include the priorities for training and timescales for attendance. That the person who receives money for safekeeping, or returns such money, signs the record of the transaction on each occasion. That separate risk assessments are recorded in respect of areas such as pressure sores and nutrition. That a timescale, or a specific time, is recorded instead of ‘regular’ when describing the frequency of support that a service user needs. 2. 3. 4. 5. 6. OP9 OP30 OP35 OP38 OP38 Highfield DS0000063586.V280769.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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