CARE HOMES FOR OLDER PEOPLE
Highfield Avon Drive Bedford Beds MK41 1HB Lead Inspector
Dragan Cvejic Unannounced 10 May 2005 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 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 I51 s14912 HIGHFIELD v227469 100505 Stage 2.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Highfield Address Avon Drive Bedford MK41 1HB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01234 267196 BUPA Care Homes (Bedfordshire) ltd Mrs Mary McCarthy Care Home 34 Category(ies) of PD(E) - Physical Disablilty over 65 registration, with number OP - Older People of places DE(E) - Dementia over 65 Highfield I51 s14912 HIGHFIELD v227469 100505 Stage 2.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 07/01/05 Brief Description of the Service: Highfield was a purpose built residential home operated and managed by BUPA Partnership Homes (Care First Bedfordshire Limited), part of BUPA Care Services. The home had recently been refurbished and provided permanent and some respite care for service users over the age of 65 years. The accommodation consisted of 34 single bedrooms over two floors with a passenger lift installed. There was a secure courtyard garden, and various communal areas. The home was located in Brickhill, a residential suburb of Bedford with a small shopping centre nearby and Bedford town’s amenities accessible via a local bus route. The home had surrounding grounds and there was ample parking available to the side of the home. The home offered accommodation in 34 single bedrooms, divided into 3 units for the operational purpose and specialised care for frail elderly and some dementia cases. Highfield I51 s14912 HIGHFIELD v227469 100505 Stage 2.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out during one working day. The inspector used different methodologies to collect the evidence, which included: document and record reading, case tracking of 4 service users, talking to 5 service users in detail and having contact with 27 service users in the dining room. The inspector talked to 4 staff, to a hairdresser and to the manager. The recently conducted service users’ survey also provided a source of information. The inspector checked the bedrooms of 4 case tracked service users, one extra bedroom was proudly showed to the inspector by a service user and the inspector went into all communal areas. The inspector visited the laundry, sluice room and the kitchen. What the service does well:
“I came to see the home prior to admission. I liked it very much, it was better than my previous home and better than the other one I considered. I have made more friends here in these 3 weeks than I had in total in my previous home.” A service user described the admission procedure to the inspector that showed how she could choose, how she was appropriately assessed and how happy she was to be here. She stated that she accepted the move easily: “I wanted to come here and found it quite easy to change to the home.” “I like things here, the girls are nice, they follow my care plan, there are no arguments or hassling, it is very, very relaxed here”, she concluded, explaining the daily life and the routine in the home that showed a really nice, friendly, homely and relaxed atmosphere in the home. Very well organised and maintained records confirmed that good care practices were in place and that service users’ needs were met. Care plans and other documents kept on service users were clear, detailed, and had their comments, preferences, wishes and abilities well described. The plans were reviewed regularly and the risk assessments related to the other documents and ensured better safety for service users. Service users were treated with respect and dignity. “Just a small touch of milk, please. Thank you, you are very kind”, stated another service user while served her favourite tea in the comfortable lounge. “You must come to see my bedroom and my pictures”, a service user insisted and the inspector visited her personally. Many personal items and beautifully framed paintings were in her room. The lift and grab rails helped everyone,
Highfield I51 s14912 HIGHFIELD v227469 100505 Stage 2.doc Version 1.30 Page 6 promoting independence. An activity board had, among other informative leaflets and events, the note on the “Pub Style Afternoon” in the home. The staff were friendly, skilled, knew service users quite well, addressed them by the recorded, preferred name and commented to the inspector: “It is nice to work here”. They were properly inducted, clear of their roles and used their skills gained through varied and good quality training to deliver good care. The manager and the administrator were in the process of sorting staff files in a programmed way, completing 4 files each week. At the beginning of the inspection, the inspector saw the need to have a lock fitted on the laundry room. By the end of the inspection the maintenance man had finished installing the lock. What has improved since the last inspection? What they could do better:
Obviously, this process of change takes time and the manager was allowed to plan and change things according to her assessment of priorities. The positive results did not mean that there was no room for further improvement. Staff files still needed a lot of work on them. Minor improvements in care plans could still improve the care. The care plan stated that staff approached a service user from the appropriate side as she could not see well, but it did not state from which side, left or right. New staff needed time to learn, as a service user stated: “ In general, things have improved. We have got practically everything we want. The food is good, I have started having three meals a day again, after eating only soup. We get grumblers, but they will always stay grumblers.” And, as stated, there were some comments relating to a particular meal ingredient, that a particular person did not like.
Highfield I51 s14912 HIGHFIELD v227469 100505 Stage 2.doc Version 1.30 Page 7 Another service user was not happy with the size of her room, but stated: “I have been promised to be offered another, bigger room, when it becomes available”. The use of agency staff was reduced, but it still presented a burden on the home’s budget and the continuity of care, and the manager was addressing this issue. There was not an established quality assurance system in the home, but the manager was negotiating with the operational manager about what system to use. She stated that service users’ survey results would be, eventually, incorporated into this system once it was set. The manager was not registered, but the registration was in process. 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 I51 s14912 HIGHFIELD v227469 100505 Stage 2.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Highfield I51 s14912 HIGHFIELD v227469 100505 Stage 2.doc Version 1.30 Page 9 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 standard(s) 1-6 Service users were given appropriate and sufficient information about the home to make an informed choice. EVIDENCE: Although the statement of purpose and service user’s guide were not checked on this inspection, the previous one demonstrated that this standard was met and that these documents accurately described the home, services and provisions. The overall progress made in the home provided reassurance that the review of these documents happened regularly on a yearly basis or more frequently if there were significant changes. All recent admissions demonstrated that the contract contained all necessary information and that terms and conditions were clearly communicated to prospective service users. The records kept in the home demonstrated that the service users’ needs were met and service users spoken to confirmed that this evidence was backed up with working principles and practices. The assessment sheets in the files were comprehensive, detailed and kept up to date. The service users recently admitted confirmed that the trial period was effectively implemented in practice.
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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 standard(s) 7,8.9.10 The health care needs of service users were met and were promoted. The care plans and other documents kept in the home about service users evidenced through their accuracy that the home had an approach by which individuality, privacy and dignity were respected and promoted. EVIDENCE: The care plans were drawn up from the initial assessment that was carried out comprehensively and by use of the BASOLL form, the home’s own form, from social services’ assessment forms and comments received from potential service users and their relatives. The home’s own assessment form was, in particular, very well devised and addressed in detail the areas of life where the service users needed help and support. Various appropriate charts contributed to the completeness of the information. The charts were drawn up as numbered scoring forms and were easy to use both for collecting information, for reviewing the previous scoring and to provide quick and accurate information to care staff of the assessed needs. Medication records, procedures and storage were appropriate. The home had a risk assessment for individuals that were able to self administer some of their medication.
Highfield I51 s14912 HIGHFIELD v227469 100505 Stage 2.doc Version 1.30 Page 11 Privacy and dignity were respected and promoted, and service users spoken to confirmed this fact. The files contained individual preferences, the staff spoken to were aware of these likes and dislikes and practical arrangements were in place to promote independence and personal preferences. There was a safety sign on the door where oxygen for a service user was in use. Highfield I51 s14912 HIGHFIELD v227469 100505 Stage 2.doc Version 1.30 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 standard(s) 12-15 The home offered various and stimulating activities, after identifying service users preferences and suggestions. The daily life and routine suited service users who were in a position to influence decisions about these matters in the home. EVIDENCE: A service user commented: “It is much friendlier here than at my previous place of living, there are more things going on here.” The home kept records of activities and listed were: reminiscence, art and craft, Pub Style Afternoon etc. A note on the notice board also encouraged service users: “Please, suggest other games and activities. Speak to the named staff member.” Service users spoken to in the lounges and in a dining room seemed engaged in conversations, socialising and occupied as they wanted to be. A service user called the inspector to show some amazing pieces of art work properly framed and displayed on the walls in her room. She was proud of these paintings. The home offered a family room for visitors and service users if they wanted more privacy. The mealtimes were relaxed and represented another social event. A long serving volunteer was in again, chatting and helping service users who appreciated her presence and company. Service users were proud of the given opportunity to maintain their autonomy as much as their conditions allowed them to.
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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 standard(s) 16-18 The home had a positive approach to complaints and an open management style reconstructed the way service users and relatives approached issues that needed addressing. Protection of service users was high on the home’s agenda and prevention was seen as the best tool to ensure the highest possible protection. EVIDENCE: The home had an appropriate complaints procedure that was displayed and available to service users, staff and visitors. As a result, there were no formal complaints and concerns were acted upon and used to improve provisions and services. Service users voted, either by postal vote or by attending pool places and their rights were promoted. Advocacy information was available to service users. A whistle blowing policy was in place and staff were aware of it. There was no one referred to POVA and there were no accusations of any kind of abuse. Highfield I51 s14912 HIGHFIELD v227469 100505 Stage 2.doc Version 1.30 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 standard(s) 19,20,22,24,25,26 The home was a nice place to live in. It was arranged in a homely style and was suitable for the service users and their needs. It was well maintained. EVIDENCE: The home was equipped, furnished and arranged to meet the needs of service users. A maintenance man stated that he regularly carried out minor repairs and, in co-operation with the manager, arranged for major repairs. Bedrooms were pleasant and contained many personal items making them homely. Shared areas were spacious and comfortably furnished. A family room offered extra privacy for service users who wanted to see their visitors in private. The home was accessible throughout. Toilets were suitably marked. The bedroom where oxygen was in use was marked. Each floor had a sluice room. The bathrooms were equipped with Malibu baths and the others had a moving bath-chair. Specialist beds were in bedrooms for service users who needed them, or special mattresses were supplied for those under risk of developing pressure sores. The grab rails also helped service users maintain higher independence. Radiators were guarded and windows had protectors installed.
Highfield I51 s14912 HIGHFIELD v227469 100505 Stage 2.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 The home employed a well balanced staff team with skills and experience that allowed them to meet the needs of service users. Staff files had not yet been arranged to show that, after a careful recruitment process, the service users’ protection would be completely ensured. EVIDENCE: The manager and the administrator were in the process of arranging staff records. Although not all records were sorted, those that were, confirmed that the recruitment process was appropriate. The files contained documents to demonstrate this. The staff were motivated and keen to undertake a variety of appropriate training courses, offered by the home and the organisation. Highfield I51 s14912 HIGHFIELD v227469 100505 Stage 2.doc Version 1.30 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32, 33, 34, 35, 36, 37 and 38 The new manager had managed to raise the standards of services and provisions, to motivate staff, to improve all outcomes for service users and to generally ensure a proactive, progressive and positive attitude that service users welcomed and consequently felt better about the care they received. EVIDENCE: The manager was experienced, very skilled and well organised. By appropriate prioritising, she managed to address the most important aspects, such as care practice, care plans and other users’ documentation. The ethos and management style in the home were inclusive and encouraging. The home did not hold any service users’ money. The home carried out a survey amongst service users on quality of the service, but the manager was trying to identify the appropriate system for total a quality assurance programme. She stated that the results of the survey carried
Highfield I51 s14912 HIGHFIELD v227469 100505 Stage 2.doc Version 1.30 Page 17 out would be incorporated into the quality assurance programme, once the system was identified. Staff supervision had just been introduced in a planned and organised way. The health safety and welfare of service users were protected by the working practices and monitoring systems in place. Highfield I51 s14912 HIGHFIELD v227469 100505 Stage 2.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3
COMPLAINTS AND PROTECTION 3 3 x 3 x 3 3 3 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 Standard No 16 17 18 Score 3 3 3 3 4 3 3 3 3 2 3 Highfield I51 s14912 HIGHFIELD v227469 100505 Stage 2.doc Version 1.30 Page 19 no 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. 1. 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 33 Good Practice Recommendations Once the action plan is produced based on a quality assurance review, the plan should be sent to the CSCI. Highfield I51 s14912 HIGHFIELD v227469 100505 Stage 2.doc Version 1.30 Page 20 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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