CARE HOMES FOR OLDER PEOPLE
Highfield Avon Drive Bedford Bedfordshire MK41 1HB Lead Inspector
Dragan Cvejic Unannounced Inspection 23rd September 2005 09:00 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 DS0000014912.V254209.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. Highfield DS0000014912.V254209.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Highfield Address Avon Drive Bedford Bedfordshire MK41 1HB 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) 01234 267196 01234 353046 BUPA Care Homes (Bedfordshire) Ltd Mrs Mary Ellen McCarthy Care Home 34 Category(ies) of Dementia - over 65 years of age (34), Old age, registration, with number not falling within any other category (34), of places Physical disability over 65 years of age (34) Highfield DS0000014912.V254209.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10/05/05 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 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 with 34 single bedrooms, divided into 3 units for operational purpose, and also specialised care for frail elderly and some dementia cases. Highfield DS0000014912.V254209.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 visit and was carried out during 3.5 hours. Only the key standards were inspected and therefore, this report should be read as a continuation of the previous report on 10/05/05, when the majority of standards were inspected and met. The methodology used for this inspection was case tracking, whereby four service users’ cases were followed. Their documentation, care plans etc, were read, their rooms and places where they spend their time were inspected. They stated what they liked to do during the day, gave their comments and expressed their satisfaction with the home and with care received. Four staff members were spoken to, two of them were key-workers for the case tracked service users. What the service does well: What has improved since the last inspection?
The philosophy of the home changed from “task” type to “respect for the individuals” type. The relationship between service users and staff changed.
Highfield DS0000014912.V254209.R01.S.doc Version 5.0 Page 6 Instead of “offering care”, staff were now helping, supporting and sharing daily routines of service users. A dog named Charlie was at the home and was being fed by two service users. This showed how a relaxed and caring atmosphere made everyone feel relaxed, friendly and happy. Art craft and other activities had become a routine in the home and, although the activity person had left since the last inspection, the other staff members were much more involved and there was no longer a need to replace the activity co-ordinator. These staffing hours were filled in by another care worker and sharing the routine of daily life ensured that service users still had a rich activity programme. “Pub evenings” and activities organised in the home, attracted the majority of the service users to join in. 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 DS0000014912.V254209.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 Highfield DS0000014912.V254209.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): 2,3,4 Service users were given appropriate and sufficient information about the home to make an informed choice. EVIDENCE: The home carried out a comprehensive and detailed assessment prior to admission. The assessment was also carried out on users discharged from hospital admissions, as the needs changed in the majority of cases. The files checked contained copies of the assessments done by others, such as social services, prior to admission and, in two “case tracked” cases, prior even to referral to this home. This provided excellent information about service users, their conditions, abilities, wishes and preferences. The home included families in the admission assessment process and exceeded the standard by collating the entire history of referred service users prior to admission. The home was clear of own abilities to meet the needs and took these into account when assessing new referrals; this resulted in the current decision not to admit service users with high needs in order to maintain the balance of users and to make sure that all service users’ needs were fully met.
Highfield DS0000014912.V254209.R01.S.doc Version 5.0 Page 9 The home kept a copy of the contract agreement for service users funded by social services. All service users were given terms and conditions on admission. Highfield DS0000014912.V254209.R01.S.doc Version 5.0 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): 7,8,10 The home’s care plans continued to be a major tool to determine users’ needs and ensure that these needs were met in a way service users wanted. Regular reviews enabled the home to meet these needs even when the users’ conditions rapidly changed. EVIDENCE: Care plans were drawn up from the excellent admission assessments and continued to maintain a high quality of documentation held on service users in relation to the content and style. The care plans clearly described the needs. The evaluation sheets, used for reviews, documented changes clearly and as in two files, stated: “…continued to enjoy independence with support provided.” Where the needs changed, the page addressing a particular need was changed to provide clear information. The dates and signatures confirmed that service users took part in the reviews. Care plans indicated the risks that were further described in the risk assessments and included the suggested action to eliminate any risks. The bed-rails were risk assessed, but the assessment went a step further and included a chart to record the bed-rails maintenance and inspections.
Highfield DS0000014912.V254209.R01.S.doc Version 5.0 Page 11 Independent use of the kettle for a service user was reviewed and assessed as a high risk. The action suggested included making the tea at the specific time when this service user could be discreetly monitored and this risk eliminated. When an alarm bell sounded from a user’s room, two staff members ran into the room from the opposite sides of the corridor to check what was happening. The home asked a GP to check and sign a form, giving his permission for a service user to use a “home remedy”, (pain killers). Highfield DS0000014912.V254209.R01.S.doc Version 5.0 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, 14 Service users’ lifestyle, wishes and preferences were respected and they enjoyed respect for their individuality. EVIDENCE: The activity coordinator left her post, but as the programme of activities was set and run smoothly, the home decided not to recruit a new coordinator. Instead they recruited another care staff member. Care staff shared service users’ engagement with their activities. Pub evenings organised in the home were in particular, very popular. Service users created friendships among themselves and were seen interacting throughout the inspection. Daily newspapers were delivered to individuals that enjoyed reading and wanted this service. Service users were encouraged to continue with their preferred activities and daily routine. A service user painted a picture of a dog and it was displayed in the home and published in the Home Front magazine. The home had a book to record service users’ personal possessions brought into the home. The home encouraged service users’ who were unable to handle
Highfield DS0000014912.V254209.R01.S.doc Version 5.0 Page 13 their finances to delegate these issues to families or to independent representatives. Highfield DS0000014912.V254209.R01.S.doc Version 5.0 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 Service users felt comfortable and able to complain if they wished. The home had a clear and straightforward complaints procedure that was displayed and provided all contact information for those that would potentially complain. EVIDENCE: The home had an appropriate complaints procedure that was displayed and available to service users, staff and visitors. There were no complaints, formal or informal, that the home or the CSCI received. A service user stated that she would complain if she “thought there was anything to complain about.” Highfield DS0000014912.V254209.R01.S.doc Version 5.0 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): none These standards were not inspected during this inspection. EVIDENCE: The home was clean and free from offensive odours, but the environmental standards were not fully inspected on this occasion. The inspected rooms and areas met the standards. The home had made a sensory garden since the last inspection and this was very welcomed by service users. Highfield DS0000014912.V254209.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): 27,30 The home employed a well balanced staff team with skills and experience that allowed them to meet the needs of service users. EVIDENCE: The home had a stable staff team, without turnover since the last inspection. Staff were committed and motivated. The philosophy that users’ were seen as individuals worked very well and service users enjoyed the extra attention from the staff members that were familiar not only with users’ needs, but also with their likes, dislikes, preferences and personalities. Staff were up to date with all mandatory training. They concentrated on BUPA’s Personal Best programme, whereby they introduced and developed a particular activity that improved provisions for service users. A sensory garden was one of the Personal Best targets and it was completed to the high satisfaction of service users. The staff were motivated and keen to undertake a variety of appropriate training courses offered by the home and the organisation. Additional training related to users’ conditions, included Dementia training and Parkinson’s disease training. All staff completed an induction programme based on Skills for Care principles. The NVQ process was slightly behind schedule, but the management has plans to bring it up to date. Highfield DS0000014912.V254209.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): 32,33 In an open and transparent atmosphere, service users were enabled to express their views through quality assurance reviews. The style of questions was not the most appropriate and the manager was devising an acceptable format that would further enable service users to influence the running of the home. EVIDENCE: The service users and staff confirmed that the ethos and management style in the home were inclusive and encouraging. The manager was observed responding to service users in an open, friendly and positive manner. The home carried out a quality assurance survey and collected questionnaires filled in by service users. However, the initial analysis demonstrated that service users needed a simplified version of questions in order to provide useful and related answers to the review questions. The manager was looking
Highfield DS0000014912.V254209.R01.S.doc Version 5.0 Page 18 into two issues: creating a simplified questionnaire and analysing collected information in order to draw a plan of action and act upon results of the survey. Highfield DS0000014912.V254209.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 3 4 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 X 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 x X X X X X X X x STAFFING Standard No Score 27 3 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 2 X X X X x Highfield DS0000014912.V254209.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? no 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 2 Refer to Standard OP28 OP33 Good Practice Recommendations The home should encourage and arrange for 50 of staff to be NVQ qualified. The home should execute their plan to achieve this target. The home should produce a plan of actions from the quality assurance review, feed back to the contributors and forward the plan of actions to the CSCI Highfield DS0000014912.V254209.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Bedfordshire & Luton Area Office 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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