Inspection on 26/09/05 for Highfield

This inspection was carried out on 26th September 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

Highfield 29/03/07

Highfield 30/01/06

Highfield 31/01/05

Highfield 17/08/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Highfield Stream Road Kingswinford Dudley West Midlands DY6 9PB Lead Inspector Mrs Cathy Moore Unannounced Inspection 26th September 2005 07.45 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 DS0000024964.V253669.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 DS0000024964.V253669.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Highfield Address Stream Road Kingswinford Dudley West Midlands DY6 9PB 01384 288870 01384 270803 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) Mrs Mary Proctor Mr Arthur Proctor Mrs Mary Proctor Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Highfield DS0000024964.V253669.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. One service user identified in the variation report dated 8 June 2004 may be in the category SI(E). This will remain until such time that the service users placement is terminated. 31/01/05 Date of last inspection Brief Description of the Service: Highfields Care Home is registered by the Commission to provide care to 13 residents’ who fall within the category of old age. It is owned by a husband and wife partnership and is managed by Mrs Proctor. The home is situated in a pleasant residential area and is located between Kingswinford and Wordsley. The home is a large detached, traditional type property set back from the main road. It has a large attractive garden to the rear and a garden area and car parking space at the front. The home provides a lounge come dining area, nine single and two double bedrooms. One bedroom has en-suite facilities. It provides assisted bathing and showering facilities, a number of assisted and non-assisted toilets, a laundry area and kitchen. Access between floors is enabled by use of a stair lift. Highfield DS0000024964.V253669.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector, on one day between 07.45 and 14.00 hours. The inspection was carried out as the first of the homes two routine statutory inspections for this year. Two residents’ were selected for case tracking. This process included the perusal of their assessment of need documentation, care plans and daily records. Both residents’ bedrooms were viewed and one was spoken to in detail. Two other residents’ and one staff member were spoken to. The premises were randomly assessed which included viewing toilets, the shower and bathroom, 6 bedrooms, the lounge come dining area and garden. Two staff files were perused to determine satisfactory recruitment processes and training. Health and safety / maintenance records, meeting minutes and some kitchen records were also scrutinised. The registered manager was involved in the inspection process along with input from the deputy manager. What the service does well: The home generates a positive, friendly, warm welcoming atmosphere. The registered manager is also the joint registered provider and spends at least four days per week on site being fully involved in the running of the home and care delivery. The deputy manager has worked at the home for 15 years and has a good working knowledge of the home and a good understanding of the needs of the residents’ in her care. The registered person/ manager and her husband the joint provider have an ongoing keen interest in continual improvement of the home and care practices. Record keeping/ systems in the home across all areas are of a good standard. Positive interactions between staff and residents’ were observed during the inspection. A good rapport between all was evident. Highfield DS0000024964.V253669.R01.S.doc Version 5.0 Page 6 The premises overall are maintained to a good standard. The joint providers pro-active in identifying and addressing any decoration and replacement of fabric needs in the home. Residents observed appeared to be well cared for. Routines in the home appear to be in accordance with individual needs. For example there is no set breakfast time. Residents’ accommodated like to get up in their own time often late morning; they then order their breakfast which is served on an individual basis. One resident commented, “ The staff and food are very good”. Another said, “ I am happy here. The staff make me happy, they look after me very well”. They allowed me to bring in my collection of miniature houses and things it makes it feel like home”. The food is good and we get choices”. One staff member commented “ All staff work well together, we discuss things. The residents’ are given choices”. The home has recently been re-accredited with the Investors’ In People Award. Over 50 of the staff have achieved N.V.Q level 2 in care. A number are working towards level 3 and the deputy manager level 4. What has improved since the last inspection? Plans have been produced and submitted to planning department for approval to build a good sized conservatory to the rear of the home which will join the existing lounge. This will significantly increase the available living space for the residents’ The exterior of the home has been painted. A number of bedrooms have been redecorated, provided with new carpets and curtains. The joint providers are due to commence the required work to achieve ISO 9002 quality award. There were no shortfalls identified in respect of staff records or recruitment processes. Similarly there were no shortfalls identified in respect of kitchen records. The organisation of resident records/ daily records has improved considerably. Highfield DS0000024964.V253669.R01.S.doc Version 5.0 Page 7 Automatic door closures linked to the fire alarm system have been installed on all bedroom doors. 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 DS0000024964.V253669.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Highfield DS0000024964.V253669.R01.S.doc Version 5.0 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 the following standard(s): 3,4,5. Residents’ do not move into the home without having had their needs assessed, being assured that these will be met or knowing that the home will meet their needs. All prospective residents’ and their families are invited and encouraged to visit the home to assess the service provided and its quality. EVIDENCE: There was evidence available to demonstrate that assessment of need processes do take place in respect of each resident before they are offered a placement at the home. Areas focussed on during the assessment of need cover the full spectrum of health and daily living activities. The registered manager is fully aware of her responsibility to abide by the homes registration categories . All prospective residents’ are given written acknowledgement that the home can meet their needs before they are admitted. Highfield DS0000024964.V253669.R01.S.doc Version 5.0 Page 10 One new resident said “ It has been a big change for me moving into a home. The staff have been very good and I am looked after”. All prospective residents’ and or their chosen representatives have the opportunity to visit the home prior to admission to assess the service it provides. A new resident commented “ My daughter came to see the home for me. A relative of ours told us that this was a good home. She knew someone who lived here before”. The home has a trial period in operation. This time to give both parties the opportunity to determine the suitability of the placement before it is made permanent. Highfield DS0000024964.V253669.R01.S.doc Version 5.0 Page 11 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. Further development is needed to ensure that all health, personal and social care needs in respect of each resident are set out in an individual care plan. Residents’ health care needs are fully met. Residents’ feel that they are treated with respect. EVIDENCE: A care plan was available in respect of each resident whose file was assessed. Whilst these were seen to be informative they lacked instruction and attention to detail. They did not always reflect all needs or risks that have been identified. Example being, one resident has diabetes which is controlled by medication yet, the diabetes was not mentioned in her care plan. There was no mention of nutritional/ tissue viability scorings where risks had been highlighted. Similarly, the management of nocturnal confusion and agitation and concerns regarding bed rails were not adequately included in the care planning processes. It is positive that residents’ or their relatives have signed and dated care plan documentation to demonstrate their involvement in the process. Highfield DS0000024964.V253669.R01.S.doc Version 5.0 Page 12 There was ample evidence available to demonstrate that residents’ health care needs are being met. The dentist, chiropodist and optician visit on a regular basis. There was evidence of doctors visits including ‘new patient’ assessments for new residents’. There was also evidence that residents’ are referred to specialists where necessary. One has recently been referred for assessment by a psychiatrist, another has been seen by an audiologist. Doctors are asked and do write their own notes on residents’ records when visiting the home. This also applies when residents’ are taken to hospital, their notes are taken with them and the doctor asked to complete this to give an accurate account at all times of what treatment/ action has been decided and what has been prescribed. There was evidence of weight monitoring, nutritional, tissue viability, moving and handling and falls risk assessments. Daily notes captured elements of personal care delivered, but lacked areas, for example oral and nail care. Records of personal care delivery are not always made on a daily basis. There was adequate evidence to demonstrate that residents are being treated respectively. Their dignity and privacy promoted and maintained. The Preferred form of address is determined and recorded on personal records. Double rooms are all provided with a privacy screen. Locks/ keys to bedrooms are offered to all residents’ on admission. Locks are provided on all toilet and bathroom doors. One resident said, “ I am treated in the way I want to be treated”. Written records confirm that the promotion of dignity and privacy is explored and discussed during formal staff supervision sessions. Observations during the inspection revealed staff interacting positively with residents’, giving them choices and talking to them respectively. Highfield DS0000024964.V253669.R01.S.doc Version 5.0 Page 13 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): 13,14, Residents’ are very much encouraged to maintain contact with family and friends. Residents’ are helped to exercise choice and control over their lives. EVIDENCE: The home has an open visiting policy. All residents’ spoken to have regular contact with family and friends either by them visiting the home or them going out with their family. One resident spoke cheerfully about a visit she had made recently to see her brother who lives in another care home. Bedrooms viewed held a range of residents’ personal belongings including ornaments, photographs, books, furniture and televisions. Inventories are in operation to record all items including furniture. The home has information available pertaining to external advocacy services. Highfield DS0000024964.V253669.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. Residents’ and their relatives and friends can be confident that their complaints will be listened to. EVIDENCE: The home has a complaints procedure which includes all relevant contact details and telephone numbers. The complaints procedure is included in the homes service user guide a copy of which is available in each bedroom. The manager has produced a ‘residents’ procedure folder’. Procedures and policies directly involving residents, including the complaints procedure have been produced in large print have been placed in the folder and are discussed with residents’ during meetings. Highfield DS0000024964.V253669.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): 19,20,21,24,25. Generally residents’ live in a safe, well maintained environment. Residents’ have access to safe and comfortable indoor and outdoor communal facilities. Sufficient bathing and lavatories are provided within the home. Residents’ live in safe, comfortable bedrooms with their own possessions around them. Residents’ live in safe, comfortable surroundings. EVIDENCE: The home generally is maintained to a good standard. There are areas which require attention, for example the carpet in the toilet at the top of the stairs needs replacement. However, the registered persons have a decorating and maintenance programme whereby they audit and identify work needed to be done and plan appropriately. This year the home has been painted externally, a number of bedrooms have been redecorated and provided with new carpets and curtains. The manager said that there are plans for the lounge in respect of redecoration and purchasing new chairs. Highfield DS0000024964.V253669.R01.S.doc Version 5.0 Page 16 The lounge come dining room is comfortable, pleasant and homely. The overall communal space however, is limited. It is positive and exciting that plans have been submitted to the planning department to have a good sized conservatory built onto the dining room / lounge area. The home offers an assisted bath and walk in shower. A number of assisted and non-assisted toilets are located throughout the home. Six bedrooms were viewed. All were seen to be of a good standard in terms of furniture, carpets, curtains, bedding and fixtures. The majority of bedrooms have been provided with ‘ touch’ type bedside lamps. These lights come on when the base is touched rather than having to use a switch. A number of bedrooms have been provided with attractive shelving. Residents’ have placed books and photographs on these. All bedrooms seen held a range of personal possessions, making the rooms feel very homely and individualised. A number of residents’ confirmed their satisfaction with their bedrooms. Size wise some are of an adequate size, others of a generous size. Radiators throughout the home are guarded. The home has a central heating supply. Testing of the hot water temperatures is carried out monthly. Three hot water temperatures were checked during the tour of the premises, these were all seen to be within the approved range. Bacterial testing of the homes water supply is undertaken by a contractor on an annual basis .The homes lighting was tested and deemed satisfactory in respect of LUX in 2003. Highfield DS0000024964.V253669.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Residents’ needs are met by the numbers and skill mix of staff. Residents’ are in safe hands at all times. Residents’ are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. EVIDENCE: Staffing is provided as follows; AM The deputy or senior plus two care staff. (During the week the manager is also on site). PM The deputy or senior and one care staff. Nighttime a senior and a sleeping in member of staff. A cleaner is provided 5 days per week. Catering hours are provided by additional staff members at the present time, although a cook to replace the one who has just gone on maternity leave will commence employment soon. There were no complaints in respect of staffing levels. A proportion of the residents’ at the present time have low to medium dependency needs. At the time of this inspection the home had one resident vacancy. One resident described the staff as being “ Very good”. Another said “ The staff make me very happy”. Highfield DS0000024964.V253669.R01.S.doc Version 5.0 Page 18 Over 50 of the staff have achieved N.V.Q 2 or above in care. Others are working towards this award, some working towards level 3, one level 4. Scrutiny of staff files revealed compliance with recruitment practices. Files seen included completed application forms, interview records, two written references, an enhanced disclosure/ POVA list check, at least two sources of identity and a photograph. There was evidence that staff had been issued with the prescribed codes of conduct and practice and have received in-house induction. Prescribed induction and foundation packages were available. The registered persons have contracted with a consultant who gives support and advice in respect of recruitment processes and employment law. Highfield DS0000024964.V253669.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,36,38. Residents live in a home which is run and managed by a person who is fit to be in charge. Residents’ very much benefit from the ethos, leadership and management approach of the home. Further development is needed in respect of quality assurance/ quality monitoring processes. (Although this is in hand at the present time). Staff are appropriately supervised. The health, safety and welfare of residents’ is promoted. EVIDENCE: The manager is also joint registered provider. She is approved by the Commission as a fit person to be in charge. She has had years of experience caring for older people both in a hospital environment and care home setting. The manager has a keen interest in continually improving the home. The manager has achieved N.V.Q level 5 in management and is also a first level registered nurse. Highfield DS0000024964.V253669.R01.S.doc Version 5.0 Page 20 The atmosphere of the home is very positive. There was ample evidence available to demonstrate that residents’ and families are involved in decision making. Regular resident meetings are held with records made. Relatives are welcome to attend meetings if they wish. Staff meetings are also held on a regular basis. The home has recently been reaccredited with the Investors In People award. Although, the home has a quality assurance process in place the manager is keen to improve on this and is having consultation with a local company with a view to commencing work to ultimately achieve ISO 9002. There was sufficient evidence available to demonstrate that staff receive regular, formal, one to one supervision. The home has a consultancy company which carries out annual health and safety audits and gives advice on health and safety issues. The last audit carried out was in May 2005. The report following this audit stated, “ The overall standard of health and safety is excellent”. Maintenance and service records in respect of fire fighting and other equipment were scrutinised and were found to be in order. The risk assessments for bedrails instructed staff to “ monitor daily”. There was however, no evidence of these daily checks. Staff training appears to be up to date. The manager provided a training matrix. The kitchen was not assessed during this inspection. Highfield DS0000024964.V253669.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 x 3 2 3 x x 3 3 x STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 2 x x 3 x 3 Highfield DS0000024964.V253669.R01.S.doc Version 5.0 Page 22 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 OP7 Regulation 15(1) Requirement The registered person/ manager must ensure that; All needs and risks identified are reflected in residents’ care plans examples being, continence promotion, confusion/ agitation, risks pertaining to nutrition and tissue viability, all health care needs etc. The registered person/ manager must ensure that care plans are expanded on in detail to include: Each problem, need, risk. What must be done, how, when, how often and by whom. Each area must be individually reviewed monthly or when changes occur. The registered person/manager must ensure that daily records / other methods of recording reflect the whole spectrum of care delivered for each resident. The registered persons must continue with the plans to have DS0000024964.V253669.R01.S.doc Timescale for action 01/11/05 2 OP7 15(1) 01/11/05 3 OP8 12(1)(a) 12(1)(b) 07/10/05 4 OP20 16(2) 01/02/06 Highfield Version 5.0 Page 23 5 OP33 24 6 OP38 13(4) the conservatory fitted. The registered persons must continue with their plans in respect of the proposed quality assurance/ quality monitoring system. The registered manager must where instructions are made in risk assessment documentation to ‘monitor daily’ ensure that evidence is available at all times to demonstrate compliance. 01/03/06 05/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Highfield DS0000024964.V253669.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Highfield DS0000024964.V253669.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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