CARE HOMES FOR OLDER PEOPLE
Highfield Stream Road Kingswinford Dudley West Midlands DY6 9PB Lead Inspector
Mrs Cathy Moore Unannounced Inspection 30th January 2006 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.V280365.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 DS0000024964.V280365.R01.S.doc Version 5.1 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.V280365.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26/09/05 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.V280365.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on one day by one inspector between 07.45 and 13.50 hours. The inspection was carried out as the second of the homes’ two routine inspections for this year. This inspection focussed on National Minimum Standards for Older People not assessed during the last inspection and previous requirements made. Two residents’ files were examined, this to include viewing their assessment of need documentation and care plans. The medication systems were assessed, as were infection control systems. Aspects concerning respect, privacy and dignity were observed and examined as were activity provision and policies and procedures. Eleven residents’ were accommodated at the time of the inspection. Six of whom were spoken to in detail. The registered persons were present during the inspection, one of whom is also the registered manager. The deputy manager was partially involved in the inspection process. Discussions were held with regard to the proposed conservatory. The building of the footings for this is to commence shortly. Not all standards were assessed during this inspection. For a full overview of service delivery this report should be read together with the last inspection report dated 26 September 2005. 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 resident’s in her care. The registered person/manager and her husband the joint provider have an on-going keen interest in continual improvement of the home and care practices. Record keeping/ systems in the home are of a good standard. Highfield DS0000024964.V280365.R01.S.doc Version 5.1 Page 6 Positive interactions between staff and residents’ were observed during the inspection. A good rapport between all was again, evident. 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 of the home. Again, similar to previous inspections residents’ observed looked well cared for. Breakfast times continue to be flexible, residents’ rising at their preferred times. 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. Residents’ spoken to were complimentary about the home and the service they receive. One said;” The staff are all very nice”. Another said;” This is a lovely home, it really is”. A resident offered;” The home is good really. Some days I would like to go back home, but I know I can’t”. One resident said of the male joint owner who was cook for the day;” He is ever such a nice man”. All requirements made following past requirements have been addressed. Two are on-going in respect of building work and quality assurance. What has improved since the last inspection?
The home has advanced tremendously in work to try to achieve ISO 9001:2000 by April 2006. Planning permission has been granted for the proposed conservatory. The footings work for the conservatory is due to commence soon. Work has commenced to refurbish the ground floor shower room. This room has been retiled. The registered manager is in the process of updating mandatory training for staff which is coming to three years since last received an example being health and safety training. Two bedrooms have had new curtains. One bedroom has had new furniture. The first floor bathroom and a first floor toilet have had new carpet provided.
Highfield DS0000024964.V280365.R01.S.doc Version 5.1 Page 7 Work has been undertaken to improve care plans and other care documentation. 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.V280365.R01.S.doc Version 5.1 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.V280365.R01.S.doc Version 5.1 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): Nil No standards in this section were assessed during this inspection. EVIDENCE: No standards in this section were assessed during this inspection. Highfield DS0000024964.V280365.R01.S.doc Version 5.1 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): 9,10. Medication systems and processes need some ‘fine tuning’ to ensure that they are adequate and safe. Generally, residents’ feel that they are treated with respect and that their privacy is ensured. EVIDENCE: Some good practice was observed in terms of medication systems and safety. The home has a contract with a large organisation pharmacy provider who carries out regular audits of the homes medications. The last audit report dated 25 Oct 05 stated;” No problems”. A further audit is due to take place on 31 Jan 06. It is positive that all staff who have responsibility for medication have received accredited medication training. The staff initial list in respect of medication administration was updated in 2005. Two staff at all times administer/witness medication being given. It is positive that drinks and measuring utensils are put ready before medication
Highfield DS0000024964.V280365.R01.S.doc Version 5.1 Page 11 administration occurs. The person giving the medications stayed with the residents’ to ensure that they had taken their medication. The homes medication policy does not refer to the Commission being informed if a medication error were to occur. It does not reference the use or not of ‘homely remedies’ in the home or the need for medication to be retained in the home for 7 days after a death has occurred. The staff member giving the medications was observed handling the medication. The home has in operation a confidentiality policy. Staff and resident interaction was seen to be positive. Staff giving residents’ choices. The preferred form of address for each resident is determined and recorded on their file at the time of admission. Staff were heard using terms of endearment examples being;” Angel, beaut and darling”. There was no evidence however, to demonstrate that residents’ had been asked if they mind being addressed in this way. Highfield DS0000024964.V280365.R01.S.doc Version 5.1 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): 12,15. Further developments are needed in terms of activity provision to ensure that the home meets the expectations and preferences as well as the residents’ recreational interests and needs. Residents’ receive a wholesome appealing diet in pleasing surroundings at times convenient to them. EVIDENCE: It is positive that communication between the management/staff and residents’ is on-going and efficient. Regular three monthly resident meetings are held to which relatives can attend if they want to. Minutes of these meetings are taken. It is positive that the registered manager has informed residents and their relatives in writing about the proposed building works and other improvements to the home for instance the purchasing of new carpets and furniture for communal areas. Evidence was available to suggest that the home takes into account preferred daily routines, rising and retiring times of the residents’. This confirmed by observations. Residents’ during the morning came into the dining room at different times.
Highfield DS0000024964.V280365.R01.S.doc Version 5.1 Page 13 Some evidence was available to demonstrate activity participation which included the following; nail care, watching television/videos, listening to old time music and discussion groups. No activity programme was available. A notice on display detailed an external activity/ exercise provider. This person however, unfortunately, had not been to the home for some time. One resident said;” I am not used to this. I have always been busy and on the go. Here I do a lot of sitting. I will be glad when the nice weather comes and I can go outside in the garden”. The home has a set 4 week menu which included 4 meals per day breakfast, lunch, tea and supper. The menu can be flexible on any day as was the case on the day of the inspection, the meal had been changed at the request of the residents’ from cottage pie to cheese and potato pie or baked and baked beans. The dessert had also been changed to shop made jam tarts. Breakfast is flexible. Residents’ were observed coming to the dining room at various times of the morning. Staff were heard asking them what they would like for their breakfast. The breakfast was taken to the residents’ individually on a tray. Mostly, residents’ choose cereal or toast. Tea for the day of the inspection was to be a choice of cheese on toast or poached egg on toast and supper milky drinks, biscuits or cake. It was observed that staff were on hand to give assistance to those residents’ who needed this at lunch time. The tables were nicely laid at each mealtime with individual teapots on tables for the residents at breakfast time and large jugs of squash at lunchtime. One resident after finishing her breakfast commented loudly;” I enjoyed that”. Residents spoken to were complimentary about the food. One said;” The food is very, very good”. Highfield DS0000024964.V280365.R01.S.doc Version 5.1 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): 18 Measures have been taken to protect residents’ from abuse. EVIDENCE: It is positive that 15 staff received abuse awareness training in October 2004. Dudley MBC’s adult protection procedures and leaflet were available in the home. The homes’ own internal abuse procedures have been produced to compliment Dudley’s’ procedures. The home has a missing persons policy, access to records policy –dated 2004 and public interest disclosure policy –dated 2002. The whistle blowing policy does not at the present time detail the contact information of other appropriate agencies for staff to approach if they have concerns about practice or other areas. Highfield DS0000024964.V280365.R01.S.doc Version 5.1 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): 25,26 Further diligence is needed to ensure that infection prevention measures are adhered to at all times. Water temperatures must be maintained within the approved temperature range to ensure complete safety. EVIDENCE: All radiators throughout the home are guarded. Control valves are fitted to hot water outlets. It has been highlighted that water temperatures are not at all times being maintained within the approved range of 38-43oc. At least 2 at times were reading 33oc. It is positive that all but one staff member have received or are receiving accredited infection control training. The home was seen to be clean and orderly at the time of the inspection. One resident commented;” You wouldn’t find a speak of dust, the beds and home are spotless”.
Highfield DS0000024964.V280365.R01.S.doc Version 5.1 Page 16 It was disappointing to see items in bathrooms that could transmit infection from one person to another examples being; bar soap, jugs, a nailbrush and talc. The home lacks ‘ hand wash’ signs in high risk areas to aid the prevention of infection/infection spread. The laundry is outside of the main home. It is planned for the proposed conservatory to go as far as the laundry to prevent staff getting wet through going outside to access the laundry. The registered manager assured that staff do not go through the kitchen with laundry at all. The laundry has a commercial washing machine with a ‘hospital ’cycle and a commercial dryer. A sink is in the toilet room adjoining the laundry. The manager said that the home does not used red disposable bags as they are not needed and that no manual sluicing is ever done. , Highfield DS0000024964.V280365.R01.S.doc Version 5.1 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): Nil No standards in this section were assessed during this inspection. EVIDENCE: No standards in this section were assessed during this inspection. Highfield DS0000024964.V280365.R01.S.doc Version 5.1 Page 18 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): 35,37 Greater diligence is needed to ensure that residents’ money held in safe keeping is accurate against the recorded balance. ‘Fine tuning’ is needed to ensure that all records and procedures are adequately maintained. EVIDENCE: Only one resident has money held in safe keeping by the home. The money is kept safe and secure with only 2 staff having access to it. Written records are maintained concerning balances, expenditure and transactions. The registered manager was surprised when it was highlighted that there was £5 excess of what there should have been in the money. It is positive that inventories to record residents’ personal possessions and belongings are maintained. Highfield DS0000024964.V280365.R01.S.doc Version 5.1 Page 19 Generally policies and procedures seen are reviewed regularly. However, a number have not been reviewed within the last 12 months this including the Public Interest Disclosure procedure and the Access to records policy. Financial records relating to one resident had been corrected using ‘correction’ fluid rather that placing a ink line through so the entry underneath can still be read. Highfield DS0000024964.V280365.R01.S.doc Version 5.1 Page 20 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 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 x x x x x x 2 2 STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x 2 x 2 x Highfield DS0000024964.V280365.R01.S.doc Version 5.1 Page 21 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. 1 Standard OP9 Regulation 13(2) Requirement The registered persons must ensure that the homes medication policy is reviewed and that all staff read, sign and date this document. The document must include; A 7 day retention for all medications after a death has occurred. The homes’ stance on homely remedies. Instruction that if a medication error were to occur then the Commission must be informed in accordance with Regulation 37. The registered persons must 15/02/06 ensure that staff do not physically handle medications. 15/02/06 The registered persons must ensure that where a choice is given for example; “one tablet or two”, the precise number given is recorded at all times. Timescale for action 28/02/06 2 3 OP9 OP9 13(2) 13(2) Highfield DS0000024964.V280365.R01.S.doc Version 5.1 Page 22 4 OP10 12(4)(a) 5 OP18 13(6) 6 OP19 16(2) The registered persons must determine/ensure that all terms of endearment used by staff ( Angel, beaut’ etc) are acceptable to the residents’. The registered persons must ensure that contact names/telephone numbers and addresses of appropriate agencies are detailed on the homes’ whistle blowing policy for staff to approach if they have concerns about practice or other areas which they feel unable to raise with the registered persons. The registered persons must continue with the plans to have the conservatory fitted. The registered person/manager confirmed that planning permission has been granted and work for was due to commence in the very near future. 15/02/06 01/03/06 30/03/06 7 OP25 13(3) 13(4) 13(3) 8 OP26 9 OP26 13(3) The registered persons must 20/02/06 ensure that the hot water from each outlet is within the temperature range of 38oc-43oc. The registered persons must 15/02/06 ensure that personal care items examples being; bar soap, jugs and talc are used for the individual only and are returned to their rooms after use. The registered persons must 15/02/06 ensure that ‘ hand wash’ signs are provided in all high risk areas. Highfield DS0000024964.V280365.R01.S.doc Version 5.1 Page 23 10 OP33 24 The registered persons must continue with their plans in respect of the proposed quality assurance/ quality monitoring system. Work is continuing. The home hopes to be accredited by April 2006. 30/04/06 11 OP35 17(2) The registered person must; Determine the reason for the discrepancy in respect of the one residents’ money held in safe keeping( It was identified too much money in relation to written balance). 20/02/06 12 OP37 17(2) 13 OP37 17(2) Inform the CSCI of the reason. The registered person must ensure that all policies and procedures are reviewed annually. The registered person must ensure that ‘ correction’ fluid is not used to erase any record keeping. 01/07/06 10/02/06 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.V280365.R01.S.doc Version 5.1 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
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