Inspection on 06/06/07 for Highfield

This inspection was carried out on 6th June 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Highfield 01/02/06

Highfield 26/09/05

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Highfield Highfield The Common Marlborough Wiltshire SN8 1DL Lead Inspector Tim Goadby Unannounced Inspection 6th June 2007 10:15 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 DS0000063586.V336365.R01.S.doc Version 5.2 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. DS0000063586.V336365.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highfield Address Highfield The Common Marlborough Wiltshire SN8 1DL 01672 512671 01672 514283 jonathanwheeler@btconnect.com www.highfieldresidentialhome.co.uk Mr Anthony Leeson Andrea Leeson Vanessa Hillier Care Home 25 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) Category(ies) of Old age, not falling within any other category registration, with number (25) of places DS0000063586.V336365.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home providing personal care only – Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 26. 1st February 2006 2. Date of last inspection Brief Description of the Service: Highfield is a privately run care home for up to 26 older people. The home is on the edge of the market town of Marlborough, overlooking the Common. The original building has been extended and facilities provided to meet the needs of older people. The period character of the house has been retained. There is a large, well maintained garden at the rear of the property. Accommodation, including service users’ bedrooms, is provided on all three floors of the house. A passenger lift is available. There are 24 bedrooms in total, two of which may be used as shared rooms by couples wishing to do so. En-suite toilets and handbasins are provided in all except two of the bedrooms. Four rooms have an en-suite bath. There are also two bathrooms for general use and a number of toilets. The communal areas include a dining room and a large lounge. The lounge provides a variety of sitting areas and looks out on to the garden. Fees for care and accommodation for new service users vary according to the type of room on offer. The two rooms which have no en-suite facilities cost £550 per week. Standard rooms cost £600. Six rooms which are larger or have the most favourable positions cost £625. If a room is to be shared, the cost for this would be around £1020. Information about Highfield is available from its own website. This includes links enabling people to download copies of the home’s Statement of Purpose, Residents’ Guide, and a copy of the last inspection report. There is also a link to the Commission’s website. The home’s documents are written in plain English, and large print or audio versions are available. DS0000063586.V336365.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was completed in June 2007. The process included a review of regulatory contact since the previous inspection of February 2006. The main event over this period was a variation of Highfield’s registration to enable it to accommodate up to 26 people. The home’s registration conditions were also updated when this was approved. The service completed an Annual Quality Assurance Assessment document (the AQAA). Surveys were distributed to service users, relatives, staff of the home and other professionals who have contact with it. Responses were received from two service users, four relatives, six staff and three GPs. An unannounced visit then took place to the home, from 10.15 am to 6.00 pm. This fieldwork section of the inspection included sampling of records, with case tracking of some individual service users; a tour of the premises; sampling a cooked meal, in the company of service users; and discussions with service users, staff and management. What the service does well: Highfield provides a homely and comfortable environment which is much appreciated by its service users and other visitors. A programme of maintenance and repairs keeps the accommodation to a high standard. Service users are able to furnish and decorate their own rooms to suit their own tastes. Communal areas and the garden are well maintained also. Service users benefit from excellent end of life care, which is in line with the best practice guidance for this area. Service users can make their own wishes known, and have comprehensive plans of care which address all aspects that are important at this significant time. Service users are able to maintain and develop relationships which enhance their quality of life. Visitors are made welcome. Relatives are kept informed of relevant developments. Steps are taken to promote links with the local community. Larger rooms mean that couples wishing to share could do so. The service is also taking steps to start a befriending scheme. Meals meet the individual needs and preferences of service users. All food is cooked at the home by appropriately qualified staff. Good quality ingredients are used. Choice is provided at all main meals, and snacks and drinks are always available on request. DS0000063586.V336365.R01.S.doc Version 5.2 Page 6 Service users benefit from the support of well trained staff. There is a strong emphasis on training, from induction onwards. This encompasses a wide range of topics which are relevant to the care of the service users at Highfield. Care staff are enabled to take qualifications which recognise their knowledge and skills. The home provides funding to help staff undertake training, and also offers higher rates of pay once qualifications are achieved. Quality assurance systems ensure that the home is conducted in line with the wishes of service users. They have regular opportunities to make comments and suggestions, and the home takes actions to respond to these. Examples have included changes to the activity programme, and providing more staff around the time of the evening meal. There was positive feedback received from service users, relatives, other professionals and staff of the home about all aspects of the service provided by Highfield. One relative commented: “Nothing is too much trouble. The atmosphere is open, friendly and caring. It really is a home from home.” What has improved since the last inspection? What they could do better: Service users are placed at risk by a failure to have effective systems in place to ensure the safe regulation of hot water. This is particularly important for baths, where there is the risk of whole body immersion. Three of the seven baths in the home were tested and all found to be above the safe maximum level. There is no clear information about what measures are in place to regulate hot water outlets. Nor is there any system of regular checks. Service user records contain examples of contradictory or outdated information and gaps in expected documentation. These may place some individuals at risk of not receiving the appropriate support to meet their current needs. DS0000063586.V336365.R01.S.doc Version 5.2 Page 7 Sampled records found examples of such deficits relating to pressure area care, the use of bed rails, self-medication and the risk of falls. Service users need reassurance that all relevant steps will be taken in response to any significant events which occur. This includes the home notifying the Commission of any such events, when it is required to do so. The home has notified various events since its previous inspection, but examples were also found where this had not happened when it should have done. 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. The summary of this inspection report can be made available in other formats on request. DS0000063586.V336365.R01.S.doc Version 5.2 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 DS0000063586.V336365.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have written information about their rights and responsibilities as residents of the home. Prospective service users have their needs assessed before a decision is made to offer them a place in the home. Standard 6 is not applicable to this service. EVIDENCE: Sampled records show clear evidence of a thorough pre-admission assessment process. This includes a written conclusion about whether or not Highfield can meet the person’s needs. DS0000063586.V336365.R01.S.doc Version 5.2 Page 10 When a service user moves into the home, records show the support that they receive to help them adjust. Notes for one person who had moved in just a week before this inspection visit showed how staff were helping the individual to deal with their anxieties, and offering support if they became distressed. Information about the home is clear about the various different fees that will be charged, depending upon the type of room occupied. There is also specific information about what is included within this fee, and what will be charged for separately. The Statement of Purpose and Residents’ Guide give details about all aspects of life at Highfield, including the terms and conditions of residence. DS0000063586.V336365.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is good overall; however, quality in the area of care planning is only adequate. This judgement has been made using available evidence including a visit to this service. Service users do not have all of their abilities, needs and goals reflected in their individual plans, placing them at risk that some of these may not be supported effectively. Service users receive effective support with their health care needs, including end of life care. Service users are protected by the home’s policies and procedures for dealing with medicines. Service users have their privacy and dignity respected. EVIDENCE: DS0000063586.V336365.R01.S.doc Version 5.2 Page 12 Seven sets of service user records were checked. The home has assessment and care plan formats which cover the expected range of topics. Plans set out each need which has been identified, the goal of what support for that need should achieve, and the actions to be taken in respect of this. Plans are reviewed at least once a month. Service users sign their own care plans as evidence that they have been consulted and informed about them. Staff also confirmed that they contribute to care plans when necessary. The home is planning to improve service users’ access to their care records. Each individual will be offered the option to keep a copy of their care plan in their own room. The Residents’ Guide is also to be amended to make clear that service users can access their own records or have a copy at any time. Risk assessments are also in place for any topics relevant to individual service users. For instance, some service users are smokers. This is only permitted in designated areas outside the building. Risk assessments set out the issues for the service users affected. Ongoing records of care are provided by report sheets, with entries being made whenever there is anything of note to record. Records of health care include details of all contacts which service users have with their GPs and with other health professionals. Three GPs who have contact with the home provided comments as part of this inspection. All indicated that they are confident in the standard of care provided by the home. When service users are nearing the end of their lives, the home puts in place specific plans of care for this period. These are in line with best practice guidance under the national End of Life Care Programme. Staff have attended relevant training to help their delivery of this. The plans are drawn up in advance as much as possible, so that the service user can contribute and make their own wishes known, whilst they are still able to do so. The plans address not only the physical care that will be required, but also the full range of emotional and spiritual needs. Service users are able to make their wishes known about how and where they wish to be cared for, and also about what they wish to happen after their death. Once implemented, the end of life care plans and their associated assessments are reviewed and updated regularly. There is also evidence of input from all relevant professionals. This includes support from hospice nurses. Relatives also give positive feedback about how the home responds to the changing needs of service users. However, some areas of care plans and assessments are not clearly up to date or in line with the care which is being given. For instance, details about the DS0000063586.V336365.R01.S.doc Version 5.2 Page 13 pressure area care needs of one service user in their records are not an accurate reflection of the support they are now receiving. There is also uncertainty about which service users have been assessed as at risk in particular areas, such as being more likely to fall. Some files in which it was expected that a risk assessment would be in place were found not to contain one. For instance, accident records show that one service user has had at least three falls so far during 2007 which led to injuries requiring treatment at a hospital accident and emergency department. But there is no falls risk assessment on this individual’s file. Medication is stored in locked cupboards and a locked trolley is used to administer the drugs. These are dispensed, where possible, in a monitored dosage system, so that they are received already portioned out according to when they are due to be given. Other items are also dispensed individually. Printed medication administration records are provided by the pharmacy. The home has attached photographs of service users to aid identification. All staff who administer medication have training. Appropriate procedures are in place. Records are generally maintained accurately. One recent error was noted, when staff forgot to book in an amount of medication received into the home. Some service users retain an element of self-medication. This is risk assessed. They have lockable storage within their own rooms. Some risk assessments are in need of updating or expanding. Some date from 2003 and do not reflect that the service users’ prescriptions have changed since then. In another case a service user manages some of their medication but receives support from staff with other parts. This is not made clear in the guidance. Service users have their dignity upheld by the care practices in the home. Observations showed that all service users are treated with respect. Staff explained the importance of working in ways that help service users to retain as much independence as possible. Relatives commented that all service users are treated as individuals and that all steps are taken to help them live the lives they choose to. This includes recognising the diverse needs which can arise due to age, gender, disability and faith. The home has a policy on equality and diversity and an explicit commitment to upholding good practice in its Statement of Purpose. DS0000063586.V336365.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are supported to exercise choice and control in their daily lives. Service users are provided with a range of activities and opportunities. Service users are able to maintain and develop appropriate relationships with family and friends. Service users are offered healthy, nutritious and enjoyable meals, in line with individual needs and preferences. EVIDENCE: The home’s assistant manager takes the lead on organising activities. Practice was reviewed around a year before this inspection. Service users were surveyed to find out what sort of activities they would like to be offered. A variety of sessions are now provided. Quizzes tend to be the most popular. Musical entertainment also takes place, and guest speakers come in to talk DS0000063586.V336365.R01.S.doc Version 5.2 Page 15 about various topics, sometimes accompanied with slide shows. There is a reading group on Thursdays, and a yoga session every Sunday. Special occasions such as service users’ birthdays and Christmas are marked with celebrations at the home. During the summer a garden party is held. A new development in 2006 was to have a pantomime at Highfield, which proved popular, and less tiring for service users than having to travel to a theatre. Links are developed with the local community. Members of a bridge club visit to play the game with service users. The home hosts charity coffee mornings. Service users are assisted to attend local events or use facilities in the town. The service is also conscious that some of its users are less able to participate in group activities. So they are planning to start a befriending scheme which will give some individuals the chance to benefit from more one-to-one contact. Volunteers will be provided with training for this role. A relative who was visiting the home during this inspection said that they call in to Highfield regularly and are always made welcome. They mentioned that one nice option at the home, especially for people who may have had to travel some distance, is that a service user and their visitors can have lunch at a table in part of the lounge. This enables them to have greater privacy whilst eating. There is no additional cost for this. Relatives report that they are kept informed about the welfare of service users as necessary. They also get more general information about the home, for instance via a newsletter which is produced a couple of times a year. Highfield employs its own catering staff. There are three cooks, who cover the week between them, and a number of kitchen assistants. The cook works between 8.30 am and 2.30 pm each day. There is clear information about the dietary needs and preferences of each service user. Special requirements can be catered for, such as people with diabetes or those with chewing and swallowing difficulties. Choice is available at every meal. Sample menus can be seen on the home’s website. There are three main meals a day. Service users can choose whether to have these in the dining room or their own rooms. Drinks and snacks are provided between meals, and can also be requested at any time, including overnight. The inspector joined service users having their main midday meal in the dining room. Sixteen service users were present. There was a relaxed and sociable atmosphere throughout the meal. Service users were at ease chatting with staff and amongst themselves. DS0000063586.V336365.R01.S.doc Version 5.2 Page 16 The food served was of good quality and made from fresh ingredients. After the main course there was a selection of desserts served from a trolley, including fresh fruit. Service users and relatives commented that food is always home cooked, offering plenty of variety and using lots of healthy ingredients such as fresh vegetables. DS0000063586.V336365.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are safeguarded by the home’s policies and procedures for complaints and protection. EVIDENCE: There are suitable procedures in place for complaints and protection. This includes a policy about how staff could raise any concerns about practice. Complaints information is displayed in the home, and is also given to each service user as part of their Residents’ Guide. Procedures for safeguarding service users from abuse are cross-referenced to the multi-agency process in Wiltshire. Staff are issued with a copy of the ‘No Secrets’ leaflet which contains the shortened version of the procedures. The home has a link to the full set on its office computer. All staff also receive training about abuse and protection; firstly as part of their overall induction, and then as a specific topic. The manager and deputy manager also attended a recent conference on adult protection. DS0000063586.V336365.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26 Quality in this outcome area is good overall; however, quality in the area of the safe provision of hot water is only adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable and clean environment, suitable to their needs. Service users are placed at risk by failure to have a safe system for the regulation of hot water temperatures. EVIDENCE: Highfield is a detached property set in its own grounds on the outskirts of Marlborough, overlooking the Common. It has been extended and adapted, but the character of the original building has been retained. The use of décor and furnishings help create a comfortable and homely environment. The large DS0000063586.V336365.R01.S.doc Version 5.2 Page 19 rear garden is well maintained. Work undertaken in the past year has included necessary repairs to exterior walls and fencing. There has also been ongoing refurbishment of some areas inside the home. Some service users’ rooms were seen. They contained various personal possessions and items of furniture, giving the rooms an individual appearance. Accommodation for service users, including bedrooms, is provided on all three floors of the home. There is a lift which gives access to all floors, but some rooms are only accessible via small flights of steps on half landings. Communal areas, including a lounge and dining room, are on the ground floor. There are two bathrooms for general use on the first floor. Both are adapted, although one gets the most use because it is more suitable for the mobility needs of most service users. Four bedrooms also have en-suite baths. All other bedrooms except two have en-suite toilets and handbasins. There are a range of storage areas throughout the building, including access to parts of the roof space. The home is engaged on a programme to provide self-closure devices for fire restricting doors. This means that they can be left open in normal use. This benefits service users who like to keep their bedroom door open and also makes it easier to move around the home. The home was clean and hygienic in all areas seen during this visit. Care staff also take part in cleaning duties. There are recorded schedules which help to ensure that all tasks are undertaken at set frequencies. Service user surveys included comments about good standards of cleanliness. All laundry is done at the home. There are suitable procedures and equipment for handling of all items to minimise any infection risk. The service is also planning to review its infection control procedures in line with recent Department of Health guidance. There is no definite information about how hot water temperatures are regulated, nor a system for regularly checking them. The AQAA states that a new hot water tank with thermostat has been installed in the last year. But the manager and other staff were not sure if temperature is regulated at each individual outlet which is accessible to service users. These need to be kept to maximum levels of 43°C, especially for baths, because of the risk of whole body immersion. Three baths were checked in the late afternoon, using the home’s own thermometers. Two were running at 46°C and the other at 48°C. DS0000063586.V336365.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are supported by suitable numbers of appropriately trained staff. Service users are protected by the home’s recruitment practices. EVIDENCE: Highfield employs a large number of care staff, most of them working a variety of part-time hours. This provides a lot of flexibility which helps with ensuring that the rota is always covered. For the purposes of day-to-day running the home is split into four areas, each with a group of service users. Staff are then deployed to work in one of these on a particular shift. They will vary which area they work in, so that they have contact with all service users. A designated senior carer is on duty for all shifts to ensure effective staff supervision and organisation. Feedback from service users was positive about the care provided by Highfield’s staff. They described them as being helpful and attentive, and always available when needed. One relative added that staff always “go the extra mile” to ensure that service users are well cared for. DS0000063586.V336365.R01.S.doc Version 5.2 Page 21 There has been low staff turnover since the previous inspection. Two sets of staff records were checked for employees recruited since that visit. Both showed that all required recruitment checks were carried out, and that staff did not begin working in the home until they had the necessary clearance. Staff explained the induction process. They have a book to work through. They shadow other staff as they go round the home and get to know the service users and methods of working. They are provided with various core training, including food hygiene, infection control and moving and handling. They also have the opportunity to undertake other courses if they wish, for instance on mental health needs. Staff surveys included the comment that they apply for any relevant training they are interested in and that they get funding for this. Training opportunities were described as “excellent”. Training records show that a wide range of areas are covered. These include dementia, first aid, disability equality, palliative care and medication. The induction booklet for carers is linked to the national standards for the social care workforce. This then acts as a pathway into National Vocational Qualifications (NVQs) in care. Fifteen carers have achieved this award at Level 2 or higher. Gaining this qualification is recognised by a higher rate of pay. The home’s overall training plan shows when staff are due to have training, including refresher sessions. DS0000063586.V336365.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38 Quality in this outcome area is good overall; however, the quality assurance system is excellent, but quality in record keeping is only adequate. This judgement has been made using available evidence including a visit to this service. The registered manager is suitably qualified, competent and experienced, so that service users benefit from a well run home. Quality assurance measures ensure that the home is conducted and developed in line with service users’ needs and preferences. Service users’ financial interests are safeguarded by the systems operated. Some areas of record keeping and reporting do not support the effective delivery of care to service users. Service users’ health and safety are protected by the systems in place. DS0000063586.V336365.R01.S.doc Version 5.2 Page 23 EVIDENCE: The registered manager for Highfield is Mrs Vanessa Hillier. She has relevant qualifications for her role, including NVQ Level 4 and the Registered Managers Award. Mrs Hillier was not on duty on the day of this unannounced inspection, but came in to assist the process. Mrs Hillier is supported by colleagues, including an administrator, deputy and assistant managers and two senior carers. Service users commented that they have a good rapport with the manager. Relatives reported that they are confident in the management of the home, and can always approach Mrs Hillier or one of her senior colleagues if they ever need to. Staff said that communication in the home is good and that they feel well supported. Highfield has an effective quality assurance system and an annual development plan. The service’s AQAA demonstrates that there is a good understanding of how to audit quality using a range of measures. Service users are enabled to contribute by being surveyed for their comments. The service also responds to any issues which arise from comments or suggestions. Actions identified in the development plan are put into place and kept under review. Recent changes have included a review of staff deployment for the early evenings, so that there are more on duty to support the evening meal. Quality is also kept in focus by senior staff developing their own learning, and updating themselves on developments in research, policy and practice. The service plans to develop its quality assurance system further over the next year. This will involve an increased focus on getting feedback from service users and also widening the scope to get comments from other stakeholders such as health professionals and service users’ relatives and friends. The home usually has no involvement with the financial affairs of service users and does not offer to store money or valuables. As a service offered to its users, Highfield will purchase items for them or lend small amounts of cash. These sums are then added to invoices. All staff receive health and safety training and are given a copy of a manual with relevant information. Suitable policies and procedures are in place, and risk assessments are carried out on various safe working practice topics. The property has a fire risk assessment and this was due to be updated shortly after this inspection visit, to reflect recent changes in guidance. There is also evidence that all checks, practices and training related to fire safety are carried out and are up to date. DS0000063586.V336365.R01.S.doc Version 5.2 Page 24 Information is in place about the use of bed rails with service users. Sampled records show that risk assessments are carried out. However, records are not always completely clear about what is happening. For instance, one service user’s file showed that bed rails had been removed at their request earlier in 2007, but reinstated a couple of months later. There was no information about why this second change had been made, if consent had been obtained from the service user, or how the decision had been approved if consent was not given. Report sheets also appeared to show that bed rails had been in use during the period when other records suggested that they had not. Practice could be developed further, in line with guidance from the Medicines & Healthcare Products Regulatory Agency (MHRA). Care should be taken to ensure that there is consistent detail in documents for different service users. Examples of relevant content include when and how bed rails are to be used. Once assessment of a service user has identified the need for bed rails, documentation should also cover the suitability of the type used. Where possible, signatures should be obtained as evidence of consent or decision making. This includes any staff involved in taking a collective decision. Records show many examples of significant incidents which should have been notified to the CSCI as they occurred. These include various illnesses and injuries of service users. The service has notified a number of significant events since its previous inspection. Any omissions appear to have been due to misunderstanding some of the notification guidance. The issue was discussed with the manager during the inspection and updated guidance sent to the home afterwards. Since the inspection visit the home has already begun to act in accordance with the guidance. DS0000063586.V336365.R01.S.doc Version 5.2 Page 25 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X 2 3 DS0000063586.V336365.R01.S.doc Version 5.2 Page 26 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 OP7 Regulation 15 Requirement Each service user’s plan of care and associated records must set out the actions to be taken to meet all their needs, and must be updated to reflect changes. Suitable measures must be taken for the regulation of hot water temperatures, to protect service users from the risk of harm. Timescale for action 31/08/07 2 OP25 13-4 31/08/07 3 OP37 37 The persons registered must 06/06/07 notify the Commission without delay of the occurrence of events specified in Regulation 37 of the Care Homes Regulations 2001. COMMENT: The service has begun to act in accordance with this Regulation since it was discussed during the inspection. DS0000063586.V336365.R01.S.doc Version 5.2 Page 27 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 OP25 Good Practice Recommendations Measures for the safe regulation of hot water should include regular temperature checks, enabling action to be taken where risks are identified. Records relating to the use of bed rails should be reviewed and updated in line with the relevant good practice guidance of the MHRA. 2 OP38 DS0000063586.V336365.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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