Inspection on 19/07/06 for Highfield Care Home

This inspection was carried out on 19th July 2006.

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 Care Home 24/05/07

Highfield Care Home 20/02/06

Highfield Care Home 28/10/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Highfield Care Home Bekesbourne Lane Bekesbourne Canterbury Kent CT4 5DX Lead Inspector Mrs Susan Hall Unannounced Inspection 19th July 2006 09:30 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 Care Home DS0000065782.V299327.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. Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highfield Care Home Address Bekesbourne Lane Bekesbourne Canterbury Kent CT4 5DX 01227 831941 01227 832400 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) Ashbourne (Eton) Limited Vacant Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (30), Physical disability (4) of places Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Physical disability is restricted to those persons whose dates of birth are 17.06.1945, 18.12.1951, 17.01.1945 and 17.04.1950 20th February 2006 Date of last inspection Brief Description of the Service: Highfield Care Home is owned by Ashbourne (Eton) Ltd, which is now part of Southern Cross Healthcare Ltd. This is a large company with experience in running care homes. Highfield is situated in the rural village of Bekesbourne near to the city of Canterbury. The home is easily accessible via the M2 motorway. Public transport is limited to a mainline railway station, which is approximately 15 minutes walking distance. The home offers nursing care for up to 34 service users. Most rooms are for single use, and most have en-suite toilet facilities. The majority of the rooms are on the ground floor. Rooms on the first floor can be easily accessed via a passenger lift. There are several communal rooms and seating areas inside the home; and extensive, pleasant gardens which are suitable for wheelchair users. Fees range from £469 - £714 per week. These figures were provided by the Acting Manager in pre-inspection documentation, in May 2006. Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place from 09.30 – 6.00pm. The Acting Manager was available throughout the day, and assisted the Inspector with locating information, and showing her around the building. The home has a friendly atmosphere, and all staff were very helpful with the inspection process. This was a Key Inspection, which included assessing information provided by different sources since the last CSCI inspection in February 2006. The home has been the subject of an adult protection alert since August 2005, and this is still ongoing. CSCI have not received any complaints since the last inspection, but have been advised of concerns regarding staffing levels, voiced by different parties. The acting manager informed CSCI in March 2006 that there were difficulties with filling staff hours, and that current staff were picking up the extra hours. While this was a satisfactory short-term solution, it was unhelpful in the long term as staff became overtired and run down. The company have recruited some care staff from abroad since this time. This, however, is posing other difficulties, as service users find it difficult to relate to the language skills and different cultures for staff from other countries. The Inspector had conversations with 7 service users, and met other service users briefly. One service user said that “the girls” (meaning the care staff) “are very nice, but it’s often hard to make some of them understand.” Other service users voiced this opinion. Survey forms were sent to a sample number of service users, relatives and health professionals. Two replies from relatives, and one from a care manager, had ticked all the response boxes positively. Replies received from a GP in respect of 5 service users, indicated that he was unsure that staff demonstrated a clear understanding of service users’ needs. The Inspector viewed the premises, and talked with 12 staff, and 2 relatives; and met 2 Health Professionals visiting the home during the day. She read documentation, and this included the Statement of Purpose and the Service Users’ Guide; care plans, medication charts, induction data, staff recruitment files, staff training records, and maintenance records. The premises were generally clean in all areas, and there were no offensive smells. Electrical re-wiring was taking place throughout the building, and appropriate health and safety measures had been taken. A new boiler was in the process of being fitted. Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Staffing levels for care staff and domestic staff are low. Care staff struggle to meet the needs of service users effectively, although they work hard, and showed genuine care for service users. The building has a difficult layout, and the call bell system is old and does not help staff in being able to find out who is ringing for assistance. There are only 2 domestic staff to keep this large building clean. The laundry room is extremely small and is inadequate for maintaining infection control. The medication room has inadequate ventilation, and the temperature is too high. Some kitchen appliances were out of order. The kitchen rooms are badly organised, and the ventilation is inadequate. A shared bedroom – designated for service users – was being used for 2 staff recruited from abroad. An immediate requirement was issued to address this. The Company’s Operations Director responded very quickly to this Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 7 requirement, and informed the Inspector that this incident was “ a temporary emergency measure when accommodation for overseas staff fell through at the last minute.” An assurance was included that this would not happen again. 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 Care Home DS0000065782.V299327.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 Highfield Care Home DS0000065782.V299327.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1-5 The quality for this outcome area is adequate. Satisfactory information is available for service users to help them with choosing a home, but this could be improved. The home ensures that service users’ needs can be met before arranging admission. EVIDENCE: The Statement of Purpose and the Service Users’ Guide had been prepared in a draft format since Southern Cross purchased the home in November 2005. These had not yet been finalised. The Statement of Purpose contains all the information required in Standard 1 and Schedule 1, with the aims and objectives of the home, and the mission statement of Southern Cross at the beginning of the document. It includes details of accommodation, admission criteria, and the complaints procedure. Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 10 The Service Users’ Guide is very detailed, including fees, contract details, and terms and conditions of residency. The draft copy was produced in rather small print, and there were no photos or pictures of the premises. The front cover stated that the Guide is available on audio cassette. Contracts and terms and conditions are agreed for all service users, whether local authority or privately funded. Extra fees are specified – e.g. for hairdressing, newspapers, toiletries. Service users already living in the home had not been provided with a copy of the Service Users’ Guide, as there was little change in information, apart from the ownership. The manager ensures that all prospective service users are provided with a copy. Pre-admission assessments are carried out by the manager. All care needs are assessed, and she checks that the room available is suitable for meeting the service user’s individual needs e.g. if additional equipment is needed. Information is accessed from joint assessments, and from hospital staff, relatives, and previous carers. A new service user was being admitted on the next day who had a different language from English as their first language (but also spoke English). The manager had asked relatives to write down some phrases which staff could learn, to help the service user to settle in to the home. This was a good example of the manager following up details of care and communication. A relative of the service user stated that the home had been “very helpful” in ensuring that the bedroom was prepared to their satisfaction. Service users are admitted for a trial period of 4 weeks. A review is arranged at the end of this time. Highfield Care Home DS0000065782.V299327.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 The quality for this outcome area is adequate. Care plans had been improved since the previous inspection, especially with recording of wound care, social, religious, and family data. Some improvements had been made with medication management, but the Company need to address the unsatisfactory temperature of the storage room. EVIDENCE: The Inspector viewed 4 care plans, - one for a new service user, one for a service user having respite care, and 2 for long stay service users. All care plans had been transferred over to “Southern Cross” documentation, but the manager stated that they had not all been completed in every area. This was evident in some sections such as lists of personal belongings, where the records referred the reader to “old records”. The new format is a good opportunity to bring such information up to date. The care plans showed good admission data, such as the service user’s choice of name by which they are called; their religion, family details, medication, Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 12 allergies (in red), life history information, and a physical and social assessment record. These included the risk of falls, communication needs, dietary needs, and mental state. Assessments were based on the “Roper’s” activities of daily living. Care plans have an admission checklist, to ensure that no items are missed. They are set out in indexed folders for easy access of information. Assessments were included for wound care (with body mapping), nutrition, continence, falls risk, moving and handling, and dependency, and these were well completed. The home uses a MUST (Malnutrition Universal Screening Tool) as well as their own nutritional assessment; these had completed weight charts, and BMI calculations to monitor the dietary needs. Service users had been appropriately referred to other health professionals. A dietician was visiting the home after receiving some referrals via GPs. She said that the documentation, and the staff, were helpful to her in her investigations. Care plans were appropriately detailed – for example, night care plans had clear data on items such as “ likes the door left open”, “ leave lamp on”, “likes hot milky drink before settling”. Diabetic care plans were backed up with records for urinary and blood sugar tests, and were up to date. Good details were noted for a change of medication for pain relief in one care plan. Wound care plans are stored separately (and confidentially) in a “tissue viability folder”. This ensures that the nurses carry out all wound care consistently, and check daily for any dressings needed. The documentation is added to the individual care plans (as a record), after the wound is healed. The home has received support from Specialist Support Nurses in the community, to bring wound care up to date. Each wound is documented separately, and each dressing change is recorded, with the state of the wound and the dressing applied. Care staff use a daily tick chart to record personal hygiene care, specifying if the service user has had a bath/hair wash/ shave/ hair brushed etc. This chart also showed if the hearing aid was put in, and spectacles cleaned – demonstrating good practice. Medication is stored in a locked room, with the medication trolley padlocked to the wall. The room had inadequate ventilation, and in spite of a cooling fan, the temperature was too high for effective storage of medication – it was 29 ° C. Drug fridge storage was satisfactory. Administration is mostly via a Monitored Dosage System (MDS). There was no overstocking, and items were properly labelled and dated. Disposal of unused medication is via a clinical waste company , and the Pharmacy has a licence to take back unused Controlled Drugs (CDs). CDs are stored in a metal cupboard within another cupboard. The Company needs to check that this storage complies with the storage regulations set by the Misuse of Drugs (Safe Custody) Regulations 1973. Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 13 Medication was properly receipted in on Medication Administration Records (MAR charts), and handwritten entries were signed by 2 nurses. Some photos were missing from MAR charts, and the Manager had been having to use her own camera/equipment to keep up with photos. The Company must ensure that suitable equipment is provided to the Home. Service users who wish to manage their own medication have a detailed assessment to ensure they understand their medication and can take it responsibly. Each service user has a lockable drawer for storage. The Inspector observed care staff caring for service users with attention to their privacy and dignity. Several service users said that the staff are pleasant, caring and hard-working. Their perception was that there are not enough staff in the home as they are “always busy”, and sometimes service users have to “wait, wait, wait”. Staff try to spend additional time with service users who are ill or dying, and ensure they are kept as comfortable as possible if hospitalisation is not indicated. Only one carer had any record of loss and bereavement training, but the manager had already booked a 1 day course on this for staff to attend. Highfield Care Home DS0000065782.V299327.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 The quality for this outcome area is adequate. Activities are well organised, and there is good contact with the local community. There is not much opportunity for service users to visit places out of the premises. The quality and variety of food is generally satisfactory. EVIDENCE: The home employs an activities organiser from Mondays to Fridays. She was busy helping service users to make items in preparation for a forthcoming garden fete. The home has a detailed activities programme in place, with designated activities for each weekday. These include items such as gentle exercises, arts and crafts, bingo, videos, games and quizzes. There is an inhouse shop twice a week, and library books can be changed twice weekly. The home had a record of holding “Awareness Days”, and recent ones included Deaf Awareness, Falls Awareness and Abuse Awareness. Photos on a corridor wall showed the involvement of service users, family and friends at the Abuse Awareness day, which was led by 2 people from Action on Elder Abuse. These days are therefore used to inform service users and relatives, as well as staff. Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 15 Some service users are able to go out with their relatives, but there is little provision for service users to go on outings, for individual walks with staff, or for one to one attention. There are only 3 care staff on duty in the afternoons, and although the activities organiser makes time for one to one care, it is not possible to get round everyone. Religious preferences were recorded in care plans. A monthly communion service is held in the home. Service users are encouraged to manage their own financial affairs for as long as possible. The management do not oversee any personal finances, but will help arrange advocacy if needed. Service users are able to bring in their own personal possessions, and small furniture items, in agreement with the manager. The provision of meals had changed from the previous method of subcontracting to a catering company, to in-house management. The home had been able to retain the same chef. His previous working hours had been reduced, and he said that he found it difficult to fit in all the kitchen duties with reduced hours. A kitchen assistant is employed each day, but their duties include clearing tables and giving out drinks. This reduces their time for cleaning and preparation tasks in the kitchen. The chef commences shifts in time to prepare breakfasts, and then cooks lunch, and prepares a hot dish for the evening meal. The kitchen assistant then completes food preparation for this meal. The Inspector noted that the kitchen assistant on duty attended basic food hygiene training on the day of the inspection. This indicated that he had previously been preparing food when he had not completed training. There was no protective clothing available for the Inspector to enter the kitchen, and no protective aprons for staff to wear when handling food at meal times. There was some miscommunication at management level regarding the provision of the chef’s uniform – he was currently wearing his own kitchen clothing. Menus are arranged by the chef and manager, and altered according to what service users currently like/don’t like. There is a good variety, and most items are home-cooked – including soups, cakes etc. However, two service users said that “the food is not as good as it used to be” – especially at tea times. A relative commented that “food is often unappetising and of a poor standard.” Care staff showed concern to ensure that service users were assisted with fluids throughout the day. As there were only 4 care staff, (and one on induction), it was difficult for them to spend time ensuring that food and fluid intake were sufficient. Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 16 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, 18 The quality for this outcome area is adequate. The home has a clear complaints procedure in place. Complaints are dealt with appropriately. Staff are aware of the recognition and prevention of abuse. EVIDENCE: The home has a clear complaints procedure, and this was displayed in the front entrance hall, and is included in the service users’ guide. Details are given for contacting senior management in the company, social services and CSCI. The home’s records showed that no complaints had been made to the home since the last inspection in February 2006. One complaint which had been made in December 2005, had been resolved in March 2006, and letters were on file to show how this was resolved. There is a monthly audit by the company’s Head Office to check on complaints. Two service users said they had “nothing to grumble about”, and one service user said that if she had concerns or complaints she would speak to the nurse on duty, or ask to speak to the manager. Comments from service users were that they did not want to make any formal complaints, but the home was “ not as good as it used to be”; “ that there are not enough staff” and that “the company does not seem to have the commitment to put things right in the home.” The Inspector was concerned that there seemed to be a general Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 17 feeling from service users that they were resigned to having insufficient staff, and did not think it was worth complaining. The home still has an “adult protection alert” raised on every service user, in respect of nursing and wound care. The manager and several trained staff had updated their own training in adult protection during the past 2 years. About half of the care staff and housekeeping staff had attended training for this in the last 2 months. Basic training is included in the induction programme. Adult protection awareness training was being implemented for all staff. The “ Abuse Awareness Day” held recently, had been informative for everyone. Some of the new staff have a poor command of English, and this may cause some difficulties with ensuring that they understand the protection of vulnerable adults. As different cultures have different approaches to people, it is important to ensure that staff from other cultures are able to recognise and understand how these service users wish to be treated. Highfield Care Home DS0000065782.V299327.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 The quality for this outcome area is poor. Some previous requirements for the premises were in the process of being met. The kitchen and laundry areas need reviewing, and action plans put in place to address the assessed needs. EVIDENCE: The Inspector viewed all corridor areas, the kitchen, laundry, communal areas, some bathrooms, and a large number of bedrooms. Service users were resting or having personal care given in some bedrooms, and so these were not viewed. The home was having electrical re-wiring carried out throughout the home in response to a previous requirement. A new boiler (oil) was being fitted to deal with previous problems with the hot water. Suitable health and safety signs were in place. Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 19 The reception area and one corridor had been redecorated since the previous inspection. The manager stated that there was an ongoing programme of redecoration to upgrade other corridors and bedrooms as identified. Ceilings will need to be repaired/redecorated after the work on the electrical wiring has been completed. A broken window had been replaced, and some slatted windows in ground floor bedrooms had been replaced. Some service users in these rooms had refused to have their windows altered, and the manager said that she had documentation to support this. These windows will need to be replaced as the rooms become vacant. Most bedrooms had door locks fitted; some service users did not want these, and there is a programme in place to fit them as these rooms become vacant. A new security key pad system is being fitted to the front door. The Inspector noted that call bells sometimes sound for a long time before they are answered. There are only 3 points for staff referral to find out who is ringing. Service users in the lounge and reception area did not have a call bell to ring, and said they shouted if they want someone. The call system should be reviewed, and the company must ensure that vulnerable service users always have the means to call for assistance. Communal areas were welcoming and comfortable. These include 2 lounges, the reception area, a dining room, and other seating areas. The activities room was temporarily out of use, as this was needed as an access point for electricians re doing the wiring. The gardens are beautiful, with a large pond and lots of lawned areas and flowerbeds. The Inspector did not view a risk assessment for the pond, but warning signs were in place. If a risk assessment has not been carried out, this must be done, and any appropriate action (e.g. fencing) carried out. A gazebo had been set up on the lawns, and service users could choose to eat their meals outside if they wished. A gardener is only employed for 2 days per week. The manager said that one of the service users loves to do the gardening, and it is excellent that they are enabled to do this. However, this must be kept under review, as the company should not rely on a service user to keep the gardens in order, and it may become too much. Bedrooms were personalised, and a newly decorated room had been completed to a high standard. New carpet and soft furnishings had been colour coordinated. Bed linen and towels were adequate, but some were becoming very worn. The manager has a monthly budget for replacements, but the Inspector was unsure that this would be sufficient for the amount of soft furnishings, towels and sheets which could do with replacing. Toilets, bathrooms and sluices viewed were satisfactory. En-suite toilet and wash basins were only suitable for service users with mobility, as they were not large enough for wheelchair users. Nursing beds, bedrails (with padded sides) pressure-relieving equipment and grab rails were all in evidence. The home has 5 hoists, and the moving and handling trainer said that these were adequate for the needs of the home. Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 20 The main kitchen preparation room is small for the number of service users it has to serve. There is an adjoining area for dry food storage, and a small room for fridges and freezers. This was packed tightly with equipment, and one of the freezers was running with an erratic temperature, because the chef said the ventilation was inadequate for so many items. He said a new freezer was being purchased, to go in the main kitchen – in place of one of these. Some items in the kitchen did not work – e.g. one of the hot rings on the cooker, and the grill. The temperature of the hot trolley could not be regulated. The kitchen had poor ventilation. There is a large room adjoining the kitchen which is used for a variety of things – storing tray racks and trolleys, various cupboards, a table which is used by staff and sometimes by service users. This could possibly be put to better use as part of the kitchens. The inspector recommends that the Environmental Health Officer is asked to visit and advise. The laundry room is very small, and had 2 washing machines (with sluicing facilities) and 2 tumble dryers. A red alginate bag system is used for soiled laundry. Dirty laundry was stored on the floor. There is insufficient space to keep dirty items separate from clean items, although the laundry assistant was trying to do this. The laundry room should be assessed in regards to meeting infection control standards, and an action plan put in place to address the resulting needs. The home was clean throughout, and there were no offensive smells. This was a credit to the 2 cleaning staff, who are employed from Mondays to Fridays. One cleaner is employed on Saturdays, but there are none in the home on Sundays – so toilets and bathrooms are not properly cleaned on this day, and no bedrooms or communal areas cleaned. Care staff do the best they can, but have their own responsibilities. There is insufficient time in the week for the cleaning staff to carry out weekly/monthly tasks such as cleaning skirting boards, windows, moving beds etc. Numbers of cleaning staff should be reviewed. Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 -30 The quality for this outcome area is poor. Staffing requirements need to be re-assessed. There have been improvements with staff recruitment procedures, and training programmes have been implemented for all staff. EVIDENCE: Staffing levels for nurses have been evaluated as needing 2 nurses in the morning, 1 in the afternoons and evenings, and 1 at night. The rota showed that there is often only 1 nurse in the mornings – or the manager is scheduled as the second nurse, when she needs to be supernumerary. The home had 25 service users (out of a possible 34) , and there were 4 care staff on duty, (with a 5th carer on induction training) in the morning; 3 carers in the afternoon, and 2 at night. This was barely sufficient in the day time just for carrying out basic care needs. The layout of the building means that more staff are needed than in some places, as it is large and rambling. It takes time for staff to find out who is ringing for assistance (because of the call system), and may take time to reach the service user concerned. Many service users need the assistance of 2 staff for moving and handling needs, and most service users need assistance with washing, dressing, and using the toilet. This was evidenced in pre-inspection documentation provided by the home. At night times, the nurse may be giving out medication, while the 2 care staff are Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 22 attending to one service user. This leaves the rest of the home unsupervised. In the afternoons there are only 3 care staff to oversee toileting needs, washing, feeding, supervision of mobility, and many other tasks. More than one service user said that while the staff are lovely and hard-working, there are “ not enough of them” and you “ have to be prepared to wait.” Staff voiced their frustrations that they cannot carry out their jobs as effectively as they wish to. New staff should not be seen as an extra pair of hands, as staff on induction actually delay existing staff further, as they need explanations, and time to have procedures demonstrated to them. As many are from abroad, this can further delay the process because of poor communication. The manager has arranged for staff to attend English lessons, but it is unhelpful for service users to be attended to by staff who do not already have sufficient language skills. The Inspector has already written about insufficient domestic staff in the previous section, and possibly insufficient kitchen hours and gardening hours. Maintenance hours may also need reviewing in the light of the amount of refurbishment which is planned. The pre-inspection questionnaire states that 75 of care staff are trained to NVQ 2 or NVQ 3 “equivalent”. This seems to include staff with qualifications gained from abroad. Qualifications gained abroad cannot be assessed for their equivalent ratio to NVQ levels 2 or 3 in this country, as there is no record of the content or details of the training programmes. Numbers of NVQ 2 or equivalent staff, should be re-evaluated. Recruitment procedures had been improved in response to previous requirements. The Inspector examined 3 staff files (chosen by her), including a new staff member, a nurse, and a carer. The files were in good order, and had been checked by the Administrator to ensure that required details were included. References for staff supplied to the company via an agency, and coming from abroad, were written to the Company, and had been translated. The translations department showed authorisation for approved translation. Training records were also accompanied by translations. POVA First and CRB checks had been carried out for all staff, and the Inspector viewed copies of these. Nurses NMC “PIN” numbers had been checked, and the administrator keeps a list of when the expiry dates are due. Induction training is carried out in accordance with “Skills for Care”, and some of these were evidenced in staff records. Training needs for nurses to update their skills and competencies had been identified. All trained staff attended wound management training during May 2006. Other training planned for nurses includes venepuncture, falls assessment, male catheterisation, diabetes management, and nutrition in older Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 23 people. Other skills such as use of syringe driver are still outstanding, but training is now under way in many subjects. Care staff records show that all staff carry out all mandatory training, and much of this had been carried out in the last few months. Some training had been completed, and other training had been arranged. Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 24 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, 37, 38. The quality for this outcome area is adequate. The manager has implemented some changes to improve standards, and staff work well together. A new building risk assessment will be needed when electrical wiring has been completed. EVIDENCE: The manager is a level 1 nurse, and has carried out adaptation training in this country. She has a certificate in business management in care, and has 6 years experience of nursing for older people. She has not yet completed the “Registered Managers’ Award”, and has not applied to CSCI for registration. Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 25 The manager leads the way for staff in having a good attitude towards care, and she demonstrates hands-on care for staff to understand and follow. The staff work well together as a team, and staff meetings are held in the home. Meeting are also held on a monthly basis for service users and relatives, and they value these. The last meeting had been attended by 13 service users. The manager uses these times to inform them of changes in the home – such as refurbishment work, and new staff. Customer surveys are carried out in the home every year. A regional manager visits to carry out monthly regulation visits. Staff supervision is carried out using a pre-printed format, and appraisals were just being implemented. Staff supervisions will be allocated to heads of different departments, with the manager supervising the trained staff. The system was in place, but was not actively set up yet. Policies and procedures had been changed to those of Southern Cross. The manager was implementing a system to ensure that staff read and understand these. Staff were in the process of completing mandatory training. COSHH training is carried out for domestic staff. Cleaning chemicals are stored in a locked cupboard. Maintenance files were viewed. Thermostats are now in place for hot water outlets. The Manager should send a copy of the certification to CSCI, for the new boiler and electrical rewiring, when these have been completed. All staff - except catering staff – had attended fire training this year. Their training needs must be addressed. Fire extinguishers were in date for servicing. Window restrictors are fitted to all windows. Health and safety signs were in place for the work being done in the home. There was a notice on the clinical room door stating “no naked lights”, but it did not actually state that oxygen is stored in this room. Accident records were viewed and had been well recorded. A monthly audit is carried out by the manager. Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 26 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 2 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 3 3 1 X 2 2 1 STAFFING Standard No Score 27 1 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X X 2 3 2 Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement To address the problem of the temperature being too high in the medication storage room, for safe storage of medication. To ensure that all necessary kitchen equipment is kept in working order. To provide the Inspector with an action plan in respect of the laundry room; following an assessment for how the Company intend to meet infection control standards for keeping clean laundry separate from dirty laundry. The call alarm system must provide an accessible call facility in every room used by service users. The company must ensure that at all times, suitably qualified, competent and experienced persons are working at the home in such numbers as are appropriate for the health and DS0000065782.V299327.R01.S.doc Timescale for action 19/08/06 2 OP19 16 (2) (g) 19/09/06 3 OP19 13 (3) and 16 (2) (j) 19/09/06 4 OP22 12 (1) (a) 01/09/06 5 OP27 18 (1) (a) 01/09/06 Highfield Care Home Version 5.2 Page 28 welfare of service users. This is with particular reference to reviewing the numbers of care staff on each shift. 6 OP38 13 (4) (a,c) To send a copy of certification to confirm the satisfactory rewiring of the home, and fitting of the new boiler, when these have been completed. 01/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations To check that the Controlled Drug storage cupboard complies with the specifications advised under the Misuse of Drugs (Safe Custody) Regulations 1973. To ensure that all medication administration charts are accompanied by a photograph of the service user. To review hygiene practices for infection control, regarding the provision of protective clothing for staff handling food. To continue with the planned programme for redecoration and refurbishment of the premises. To request advice from the Environmental Health Officer regarding the layout and ventilation of the kitchen area, and to act on this accordingly. To review the numbers of cleaning staff employed by the home. 2 3 4 5 OP9 OP15 OP19 OP19 6 OP26 Highfield Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 Care Home DS0000065782.V299327.R01.S.doc Version 5.2 Page 30 - 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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