Inspection on 20/02/06 for Highfield Care Home

This inspection was carried out on 20th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Highfield Care Home 24/05/07

Highfield Care Home 19/07/06

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 Wendy Gabriel Unannounced Inspection 20th February 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Highfield Care Home DS0000065782.V250527.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 Care Home DS0000065782.V250527.R01.S.doc Version 5.1 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.V250527.R01.S.doc Version 5.1 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 Date of last inspection Brief Description of the Service: Highfield Care Home is registered to offer nursing and residential care for up to 33 residents. The home is situated on the outskirts of the rural village of Bekesbourne and is within 10 minutes drive of the City of Canterbury. The Acting Manager has stated that the four double bedrooms are currently used as single accommodation. The surrounding gardens are well maintained and there is plentiful parking to the side of the premises. Access to the grounds is suitable for wheelchair use. Public transport is limited to the mainline railway station within approximately 15 minutes walking distance. The two storey building has the benefit of a shaft lift to the 3 bedrooms on the first floor. Highfield Care Home DS0000065782.V250527.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was undertaken to review the homes response to requirements and recommendations made at the previous inspection in 2005. Information regarding staffing was also viewed and discussed. Regulatory Inspectors Wendy Gabriel and Tina Thomas undertook the inspection. Since the previous inspection the acting manager has been appointed as manager and will be seeking registration in due course. The Deputy Manager was on duty at the time of the visit. The Inspectors were disappointed that a care plan viewed had not had issues addressed that had been discussed at the previous inspection. Staff files viewed were still lacking information discussed at the previous inspection. Some maintenance issues had been addressed since the previous inspection including installing thermostatic valves to the hot water system. A hoist has been re-sited, resulting in an attractive and useable bathroom. The attic steps are potentially dangerous to use due to the design and siting of them and they also block the upstairs fire exit when in use. The Inspectors recognise this has been inherited by the company but they must be assessed urgently and suitable action taken. The Deputy Manager stated that the new company now requests a monthly audit of various issues including staff training. The Inspectors view this as good practice. However, there was no written evidence of staff training in the staff files seen by the inspectors. The Inspectors noted that the call bell rang for long periods before being answered throughout their visit. This indicates that the staff are too busy to answer them immediately. The call system is centrally located and staff have to go to that area each time a bell rings to ascertain who is calling for assistance. The Deputy Manager stated that the company are reviewing this with a view to replacing it with a modern system. Staff interviewed, indicated an awareness of the needs of the residents in the home and were enthusiastic about the care of the residents. The home was clean and tidy and with no unpleasant odours at the time of the visit. One sitting room used by the Deputy Manager and the Inspectors was not very warm but other areas around the home were comfortably warm. Highfield Care Home DS0000065782.V250527.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The Inspectors were disappointed that some requirements made at the previous inspection had not been met or completed. Staffing levels are still an issue and a requirement was made for this to be continually assessed to ensure residents’ needs are fully met by sufficient and competent staff. Staff files contained little of the required documentation. Although one care plan seen was well documented and reviewed another had not had the issues discussed at the previous inspection actioned. Some maintenance and decoration was identified and is to be undertaken. Information regarding medication administration recording is to be accurately recorded. Highfield Care Home DS0000065782.V250527.R01.S.doc Version 5.1 Page 7 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.V250527.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 Care Home DS0000065782.V250527.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): Standards 1-6 were not inspected on this occasion. EVIDENCE: Although not inspected at this time, the Inspectors were pleased to be informed that the new company is updating the statement of purpose and the Deputy Manager agreed to forward a copy to the Inspector when completed. Highfield Care Home DS0000065782.V250527.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): 89 Residents’ health care needs are compromised by incorrect recorded information and lack of evidence of risk assessments for self-administration of medication. EVIDENCE: Two care plans were viewed. Both had photographs of the service user. They both had good quality initial assessments. The first had a nutritional risk assessment. The assessment was incorrectly filled out. The service user was obese, yet a trained nurse had, without suitable calculations expected from the tool used, determined that the service users body mass index was normal. The inspector had highlighted this point at the last inspection. The inspector is disappointed that matters bought to the attention of the home at the last inspection regarding this service users care plan have not been actioned. The obesity was not addressed in the care plan. Issues around medication including risk assessments for self-administration, have not been addressed and once again were not evident. A requirement has been made that all members of staff completing nutritional risk assessments are trained to do so and have a basic understanding of the use of the BMI scale to protect the health and well Highfield Care Home DS0000065782.V250527.R01.S.doc Version 5.1 Page 11 being of service users. A requirement is made that this persons care plan is suitably reviewed and updated to include necessary risk assessments. The inspector observed that although this service user was able to contribute to, and understand their care plan, there was no evidence that they in fact had. It was recommended at the last inspection that people were to become more involved with their care plans. This was not evident. The second care plan was of far better quality. It was well documented and well reviewed. It had some very good quality documentation pertaining to the care and prevention of pressure wounds. The home has a suitable room for the storage of medication, which contains lockable cupboards, a sink for hand washing and a medication fridge. Medication is delivered in MDS from Boots. The Deputy Manager orders medication on a monthly basis. The medication when it arrives is checked in and recorded. Only trained nurses administer medication. The home has a signature form so that signatures and initials of nurses can be recognised against a name. Therefore anyone who signs for medication can be identified. Mar chars were viewed. Handwritten entries on Mar sheets did not identify 1) who wrote the instructions, 2) who the instructions came from, 3) when medication commenced 4) the route the medication was intended to be administered. One resident was identified by two different first names and spelling of second name in the medical administration folder. A requirement was made for this to be amended. Highfield Care Home DS0000065782.V250527.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): 15 The home provides a nourishing choice of meals and residents know they are able to make daily choices for their preferred food. EVIDENCE: The subcontracting of meal provision to an outside company is to cease at the end of March and meals will be provided directly from the homes own kitchen. The larder was adequately stocked with fresh, frozen and dried stored food. There was a variety of fresh fruit and vegetables in the store cupboard. A daily menu is given to each resident to make his or her choice of meals for the following day. The Inspectors were pleased to note that residents had chosen to eat their meals in different areas of the home including bedrooms and that this had been accommodated by the staff. There was also pleasant banter between residents and staff when their meals were being served to them. One resident confirmed that she was eating her lunch in her preferred area of the home. The kitchen was clean and tidy. Despite a cleaning rota for the kitchen in evidence, the staff rota did not indicate that adequate staff time had been allocated to undertake the tasks. The Inspectors noted that the chef Highfield Care Home DS0000065782.V250527.R01.S.doc Version 5.1 Page 13 undertook most of the cleaning in addition to his cooking duties. A requirement was made elsewhere in the report for the home to continually assess the staffing levels and this is to include the domestic hours to ensure the kitchen maintains an hygienic environment without compromising the chefs’ work time. Highfield Care Home DS0000065782.V250527.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): 16 A suitable complaints procedure displayed will improve communication if a complaint is to be made. EVIDENCE: The company operates a complaint procedure. Comment cards are available in the reception area for people to write their opinions of the home and add suggestions to improve the home. A requirement was made for a suitable complaints procedure to be displayed in the entrance area of the home. Highfield Care Home DS0000065782.V250527.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): 19 21 24 26 Maintenance work and risk assessments, will improve and make safe the residents environment. Residents have sufficient lavatories and washing facilities. Residents’ bedrooms reflect their needs and include their personal possessions. The home was clean, pleasant and hygienic. EVIDENCE: The Inspectors were pleased to see that hot water thermostats had been provided to baths and sinks in the home following a previous requirement. A recent fire risk assessment has been undertaken in response to a previous requirement. The home has previously reported to their head office certain maintenance work that required undertaking. An electrical engineer is to undertake the emergency lighting maintenance. The Inspector noted that the annual lift maintenance certificate stated that it should be taken out of service until an appropriate sign stating the maximum weight to be carried was put in place. The Deputy Manager and the homes maintenance man were not aware of this Highfield Care Home DS0000065782.V250527.R01.S.doc Version 5.1 Page 16 and the maintenance man immediately telephoned the lift company to organise this as a matter of urgency. At the previous inspection, the Inspectors had required a risk assessment to be made of the attic steps that are poorly sited and when extended block the upstairs fire door exit to the fire escape. The steps are in two parts, the lower half creates a moving and handling hazard when lowered to the floor and placed in position. The risk assessment has not been actioned and another requirement was made for this to be undertaken as a matter of urgency. The maintenance man has made a start on cleaning the wooden fire escape steps but had ceased due to the bad weather. A requirement was made for this to be completed. Painting on window ledge viewed from Room 11 in poor condition and needs making good. Rooms have lockable facilities. All radiators have covers. All water temperatures are safe. One room had an air mattress but the mattress was deflated. The battery had been used for an air cushion. A cracked window pane in the conservatory is to be replaced. Several areas of ceiling are damaged. The area outside room 21 is water damaged. Another area has a piece of ceiling removed. This is due to identified pipe work being replaced. The maintenance man said that once the work has been completed the ceilings would be made good and decorated. One area of hallway carpet has been repaired with silver tape. It looks shabby and creates a trip hazard. The Inspectors appreciate that much of the ongoing maintenance has been identified by the home and that ongoing work is allocated by the owning company. The dining room and two lounges were furnished and decorated in an attractive, homely and comfortable manner. There is a large and light reception area with comfortable lounge furniture. Residents were seen at different times of the day, relaxing in this area. Residents’ bedrooms are comfortable and some contained personal possessions, making them a welcome environment. There are sufficient lavatories and washing facilities. Eighteen bedrooms have en-suite facilities. As previously commented on, the upstairs bathroom is now an attractive and comfortable environment since the incorrectly placed hoist has been removed. The home was clean, light and with no offensive odours at the time of the inspection. Highfield Care Home DS0000065782.V250527.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): 27 29 Residents’ needs may be met if recruitment practices are improved. An assessment of staffing numbers may improve in residents needs being met. EVIDENCE: Staffing- The home has 2 new flexi bank nurses and 5 RGN. The home has 26 residents. 6 people are double handers. 5 are hoisted. There was no written evidence of a suitable staffing tool being used to determine staff numbers. In the mornings there are 2 trained staff and 5 carers on duty. In the afternoon there are 2 trained staff and 3 carers. There is also an activities lady (10-4.30). The Inspectors noted that the call bell rang for long periods before being answered throughout their visit. This indicates that the staff are too busy to answer them immediately. The call system is centrally located and staff have to go to that area each time a bell rings to ascertain who is calling for assistance. The Deputy Manager stated that the company are reviewing this with a view to replacing it with a modern system. Staff confirmed that they believed that they were sometimes short staffed. One member of staff said it was 4 carers sometimes in the morning not 5. The home does not have student nurses or adaptation nurses, although some carers are trained nurses from other countries that are awaiting adaptation. Highfield Care Home DS0000065782.V250527.R01.S.doc Version 5.1 Page 18 The deputy manager said that night staff have supervision but this was not evidenced in a member of night staffs file. Four staff files were viewed. 2 trained nurses and 2 carers. One file contained two written references and there was evidence that one reference had been followed up with a telephone reference. There was no evidence of a formal interview. There was no evidence in the file to confirm that the nurse was qualified or had a current Personal identification Number issued by the Nursing and Midwifery Council. There was only 1 form of identification contrary to Schedule 2 of the National Minimum Standards. The file had no CRB or evidence that a CRB had been undertaken. The file had no evidence of formal supervision. The file had held no certificates and no evidence of current training undertaken. The second file contained no certificates of proof of current training. No evidence of supervision. No CRB check. The third file – a carers, did not have any interview notes, no supervision notes, no evidence of induction and no certificates. Did have 2 refs, CRB, Birth cert. Passport. But had changed jobs on a yearly basis and more should have been done to find out about previous positions. The forth was a file of a carer working here from abroad. There was insufficient evidence to show home office clearance. Although the home states it has seen this there is no clear evidence in the carers file. A recommendation is made that photocopies of any documentation is legible. This file only had one reference. The inspector spoke with two members of staff. One was a trained nurse from abroad awaiting adaptation training, to work as a trained nurse in Britain. The other was a carer working on permit from abroad. The home has a multi national staff, who communicate well with the people that live in the home and with each other. Both the carers enjoyed working for Highfields and spoke enthusiastically about the people that live there and also their work. They demonstrated a good knowledge of the needs of the people that they care for. Both carers thought that the food was good at the home. They thought that people were well looked after at the home. Both indicated that there were times when they could do with an extra carer to help. One discussed how sometimes female service users say ‘no’ to a male carer and this accepted by the home and understood by the carer. A female carer will then work with them instead. The chef was enthusiastic and knowledgeable about the residents’ menus and showed a great awareness of the health and hygiene needs of maintaining a kitchen to a high standard. Highfield Care Home DS0000065782.V250527.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 36 38 Residents’ health safety and welfare are compromised by lack of required information in care plans and staff files including evidence of suitable recruitment, training and supervision. EVIDENCE: As previously indicated in this report, care plans and staff files viewed on the day of the inspection do not contain the all the information indicated in the National Minimum Standards. A requirement was made for these to be completed. There was no written evidence seen at the time of the inspection, of staff supervision being regularly undertaken. Highfield Care Home DS0000065782.V250527.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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 2 X 3 X X 3 X 3 STAFFING Standard No Score 27 2 28 X 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 2 X 2 Highfield Care Home DS0000065782.V250527.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP29 Regulation 19 Requirement Recruitment and supervision practices are to meet National Minimum Standards and staff files maintained appropriately. Staffing levels to be reviewed. Maintenance work identified is to be assessed and an action plan sent to the Inspector. A complaint procedure is to be displayed in the home. Accurate recording for medical administration is to be maintained. The health and welfare of residents is to be recorded and monitored and preventative and restorative care provided. Timescale for action 20/03/06 2 3 4 5 6 OP27 OP19 OP16 OP9 OP8 19 23 10 12 12 20/03/06 27/02/06 21/02/06 20/03/06 20/03/06 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 Care Home DS0000065782.V250527.R01.S.doc Version 5.1 Page 22 Highfield Care Home DS0000065782.V250527.R01.S.doc Version 5.1 Page 23 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.V250527.R01.S.doc Version 5.1 Page 24 - 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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