Inspection on 23/01/07 for Highfield Care Home

This inspection was carried out on 23rd January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 07/01/09

Highfield Care Home 08/11/05

Highfield Care Home 21/06/05

Highfield Care Home 02/12/04

Highfield Care Home 06/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta 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 34-36 Hoe Lane Ware Hertfordshire SG12 9NZ Lead Inspector Mrs Jan Sheppard Unannounced Inspection 10:00 23 January 2007 rd 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 DS0000019425.V315252.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 DS0000019425.V315252.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highfield Care Home Address 34-36 Hoe Lane Ware Hertfordshire SG12 9NZ 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) 01920468976/467508 01920 485 728 highfield@fshc.co.uk Tamhealth Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Lilian Nwamaka Ofondu Care Home 54 Category(ies) of Old age, not falling within any other category registration, with number (54) of places Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home may accommodate 54 older people who require general nursing care. This home may accommodate up to 10 older people who require personal care. 8th November 2005 Date of last inspection Brief Description of the Service: Highfield Care Home provides nursing care and accommodation for 54 older people. It is owned and managed by Tamhealth Limited, which is a member of the Four Seasons Health Care group. The home is located on a hill on the outskirts of Ware, about a mile from the main shopping centre and local amenities. The home was opened in 1999 and consists of a two-storey building set in beautiful well-maintained gardens. The majority of the homes bedrooms are for single occupation but there are some double rooms, which are currently being shared. Some rooms have ensuite facilities. The attractive level garden gives easy access for the service users. The current fees range from £513 to £850 per week. Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day when two inspectors visited and spoke with residents, staff, visiting relatives and the homes manager and spent time inspecting the building and its facilities and reviewing its administration and record keeping. This was a positive inspection; it was found that all the requirements made following the last inspection have been met. Four good practice recommendations are made following this inspection. Since the last inspection the home has been subject to major refurbishment works, which have greatly improved the overall ambience of the home. What the service does well: What has improved since the last inspection? The refurbishment works that have been undertaken since the last inspection have greatly improved the homes appearance and general ambience this being very positively commented on by residents and relatives alike. Since the last inspection the range of activities offered to the service users has increased, as has the time that staff are able to spend engaging them in these activities. Since the last inspection following specialist training good links have been established with the local Palliative Care Services. Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 Page 7 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 DS0000019425.V315252.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 is not applicable as this home does not accept residents for intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The care needs of all prospective service users are fully assessed by the manager before admission is agreed. Prospective service users have good information about the home this to enable them to make an informed decision as to whether the home can provide the service they need. EVIDENCE: The homes pre admission policy and procedures are compliant with the requirements for these standards and were found to have been fully carried out for the residents recently admitted to the home. The manager explained that she carries out these pre admission assessments herself visiting the prospective applicant either in their own home or, more usually, in hospital. Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 Page 9 Medical and social service reports are always sought so that the home can be fully informed about the prospective residents circumstances, and she mentioned how difficult it can be to obtain any such reports for privately funded applicants. Relatives of recently admitted residents spoken with confirmed that this admission process had been handled sensitively, that their relative had settled into the home quickly and that the were always made to feel very welcome when they visited. One said, “ the staff have always got time to talk with me which I really do appreciate as this is a difficult time for the whole family.” Another commented how much they appreciated the good kind care that their relative was receiving for these last days. The records evidenced that pre admission needs assessments are constantly reviewed with time intervals set as individual needs dictated to meet the quickly changing needs of the residents, and that relatives are involved with these reviews if the wish. Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 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): 7,8,9, 10 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. All the residents care needs are set out in their individual care plan. Recommendations are made for improving the recording of requests for medical visits, catheter care and of the care for pressure areas. The homes robust policy and procedures for the storage and administration of medication were found to be being followed and the standards met. Residents are treated with respect and dignity. Special care is arranged for residents and their families during the time of a final illness. EVIDENCE: Personal care was seen to be being delivered by qualified and experienced staff in a kindly manner that respected the residents dignity and individuality. It was noted that staff of all grades worked very well together as a team and that they promoted a calm and relaxed atmosphere within the home. They all Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 Page 11 appeared to have good knowledge of the residents individual needs, preferences and requirements and particular ways of how these care needs could best be delivered. Care plans examined were all found to be very well maintained. The company has recently introduced a new care plan format, which has made a considerable overall improvement. Very good detail was seen to be recorded as to how appropriate care was to be delivered. Clear recording of weights, fluid monitoring and referral to dieticians and doctors was seen. However so that the care process can be fully evidenced it is recommended that more detail is recorded as to the exact reason a request for the doctor to visit is made; i.e. doctor asked to visit to assess weight loss rather than just the statement that a doctors visit is requested. The manager explained that since the last inspection senior staff had attended training on specialist care for pressure areas, the Liverpool Care Pathway Programme, and that subsequently the home had developed good working links with their local specialist palliative care team. The records evidenced that daily records are kept for each resident with progress sheets with regular reevaluations, reassessment of wound size and a monthly photograph taken. A separate wound care plan should also be compiled for each wound so that their progress can be assessed and treated separately. Staff consulted evidenced their good awareness of these new recording processes and care arrangements for pressure areas. Concerning catheter care the size of this should be recorded along with the frequency of changes of the catheter bag. Information from relatives and evidence from the care plans evidenced that the staff have a good awareness of the particular strains and needs for service users and for their families during a final illness. The home makes special arrangements to cater for families who may wish to stay in the home or to participate in some care duties for their relative in their final days. The sensitivity and manner in which this was handled by the home was favourably commented on. Additional training for all staff concerning this area is being planned for the spring. Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home provides a variety of activities, which meets the varied needs of all the service users. Relatives and visitors are always welcome in the home. Good quality and nutritious food is provided. EVIDENCE: Residents spoken with were all very complimentary about the quality and variety of the food. One said,” the chef comes around nearly everyday to ask us for our opinions and will always try out a new recipe for us.” One visiting relative commented favourably on the fact that she is always offered refreshments whenever she visits and is able to share lunch with her mother. The inspectors observed the serving of lunch. The meal was presented in an appetising manner and the residents were helped to make a daily menu choice. For those who needed it, assistance was given with feeding in an Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 Page 13 discrete manner, at an individually assessed speed with attention being given to enabling the resident to retain their dignity with encouragement given for them to do as much for themselves as they could comfortably manage. The range of activities offered in the home has increased since the last inspection and during the time of this visit a number of classes and individual activities were observed. Residents mostly spoke very positively of these activity opportunities and several said that as they did not wish to participate they were not expected to do so. Records of each residents individual activity preferences and participation were seen to be recorded on their care plans. For the residents who were very unwell and bed bound an activities worker spent time individually with them in their rooms following a particular activity or interest that they had. Records of this one to one involvement were also seen to be recorded such as “ Spoke and shared with Mr. X about this love of classical music “. The home has a high number of visitors and many were seen in the home on the day of this inspection. Several commented favourably on the recent improvements to the decorations of the home and appreciated the fact that a specific meeting was held to allow them to give their views about this. Others said that they were involved with various fund raising activities for the home. Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a robust complaints procedure and follows the Safeguarding Adults procedures as set out in the Hertfordshire County Council Joint Agency Guidelines. EVIDENCE: There have been no incidents concerning Safeguarding Adults since the last inspection. Staff all attend training on the protection of vulnerable adults and whistle blowing procedures. Staff spoken with during this inspection were familiar with what action they should appropriately take if ever they had suspicions concerning possible abuse. No complaints have been made to the CSCI concerning this home since the last inspection. A number of complaints made by relatives concerning the delay in redecorations to residents bedrooms during the homes recent refurbishment programme were seen to have been handled correctly, and were according to the manager justified complaints in that she and relatives were originally told that all residents bedrooms would be redecorated at the same time and then due to financial constraints a longer time frame was agreed without any consultation. The matter has now been resolved and all residents consulted and their bedrooms are being redecorated and a number of refurbishment Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 Page 15 works are also being carried out. Relatives confirmed that they had confidence that the manager would listen to them and would sort out any problems. Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 Page 16 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home is spacious, well appointed and with the exception of small items in the kitchen, is generally well maintained. With one exception it adequately meets the space and facility provision standards. On the day of this unannounced inspection it was found to be odour free and very clean and tidy. EVIDENCE: The home was found to be very clean and tidy with spacious space provision and attractive decorations. Since the last inspection the home has under gone a “Make-Over” with refurbishment works, new furnishings, floorings and fittings to all the communal areas recently completed and works of redecoration and replacement of some furnishings still continuing in the residents bedrooms. The overall appearance is fresh and attractive although Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 Page 17 some staff and residents did comment that they thought that the style was too modern and did not really reflect the perceived tastes of older people. Most of the residents consulted said that they were very happy to be in such lovely colourful surroundings but added that they were very pleased that they could make their own choices for the redecorations of their own rooms which were all found to be very well personalised in styles and colours that reflected their individual tastes. One resident told the inspector “ my room is very comfortable and I have all the things I need in it, the staff and my family helped me to get it as I wanted it “. The manager explained that a new kitchen floor has still to be fitted. It was noted that repairs are also needed to the leaking tap on the wash hand basin in the kitchen and that the window should have a mesh protector to keep out flies etc. Specialist equipment is provided for each resident to meet their particular needs following an OT assessment. This promotes the residents ability to retain their independence for as long as possible. The facilities provided in the home generally meet the needs of the service users very adequately. Over the past year the number of hoists has been increased and all new residents will be provided with a pro filing bed. However the homes lift is very small and several staff commented about the inadequacy of this and the difficulties experienced getting large objects from the first floor. It is unfortunate that this aspect was not included in the recent refurbishment and improvement works to the home. Consideration must be given to replacing the lift with one which will more adequately meet the increased service needs of the home. Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome is is good. This judgement has been made using available evidence including a visit to the service. The home is adequately staffed with experienced and qualified nurses and carers who all seemed to be very positive about their work and to work well together as a team. The home has robust policies and procedures for the recruitment of staff, which ensure the proper protection for the service users. EVIDENCE: Staff were seen to be working well together as a team and to be providing support for the residents in a kindly unhurried manner, allowing them to do as much for themselves as it is safely possible for them to do. Staff were found to be familiar with the needs of the residents and a good rapport was seen to exist between them. The home continues to retain a core group of very dedicated and well-trained staff many who have worked at the home for many years. Staff who spoke to the inspectors during this inspection all said that they were happy working at the home, happy with the manner in which they were managed and with the training opportunities offered them. Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 Page 19 The recruitment records examined for staff most recently appointed to the home evidenced that all the required checks had been made this to ensure the safety of the residents. Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 Page 20 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): 31,33 and 38. Quality in this outcome area is good. This judgement has been made sing available evidence including a visit to the service. The home is run in the best interests of the service users.The registered manager provides strong leadership in the home. The health and safety of the residents is promoted by the homes good maintenance of its safety checks and procedures. EVIDENCE: The home benefits from a stable management team who are all well qualified and experienced managers whose ethos is very clearly to put the needs of the service users first. Their confident and calm approach to their work positively influences the homely and relaxed atmosphere in the home where meeting Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 Page 21 the nursing and social care needs of the service users integrated. was found to be well Residents relatives and visiting professionals interviewed for this inspection confirmed that the manager and her team were always very approachable and make every effort to sort out any problems quickly. A relative commented “ I am always made to feel welcome when I visit the home”. The records evidenced that a supervision matrix is in place to ensure that all staff receive formal supervision at least six times a year. Staff spoken with confirmed to the inspector that they felt themselves to be well supervised and managed and that they could speak to the manager at any time regular staff meetings are held with appropriate agendas and minutes being kept. Quality assurance systems are in place and discussions with the manager evidenced that she is proactive in addressing quality issues within the home. The manager is committed to promoting equality and diversity in the service and meeting the service users individual needs. The records relating to Fire Testing, the monitoring of water temperature, risk assessments for the environment and safety checks for the home equipment were seen to be well maintained this ensuring the safety of the residents at all times. Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x x x 3 Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 Page 23 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 OP24 Regulation 13(4)(c) Requirement An action plan including risk assessments concerning how the renovation works to the internal fabric of the home are to be managed must be submitted to the CSCI before the work commences in 2006. This standard has now been met. Timescale for action 31/01/07 Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 Page 24 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. 2 Refer to Standard OP7 OP7 It is recommended that to ensure clarity precise reasons for the request for a doctor to visit are recorded. It is recommended that the size of the catheter should be clearly identified on the care plan along with records as to the frequency of the change of catheter bags. It is recommended that to fully meet the needs of the service a larger lift is installed; and that repairs and improvements as detailed in the text for this standard are made in the kitchen. Good Practice Recommendations It is recommended that to ensure better clarity details of the care plan of each individual pressure wound should be recorded. 3 OP7 4 OP19 Highfield Care Home DS0000019425.V315252.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hertfordshire Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 DS0000019425.V315252.R01.S.doc Version 5.2 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!