Inspection on 07/01/09 for Highfield Care Home

This inspection was carried out on 7th January 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Highfield Care Home 23/01/07

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 20/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Highfield Care Home 34-36 Hoe Lane Ware Hertfordshire SG12 9NZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Yoke-Lan Jackson     Date: 0 7 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Highfield Care Home 34-36 Hoe Lane Ware Hertfordshire SG12 9NZ 01920468976/467508 01920485728 highfield@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Tamhealth Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Name of registered manager (if applicable) Lilian Nwamaka Ofondu Type of registration: Number of places registered: care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 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. Date of last inspection Brief description of the care home Highfield Care Home is a residential care home for older people who require nursing care. It is owned and managed by Tamhealth Limited, which is a member of the Four Seasons Health Care group. The home is located on the outskirts of Ware, about a mile from the main shopping centre and local amenities. The building is a two-storey building served by a small lift. The administrative offices, dining room, kitchen and laundry room are all on the ground floor. There are ample community spaces including a main lounge and smaller sitting areas. There are bedrooms on two floors and most of the bedrooms are for single occupancy but there are some double rooms. Some Care Homes for Older People Page 4 of 25 Over 65 54 0 Brief description of the care home bedrooms have en suite facilities. There is a large back garden overlooking the countryside. The garden is well maintained with garden furniture and is accessible to wheelchairs. The home charges £538.93 to £850 per week. Information about the home and the service it offers is contained in the Statement of Purpose and the Service User Guide. A copy of these and the most recent inspection report are available in the home. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection was carried out on 07/01/2009. Both the registered manager and the deputy were present. The inspection included a tour of the premises. Time was spent observing how the staff interacted with residents and included a lunchtime observation and an observation of group activity in the main lounge in the afternoon. Residents, relatives and staff were interviewed and relevant documents were examined. Information received by us since the last inspection was reviewed. This included the Annual Quality and Assurance Assessment (AQAA) which providers of registered services are required to complete. The AQAA focuses on how the outcomes are being Care Homes for Older People Page 6 of 25 met for people using the service and also provides us with statistical data. Survey questionnaires were sent to residents and their responses were reviewed, and the opinions of relatives were also taken into consideration. What the care home does well: What has improved since the last inspection? What they could do better: The current arrangement by the provider to keep a pooled bank account for personal allowances may not be in the best interest of each person who lives in the home. The bank interest accrued is added to a fund-raising account. Fund-raising is carried out by staff. There is no fund-raising committee and therefore no proper representation of the residents and relatives. The current system may not ensure that each residents money is handled appropriately or safeguarded. These financial matters have since been referred to Hertfordshire County Council under the Joint Safeguarding Procedures for further investigation. The continued use of wedges to prop doors open exposes residents to risk of being harmed should there be a fire in the building. Since the site visit, the use of wedges to prop doors open has discontinued and the manager has confirmed that all the remaining doors that needed automatic hold-open door devices have been fixed with Care Homes for Older People Page 8 of 25 the devices. To ensure the safety of all the people who live in Highfield, we have informed the Hertfordshire Fire and Rescue Service who will conduct a Fire Inspection. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A prospective client can be assured that a pre-admission assessment will be completed before they are admitted to ensure that the home can meet all their care needs. Evidence: The home manager carries out the pre-admission assessment using the organisations specially designed form called the Dependency Rating Tool for Assessment and Admission which was reviewed and improved in October 2008. The pre-admission documents for two recent admissions had detailed information about their personal, health and social care needs. The deputy manager confirmed that the initial care plan is drawn up with the person and their relative on admission and this forms the basis for the care to be delivered. A nurse is assigned as the key worker, who is also responsible for the monthly review of the persons care needs. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can expect to be treated with respect and can rest assured that although care plans are not yet in person-centred format their personal and healthcare needs can be met. They are protected by the homes medication policy and procedures. Evidence: Each resident has a comprehensive written care plan. The care plans examined were informative and detailed with specific needs identified and risk assessments carried out where appropriate. However, the written care plans are not in person-centred format which would enable staff to identify and deliver care in a manner that upholds the persons individuality while meeting their care needs. The management said that they will discuss this issue with their training officer before reviewing the written care plan format. Each resident has a regular review of their care needs and there is a review that involves all parties including their next of kin and the relevant social worker. The daily Care Homes for Older People Page 12 of 25 Evidence: records were well maintained. The deputy manager said that one of her roles is to ensure that all the written care plans are properly documented and that they are kept up to date. She confirmed that the current group of residents have no incidence of pressure sores, except for a case where the skin is slightly red. Residents have access to their own doctor and healthcare services when required. One of the residents who requires daily food intake via a percutaneous gastronomy tube (PEG feeds) was visited by the dietician in the afternoon. The referral was made to ensure that the residents nutritional needs and fluid intake are balanced and adequate. The home works closely with and is supported by the local palliative care specialist team. The nurses have regular refresher training on the administration of medication. The Medication Administration Record (MAR) charts examined were correctly signed with no gaps. However, there were a couple of handwritten notes that were not signed and dated by the author. The management assured us that this issue will be addressed immediately. There were some controlled drugs and temazepam in use and these were stored in the Controlled Drugs Cupboard and accurately recorded. There have been no errors in the administration of medication. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are given every opportunity to participate in all aspects of daily routine living and they receive a wholesome and balanced diet. They are encouraged to maintain links with their family and friends. Evidence: The chef and his assistants discuss the menu with every new resident to ensure that the menu reflects the residents preferences. The home follows the Food for Thought manual, produced by Best Chef, in planning the menu and a new policy named New Standards for Food and Nutrition was launched in October 2008. On the day of the site visit, the chef was observed dishing out the hot meals for each resident according to the choices they have made. The daily menu was on display in the dining room and the main dish for the day was chicken pie, mashed potatoes and vegetables. An alternative dish was provided to a resident on a vegetarian diet and another had fried eggs as requested. Mealtime was unhurried and a member of staff was present to give assistance as Care Homes for Older People Page 14 of 25 Evidence: required. The member of staff said that normally there are 2 care workers present in the dining room. However, on the day of inspection, the second member of staff had gone to help a resident in their bedroom. The residents consulted were all complimentary about the meals provided. It was noted that some residents remained in their wheelchairs as they have their lunch. A resident consulted said that they prefer to be in their wheelchair as it is more comfortable for them. The manager ensures that each wheelchair user is given a choice as to which chair they wish to use, subject to any risk assessment. The manager said that a form will be used in future to evidence the choice given and this will be reviewed on a regular basis. On the afternoon of the site visit, it was noted that most of the residents were in the main lounge. Some residents took part in a group activity called Countdown. Those who participated seemed to enjoy themselves. The part-time activity co-ordinator works 24 hours a week and the manager said that the hours will soon be increased to 30 hours per week from 12/01/2009. The activity co-ordinator said that members of staff assist with activities if they are not busy with personal care. The activity programme and some photographs of social events were on display in the entrance hall. We received positive responses from a recent survey which indicated that residents are generally satisfied with the activities provided. The activities offered vary and they include a Sing-Along entertainer and other entertainment twice or more a month. The co-ordinator also organises outings, and visits include the garden centre for tea. It was noted that the budget allocated by the provider is below the expenses incurred by the home. In order to ensure that residents activities and outings continue to be well maintained, the home has fundraising events to contribute towards the cost. As a result of listening to residents at the Residents meeting, a gazebo was purchased using the fund-raising account. Residents make full use of this especially in the warmer months. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a robust Complaints Policy and Procedure and people can be assured that their complaints will be listen to and acted upon. However, the current system for handling residents personal allowances may not safeguard each residents finances. Evidence: The manager said that all members of staff have had training on issues regarding abuse and the Whistle-blowing Policy. Staff are aware of the joint agency Safeguarding of Vulnerable Adults (SOVA) Procedures of Hertfordshire County Council Adult Care Services. The home has received three complaints which have been investigated within the specified time scale and in accordance with the homes Complaints Policy and Procedures. There has been a written complaint that was referred by us as a safeguarding issue and which is currently being investigated by the Hertfordshire County Council Adult Care Services. Since the inspection, we have also referred to Hertfordshire County Council under the Joint Safeguarding Procedure some issues in regard to the way personal allowances of residents are being handled. (See section on Management and Administration). Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is attractively decorated and well maintained to meet peoples needs. However, better attention needs to be given to fire risks to ensure people are kept safe at all times. Evidence: The home is generally well maintained, comfortable, clean and tidy. The dining room is attractively refurbished and decorated. The residents spoken with said that they were pleased with their bedrooms, which have personal items on display. One of the residents whose bedroom overlooked the large garden and open countryside said I have no complaints about my bedroom. However, on the day of the site visit, it was noted that many of the bedroom doors have been wedged open manually with wedges. This practice exposes residents to risk of being harmed should there be a fire in the premises and the Regulatory Reform (Fire Safety) Order, 2005, disallow the use of wedges in residential care homes. Doors, including bedroom doors should be held open with automatic hold-open door devices so that in the event of a fire these doors will be automatically shut to protect residents who are in their rooms. It was further noted that the door to the small lounge called the Lilac Room was Care Homes for Older People Page 17 of 25 Evidence: wedged open with a wooden wedge and there were three residents in the lounge having their hair dried under the hairdryer. The manager and maintenance man later confirmed that there are 38 doors that require automatic hold-open door devices to be installed. Since the inspection, hold-open door devices have been installed to these doors. It was noted that the home has had an inspection from the Hertfordshire Fire and Rescue Service in February 2008. The home was instructed to install intumescent strips and smoke seals on all fire doors. The manager said that this requirement has been met. The passenger lift remains inadequate due to the restricted space within. The manager said that there has been a consultation and review but due to the high cost involved, the idea to resite and fix a larger size lift has been abandoned. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be assured that the service has a thorough recruitment process to help keep them safe and that there is an effective staff team who will support them. Evidence: The home has recruited nurses and care workers of diverse backgrounds and experience to ensure that the skill mix of staff is appropriate to the assessed needs of the residents. The registered manager spoke highly of her staff and the feedback from some residents and some relatives have been also positive. Members of staff spoken with confirmed that they have had induction training and that they only commence working after they have been checked against the Protection of Vulnerable Adults (POVA) and the Criminal Record Bureau checks and clearance. The home follows the Skills for Care training programme and new recruits have a 12-week induction programme. Nurses have regular refresher courses which include the Liverpool Care Pathway Programme, Wound Care and Prevention of Pressure Sores and Medication. All staff have training on Dementia and other specialist conditions including palliative care. Care Homes for Older People Page 19 of 25 Evidence: The manager confirmed that all the staff record files have been kept up to date. The files examined were well documented and complied with the homes recruitment policy and procedures and with legislation which ensure residents safety. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home can be assured that they will receive good personal care. However, their safety and welfare may be compromised because of fire hazards and a pooled bank account for personal allowances. Evidence: The general administration and management of the service is well maintained. However, residents have been exposed to fire risk due to doors being propped open with wedges. Since the site visit, the use of wedges to prop doors open has discontinued and the manager has assured us that automatic hold-open door devices have been fixed to the remaining doors instead. All the residents personal allowances are currently kept in a pooled account in the bank and the monthly bank interest accrued is added to the fund-raising account. Although there is an internal ledger kept of each residents personal allowance contribution and balance it does not include the bank interest accrued as the interest Care Homes for Older People Page 21 of 25 Evidence: gained is not added to each persons account. The registered manager said that she has no control over the current practice as the direction comes from the provider, Four Seasons Healthcare Limited. Fund-raising is carried out by staff. The manager hopes to set up a fund-raising committee with proper representation from residents and relatives. The current system may not ensure that each residents money is handled appropriately or safeguarded. These financial matters have since been referred to Hertfordshire County Council under the Joint Safeguarding Procedures for further investigation. The home has an annual quality assurance and monitoring system in place that includes survey questionnaires for residents, relatives, staff and others. Information received is collated and analysed and an annual report is produced, which is readily available for inspection. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 23 All doors should be held open with automatic holdopen door devices approved by the Fire Authority. This is to protect people living in the home from harm should there be a fire in the premises. (This Requirement was met on 16/01/2009) 31/03/2009 2 35 12 The registered provider must ensure that residents personal allowances are not kept in a pooled bank account. This is to safeguard each residents personal allowance. 30/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 25 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - 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!