Inspection on 16/01/07 for Highfield Grange

This inspection was carried out on 16th 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 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 Grange 14/01/08

Highfield Grange 27/07/06

Highfield Grange 29/11/05

Highfield Grange 29/04/05

Highfield Grange 04/01/05

Highfield Grange 19/05/04

Highfield Grange 09/03/04

Similar services:

Snydale Care Home

Abbey The

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Highfield Grange John Street Wombwell Barnsley South Yorkshire S73 8LW Lead Inspector Mrs Jayne White Key Unannounced Inspection 16th January 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Highfield Grange DS0000038647.V324975.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 Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highfield Grange Address John Street Wombwell Barnsley South Yorkshire S73 8LW 01226 341123 01226 756 986 none None Barnsley PCT 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) Mrs Susan Christine Thickett Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The ten single bedrooms with a partition screen must be used as double bedrooms. The occupants of these double rooms must be given the option to move to single bedrooms when available. Flats 1, 2 & 5 must be used for intermediate care only. Flats 3 & 4 must be used for long-term care/short stay only. Staffing levels must be maintained at, at least, the minimum levels required by the April 2002 published `Residential Forum, Care Staffing in Care Homes for Older People` by 1/5/2003. These levels do not include managerial, nursing, administrative or ancillary hours, which must be over and above these levels. The area used for day care must be available for use by the home’s service users from 1600hrs to 0700hrs, Monday to Friday and at all times Saturdays and Sundays. The registered manager works 5 days (37 hours) per week as the registered manager. Three of the forty registered places can be used as either intermediate or short stay care for persons aged 55 - 65 years. 27th July 2006 5. 6. 7. Date of last inspection Brief Description of the Service: Highfield Grange is registered as a care home providing personal care and accommodation for 40 older people. Barnsley Primary Care Trust owns the home. The home layout consists of five flats. Since registration the use of flat 5 has changed. A variation of registration form was sent to the provider but has not been returned, however, currently flat five is not being used. Residents on flat one and two were admitted for intermediate care and residents on flat three and four were long term residents and those admitted for short stay and respite care. Accommodation is all on one level. There home is registered for thirty single and five double bedrooms. A range of communal areas are provided. A commercial type kitchen and laundry serve the home and there are domestic type kitchenettes on each flat. Sufficient bathing facilities are provided. The home stands in its own grounds and has garden areas that were well Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 5 maintained and accessible. There are car-parking facilities. Highfield Grange is close to Wombwell town centre. Main bus services run close to the home and the home is a short distance from the town centre. Information about the home is available in the entrance hall to the home and a service user guide is provided in each bedroom. The latest CSCI inspection report is also available in the entrance hall and the service user guide informs residents where this can be obtained. The fee for permanent residents was £291.83 and the cost for respite and short stay residents was £41.69 per night. There was not a fee for intermediate care residents. Additional charges were made for hairdressing, private chiropody, toiletries, papers and magazines and manicures. The fees were those that applied at the time of inspection and people may wish to obtain more up to date information from the care home. Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place over eight and a half hours from 9:30 to 18:00. As part of the inspection process ten questionnaires were sent to residents and six to GPs to obtain their opinions of the home. Residents returned six questionnaires and GPs three. On the day, opportunity was taken to make a partial inspection of the premises, inspect a sample of records, observe care practices and talk to residents, visitors, staff and the manager. Nine of the staff on duty were spoken with about their knowledge, skills and experiences of working at the home, together with two of the twenty eight residents about their views on aspects of living at the home and one relative about their opinion of the home. Also taken into account was other information received by CSCI about the service since the last inspection. In addition the CSCI have reviewed their guidance on requirements, therefore, some requirements have been removed if they had no direct evidence of service user outcome, or reworded. The inspectors wish to thank the residents, staff and managers for their time and co-operation throughout the inspection process. What the service does well: On the whole residents and staff benefited from the ethos, leadership and management approach. Staff morale was good and all residents, their advocates and staff spoke positively about the management team. The home had a warm and welcoming atmosphere and residents were comfortable to give their opinion of the service. Residents spoken with said their needs were met and they were happy with the care offered to them. The focus of the home was to admit residents’ for intermediate care, respite and short stays although there were residents that lived at the home on a permanent basis. Residents had their needs assessed prior to admission and the intermediate care service provided residents with rehabilitation, to enable them to return home and it was evident that this service worked well. Residents comments about their admission and stay at the home included “I was discharged from hospital to the home as I couldn’t go home because of the access”, “I was transferred to Highfield Grange by Barnsley District General Hospital, for re-habilitation”, “I was well looked after during my stay at Highfield and would consider going back for respite care any time I need to” and “my stay in Highfield Grange was excellent. I was met at the front door on my arrival, wheeled to show me my room, a quick visit to the sitting room plus a nice, hot, welcoming cup of tea and then shortly wheeled to the dining room Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 7 for an excellent lunch. The physios were marvellous in every way, as were all the staff on every level”. Residents’ admitted solely for intermediate care were provided with the appropriate facilities to maximise their independence and return home. Residents were provided with good access to health care services to promote and maintain their health care needs. The staff spoken with had a good knowledge of residents care needs and were able to demonstrate the services that the home provided. Residents were treated with respect and dignity and their right to privacy upheld. Discussions with residents’ and their advocates described how they were helped to exercise choice and control over their lives and how the lifestyle within the home met their preferences, interests and needs. Relatives and friends of residents were encouraged to visit the home and received a warm welcome. On the whole residents received a diet that satisfied their requirements in a pleasant dining area. There was a clear and accessible complaints procedure and residents comments in regard to complaints included “never have any complaints”, “if I needed to complain, I would’ve known who to speak to” and “there was no need to make a complaint”. The building and its environment was clean and on the whole well-maintained so that residents were provided with an environment that was generally safe, accessible and homely. Residents commented, “I am highly satisfied”, “I’m happy living at Highfield Grange” and “it’s spotless”. Staffing hours calculated using the residential staffing forum calculation confirmed minimum staffing levels at the home were met. Staff were trained to equip them with the knowledge and skills for their roles within the home, to enable them to care for residents safely. Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: Provide information to residents about the home, including the service user guide before they are admitted. One resident said, “I didn’t get any information at all”. Ensure residents are aware of the cost and terms and conditions of their stay. Ensure the generic plan of care is adapted to record the specific action to be taken to meet each residents individual care needs. Improve the recording of health care appointments and requests within the individual plan of care. Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 9 Improve some aspects of the receipt of medication and its administration and recording to ensure it is sufficient to ensure residents are not placed at risk of harm. Have a better method for displaying alternatives available at meal times to ensure residents know that a choice is available should they wish. Demonstrate an open and transparent culture when documenting complaints that are received including the investigation detail, outcome, any action taken as a result of the complaint and include dates when the complainant has been responded to. Progress the documentation on recruitment files to support a thorough recruitment process including full employment histories, obtaining a reference from the last employer, documenting verification of training completed identified on the application form and the memo provided from the PCT to confirm the CRB was satisfactory containing more information. Improve the documentation within the financial records to support withdrawals from the bank on behalf of residents so that documented records correlate with withdrawals made from the bank. Facilitate a robust system of supervision for staff to support the philosophy of the care home, their own practice and career development. To have the gauge on the bath that identifies the water temperature level checked, to ensure the temperature of the water provided at the outlet could be verified by using this system. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 10 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 Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 1, 2, 3 & 6 were inspected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents did not always receive information about the home before they were admitted. Resident files inspected demonstrated residents had details of the terms and conditions of their stay, although 50 of residents who returned questionnaires said they hadn’t received one. Residents had their needs assessed prior to admission. Residents’ admitted solely for intermediate care were provided with the appropriate facilities to maximise their independence and return home. Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 12 EVIDENCE: Four of the six resident questionnaires returned said they received sufficient information before moving to the home. Comments by residents about the information they received prior to moving to the home included “I was discharged from hospital to the home as I couldn’t go home because of the access”, “I was transferred to Highfield Grange by Barnsley District General Hospital, for re-habilitation”, “I was well looked after during my stay at Highfield and would consider going back for respite care any time I need to” and “I didn’t get any information at all”. One resident did comment however, that once admitted, “my stay in Highfield Grange was excellent. I was met at the front door on my arrival, wheeled to show me my room, a quick visit to the sitting room plus a nice, hot, welcoming cup of tea and then shortly wheeled to the dining room for an excellent lunch. The physios were marvellous in every way, as were all the staff on every level”. The nature of the intermediate care service and short stay and respite service is process driven and does not facilitate residents being able to visit the home prior to admission. The manager stated the home had now gone no smoking for staff and residents that were admitted. This did not include residents that lived at the home on a permanent basis. It was discussed with the manager that this needed adding to the service user guide and that it was imperative that this information was provided to residents before their admission, to ensure they were able to make an informed choice about whether to move to the home. From information received from the service user questionnaires fifty per cent of residents said they had not received a contract. Five residents’ case files were inspected for a contract/terms and conditions of their stay. All residents had been provided with the terms and conditions of their stay. Inspection of two intermediate care files identified a needs assessment was carried out for those residents prior to their admission. This confirmed that the service was appropriate for the resident and provided staff with the information to formulate an individual plan of care. Intermediate care was provided, which provided residents with short-term intensive rehabilitation to enable them to return home. Specialist health staff including nurses, physiotherapists and occupational therapists supported this service. Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 7, 8, 9 & 10 were inspected. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ had an individual plan of care that in the main contained details of resident’s health and personal care needs, but a substantial element of the plan was a generic plan that had not been amended to detail specific individual needs. Residents were provided with good access to health care services to promote and maintain their health care needs. A policy and procedure was in place to ensure that staff adhered to the safe administration of medication, however, improvements with medication administration and recording is required to ensure it is sufficient to ensure residents are not placed at risk of harm. Residents were treated with respect and dignity and their right to privacy upheld. Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 14 EVIDENCE: Five residents’ individual plans of care were inspected on a sample basis. The files inspected were tidy, organised and on the whole the information provided was easy to track. The plans contained some good profile information, including records of medical treatment and risk assessments for falls, nutritional screening and moving and handling. There continued to be omissions of residents’ wishes in the case of death, despite it being demonstrated through notifiable incidents to the CSCI that this is necessary. It was noted that the actions to be taken identified in the plan of care were generic. This generic information was not always amended to allow for the detail of how individuals must be cared for including their choices and preferences. As a consequence the action taken by staff to meet the residents’ needs recorded in the continuation sheets did not always correlate with the plan of care. All residents spoke positively about the care that they received and were able to describe in detail the health care visits that they had received or were attending, however, the documentation of healthcare records within the plan of care, was not easy to find, for example, a request was made at a review for a chiropody visit. Documentation could not be found that this had been requested or taken place although it became clear during the inspection it had. All residents’ questionnaires identified residents thought they always or usually received the support and care they needed together with any medical support they required. Likewise, all questionnaires returned identified staff listened and acted on what residents had said and that staff were always or usually available when residents needed them. There was a policy and procedure to ensure that staff adhered to safe practices regarding medication and the protection of residents, however, staff were not always following those procedures. It was positive to note residents were enabled to maintain control of their medication, with self-administration risk assessments in place. Four residents’ medication records were inspected on a sample basis for their receipt, administration, record and storage. The recording of the dates when medication was received and commenced provided ambiguous information with a number of possible explanations, resulting in the inability to do a thorough audit trail of that medication. There were four occasions when the amount of medication recorded as being received would have ran out before further medication was received, however, there were signatures confirming administration of the medication had taken place. The resident stated it had not. Discussions with staff identified there were systems in place that this should not happen, however, on this occasion family dealt with the medication. There was no documentation of this and/or that the family were advised of the state of the medication. The date medication was received was not always recorded. In one instance one type of Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 15 medication was not administered as prescribed. Again, discussions took place with staff who identified the resident refused the medication. This was not recorded, the whole record was blank. There were some gaps in the medication record. The amount of prescribed supplement drinks were recorded when received, together with administration of those drinks. Staff were observed approaching residents in a respectful manner and respecting individual preferences. Good relationships between staff and residents were evident. There were areas where the privacy and dignity of residents was respected, for example, knocking on residents’ doors before entering, closing toilet doors when in use and asking residents if they would like an apron at meal times. Discussions with staff identified they were aware of the action to be taken to maintain the personal care needs of residents in a timely manner to respect their dignity. All residents spoken with said that they felt well cared for, staff treated them with respect and they were able to spend time in their room if they wished. Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for 12, 13, 14 & 15 were inspected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Discussions with residents’ and their advocates described how they were helped to exercise choice and control over their lives and how the lifestyle within the home met their preferences, interests and needs. Relatives and friends of residents were encouraged to visit the home and received a warm welcome. On the whole, residents received a diet that satisfied their requirements in a pleasant dining area, but a couple said there should be more choice available. Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 17 EVIDENCE: Questionnaires returned by residents identified the home always or usually arranged activities that they could take part in. Residents were observed to spend time in the lounges sitting, watching TV, knitting, doing word searches, chatting with other residents, visitors and/or staff, playing draughts and dominoes, reading newspapers, whilst others chose to spend their time in the privacy of their bedroom. Discussions with residents demonstrated they spent their time in different ways, one said they liked knitting, the other just spending time sitting on their own. There was a pleasant enclosed garden area, which residents commented was a pleasant area to look out on to. There was good interaction between residents, visitors and staff. A number of residents were observed receiving visitors throughout the day. Visitors spent time with their relatives/friends in both communal areas and residents’ bedrooms and staff were welcoming and friendly to visitors. Residents confirmed that they maintained good links with their family and friends and that they could visit “at anytime”. The home advised visitors to try and avoid meal times. Meal times were 8:30 for breakfast, 12:15 for lunch when the main meal of the day was served, 16:30 for tea and 19:30 for supper with some flexibility around these times. The menus submitted with the pre-inspection questionnaire indicate that residents were offered varied and wholesome meals, but a choice was not evident. The main menu for the day, which did not display alternatives that could be provided, was displayed on a large wipe board in the dining room and was able to be seen by the majority of residents. That alternatives were available was displayed on an A4 sheet underneath and was unable to be seen, unless residents went right up to the sheet. This may mean some residents were not aware they were able to have an alternative to the meal on offer. This was demonstrated by some of the comments made by residents and these included “should be more choice available” and “compliments to the cooks”. Service user questionnaires returned identified three always, two sometimes and one usually enjoyed their meals at the home. On the day of the visit the lunch of savoury mince, chips and carrots and chocolate sponge and custard for pudding for pudding was observed. The meal was well presented and looked appetising, with plenty of attention being provided by staff. The dining area was pleasant and it was positive to see that tables were nicely laid using tablecloths, condiments and matching crockery and cutlery. Residents were given sufficient time to eat their meal. Special dietary needs were catered for. Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 16 & 18 were inspected. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was a clear and accessible complaints procedure, however, the complaints record did not document complaints were dealt with. Residents had no cause to complain. There was an adult protection procedure and staff had received adult protection information that enabled them to identify and report any allegations or incidents of abuse to residents. EVIDENCE: The complaints procedure ensured that residents and/or their advocates were aware of how to make a complaint and who would deal with them. The complaints procedures had been updated to include the name and address of the CSCI; however, the telephone number had been omitted. This was brought to the attention of the manager. All questionnaires identified residents knew who to speak to if they weren’t happy and how to make a complaint. Additional comments included “never have any complaints”, “if I needed to complain, I would’ve known who to speak to” and “there was no need to make a complaint”. All residents spoken with said they were satisfied with the care provided and had no complaints. The pre inspection questionnaire identified no complaints had been made. The complaint recorded on the last inspection that Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 19 had been passed on to the responsible individual still did not have the recorded the investigation methodology, the outcome, any action taken as a result of the complaint and the dates the complainant was responded to. This does not demonstrate an open and transparent manner of dealing with complaints and demonstrating action has been taken where necessary to address any weaknesses within the service. The manager did ascertain on the day however, that the complainant had been provided with information in regard to their complaint but they had heard nothing further. There was an adult protection policy and procedure that promoted the protection of residents from harm or abuse, however, there had been an allegation of abuse made by a resident at the home and staff had not followed the reporting procedure. It was the care management team that had reported the allegation to CSCI, despite the home being required to provide CSCI with information of incidents as required by the regulations at the last inspection. However, recommendations made through the referral of the allegation to adult protection by care management staff had been met by the home, including the home now submitting notifiable incidents as required by the regulations. Staff confirmed that they had been provided with basic adult protection information, which enabled them to identify and report any allegations or incidents of abuse to residents. Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 19, 23 & 26 were inspected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The building and its environment was clean and on the whole well-maintained so that residents were provided with an environment that was generally safe, accessible and homely. EVIDENCE: Residents’ that were spoken with said they thought the home was comfortable and were pleased with their living environment. Their comments included “I am highly satisfied”, “I’m happy living at Highfield Grange” and “it’s spotless”. The home was clean and tidy, which promoted a comfortable and homely environment. The home was decorated in a comfortable and welcoming manner, including homely touches of pictures and ornaments. Furnishings and fittings on the whole were of a good standard, although the kitchenettes were Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 21 looking past their best. Of the questionnaires returned five always thought the home was fresh and clean, one sometimes. Residents had access to all indoor and outdoor facilities. There is a condition of registration that the ten single bedrooms with a partition screen must be used as double bedrooms. Discussions with the manager and observation of those bedrooms demonstrated that when used on a single basis, efforts had been made by staff to rearrange the layout to suit the needs of the residents accommodating them. However, the manager said removal of furniture from those rooms, to accommodate a better layout was difficult because of lack of storage. It was noted that the temperature in the bedrooms was cool. Residents confirmed they were sometimes cool in their own rooms. This issue has been raised before, but the home are unable to control the temperature in the home as this is done centrally. This must be re-addressed, as it is not acceptable that residents cannot use their own rooms because they are not warm enough. Laundry facilities were sited away from food preparation areas. Discussions with residents identified on the whole the laundry system works well. One resident said that items of their clothing had gone missing and not been found. The laundry staff said that to help with items that may go missing, each flats laundry was washed separately, to reduce the number of other residents, the laundry may get placed with and if the clothing is not named it will be one of the persons on that flat. Care staff were able to describe systems that were in place to control the spread of infection. Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 27, 28, 29 & 30 were inspected. Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. Staffing hours calculated using the residential staffing forum calculation confirmed minimum staffing levels at the home were met. Staff were trained to equip them with the knowledge and skills for their roles within the home, to enable them to care for residents safely. On the whole residents were supported by the home’s recruitment policy and procedure, however, further detail is required with documentation to support this. EVIDENCE: Residents and relatives spoke highly of the staff team and all questionnaires returned identified staff always listened and acted on what residents said and that staff were always or usually available when residents needed them. Good relationships between staff and residents were evident. Residents stated that they were satisfied with the level of care they received and that staff knew how to care for them. Observation of staff responding to assistance as required was good. Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 23 The staffing forum provided to identify the total care hours to be provided for the week of the inspection calculated those hours as 597.74. The manager provided the total number of care staff hours provided and this was 789. Sufficient ancillary staff were employed to ensure standards relating to food, meals and nutrition were fully met and the home was maintained in a clean and hygienic state. Discussions with staff identified a training programme was in place to enable them to meet the assessed and changing needs of residents, however, the staff files inspected did not demonstrate documentary evidence of the qualifications and training they had received. The pre inspection questionnaire identified training in the past 12 months has included moving and handling, fire awareness, food hygiene, resuscitation, record keeping, first aid, computer, exercise, palliative care, infection control, NVQ Level 3 Management and NVQ Level 2 & 3 in Care. Future training identified included HIV awareness, conflict resolution, adult protection, continence assessment and management, diversity and social inclusion. Staff confirmed that they had attended various training courses that included Skills for Care induction, health and safety, moving and handling, fire, first aid and food hygiene. The pre inspection questionnaire identified seventy seven per cent of care staff had achieved their NVQ level 2 in Care or equivalent and seven staff hold a first aid certificate. A recruitment policy and procedure was in place. Two files were provided to demonstrate the recruitment process, the one held centrally by the Primary Care Trust and the one held at the home by the manager. The combination of the two files was sufficient to demonstrate a satisfactory recruitment process, but it must still be noted that documentation provided by the PCT to demonstrate this would not have done so. This has been discussed with managers of the PCT and was discussed with the manager on inspection. The combination of the files for four members of staff were inspected. They demonstrated application forms were completed; three of the four files demonstrated two references had been received, however, in one instance this had not been from the last employer. Appropriate CRB checks were in place. One CRB noted a criminal conviction. The manager stated this had been discussed with the applicant and a risk assessment completed as to their suitability for employment. The risk assessment provided was not clear this was as a result of the conviction. Additionally the memo supplied by the PCT did not demonstrate openness and transparency with the process as the memo made no reference to the conviction and that a risk assessment had taken place to confirm suitability. A full employment history was noted as having been checked at the interviews of three of the four members of staff but the written documentation of this was unsatisfactory. Proof of training completed identified on the application was not documented as having been verified although the manager said this did take place. Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 31, 33, 35, 36 & 38 were inspected. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. On the whole residents and staff benefited from the ethos, leadership and management approach. Staff morale was good and all residents, their advocates and staff spoke positively about the management team. A quality assurance system had been implemented that sought the views of residents about the quality of the service provided, although this was still in its infancy. Systems in place to deal with monies/valuables held by the home on behalf of residents’ were comprehensive, however, the documentation to support withdrawals from the bank was insufficient to protect residents. Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 25 There was some supervision of staff, but not at the intervals recommended by the standard. On the whole the home’s policies and procedures promoted the health, safety and welfare of residents and staff, but improvements were required in ensuring the systems in place to maintain weekly checks of water temperatures was sufficient to protect residents. EVIDENCE: The manager had many years experience within the caring profession that enabled her to contribute to the care of residents. This was demonstrated by the fact that residents and relatives spoke highly of the management and staff team. Although the manager demonstrated she cared about the residents and was familiar with their needs she had not yet completed her NVQ Level 4 in Management and Care. The provider dataset identified training in the past 12 months has included NVQ Level 3 & 4 in Management. For the most part the manager worked five days a week, 37 hours. Staff felt that there was good teamwork within the home and that they enjoyed working there. Several staff had worked at the home for many years, enabling them to provide a consistent service to residents. The quality assurance system at the home consisted in the main of management audits for health and safety, the kitchen, cleaning, record keeping and medication. The manager had implemented a system to include residents in the quality assurance process but this was still in its infancy and a report had not been produced. The line manager for the service did complete regulation 26 visits. Residents’ were able to maintain control over their finances if they wished and had the capacity to do so. The companies treasury department dealt with all finances that related to the permanent residents. They acted as appointees for residents, gave the resident their personal allowance, banked monies of residents when required and maintained the records of those transactions. It was noted when inspecting monies held by the home for those residents, monies withdrawn from the bank had not all been documented as being received by the home. The manager stated that some would have been given to the resident and they wouldn’t keep a record of this. This would she assumed be kept by the treasury department. This was discussed and how this needed to be documented to verify this is what had occurred. Apart from this discrepancy the procedure for dealing with monies received by the home on a residents behalf was comprehensive and at least two signatures were obtained when money was exchanged with residents’ and/or their advocates. Written records and monies balanced. There was a secure facility for the safekeeping of monies and valuables on behalf of the resident. Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 26 Discussions with staff confirmed they were aware they should have supervision although this had not taken place. The home did have a health and safety policy. When the building was inspected no fire exits were blocked. Fire training and/or drills for staff were in place, however, the fire risk assessment had not been reviewed since January 2004. Hazardous products were safely stored. The provider dataset identified servicing was in place for the gas and electrical systems and equipment, as were water temperature checks for compliance with legionella. It was noted, however, that the system used to verify water temperatures at water outlets to ensure it was provided was unsatisfactory – the gauge on the bath stated 44 degrees, the mobile hand thermometer 47 degrees. The water temperature record for the week before was recorded at 44 degrees and discussions with staff confirmed they used the gauge on the bath as the verification. In the inspector’s opinion it was the mobile hand thermometer that was correct as she could not leave her hand under the water as it was too hot. This is potentially a dangerous situation as it presents a risk of scalding to residents. This was discussed with the manager who said they would get the company to attend and check the calibration of the water temperature gauge on the bath. Subsequent to the inspection, the manager confirmed this had been completed. Sluice room and laundry doors had been fitted with numerical locking systems to increase the probability that they were locked at all times to maintain the safety of residents. They were noted to be locked on the visit. There was sufficient equipment and aids and adaptations provided to meet the needs of the residents and good moving and handling techniques were observed, which maintained the safety of residents and staff. Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X 2 X 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 1 X 2 Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 28 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 OP7 Regulation 15 Requirement Care plans must contain details of residents’ care needs in regard to their wishes on death and dying. Previous timescales of 31/03/05, 30/06/05, 28/02/06 & 31/08/06 not met. The action to be taken by care staff documented in the plan of care must be specific to each resident’s specific health, personal and social care needs and individual choices and preferences. The individual plan of care must contain clear information of all medical appointments attended or requested, together with the outcome of the result of that visit. There must be no gaps in the recording of medication. Previous timescale of 31/08/06 not met. All information for medication requested must be recorded. Medication must be administered as prescribed. Where a resident DS0000038647.V324975.R01.S.doc Timescale for action 31/03/07 2. OP7 15 31/03/07 3. OP7 OP8 15 31/03/07 4. OP9 13 & 17 31/03/07 5. 6. OP9 OP9 13 13 31/03/07 31/03/07 Highfield Grange Version 5.2 Page 29 7. 8. OP9 OP16 13 22 9. OP23 23 10. 11. OP25 OP29 23 19 12. 13. OP29 OP29 19 19 14. OP29 OP30 19 15. OP35 12 & 17 16. OP38 13 refuses this medication, this must be recorded and advice from the GP sought and recorded. The date medication is received must be recorded. The complaints record must include the investigation detail, outcome, any action taken as a result of the complaint and include dates when the complainant has been responded to. Previous timescale of 31/08/06 not met. Provide sufficient storage to enable furniture from double rooms to be removed when being used as a single room. The temperature in bedroom areas must be warm enough for residents. Two written references must be obtained, including a reference from the last employer where this involved work with vulnerable adults, of not less than three months duration. The recruitment record must contain details of any criminal offences. Where a full employment history is discussed at interview the documentation must note a satisfactory written explanation of any gaps in employment. The staff files must demonstrate documentary evidence of any qualifications and training. Previous timescale of 31/10/06 not met. The financial record held by the home must correlate with withdrawals made from the bank on behalf of residents. The temperature gauge on the bath must be checked to ensure the water temperature level it DS0000038647.V324975.R01.S.doc 31/03/07 31/03/07 31/03/07 31/03/07 31/03/07 31/03/07 31/03/07 31/03/07 31/03/07 17/01/07 Highfield Grange Version 5.2 Page 30 identifies can be verified as the temperature of the water provided at the outlet. 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. 3. 4. 5. 6. 7. 8. Refer to Standard OP1 OP2 OP9 OP15 OP25 OP29 OP31 OP36 Good Practice Recommendations Residents should be provided with information about the home, including the service user guide, prior to their admission. It should be made clear to residents they have a contract/terms and conditions in place. The medication record should provide clear information as to when medication received has been commenced. Have appropriate systems in place to ensure residents are aware that alternatives/choices are available at meal times. That residents should be able to control the heating in their own rooms. The risk assessment completed for persons who have a criminal conviction should demonstrate the purpose for which the risk assessment was completed. That the manager obtains an NVQ Level 4 or equivalent in Management and Care. That supervision takes place at intervals recommended by the standard. The fire risk assessment should be reviewed. 9. OP38 Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Highfield Grange DS0000038647.V324975.R01.S.doc Version 5.2 Page 32 - 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!