CARE HOMES FOR OLDER PEOPLE
Highfield Hall Care Centre Grane Road Haslingden Rossendale BB4 5ES Lead Inspector
Mrs Susan Hargreaves Unannounced Inspection 10:00 28 September 2005
th 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 Hall Care Centre DS0000022505.V254261.R01.S.doc Version 5.0 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 Hall Care Centre DS0000022505.V254261.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Highfield Hall Care Centre Address Grane Road Haslingden Rossendale BB4 5ES 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) 01706 222326 01706 219455 Highfields.Hall@ashbourne-homes.co.uk Ashbourne Homes Limited Mrs Carole Ann Ashburne Care Home 75 Category(ies) of Dementia - over 65 years of age (21), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (2), Old age, not falling within any other category (52) Highfield Hall Care Centre DS0000022505.V254261.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. The total number of service users within these categories not to exceed 75 (seventy five) Staffing for service users requiring nursing care will be in accordance with the Notice issued on 15 January 2002 Within the overall total of 75 a maximum of 25 service users requring nursing care who fall into the category of OP. Within the overall total of 75 a maximum of 33 service users requring personal care who fall in the category of OP. Within the overall total of 75 a maximum of 21 service users requiring personal care who fall into the category of DE(E). Within the overall total of 75, 2 named service users requiring personal care who fall into the category of MD(E). When any of the named service users are no longer resident in the home, the registration must be changed to reflect this. The registered provider must, at all times, employ a suitably qualified and experienced person who is registered with the Commission for Social Care nspection as manager of Highfield Hall Care Centre. 28th April 2005 Date of last inspection Brief Description of the Service: Highfield Hall Care Centre is a two storey purpose built care home in it’s own grounds. The home offers 24 hour care for up to 75 older people who require either nursing or personal care. There is also a separate dementia unit. Accommodation is provided in single en-suite rooms. Communal lounges and dining rooms are located on both floors. A passenger lift facilitates access to all areas of the home. There is an enclosed garden, which is easily accessible to residents. There is ample parking for staff and visitors. Highfield Hall is situated in the small town of Haslingden close to local amenities and public transport. Highfield Hall Care Centre DS0000022505.V254261.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 8 hours. No additional visits have been made since the last unannounced inspection. At the time of this inspection 70 residents were living at the home. A tour of the premises took place and staff files and care records were inspected. Members of staff on duty, residents and visitors were spoken to. Discussions also took place with the manager regarding issues raised during the inspection. What the service does well: What has improved since the last inspection?
Following pre-admission assessment prospective residents received confirmation in writing that their needs could be met at the home. In order to provide all members of staff with more information and advice about nutrition and feeding new policies and procedures have been developed. The manager of the dementia unit explained how she had revised and developed the role of the key worker. Each carer assistant working during the day was the key worker for two or three residents. Their role was to liaise with the relatives of these residents and inform them when new items of clothing etc. were needed. Key workers also provided opportunities for relatives to be involved with care planning and care if they wished. Highfield Hall Care Centre DS0000022505.V254261.R01.S.doc Version 5.0 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 Hall Care Centre DS0000022505.V254261.R01.S.doc Version 5.0 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 Hall Care Centre DS0000022505.V254261.R01.S.doc Version 5.0 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 and 5 Admission procedures were thorough. Comprehensive pre-admission assessments were completed for each resident prior to admission. EVIDENCE: Individual records of seven resident’s were inspected. Each contained a detailed pre-admission assessment of need. A senior member of staff visited prospective residents in hospital or their own home prior to admission. The assessment of need provided useful information for the care plan. Prospective residents received confirmation in writing that their needs could be met at the home. A procedure was in place for the admission of a resident in an emergency. Highfield Hall Care Centre DS0000022505.V254261.R01.S.doc Version 5.0 Page 9 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 and 9 Detailed care plans were in place for all except the newest residents. This meant that there was the potential for some care needs not to be fully met. Medication was well managed promoting good health. Members of staff were friendly and attentive to the needs of the residents. EVIDENCE: Individual care records of seven residents were inspected. The care plans for five of these residents provided detailed information about their care needs and explained how these needs were addressed. Appropriate risk assessments had been carried. Information about how identified risks were dealt with was also included in the care plans. Nutritional screening and a care plan about eating and drinking was not in place for a resident who needed a special diet. The care needs had been identified for a recently admitted resident but care plans explaining how these needs were to be met had not been completed. A risk assessment relating to pressure sores had not been carried out for this resident. Records of the visits of other healthcare professionals e.g. GP, dentist, chiropodist, district nurse etc. were included in the care plans.
Highfield Hall Care Centre DS0000022505.V254261.R01.S.doc Version 5.0 Page 10 All care plans were reviewed monthly and updated when necessary. Resident’s and their relatives were, if possible, involved in care planning. At the time of the inspection none of the residents were self-medicating. Appropriately trained members of staff were responsible for administering all medication. Records relating to the management of medication were seen to be up to date. However, the manager was advised to provide written instructions explaining when medication prescribed ‘when required’ should be given to individual residents. Although medication was stored correctly the temperature of the storage area on the residential unit was frequently in excess of 25 degrees Celsius. The manager was advised to contact the pharmacist to check if any of the drugs would have deteriorated. All the residents spoken to praised the staff for their care and hard work. During the inspection members of staff were observed attending to residents in a caring and sensitive manner. Highfield Hall Care Centre DS0000022505.V254261.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 The meals were wholesome and menus offered variety and choice. EVIDENCE: The meal served at lunchtime looked wholesome and appetising. The menus were varied and offered choice. Lunchtime was unhurried allowing residents time to chat and enjoy their meal. Members of staff were observed assisting residents in a sensitive and patient manner. All except two of the residents asked said the meals were good. Highfield Hall Care Centre DS0000022505.V254261.R01.S.doc Version 5.0 Page 12 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 Complaints were taken seriously and investigated. Appropriate procedures and training were in place to ensure the protection of residents at the home. EVIDENCE: A comprehensive complaints procedure was in place. Two complaints had been made to the home since the last inspection. Detailed records of the complaints, investigation and any action taken were kept. Policies and procedures relating to the protection of vulnerable adults were in place. This issue was discussed with four members of staff. They were aware of the procedure and said they would report any concerns immediately. Highfield Hall Care Centre DS0000022505.V254261.R01.S.doc Version 5.0 Page 13 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 The home was clean, comfortable and well maintained. Laundry facilities were appropriate for the size of the home. EVIDENCE: At the time of the inspection the home was clean, tidy and well maintained. This provided a safe and comfortable environment for the residents. To further improve the premises there were plans to replace the corridor carpets on both floors and buy some new chairs for the residential unit lounge. Bedrooms were redecorated when they became vacant. Laundry facilities were appropriate for the size of the home. Policies and procedures for the control of infection were in place. Highfield Hall Care Centre DS0000022505.V254261.R01.S.doc Version 5.0 Page 14 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 and 29 Staffing levels were appropriate to meet the assessed needs of the residents on the residential and dementia units. An increase in the staffing levels on the nursing unit would ensure that the needs of the highly dependent residents were fully met. Recruitment procedures were thorough. Care staff were encouraged to obtain NVQ qualifications. EVIDENCE: Examination of the duty rota confirmed that staffing levels on the residential and dementia units were sufficient to meet the assessed needs of the residents. However, two members of staff on the nursing unit explained how they were struggling to fully meet the needs of all the highly dependent residents. A registered nurse was on duty for each shift along with four care assistants in the morning, three in the afternoon and evening and two during the night. At the time of the inspection there were twenty-two residents who required nursing care. Twenty of these required the assistance of two members of staff with personal care needs and sixteen required help with feeding. In addition to this most of these residents rested in bed in the afternoon to help prevent pressure sores and got up again for tea. The general manager was aware of the situation and said she would try to address the problem. It was evident from discussion with four members of staff that training was actively encouraged. Seventeen members of staff (47 ) had an NVQ level 2 in care. The manager explained that when a new employee with NVQ 2 started work at the home 50 of the care staff would have the required NVQ qualifications.
Highfield Hall Care Centre DS0000022505.V254261.R01.S.doc Version 5.0 Page 15 The files of five members of staff appointed since the last inspection were checked. These indicated that all the required pre-employment checks to ensure protection of the residents had been completed. Highfield Hall Care Centre DS0000022505.V254261.R01.S.doc Version 5.0 Page 16 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): 33 and 38 Residents and their relatives were consulted about the quality of the care and services provided at the home. Appropriate procedures were in place to safeguard the health, safety and welfare of residents. EVIDENCE: The home had achieved the nationally accredited RDB star rating quality assurance award. This involved an annual assessment of all aspects of the care and facilities provided at the home. Residents and staff were given questionnaires to complete as part of the assessment process. Feedback from these questionnaires was included in the final report. An annual development plan was available. Residents and relatives meetings were held about every six months. Policies and procedures were reviewed regularly and up dated when necessary by the company. Records of fire drills were kept. Fire alarms and emergency lighting were checked regularly. A detailed fire risk assessment had been carried out. Records of the routine servicing of equipment were seen. General risk
Highfield Hall Care Centre DS0000022505.V254261.R01.S.doc Version 5.0 Page 17 assessments were clearly written and gave instructions for staff to follow in order to manage any identified risk. A health and safety committee met every three months. Their role was to identify and address any health and safety problems. Safety notices were displayed in the home. Highfield Hall Care Centre DS0000022505.V254261.R01.S.doc Version 5.0 Page 18 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X 3 Highfield Hall Care Centre DS0000022505.V254261.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? N/A 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. Standard Regulation Requirement Timescale for action 1 OP7 15(1) Unless it is impracticable to carry 27/09/05 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. Care plans to address all identified needs must be completed for all residents on admission. 2 OP8 12(1)(a) The registered person shall 27/09/05 ensure that the care home is conducted so as – (a) to promote and make proper provision for the health and welfare of service users. Risk assessments relating to nutrition and pressure sores must be completed for all residents on admission. 3 OP9 13(2) The registered person shall make 30/12/05 arrangements for the recording, handling, safe keeping, safe administration and disposal of medicines received into the care home. The temperature of the drugs room on the residential unit
Highfield Hall Care Centre DS0000022505.V254261.R01.S.doc Version 5.0 Page 20 4 OP27 18(1)(a) must not exceed 25 degrees Celsius. The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users – (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. Staffing levels on the nursing unit must be reviewed and increased to ensure the needs of all the residents are fully met. 25/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations Written instructions should be in place for individual residents stating when medication prescribed when required should be given. Highfield Hall Care Centre DS0000022505.V254261.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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