Inspection on 10/07/07 for Highfield House

This inspection was carried out on 10th July 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Highfield House 28/11/08

Highfield House 10/12/07

Highfield House 22/05/06

Highfield House 19/12/05

Highfield House 20/07/05

Highfield House 26/07/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Highfield House 28 Clifton Road Ashbourne Derby DE6 1DT Lead Inspector Helen Macukiewicz Key Unannounced Inspection 10th July 2007 09:15 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 House DS0000002118.V340271.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 House DS0000002118.V340271.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highfield House Address 28 Clifton Road Ashbourne Derby DE6 1DT 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) 01335 342273 01335 346942 highfield.house@fshc.co.uk Grandcross Limited (wholly owned subsidiary of Four Seasons Health Care Ltd) Post Vacant Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd May 2006 Brief Description of the Service: Highfield House is a large detached period property, which has been extended to accommodate 37 older people. There is a large car park with a number of steps up to the home or a driveway for wheelchair users. An experienced person, who is currently awaiting registration, manages the home. The home is situated very close to the small town of Ashbourne. Weekly fees range between £333.85 and £654.00. Inspection reports are made available in the foyer. The Manager provided this information during this Inspection. Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection was unannounced and lasted 7.5 hours during one day. 1 preinspection questionnaire was received from a person living in the home and three from relatives. This represents about 12 of the total number of people. Findings from these questionnaires are included in this report. The Manager had completed a self-assessment of the home and information from this was used in the planning of this inspection. Computer held records of all contact between the Home and the Commission for Social Care Inspection since the last Inspection were also referred to in the planning of this visit. During this Inspection discussion with people who use the service and their relatives took place. Time was spent in discussion with the Manager and staff. Three residents care files were looked at in detail and their care was examined to see how well records reflect care practices within the home. Relevant records belonging to the home were also examined such as complaints and policy documents. A brief tour of the home took place with the assistance of two people living in the home, including some bedrooms. An interim unannounced Inspection took place on 17 October 2006. The purpose of this visit was to follow up on the recommendations made at the previous inspection on 22 May 2006, and some issues arising from a complaint. The outcome of the interim Inspection is not available as a public document but should be available by the Manager of this Home. Reference to the Inspection and any requirements will be made in this report where necessary. What the service does well: Admission assessments seen in resident’s files were comprehensive and generally allowed for an adequate assessment of people’s needs. A recently admitted resident and their visiting relative were satisfied with the admission procedures, and had been welcomed by staff. There was plenty of documentation in care files to support that assessment and monitoring of pressure sores, nutritional intake, moving and handling needs and continence needs is undertaken and reviewed regularly. Positive comments were received from residents and relatives about the catering arrangements. Comments included ‘The food is very good –praise for the cook’. The Home was clean, and nicely decorated throughout. There was no evidence of outstanding maintenance works; One resident said ‘we have a wonderful handyman-the best we’ve ever had’. Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 6 The gardens were well maintained and residents said that this is one aspect they particularly like about the home. One relative said ‘ staff are very nice’. Relatives in their pre-inspection questionnaires described the Manager and administrator as ‘very helpful and down to earth’. Residents were happy with the management of their personal money by the home. Comments included ‘you can have it straight away’ and ‘it works quite well, the money’. What has improved since the last inspection? What they could do better: Social, spiritual and cultural needs were not well identified in assessments and care plans. Some care plans were not up to date and did not identify all the persons needs. There was little evidence of person centred care for those with higher physical and/or mental health needs. Medication Administration Records contained unexplained gaps where staff should have signed for medications that had been given. There is evidence to suggest that staff do not always recognise complaints and matters that need referring through safeguarding procedures. Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 7 Where equipment that carries a degree of restraint is in use, care plans do not document full assessment of the equipment or consent. There was no evidence that regard to the Mental Capacity Act had been given. There were several examples where shortfalls in numbers of staff and their level of training have adversely affected the dignity and rights of residents living in the Home. Staff recruitment files were viewed and contained some gaps in information which does not fully safeguard people living in the home. There are no individual training records kept, or staff development programme in place to cover additional training needs. Evidence suggests staff require additional training on dementia, managing challenging behaviour, complaints and person centred care. There were some examples whereby the level of monitoring of the management of the home by Four Seasons is not effective. 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 House DS0000002118.V340271.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3. Standard 6 does not apply; the home does not offer intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who may use the service have the information needed to choose a home that will meet their needs EVIDENCE: The manager confirmed that there had been three amendments to the Service Users Guide and Statement of Purpose since the last Inspection. The name of the Responsible Individual for Four Seasons Healthcare and the Manager for the Home had been changed, and a statement had been added to say that the home is now a non-smoking environment. This last change has not adversely affected the people already living in the home, as none currently smoke. Copies of these documents are kept in the foyer and each resident’s bedroom. Residents were able to confirm they had seen copies. The Manager uses staff Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 10 and residents/relatives meetings to inform people about changes to the Statement of Purpose and Service Users Guide, minutes of staff meetings supported this. The Manager said there are copies of the latest Inspection reports in the foyer, which was confirmed through observations. However, none of the residents or relatives asked knew of the availability of these reports. Four Seasons healthcare operates clear admission procedures, with specific forms for staff to complete at each stage of the admission process. The Manager indicated that Four Seasons use a ‘mystery shopper’ approach to internally audit each of their Homes’ admission procedures, to ensure they work effectively and consistently. Admission assessments seen in resident’s files were comprehensive and generally allowed for an adequate assessment of people’s needs. However, the form used did not fully allow for acknowledgement of the needs of people who may be in same sex relationships. Social, spiritual and cultural needs were also not well identified. Care Management assessments were seen in some files. A recently admitted resident and their visiting relative were satisfied with the admission procedures, and had been welcomed by staff. Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 11 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): Standards 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The principles of dignity and respect are largely put into practice although staffing arrangements means the care needs of some people are not met. EVIDENCE: Each care file seen contained a plan of care based on the information gained from the initial assessment. There was evidence to support that care had mostly been reviewed. Relatives were able to confirm they knew the content of the resident’s care plan. One care plan named a current key worker as being a member of staff who no longer worked in the home. Another file contained a plan of care to meet social needs that did not reflect the current abilities of the person, so needed updating. There was use of correction fluid on some assessment sheets, which is not consistent with nursing guidelines for record keeping. Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 12 Care plans covered most areas of need, although as with the assessment of need, diversity issues and social care needs were not well documented. There was some evidence of relatives involvement in the care plans but not much evidence of resident’s involvement and agreement to their plan of care. The Manager had devised a social history sheet, which did cover most of the missing areas of need; she plans to implement this by the end of July. There are people living in the home who require a higher level of supervision due to their health needs, some of whom also have mental health needs. There was documented evidence that staff are exposed to aggressive behaviour on occasions and the Manager confirmed that this is being monitored, but that staff had not received training on mental health or dealing with aggression. The Manager also confirmed that there are no Registered Mental Nurses within the staff team. There was little evidence of person centred care for these people both during direct observations and in their care records. The Manager felt this was partly due to shortfalls in staffing. There was plenty of documentation in care files to support that assessment and monitoring of pressure sores, nutritional intake, moving and handling needs and continence needs is undertaken and reviewed regularly. One resident confirmed they are being supported to stop smoking and are attending a ‘fresh start’ programme run by the local G.P. surgery. Care files and comments from residents confirmed that outpatients and other appointments are attended and there is liaison with other health professionals for advice and support. One resident said ‘there is always a member of staff goes with you to appointments and I found that very reassuring’. Residents confirmed that they see the dentist, G.P and optician when needed; one resident said they had new glasses recently and said they were ‘very good’. Minutes of the staff meeting in June referenced instructions for staff to ensure residents glasses and hearing aids are checked and cleaned regularly. One visitor said ‘on the whole I’m quite happy with (my relative) being here’. Staffing shortfalls had affected a couple of areas of care, visitors said they had to ask on several occasions for their relative to be assisted with their food and drinks, and on two occasions had found their relative to be very thirsty. One resident said ‘I found staff quick to come up when I rang my bell, but residents do moan about having to wait – we do get short staffed especially at weekends, but we have agency now’. (See section on staffing for more information). The administration and storage of medicines is largely satisfactory. Both the Manager and a member of Nursing staff confirmed that monthly medication audits are undertaken. A qualified nurse confirmed they had received medication training. Medication Administration Records contained unexplained gaps where staff should have signed for medications that had been given. The Manager said this was a common problem and both she and the Nurse said Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 13 action has been taken to improve this area. However, the Manager had not formally discussed this with staff during one to one supervisions. There was no evidence to suggest residents had not received the medication they required, a random check of one stock of medication supported that the correct number of tablets were in place. The management of homely remedies was consistent with the Homes’ policy. Some residents confirmed they manage their own medication. Where observed, residents had ensured they were following correct procedures on the storage of their medicines, and a risk assessment for self-medicating was contained within their care file. Residents confirmed that they are given enough privacy when being assisted to bathe, and within their bedrooms. They confirmed that staff knock to request permission before entering their bedrooms. Some residents have their own bedroom door key. A telephone for residents use was seen in a private area of the home. One resident said ‘we don’t have a payphone, most residents have their own phone but you can use the homes’ phone – they never refuse you’. ‘Letters can be posted (named the administrator) is very good’ Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 14 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): Standards 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The daily life of residents largely meets their needs although staffing arrangements has reduced the amount of activities provided. EVIDENCE: Residents confirmed that they have a choice about what they do with their time during the day. They said that there is a Communion held once a month and that a motivator calls twice a week. One resident said ‘we have our own committee called friends of Highfield, we raise money for Christmas, Birthdays and entertainment’. One resident said she regularly walks into Ashbourne. There is a varied mix of ability within people living in the Home; some are very able and mobile, whilst others need total care. The Manager said this creates problems when planning activities to meet everyone’s’ needs. Shortfalls of staff recently have compounded this problem and comments from residents about their social lives reflect this. One resident said ‘Entertainers come in and Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 15 we go on trips out, we haven’t done well for trips this year as people haven’t been well enough to go’. ‘A motivator comes in on a Monday and Thursday’. Another resident said ‘my sister said there was a lot to do here, but I’ve not found it so’. However, they went on to say that someone had sat with people and played cards. Further comments from residents about social activities included ‘we have fish and chips from the chip shop sometimes’; ‘There’s not much to do, we would like more trips’; ‘I have been on a trip to Matlock and really enjoyed that’. Residents confirmed that they have been able to bring possessions in from home with them. They were also able to say that they have some control over their personal finances. Positive comments were received from residents about the catering arrangements. Comments included ‘The food is very good –praise for the cook’ and ‘I was asked where I wanted to eat my meals, I chose this lounge’. Residents also confirmed they could have meals in their bedrooms. One relative said the food was ‘fantastic’. Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 16 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): Standards 16 and 18. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who use this service are able to raise concerns but complaint procedures are not responsive to these. Unclear safeguarding procedures and gaps in documentation and knowledge leave people vulnerable. EVIDENCE: There have been 5 complaints documented by the Home since the last Inspection. Two have been formally raised with the Commission for Social Care Inspection. A satisfactory response to all complaints is evidenced. The last complaint known to Commission for Social Care Inspection is still ongoing. However, there is evidence to suggest that staff do not always recognise complaints, and therefore records do not provide an adequate picture of the actual numbers of concerns that have been raised. When asked, staff said they would only make the manager aware if they felt a concern raised by a resident or relative needed an investigation. The Manager confirmed staff have not had training on complaints management. The minutes of a recent staff meeting documented that discussions had taken place with staff about concerns raised by residents that their laundry had gone missing, these were not logged as minor concerns in the complaints log. Some relatives said they had informally raised issues about the care of their mother with several staff members and the manager but felt nothing had been Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 17 done. These were not acknowledged as minor concerns in the complaints log, so the home could not demonstrate they had taken any action to address these. The minutes of the last 3 residents’ meetings contained some complaints from residents, some of which needed to be dealt with as formal complaints, and in one case, as an adult protection issue. However, this had not occurred. Residents said about their meetings, ‘some things get done, others not’, ‘they are very useful, you can bring things up-you are free to do that, you can complain’ and ‘you can say what you want, relatives can come as well which is good’. Residents and relatives’ said that they did feel able to complain both through pre-inspection questionnaires and by direct consultation on the day. However, those spoken to on the day did not know they could complain to the Commission for Social Care Inspection, which is stated in the Homes’ complaint procedure. As a result of one complaint, the Manager now records what time residents prefer to get up in a morning. The Governments document ‘No Secrets’ was seen in the Managers office. A member of staff has attended Derbyshire County Councils’ four day training on Protection of Vulnerable Adults’ and is now able to cascade that training to other staff in the home. Most staff confirmed that had received safeguarding training. The minutes of staff meeting held in April documented that the Manager had reminded staff about safeguarding and whistle blowing procedures available to them. The Manager and a member of maintenance staff had not had any recent training on safeguarding although the cascade training is planned for July. The safeguarding procedure was seen in the policy file. The layout and order of sequence of events does not allow staff to gain a clear picture of the actions they need to take at each stage. The Manager confirmed there had been no safeguarding referrals since the last Inspection. Some pieces of equipment are in use at the home that carry with them a degree of restraint, or restriction of movement. For bed rails, there is a consent form in care files. However, for use of wander mats, and specialist chairs, one of which also had a foot restraint, there was no documented consent in care files. In one case, a chair was in use without a documented assessment of need from an Occupational Therapist, although the Manager was certain this had taken place. There was no evidence that regard to the Mental Capacity Act had been given. Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 18 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): Standards 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a home that is homely, well maintained and comfortable. EVIDENCE: Many areas of the Home have been refurbished over the past year, residents acknowledged this expenditure. The Home was clean, and nicely decorated throughout. There was no evidence of outstanding maintenance works; one resident said ‘we have a wonderful handyman-the best we’ve ever had’. Residents were happy with their bedrooms and said they had personalised them. Comments included ‘you have a choice of room. If you want to change you can, I asked for a bigger room and got one. You can’t ask for more than that’ and ‘they ask you what colour (paint) you would like’. Those bedrooms Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 19 seen were homely and contained personal photographs and pieces of furniture from peoples’ own homes. Residents said they are happy with their environment and said there is the possibility of a new conservatory due to a recent Government Grant. Comments included ‘It’s lovely at Christmas, we decorate it lovely’ and ‘It’s a very nice home actually’. The gardens were well maintained and residents said that this was one aspect they particularly liked about the home. The passenger lift is not working, Four Seasons have provided a second stair lift whilst it awaits repair. There is a Laundry room. Relatives said ‘Laundry does come back clean’, another resident in a completed questionnaire confirmed they have clean clothes, which are changed every day. Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 20 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): Standards 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The numbers of staff and their level of training does not allow for person centred care, the needs of some residents are not being fully met. EVIDENCE: Staffing rotas showed some shortfalls in numbers of staff due to sickness. Feedback for relatives in their pre-inspection questionnaires also suggested the Home is short staffed. The need to recruit more staff was acknowledged by Four Seasons in a monthly monitoring visit report, which was seen at the home. There were examples of Agency staff being used to cover gaps in the staffing rota. The Manager confirmed that she has recently recruited 2 full and 2 part time care staff, an activity co-ordinator for 21 hours/week and a cook. However, these were yet to commence employment. She also felt that some of the staffing problems had arisen sue to a sudden increase in occupancy. There were several examples where the current staffing arrangements have adversely affected the dignity and rights of residents living in the Home. Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 21 Minutes of a residents meeting in June documented that one resident had complained about having to wait a long time for the call bell to be answered, also that they had requested to get up early but had been told they couldn’t as the home is short staffed. One resident said ‘I would like to see my husband at home but (named member of staff) said I need a member of staff with me, and there’s none available’. Another resident said ‘dependencies have gone up, this has affected trips (out) due to staffing shortage’. A further resident said ‘staff get tired, they are overworked and get niggly’. One resident said ‘It has been very difficult recently, you have to wait for police checks and things (talking about staff recruitment)’ (see also comments under Health and Personal care). One relative, in a pre-inspection questionnaire stated ‘there is a problem accessing the bedroom sometimes due to lack of/busy staff’. Another recorded ‘I have noticed shortage of staff’. Further comments included ‘More care staff would be beneficial. Occasions when staff are stretched and unable to meet residents needs e.g. toileting when requested and not half an hour later’ and ‘Slightly higher staffing levels (needed) to allow for individual care needs e.g. choice of where to have meals, help to room without waiting ages’. Compounding the current problem with staffing shortfalls is the fact that the passenger lift has been out of operation recently whilst they await a new part. A second stair lift has been provided but staff said it takes them longer to assist people up and down the stairs. Although the Home undertakes monitoring of dependency levels of residents, staffing was determined more by the numbers of residents than their dependencies/training needs of staff or other factors such as the lift breaking down. Relatives’ understanding was ‘if they lose a lot of patients, they have to lose staff, they cut hours down’. One relative said ‘ staff are very nice’. Three staff recruitment files were viewed. These contained some gaps:• None had written verification why the person had ceased working with vulnerable adults. • Not all had certificates relevant to any training or qualifications. • None contained a full employment history. • One member of staff recruited from ovcerseas had vey little information in their recruitment file except for confirmation of identity, qualification and criminal records check. 67 of care staff are qualified to level II NVQ (National Vocational Qualification) or above. A member of staff who undertakes domestic duties confirmed they had completed an NVQ in cleaning and had received COSHH (Care of Substances Hazardous to Health) training. Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 22 Staff were asked about training. They confirmed they had completed Health and Safety Workbooks, Equality and Diversity Workbooks and the Infection Control Workbook. They had also attended training on the Liverpool care pathway, which they had found beneficial. The manager had a training matrix on display in the office, this identified that first aid, basic food hygiene, night staff fire training and Appraisals were areas for priority. There are no individual training records kept, or staff development programme in place to cover additional training needs. Evidence elsewhere in this report suggests staff require additional training on dementia, managing challenging behaviour, complaints and person centred care. Each resident has a key worker. Staff were clear about their role as key workers and were able to describe tasks they undertake as part of this role. Most staff who were consulted had worked at the home a number of years so could not remember their induction to the home. However, one new member of staff was working a supernumerary shift on the day of Inspection, which the Manager confirmed is usual procedure Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 23 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): Standards 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Management of the home does not fully ensure the well being of service users. EVIDENCE: The Manager has yet the register with the Commission for Social Care Inspection; however, she was able to demonstrate she is in the process of doing so. She confirmed that she has a Registered Managers Award. She has previously managed residential care services. She is not a qualified nurse so the lead for clinical issues lies with the Deputy Manager who has a nursing qualification. The two meet regularly to ensure consistency, and the Manager retains overall responsibility for all aspects of the running of the Home. Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 24 Staff said the Manager is very approachable, and said they have found improvements in the management of the Home since her appointment. Specifically they said they felt more valued and appreciated. Relatives in their pre-inspection questionnaires described the Manager and administrator as ‘very helpful and down to earth. If I have any concerns they are always willing to help me’ and ‘management is very approachable and responsive to requests or enquiries’. The Manager was able to provide both a Business Plan for the Home and a Marketing Strategy. Both documents contained some focus on improving outcomes for people who use the service. There is evidence that the home receives monthly monitoring visits from a representative from Four Seasons and that these visits include discussion with residents and staff about how well the home is running. There is some internal quality monitoring, some satisfaction surveys have been sent out. The Manager, in her pre-inspection information documented that the Company have introduced a new structure for customer satisfaction surveys and Highfield House is scheduled for later in the year. The results are collated at head office and then made available to the home who then provide written feedback to residents and relatives. There were some examples whereby the level of monitoring of the management of the home by Four Seasons is not effective. Firstly the Manager reported that she sends copies of the residents meeting minutes to her line manager. This had not alerted the Company to the fact that some of the issues arising from recent meetings should have been managed as formal concerns and also referral to adult protection was needed, which had not occurred. Secondly in the fact that the Manager confirmed that although she speaks to the Regional Manager regularly, she does not receive formal supervision. Also, the fact that the Company had not been responsive to the staffing shortfalls in a timely way, despite this being recognised through regulation 26 visits. Care staff and a qualified nurse confirmed that they receive supervision and find this useful. They also confirmed their attendance at staff meetings, which they felt was a useful forum to raise issues of concern and work through problems. Minutes of a qualified staff meeting documented discussions on subjects such as medication and care planning, management of staffing and leadership of shifts. Residents were happy with the management of their personal money by the home. Comments included ‘you can have it straight away’ and ‘it works quite well, the money’. Residents knew where their money was being held. The system for retaining resident’s money is secure, but the banking arrangements are in the process of being reviewed to ensure money is more individually managed. Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 25 The Manager and Deputy are due to attend a health and safety course over the next twelve months. Quarterly meetings to discuss health and safety issues are documented, and so are quarterly health and safety audits, areas covered include environmental risks, and an action plan is drawn up if needed. Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 26 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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 3 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 X 3 2 x 3 Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1)(2) (b)(c) Requirement The service users plan must be kept up to date through regular reviews in consultation with the service users and their representatives. To ensure information gives staff clear direction on how to meet their current needs. Care plans must document evidence of service users/representatives involvement and agreement to their plan of care. Service Users must receive care appropriate to their needs. To ensure those people with mental health needs receive proper care and support. Medications administered must be signed for by Nursing staff to support service users are receiving the care and treatment they require. There must be an effective complaints procedure that ensures that all complaints raised both formally and informally by service users or their representatives are DS0000002118.V340271.R01.S.doc Timescale for action 31/08/07 2. OP7 12(3) 31/08/07 3. OP7 12(1)(b) 31/08/07 4. OP9 13(2) 31/08/07 5. OP16 22(1)(2)( 3) 31/08/07 Highfield House Version 5.2 Page 28 6. OP18 13(6) acknowledged and acted upon. All allegations of suspected/actual or potential abuse must be identified effectively and result in referral through safeguarding procedures to ensure the wellbeing of service users is safeguarded. The Manager must refer potential safeguarding issues identified through this Inspection, using safeguarding procedures. Any equipment that has a degree of restraint must only be used following a full assessment of need, regularly reviewed and documented with consent in the service users plan of care. To ensure service users are safeguarded and that regard to the Mental Capacity Act has been given. There must be adequate numbers of suitably qualified, competent and experienced staff provided, to ensure service users needs are met with dignity and to ensure their rights are upheld. Recruitment checks on staff must be undertaken prior to commencement of employment, this must be evidenced in staff files. To ensure that service users are safeguarded. Staff must receive training appropriate to their role to ensure they safeguard service users and provide them with the care they require. There must be effective oversight and monitoring of the home by the Registered Provider. To ensure the home is run in the best interests of service users and to ensure they are safeguarded. DS0000002118.V340271.R01.S.doc 31/07/07 7. OP18 13(7) 31/07/07 8. OP27 18(1)(a) 31/08/07 9. OP29 19(1)(a) and (b) and Schedule 2. 18(c) 31/08/07 10. OP30 30/10/07 11. OP33 10(1) 12(1)(a) 31/07/07 Highfield House Version 5.2 Page 29 12. OP36 18(2) The registered Provider must ensure that all staff are appropriately supervised, including the manager. To ensure the service is run in the best interests of service users, and to ensure they are safeguarded. 31/08/07 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. Refer to Standard OP1 OP3 OP7 OP12 OP16 OP18 Good Practice Recommendations Service Users and relatives should be given information about the Inspection reports and how to contact the Commission for Social Care Inspection. Admission forms should allow for a record to be made of the needs of people who may be in same sex relationships. Social, spiritual and cultural needs. Care plans should be written in a way that complies with Nursing and Midwifery Council Guidelines. Activities should be planned that meet the needs of all service users. Staff should receive training on complaints. The layout and order of sequence of events in the safeguarding procedure should be reviewed, so it allows staff to gain a clear picture of the actions they need to take at each stage. Staffing levels should be determined by dependency levels rather than numbers of service users living in the home. There should be a staff development programme in place to cover additional training needs. Staff should receive training on dementia, managing challenging behaviour and person centred care. The Manager should register with the Commission for Social Care Inspection. The banking arrangements for service users should be reviewed to ensure money is more individually managed. Supervision of staff should include identification and DS0000002118.V340271.R01.S.doc Version 5.2 Page 30 7. 8. OP27 OP30 9. 10. 11. OP31 OP35 OP36 Highfield House monitoring of poor practice issues (e.g. medication errors) Highfield House DS0000002118.V340271.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 House DS0000002118.V340271.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. 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