Inspection on 14/09/09 for Highfield House Residential Home

This inspection was carried out on 14th September 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC 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 Residential Home 23/09/08

Highfield House Residential Home 27/03/08

Highfield House Residential Home 13/03/07

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Highfield House Sycamore Terrace Haswell Co. Durham DH6 2AG Lead Inspector Jim Lamb Key Unannounced Inspection 14th September 2009 10:00 DS0000068092.V377614.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Highfield House DS0000068092.V377614.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Highfield House DS0000068092.V377614.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highfield House Address Sycamore Terrace Haswell Co. Durham DH6 2AG 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) 0191 5261450 0191 5261450 Susan Burns Mrs Marion Burns Manager post vacant Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25) of places Highfield House DS0000068092.V377614.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only : Care home only - code PC to service users of the following gender - either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - code OP, maximum number of places 25 Dementia - Code DE(E), over 65 years of age, maximum number of places 25 The maximum number of service users who can be accommodated is: 25 23rd September 2008 2. Date of last inspection Brief Description of the Service: Highfield House is a care home that provides personal care and accommodation for up to 25 people who are over 65 years old. The home is registered to provide care for older people and older people with dementia. This home does not provide nursing care. The home has been operating for about 20 years. The current owners purchased the home about 2 years ago and have almost fully refurbished it. Highfield House is in a pleasant rural location on the outskirts of Haswell village. The home is close to the local communitys resources, including a shop, pubs, club, post office, and health centre. The ground floor accommodation has a large lounge and separate dining room, with good access to a patio and lawned gardens. The majority of bedrooms, toilets and bathrooms are also located on the ground floor. The first floor has a small number of bedrooms and an additional bathroom, with both lift and stair access. Bedrooms are mainly single occupancy with the exception of one double room (which is not currently occupied). Ten bedrooms have en-suite facilities. The weekly fees at the time of inspection were £404.00 to £439.00 depending Highfield House DS0000068092.V377614.R01.S.doc Version 5.2 Page 5 on care needs. Highfield House DS0000068092.V377614.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations - but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The quality rating for this service is 1 star. This means that the people who use the service experience adequate quality outcomes. How the inspection was carried out. Before the visit we looked at information we have received since the last visit, how the service dealt with any complaints and concerns since the last visit, any changes to how the home is run, the providers view of how well they care for people, and the views of people who use the service and their relatives, staff and other professionals. During the visit we talked with people who use the service, relatives, staff, the manager, proprietor and visitors, looked at information about the people who use the service and how well their needs are met, looked at other records which must be kept, checked that staff had the knowledge, skills and training to meet the needs of the people they care for, looked around the building/parts of the building to make sure it was clean, safe and comfortable, and checked what improvements had been made since the last visit. We told the manager/provider what we found. What the service does well: Highfield House DS0000068092.V377614.R01.S.doc Version 5.2 Page 7 The home provides a good range of information to people thinking of coming to the home, so they can make an informed decision. Service user’s health care needs are also fully assessed and properly met. Service users say that staff treat them well and treat them with respect. Service users are encouraged to keep in regular contact with family and friends, who say they are always made welcome in the home. Service users are also encouraged to take as much control over their own lives as they are able, and make their own decisions. Service users are very complimentary about the staff and the care that they receive. Complaints and concerns are now taken seriously and are responded to properly. The home is kept clean, hygienic and free from odours. The home has enough staff to meet the needs of service users. The manager is experienced and is providing very positive leadership to the home. The home is being run in the best interests of the service users. Service users finances are protected by the homes policies and accounting systems. The health and safety of the service users and of the staff are protected by the homes policies and systems. What has improved since the last inspection? Recent improvement has significantly improved the appearance of the home creating a very comfortable and safe environment for those living there. With support from Durham County Council’s safeguarding team and training officer’s, staff now have good knowledge and understanding of Adult Protection procedures, and this knowledge now provides a safe environment to protect service users from harm. Highfield House DS0000068092.V377614.R01.S.doc Version 5.2 Page 8 After a long period of instability, the home has a new manager who has a clear development plan and vision for the home. The health care needs of the service users are well met with evidence of good multi disciplinary working taking place. The visiting District Nurse said that the care provided was very good, and that there was good communication between her and the staff team. The staff had a good understanding of the service user’s support needs; this was evident from the very positive relationships which have been formed between service users and staff. Without exception, all service users spoke highly of the staff and the care provided. What they could do better: Staff recruitment and training records, including staff induction training records, need to be easily accessible and organised properly. The menus only cover a two week cycle; therefore they do not fully provide enough choice and variety. Consideration must be given to implementing a four week menu cycle. Employing an assistant cook will ensure that a qualified person is available in the kitchen each day. The medication systems are well managed promoting good health; however the procedures for recording handwritten entries in the medication records must include two staff signatures and the quantity received. The recognised codes must be used to explain any gaps in the record keeping. Excellent progress has been made with some of the service users individual care plans. All care plans will need to be revised, reviewed and evaluated to bring them all up to the same standard. This will them provide staff with the information they need to fully meet the holistic needs of all the service users. Employing an activities co-ordinator will provide service users with the opportunity to become involved in a range of social activities based on individual interest and choice. This will provide a structured and therapeutic daily life for service users. A detailed pre admission assessment format should be implemented. This will ensure that prospective service users need’s can be met by the home prior to admission. Highfield House DS0000068092.V377614.R01.S.doc Version 5.2 Page 9 The service should consider introducing a key worker system. This will provide service users with access to a particular member of staff who will take a special interest in their care and well-being. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Highfield House DS0000068092.V377614.R01.S.doc Version 5.3 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 House DS0000068092.V377614.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 4 6 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users are provided with enough information about the service to enable them to make an informed choice about whether this is where they want to live. EVIDENCE: People who come to stay here are given an information pack, called a Service Users Guide, which includes useful information about what they can expect from the service. Information is now available on audiotape for people with visual impairments. Highfield House DS0000068092.V377614.R01.S.doc Version 5.3 Page 12 Everyone is encouraged to come and have a look around the home before making a decision. In this way people have good information to make a decision about whether to move to this home. There are clear records to show that the needs of the service users were assessed before they moved in so that the home knows whether those needs can be met here. Care managers of the Social Services Department carry out most assessments and these are provided to the home. The service also carries out assessments of prospective new service users, to make sure that the home can meet their individual needs. The pre assessment currently used is not detailed enough and does not provide enough information about the following areas; personal care and physical well-being, diet, including dietary preferences, sight, hearing and communication, oral health, foot care, mobility and dexterity, risk of falls, continence, medication usage, detailed mental state and cognition, social interests, hobbies, religious and cultural needs, family involvement and social contacts. The new manager said that she has a new format that will address all these areas, and she will ensure that this new pre admission assessment is used for all new referrals to the home. The home does not provide intermediate care. Highfield House DS0000068092.V377614.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system is not yet clear enough to ensure that staff have the information they need to meet the assessed needs of the service users. EVIDENCE: Three staff were interviewed. It was evident that they were fully committed to helping people living at the home to live fulfilling lives as independently as possible. During the inspection, there was evidence that the people using the service made their own decisions about how they lived their lives. For example, two service users said that they are supported to make decisions about their dayto-day lives. The care records of five service users were examined. Their care plans had not all fully taken account of the information contained in the assessments and Highfield House DS0000068092.V377614.R01.S.doc Version 5.3 Page 14 care plans supplied by social services as well as that of the homes own admission assessment. Care plans should be based around service user’s strengths and their preferences for how they want to be cared for. Each plan and risk assessments should be signed by the service user whenever capable, or their representative. This will make sure that everyone has agreed and understands the information recorded. All care plans should be easy to understand and written in plain English. Each plan must accurately describe the service user’s needs/preferences and how staff will meet these needs. All plans must be reviewed monthly. The new manager described how she intends to review and evaluate each persons care records; she demonstrated that she has the skills and knowledge needed: She is aware that care must be delivered in accordance with the service user’s plan for that individual. She knows that the plan becomes the yardstick for judging whether appropriate care is delivered to the individual service user. She will also provide in-house training for care staff to ensure they have the skills to address all aspects of the health, personal and social care needs of each person; this will also include the detail and action to be taken by them to meet each persons needs. A key worker system does not operate, and again the new manager has plans to change this, this will allow staff to work more closely with some nominated people whilst also contributing to the care of all living at the home. Two of the service user’s individual care plans had been revised, and new formats introduced, these were recorded to a very good standard and each plan is now linked to a risk assessment and intervention format. This is good practice. Durham County Council’s safeguarding team have been working closely with the home, and they have contributed greatly to helping the service improve the standard of the service users care records, via staff training and development. The new comprehensive risk assessment information was available. For example, risk assessments covering the following areas had been completed: nutrition, falls, mobility, skin care and living independently. Pressure area care assessments are completed if necessary. No limitations had been placed on service user’s right to make decisions and choices about how they lived their lives. The home had a medication policy that was available in the main office. Highfield House DS0000068092.V377614.R01.S.doc Version 5.3 Page 15 The medicines trolley was clean, tidy and it was easy to identify what medication belonged to which person. Only limited stocks of medication were kept at the home. Photos to identify each person were in their medication records. There were records covering the ordering, administration and disposal of medication within the home. All staff administering medication had received accredited training. No incidents concerning the mis-administration of medication had been reported to the Commission. Advice was given about handwritten entries in the medication records: there must always be two staff signatures for each entry, and the quantity received must also be recorded. Staff are now aware of the need to treat people living at the home with respect and dignity when providing support and personal care. Service users said that they were happy with the way that staff cared for them. Staff were observed caring in a way that respected their right to privacy. Highfield House DS0000068092.V377614.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users are not fully offered a good quality lifestyle, which includes varied social contact and activities. EVIDENCE: The service users are offered a lifestyle, which includes varied social contact. All the people who live in the home have involvement with their families. The degree of contact is decided by the wishes of each individual, and it can be in person or by phone. Some choose to visit their family members outside the home; others, to be visited at home. Each service user has a social skills assessment carried out. All service users and their representatives participate in this process. The completion of the skills assessment should be used to assist staff to implement more detailed social care plans. Highfield House DS0000068092.V377614.R01.S.doc Version 5.3 Page 17 The social care plans do not currently include each person’s interests, hobbies or social contacts. Again, the new manager will ensure that each person’s individual’s social needs will be recorded and acted upon. There are currently no planned daily activities available. There was evidence that entertainers frequently visit the home. The new manager will devise an activities programme that is based on service user’s interests and choice. She also intends to employ a part time activities co-ordinator All service users are supported to maintain very close links with their families. They can choose who they want to see and when. The homes menus are based on the known likes and dislikes of the service users. At least two hot meals are provided each day. The menus cover a two week cycle only, the new manager has arranged a meeting with the catering staff, and she plans to introduce a 4 week menu cycle, this will provide a greater choice and variety. Special diets are provided when necessary, and food moulds are going to be purchased for those that require a soft diet, this will improve the presentation and resemble the food that it is. Currently one of the proprietors does the cooking on the cook’s days off. In the short-term this arrangement is acceptable, but she was not aware that food temperatures had to be monitored/checked. Therefore, she has agreed to employ a part time catering assistant to as soon as pssible. All those spoken to said that the meals were very good and that they were always offered a choice. Highfield House DS0000068092.V377614.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints procedure. The procedure is written in a way that ensures service users fully understand its contents. EVIDENCE: Three service user said that she had been given a copy of the procedure and that staff always listened to any concerns and always dealt with them fairly. The home keeps a record of complaints. The home has a Whistle Blowing policy, the Local Authorities Vulnerable Adults procedures, and a copy of the Department of Healths document, NO SECRETS. Staff are aware of these procedures and have easy access to them. Since the last inspection visit, there have been no complaints received. One safeguarding concern is currently ongoing. Durham County Council has provided excellent support and staff training during the last 3 months: The complaints management is now effective, and this results in the service users being protected from harm and abuse. Safeguarding adults training is ongoing for all staff. Highfield House DS0000068092.V377614.R01.S.doc Version 5.3 Page 19 Service users can deposit cash for safe keeping and records are kept of accounts. A sample of personal finances records was examined. Transactions were appropriately recorded and had two signatures for each entry. There was plenty of evidence of personal spending. Receipts are obtained for purchases and numbered to cross-reference to the transaction. Weekly checks of balances and cash are carried out. Highfield House DS0000068092.V377614.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 21 22 23 24 25 26 People using the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a very comfortable and safe environment for those living there. EVIDENCE: All parts of the building seen were exceptionally clean, suitably equipped and have good quality decoration and furnishings. There is an ongoing programme of decoration and refurbishment. Most bathrooms and toilets have been refurbished to a high quality, ten bedrooms have en-suite facilities and these are also being refurbished. A large conservatory is being built, new dining room furniture has been purchased, most of the communal areas have been fitted with new flooring, a Highfield House DS0000068092.V377614.R01.S.doc Version 5.3 Page 21 new front entrance and lobby area has been built. (The main entrance will have a ramp for wheelchair access). The grounds are well maintained and are used regularly by service users. A number of service users spoke positively about their bedrooms and the accommodation in general. The new manager intends to display Orientation boards providing information depicting: date/day, weather, the names of the staff on duty, appropriate signs on toilet doors, bathrooms, dining and lounge areas. This will enhance and promote the orientation for people with memory problems. If contacted, Stirling University will provide appropriate information about environmental design, and colour schemes suitable for this client group. Service user’s bedrooms have opening windows and restrictors are in place. The rooms were centrally heated and the heating level could be controlled within each bedroom. Radiators and pipes were guarded. All rooms are highly personalised, furnished and decorated to a high standard. The home has policies and procedures on hygiene and control of infection. All staff receives infection control training. There is suitable hand washing facilities throughout the building. Disposable gloves and aprons are provided for staff use. Arrangements are in place to dispose of clinical waste. The home does not have a sluice facility: an area should be considered to install a sluice/commode disinfector, and this will promote hygiene practices. Highfield House DS0000068092.V377614.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. After a period of instability there is now a management structure in place that will provide staff with clear leadership and direction. EVIDENCE: Staff levels on the day of the inspection met the level for the number of service users. On the day of the inspection there were 19 service users. In addition to the manager, the required numbers of staff were on duty across the day 3 from 8am to 8pm. There are 2 carers between 8pm and 8am. There are enough domestic, maintenance hours, and catering hours need to be extended to cover the cooks days off. All staff were over 18 years of age and those left in charge were at least 21. The training needs of the staff are identified in supervision and appraisal sessions. Highfield House DS0000068092.V377614.R01.S.doc Version 5.3 Page 23 The homes new manager will ensure that the homes training programme will meet the National Training Organisation requirements for the first six months. Staff receives at least three days paid training each year. All statutory training was up to date and all of the staff team has completed NVQ level 2/3. The filling systems made it difficult to check the staff recruitment records, the new manager intends to reorganise these systems within the next few weeks, she will ensure that each employee has the correct documentation on file, these will include: application forms, the dates of employment to be made clear, making it easy to follow a clear employment ‘audit trail’. She will complete an audit check list to ensure that all the necessary checks have been completed prior to commencing employment: All must have two work written references, (crb) criminal record bureau check, documentary evidence of identity, induction and training and development information. The manager confirmed that, if there are any concerns about the content of a CRB disclosure, these are discussed with the proprietor. Highfield House DS0000068092.V377614.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new manager has a good understanding of the areas in which the home needs to improve. She has plans in place indicating how improvements are going to be resourced and managed. EVIDENCE: The new manager has applied for registration. She is well qualified and experienced in senior roles within social care settings. Service users, relatives and staff described her as being approachable and caring. She has the Registered Managers Award at National Vocational Qualification (NVQ) level 4. Highfield House DS0000068092.V377614.R01.S.doc Version 5.3 Page 25 She confirmed that all staff will be regularly supervised (bimonthly) and have an annual appraisal. Good accounting procedures are followed, with receipts and signatures being obtained for all financial transactions involving service users personal monies, such as pocket monies, clear individual accounts and records are maintained. Service users have ready access to their money, even at short notice. Comments received from staff and management confirmed that there are good health and safety policies and practices that promote the health, safety and welfare of service users and staff. All relevant staff members do refresher training in Health and Safety, such as moving and handling, fire safety and food hygiene. This helps reinforce the registered providers written policies on Health and Safety. Health and Safety issues are also discussed at staff meetings. The proprietors’ visit the home daily and are offering positive support to the new manager. Service users and staff expressed satisfaction with the way the home was run and the good standards that were evident in many instances. For example, all service users and relatives commented that the home was always fresh and clean. Service users and staff said they enjoyed living and working at the home and believed the home was safe and run in the best interests of the service users. The manager said she will routinely invite comments and suggestions for improvements from both service users and visitors to the home, via regular meetings, surveys and consultations. She will also implement an annual development plan. Checks of the fire log book showed that all the required checks and tests of equipment and systems take place at the proper intervals, as does fire safety training. The home’s accident book is kept up to date and information is fully recorded. Each accident is reviewed after 24 hours to check the outcomes of the accident and any treatment given. There is a monthly audit of accidents, and a detailed audit of all falls. Servicing and maintenance records are comprehensive and well maintained. Highfield House DS0000068092.V377614.R01.S.doc Version 5.3 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 3 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 3 3 4 4 4 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 3 X 3 X 3 X X 3 Highfield House DS0000068092.V377614.R01.S.doc Version 5.3 Page 27 Are there any outstanding requirements from the last inspection? 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 OP3 Regulation 14 (1) Requirement A detailed pre assessment should be implemented and should also include details of a prospective service user’s mental health or dementia care needs. This information will ensure that the home is fully aware of that person’s needs before deciding whether those needs can be met by the service. 2. OP7 15(1) All the care plans must be brought up to the same standard of those that have already been reviewed, revised and evaluated. This is to guide staff in how to support people with their holistic care needs in a consistent, planned way. 14/12/09 Timescale for action 14/12/09 Highfield House DS0000068092.V377614.R01.S.doc Version 5.3 Page 28 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 OP1 Good Practice Recommendations To ensure that prospective service users need’s can be met by the home, a detailed pre admission assessment format must be used to identify the person’s holistic care needs. The medication systems are well managed promoting good health; however the procedures for recording handwritten entries in the medication records must include two staff signatures and the quantity received. The recognised codes must be used to explain any gaps in the record keeping. Employing an activities co-ordinator will provide service users with the opportunity to become involved in a range of social activities based on individual interest and choice. This will provide a structured and therapeutic daily life for service users. The service should consider introducing a key worker system. This will provide service users with access to a particular member of staff who will take a special interest in their care and well-being. To promote hygiene practices in the home, consideration should be given to installing a sluice/mechanical commode washer. The menus only cover a two week cycle; therefore they do not fully provide enough choice and variety. Consideration must be given to implementing a four week menu cycle. Employing an assistant cook will ensure that a qualified person is available in the kitchen each day. 2. OP9 3. OP12 4. OP7 5. 6. OP26 OP15 Highfield House DS0000068092.V377614.R01.S.doc Version 5.3 Page 29 Care Quality Commission Care Quality Commission North Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.northeastern@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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