Inspection on 19/09/06 for Highfield House

This inspection was carried out on 19th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 03/10/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Highfield House 70 Manchester Road Heywood Lancs OL10 2AN Lead Inspector Diane Gaunt Key Unannounced Inspection 19 September 2006 09:15a 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 DS0000066357.V298177.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 DS0000066357.V298177.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highfield House Address 70 Manchester Road Heywood Lancs OL10 2AN 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 624120 F/P 01706 624120 None Eagle Care Homes Ltd Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 25 service users to include: up to 25 service users in the category of OP (Older People). The service should employ a suitably qualified and experienced manager who is registered with the CSCI. N/A Date of last inspection Brief Description of the Service: Highfield House is registered to provide personal care and support for 25 people aged 65 years and over, nursing care is not provided. Eagle Care Homes Ltd became the registered owners of Highfield House in March 2006. Highfield House is situated close to the centre of Heywood and provides easy access to all local amenities. Transport between Heywood and Rochdale is also easily accessible. The home provides 2 lounges and 2 dining rooms. There are 23 single bedrooms and 1 double suite; all have the provision of a private toilet with the double suite having a full bathroom. The home is set in its own grounds and has ample parking space. Externally there is an enclosed patio area, with access for wheelchairs and a large rear garden. The home welcomes visitors and as such operates no formal visiting hours. At the time of this inspection weekly fees were from £333. 70p to £350 per week, approximately £1446 - £1566 per month. Additional charges were for hairdressing, chiropody, toiletries and newspapers. Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been written using information held on CSCI records and information provided by people who live at Highfield House, their relatives, professionals who visit the home, the operations manager, acting manager and staff at the home. A site visit to Highfield House by the lead inspector and a CSCI pharmacy inspector took place on 19 September 2006. The pharmacy inspector spent 7 hours at the home, the lead inspector spent 11¼ hours. The home had not been told beforehand when the inspectors would visit. The pharmacy inspector looked at arrangements for ordering, receiving, giving out and returning unused tablets and medicines. The lead inspector looked around the building and looked at paperwork that had to be kept to show that the home was being run properly. To find out more about the home the inspectors spoke with six residents, three visitors, one senior carer, two carers, the cook, two District Nurses, the acting manager, the operations manager and one of the directors of Eagle Care Homes Ltd who is registered with the CSCI as the Responsible Individual. The lead inspector also spoke on the telephone with two relatives. Questionnaires/comment cards asking residents, relatives and professional visitors asking what they thought about the care at Highfield House had been given out a few weeks before the inspection. Five residents, five relatives, and three GP’s filled them in and returned them to the CSCI. What the service does well: What has improved since the last inspection? Improvements had been made in each of the areas identified above. In addition, new crockery and tablecloths had been bought; communal areas on Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 6 the ground floor had been decorated and carpets cleaned; thermostatic mixer valves had been fitted to wash hand basins to make sure water was delivered at a safe temperature; the fire alarm had been serviced; and outside of the house and gardens had been maintained. Relatives reported that there was no longer an unpleasant smell in the home. The number of health and safety courses for staff had improved and managers had begun to check people out more before they offered them a job at the home. 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 House DS0000066357.V298177.R01.S.doc Version 5.2 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 House DS0000066357.V298177.R01.S.doc Version 5.2 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): 1, 2 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were assessed prior to admission to ensure their needs could be met but written information and terms and conditions of their stay were not issued at this point to help them decide if they wanted to live there. EVIDENCE: Copies of the Statement of Purpose/Service User Guide written by the previous owner were available at the home and whilst they provided some relevant information they had not been updated to include changes in ownership, staffing and contractual arrangements for residents. Eagle Care Home Ltd contracts and/terms and conditions had not been issued to residents, although Social Services Department Service Delivery Agreements were in place for all residents whose care they funded. Individual records were kept for each resident. Those of the three most recently admitted residents were inspected and each had assessments completed by the acting manager prior to admission as well as the Social Services Department care management assessment. The acting manager had Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 9 visited people in their home or hospital settings in order to assess them. The assessments indicated the home could meet the residents’ needs. Each of the residents told the inspector they had been satisfied with the assessment and admission processes. Five others returning questionnaires considered they received sufficient information about the home before moving in, they did not say how long ago they moved in but it was apparent some had moved in prior to the present ownership. If people needed to move in an emergency the manager would not always visit to assess but the home reserved the right to ask the person to find an alternative placement if they could not meet their needs. Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 10 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, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Due to recent changes in care plan formats, personal and healthcare needs were not always fully recorded or discussed with residents and/or relatives, leaving residents at risk of not having their needs met. Handling of residents’ medicines was in need of improvement to reduce the risk of mistakes, the implementation of the new management teams plans will achieve this. EVIDENCE: At the time of this visit a new care plan format was being introduced. Three care plans were inspected; one related to a resident who had moved in within the previous 6 weeks, and two related to residents who had lived at the home for a longer period. None of the new formats were fully completed but information held on old care plans and on the assessment of the most recently admitted resident supplemented this information. However, it was noted that staff completing the plans had not always addressed the areas of most importance to individuals and pertinent updated risk assessments were not always in place e.g. continence plan with regard to a resident who was experiencing problems in this area; falls assessment with regard to a resident who regularly fell; pain Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 11 assessment chart for someone who experienced regular pain. During the changeover process the acting manager should monitor and advise staff completing the care plans, in order to prioritise the order in which they were completed, addressing the most important needs first. Despite relevant information not being recorded, staff spoken with were aware of residents needs. Residents all appeared clean and well cared for. Most of the residents returning questionnaires said they usually got the care and support needed, and 3 relatives returning comments cards were satisfied with the overall care given at the home. Discussion with residents and relatives indicated that a minority of staff did not respond as quickly or were as considerate as the majority of staff. Senior managers were aware and were addressing the issue. One relative said that when they had raised issues with the operations manager at the home he had responded swiftly and was ‘working hard’ to address them. Completion of the new care plan formats was serving as a review of residents needs, ensuring up to date information was recorded. The format included sheets to be signed by residents/relatives on review but care plans were not being completed in consultation with residents or their relatives. The inspector was advised Eagle Care Homes Ltd have a policy of monthly reviews and when introduced these reviews would include residents and relatives. Two relatives commented that staff provided ‘good care’ for a frail resident they visited. Staff offered regular pressure care relief and ensured all the resident’s needs were met. Observation showed that they did so sensitively. Suitable equipment was in use for both recovery from and prevention of pressure sores. District Nurses considered that some staff were better than others in communicating with them and in passing information on to colleagues. A page to record professional visits in the new care plan format should help staff to improve in this area. There was evidence on file that GPs were consulted as necessary and a record made of advice given during their visits. Three GPs returning comment cards said they were satisfied with the overall care at the home. Three returned resident questionnaires said the medical support required was always provided and two said it usually was. Some staff had attended training with the dietician on how to use the MUST tool (Malnutrition Universal Screening Tool). This was an assessment document that alerted staff to take action if a resident was assessed as being at risk of malnutrition. The acting manager had not been working at the home when the training was held and the tool had not yet been introduced. At the time of the inspection there were no residents who required regular monitoring of food/fluid intake. The acting manager planned to invite the dietician to hold another session which she would go to along with staff who hadn’t previously attended. Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 12 The activities co-ordinator was mindful of the need to encourage exercise and was doing so regularly following a request from residents. The activities book showed that the co-ordinator also offered games which games which involved residents in movement. The new management team had audited the handling of medication and found some weaknesses in the existing procedures. The medication storage had been organised and all unwanted medicines had been sent for safe destruction. A stock check had been carried out (the day before the inspection) and records completed making it possible to track the handling of residents’ medicines. A regular check of controlled drugs had been introduced to help make sure they were well managed. Some weaknesses remained. Following the stock check it was clear that some medicines listed on residents’ administration records were not available at the home. The medicines records were marked as refused, this may need to be reviewed with the prescriber. If they are still needed supplies must be ordered. Poor practice during the mediation round had resulted in residents not being given eye drops as prescribed. It was not possible to tell whether creams were being used correctly as staff sometimes signed the records even though they had not personally applied the creams. Two medicines looked at had special instructions that they were to be given at least 30 minutes before food. Arrangements had not been made to make sure that this happened. Some residents had chosen to manage their own medicines. Those spoken with were happy with their choice to self-administer but written risk assessments had not been completed. These need to be completed and care plans drawn up to help make sure that residents get any support they may need with their medicines. To help improve the management of medication, managers are planning to enrol staff on further medication training and to complete in-house supervision of the medication round. There are also plans to include the management of pain and use of prescribed laxatives in care plans to help make sure they are well managed. Most of the medication administration records were pre-printed and up-todate. But, some handwritten records were not clearly completed. The instruction on one handwritten entry was different from that on the pharmacy label, another entry for a change in medication was unclear and did not include a start date. Completely handwritten records did not include the month and year of administration. A second check (signing and countersigning) would reduce the risk of this type of mistake happening. The signature list of staff authorised to handle medication should be kept up-to-date and include an initial signature. This will enable signatures used on the medication records to be identified. Medicines were securely stored. The home had a ‘mini fridge’ for medication needing refrigeration but the temperature was not monitored. This is recommended to make sure that the correct temperature range is maintained. Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 13 New medication policies and procedures were available in the home, but had not yet been implemented. The procedure for safe disposal of unwanted medicines was in need of review, as it did not describe how disposal was managed at the home. A procedure for managing medication errors should be included. The management team said that they would review the procedures as they planned to implement new procedures as soon as possible. This will help to ensure that staff have clear guidance about the handling of medication at the home. Observation showed that staff spoke to residents in a manner which respected their dignity. Residents said staff were good at maintaining their privacy and dignity when helping with personal care tasks. Staff interviewed were able to describe good practice in this area. All residents had single en suite rooms and those spoken with said they appreciated the privacy this afforded them. Locks were provided to bedroom doors and a small number of residents had chosen to have keys. Although none of the residents raised it as an issue, the locks could become problematic in that they automatically shut when doors were closed. If this becomes a problem for residents, safety locks should be fitted. Lockable space was provided in all rooms. Visitors were able to see residents in their own rooms or in communal areas, and the GP and District Nurses said they were able to see their patients in private. On the day of the inspection visit residents chose to see relatives in the privacy of their own rooms. Highfield House DS0000066357.V298177.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Residents were, in the main, able to follow their chosen lifestyles inside and outside of the home, and whilst meals offered choice and variety they were being reviewed to further meet residents wishes. EVIDENCE: A social activities organiser worked at the home for approximately 1½ hours each weekday, although this had recently reduced due to an increase in responsibilities at the neighbouring home which is also owned by Eagle Care Homes Ltd. A formal programme was not used by her but she kept a daily record of activities. Discussion with her indicated she knew the residents well and was aware of their social needs from spending time with them. The inspector observed residents taking part in an exercise session in one of the lounges. The organiser’s manner was enthusiastic which encouraged residents to participate. Those not participating appeared to enjoy the music played to accompany the exercises. The activities diary included regular chair exercises, bingo, skittles, crosswords, and reading horoscopes. Care staff said that in addition to this they read the Heywood Advertiser out loud for everyone, chatted to residents and manicured nails. Residents spoken with confirmed this information but one added that they missed the art and craft sessions that the activities organiser used to hold and wished that the organiser had more Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 15 time to spend with them. As part of her role the activities organiser also cut up fruit and took it round to residents. In order to allow her to spend more time with residents, care staff or the cook could undertake this activity. A notice displayed on the board in the entrance hall listed activities that care staff should undertake each evening and this included arts and crafts. There was no evidence that these activities were taking place and the acting manager said staff had reported that residents didn’t wish to participate. Of the five residents returning questionnaires, four said there were usually activities arranged which they could take part in and one said there never were. The acting manager said she would review the present arrangements at the next resident’s meeting to make sure the activities they like best are provided at times suitable to them. Residents enjoyed sitting outside on the patio in good weather and two of them enjoyed the fresh air there on the day of inspection. The activities organiser and staff took residents out shopping on occasion and, when necessary, used a local community bus service which had lifting equipment for wheelchairs. Care plans showed that the faith needs of some but not all residents were established on admission. A Roman Catholic priest visited individual residents and a Roman Catholic eucharistic visitor called each Sunday for prayers and communion. One resident said they would appreciate the opportunity to occasionally take communion from a Church of England representative. All relatives spoken with and completing comment cards said they were made to feel welcome by staff, describing them as ‘very friendly’. Seven of these relatives said they were kept informed when their relative was ill or any changes to their condition were identified, but three did not consider they were sufficiently informed. Observation and discussion with residents and staff showed that residents were able to make day to day decisions regarding rising/retiring times, what clothing to wear, where to sit, what to eat, whether or not to be involved in activities. Two residents had enjoyed a trip to the local pub the previous evening and staff were helping them to arrange a taxi to go again on the evening of the inspection. A number of residents chose to stay in their rooms during the day, staff were observed supporting them to do so. They also made sure that they were provided with sufficient drinks and their needs were not neglected. Senior management had recently introduced an hourly chart for one resident to ensure this contact. Minutes of a residents meeting held in July showed that residents were encouraged to express their views and alter things they were not happy with through the meeting. Residents had requested more chair exercises and this had been implemented. Residents wishes regarding involvement in their financial affairs were established on admission, one person had chosen to control their own monies. Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 16 The majority had asked relatives or friends to be responsible for finances. Of those returning questionnaires, three said that staff always listened to and acted upon what they said, and one said they sometimes did. Discussion with residents indicated that the majority of staff always did so, but a minority did not. One resident said that when they had rasied this with management, the operations manager had ‘got things done’. Residents gave mixed feedback about the food – the majority said they enjoyed it but two returning comment cards said they sometimes did. Comments from those spoken with included ‘smashing’; ‘I get enough’; ‘choice is fine’; ‘I’m satisfied’, ‘it’s not too bad’ and ‘it’s OK’. Two particularly enjoyed breakfast and one resident said the home provided the breakfast cereal they wanted. At the residents meeting in July those present said they were happy with the menu. The inspector stayed for lunch, a choice of chicken breast or beefburger, chips, carrots and sprouts were provided. The food was tasty and hot when served. Residents had been asked for their choice of meal by care staff earlier in the morning. Only one dessert was prepared and offered at lunchtime (trifle), although yoghurts were served to two residents who had diabetes and one who staff knew didn’t enjoy trifle. The cook may wish to extend this good practice by offering all residents a choice of dessert. New crockery and tablecloths had recently been purchased and were seen to be in use. Four weekly menus were in place and the newly appointed cook had begun to review them. Inspection of the menus showed that the 2nd option was at times repetitious (e.g. sausages within two days of each other). If red meat was served a fish, cheese or white meat option was not always an alternative and the 2nd option was not always as nutritiously balanced as the first (e.g. spam fritters, chicken dippers, sausages). When menus are reviewed attention should be paid to the nutritional balance of all choices at each mealtime. Residents’ food likes and dislikes had been recorded not long before the inspection and were held in the kitchen and on some care plans. Whilst an error was noted in the recorded information (a resident was not recorded as being diabetic), the cook showed her knowledge of each resident. Special dietary needs were being met and soft diets were provided those unable to chew. One staff member was observed assisting a frail resident with lunch and did so in a sensitive and encouraging way. He showed a clear understanding of the resident’s likes and preferences. Feedback from one resident and one relative indicated that some staff were not as helpful as others when residents needed their food cutting up. However, those on duty at lunchtime were seen to cut up food as residents required and to encourage people to finish their meals. Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most residents and relatives knew who to go to with concerns and complaints and issues raised were addressed. Staff were familiar with internal alerting procedures for the protection of residents but the lack of interagency procedures could affect the full alerting and reporting of protection issues. EVIDENCE: The home had a complaints procedure which was on the notice board in the entrance area. The procedure did not include telephone numbers however. Whilst the majority of residents and relatives returning questionnaires/comment cards knew who to speak to if they had a complaint, a minority were not familiar with the ‘official’ complaints procedure. Staff interviewed were aware of the procedure and were able to describe appropriate action to take if someone complained to them. A complaints log was kept and two entries had been made since the last inspection. One of the complaints was unsubstantiated and one was partially substantiated. Action had been taken to address the substantiated area. CSCI had received one anonymous complaint since the change of ownership and the operations manager had been asked to investigate it. The response indicated that the complaint was unsubstantiated in the main. One issue relating to carers undertaking cooking duties had been resolved as a vacant cooks position had been filled. Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 18 A copy of Rochdale’s Inter-agency protection procedure could not be located. The home’s policies and procedures included one on whistleblowing as well as a more detailed one on abuse. Protection of Vulnerable Adults (POVA) was also addressed in the home’s induction training. Staff spoken with understood the importance of reporting malpractice and the operations manager was familiar with Rochdale’s Inter-agency protection procedure, although the acting manager was not. Four staff had attended external Protection of Vulnerable Adult (POVA) training provided by Rochdale Social Services Department, and a further five had completed NVQ level 2 or 3 which included elements of the training. The remainder, including the acting manager, should also have this training. Feedback from residents indicated they felt safe living at Highfield House. Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. A safe, well maintained and comfortable environment was provided for residents and the decor and furnishings were being improved to increase the comfort of their surroundings. The home was adequately cleaned and infection control practices were satisfactory. EVIDENCE: A tour of the premises during the site visit on 19 September 2006 confirmed that the home was safe, well maintained, and comfortable. Grounds were seen to be safe, tidy and accessible. Residents said they had enjoyed sitting out in the patio in good weather. Since Eagle Care Homes Ltd became the registered owners in March 2006 outside security lights have been replaced, gutterings had been cleared and the garden tidied and regularly maintained. Inside the home, lounges, dining rooms and corridors had been decorated and carpets cleaned. The fire alarm Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 20 had been serviced. The use of a maintenance book ensured issues were raised with the maintenance worker as they occurred and were quickly attended to. A written maintenance and renewal plan was not available although it was apparent that areas of need had been identified and were being addressed. The inspector was informed bedrooms were being decorated on a rolling programme and a number of worn easy chairs were to be replaced. Other areas observed to be in need of attention included a Scandia frame in a ground floor toilet, the carpet and worn french dresser in one of the dining rooms; and cracked floor tiles in a ground floor bathroom. These should be included when a renewal plan is written. On the day of the inspection thermostatic mixer valves were being installed on 18 wash hand basins which had not previously had them. This would ensure that residents were able to wash in water which was not too hot nor too cold. Level access was provided along with a passenger lift and handrails in corridors. Grab rails, raised toilet seats and Scandia frames were also provided. Two of three baths were equipped with hoists and the home had two mobile hoists and a Stand Aid. Everyone spoken with thought the home was a safe place to live and work in. The Environmental Health Department had inspected the home in July and August 2006. Requirements and recommendations of the second visit were in the process of being met. Greater Manchester Fire Officers also visited in July 2006 and the inspector was informed an officer had called at the home the week prior to the inspection, and requirements had been met. Residents returning questionnaires had mixed views regarding the cleanliness of the home, although the majority considered it was usually clean. Of those interviewed one relative said that there had been occasion when a bedroom needed further cleaning but once this was raised it had been addressed. Residents interviewed all thought the home was clean enough. On the day of inspection there was no cleaner on duty and care staff were undertaking basic cleaning tasks. Rotas showed that one cleaner had been on sickness leave for some time. The inspector was informed the matter had been addressed, one part time cleaner was in post and another was due to begin work the following week. An infection control policy was in place and staff spoken with described safe infection control practice. There was no malodour in the home and residents and relatives spoken with said this was a good improvement. Staff wore disposable gloves and aprons when assisting residents with personal care tasks and cloth aprons and hats when in the kitchen and serving food. Liquid soap and paper towels were provided in communal areas. Practice had improved with regard to disposal of clinical waste which was now collected separately from household rubbish. Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 21 The laundry was sited away from the food preparation area and was seen to be clean and orderly. Sufficient and suitable equipment was provided and laundry appeared to be attended to efficiently. Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. For the majority of the time there were sufficient staff provided to meet residents’ needs. Recruitment and selection practices and training provision had improved but needed further improvement to ensure resident protection and staff competence. EVIDENCE: Prior to the inspection visit CSCI received information that the home had been short staffed on occasions, as a result of a number of staff leaving and others changing shifts without management agreement. However, residents and relatives spoken with said that the situation had improved. Inspection of rotas overall there were sufficient staffing hours provided each week and the home had begun to employ agency staff when unable to cover the rota. However, the way rotas were organised meant that only two carers were rota’d on duty between 3.00pm and 4.00pm on 2 or 3 occasions each week. The inspector was informed that the line manager sometimes stayed on duty to cover the gap but this was not recorded on the rota. On each occasion both the acting manager and operations manager were working at the home but were not ‘hands on’. In order to ensure sufficient staff are always available, formal arrangements must be made and recorded on the rota. A number of staff, including the registered manager, had left the home since the change of ownership, but an experienced core staff group remained and Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 23 two new carers had been recruited. The home was actively recruiting and a number of applicants attended for interview on the day of inspection. In the main, residents spoke positively about the staff, one person described them as ‘smashing’ and another as ‘very friendly’, and ‘very nice’. Relatives considered them to be ‘welcoming’ and ‘friendly’. One resident said that ‘on the whole’ they were ‘really nice’, most were ‘conscientious’ but a few were a ‘waste of time’. Examples of a less caring approach by some staff are detailed elsewhere in the report. Senior management are aware of them and had begun to take action to address the issues. 50 of carers hold an NVQ level 2 or above. Of thirteen care staff employed, three senior staff and one carer had NVQ level 3 and four carers had NVQ level 2. One carer was on the course at the time of the inspection and two others intended to enrol, indicating Eagle Care Home Ltd’s commitment to training. . Inspection of staff files provided evidence that in-house induction training had been introduced but not always completed within the recommended timescale. One recently recruited staff member considered their induction met their needs. The acting manager was also using the programme with long serving staff to identify and address outstanding needs. The programme had not been checked against Skills for Care Common Induction Standards which became fully operational in September 2006. However, the operations manager was aware of these standards and the need to address them. A training matrix was held at the home but was not up to date. The matrix showed that prior to Eagle Care Homes Ltd purchasing Highfield House, staff had not all attended refresher training at required intervals with regard to health and safety. Improvement was noted in that courses had been booked on a rolling programme between May and August which had increased the number of staff with current training. Further comment is made in the Management and Administration section below. Seven staff had attended training in the care of people with dementia and one had attended a loss and bereavement course. Staff files inspected provided evidence of improved practice with regard to recruitment and selection. The operations manager had audited files and where there were gaps with regard to CRB (Criminal Record Bureau) and POVA (Protection of Vulnerable Adults) checks he had applied for them. With regard to recent employees, two satisfactory references and a POVA 1st check were requested and received prior to appointment. Although CRB checks had been applied for by the home prior to appointment, they had not always been received before the person started work. The inspector was informed this was due to staff shortages and that appropriate induction and supervision was provided for these staff. Only in exceptional circumstances should staff begin work prior to receipt of satisfactory CRB check. Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 24 Staff were in the process of negotiating new contracts with Eagle Care Homes Ltd whilst continuing to work under the conditions of their previous employer. Prior to signing contracts staff were required to read and agree to a number of Eagle Care Homes Ltd policies which included health and safety issues, supervision and confidentiality. Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 25 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): 31, 33, 35, and 38 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to this service. Management responsibilities were fulfilled, residents financial interests safeguarded and quality assurance systems being further developed to ensure residents’ views were regularly sought. With the exception of sufficient up to date health and safety training for staff, the health, safety and welfare of residents was protected. EVIDENCE: Due to the registered manager leaving the home, there was no registered manager at the home at the time of the inspection visit. An acting manager had been appointed 3 weeks prior to the visit and was working alongside the operations manager. The acting manager is a trained nurse with some management experience in care homes and nursing settings. It is her intention to undertake the Registered Manager’s Award. Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 26 A number of quality assurance systems were in place e.g. 3 monthly staff meetings; resident meetings which were to be held monthly (although the last one took place on 26 July 2006); staff supervision; circulation of questionnaires to residents/relatives and other stakeholders. Questionnaires had been circulated but at the time of the inspection site visit, responses had not been collated. One returned questionnaire seen by the inspector recorded satisfaction at improvements made at the home since the change of ownership. The operations director said it was his intention to collate and publish responses, as well as addressing any matters raised. The responsible individual had written a business plan prior to registration and an action plan had been written to improve the quality of the service. Eagle Care Homes Ltd had introduced company policies and procedures which in some instances were running alongside the home’s previous policies and procedures (e.g. medication). Although only one Regulation 26 visit report had been written since March, the operations manager had fulfilled the functions of these visits as evidenced in the action plans and the current day to day contact with the home. Once the operations manager is no longer based at the home the monthly visits should be reinstated and recorded for monitoring purposes. Eagle Care Homes Ltd did not act as appointee for any residents. In the main relatives or solicitors assisted residents in the management of their finances. One resident managed their own money. Some relatives chose to leave small amounts of money in the home’s safekeeping. This was held securely and all incomings and outgoings recorded. Records and monies held in respect of two residents were inspected and seen to be in order. As stated above, health and safety training had not been kept up to date prior to Eagle Care Homes Ltd ownership. Improvement was noted since the new ownership and at the time of the inspection visit, approximately one third of the staff needed to attend up to date moving and handling, food hygiene, and infection control training. Sufficient staff had attended 1st Aid training to ensure one per shift was on duty. The recently appointed cook did not have a Food Hygiene certificate, although following an Environmental Health department inspection on 14 August 2006 the operations director was planning to book Hazard Analysis Critical Control Point (HACCP) training for food handlers. The day following the inspection visit arrangements were made for the new cook to take NVQ level 2 in catering. Sufficient staff had completed 1st Aid training to ensure one per shift was on duty. Maintenance records were inspected and seen to be in order and COSHH risk assessments were written. Water temperatures were checked regularly by the maintenance worker and as stated above, thermostatic mixer valves were being installed on the day of the inspection for the safety of residents. Fire precaution checks were undertaken but not as regularly as recommended by Greater Manchester Fire Officers. Not all staff had attended a fire drill/practice or lecture within the last 12 months, although there was evidence Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 27 drills/practices had been held regularly since the end of June 2006, and the home was on target to achieve at least one drill for each staff member. Accidents were appropriately recorded. The manager was advised to contact the Falls Co-ordinator with regard to residents who regularly fell. Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 28 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 1 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 29 N/A 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 OP1 Regulation 4&5 Requirement An up to date Statement of Purpose and Service User Guide must be made available to prospective and current residents to include terms and conditions of their stay. Copies must also be provided to CSCI. Residents and/or relatives must be consulted when care plans are written and reviewed to ensure they include accurate, individual and agreed interventions to meet their needs. Timescale for action 31/10/06 2 OP7 15 19/09/06 3 OP9 13(2) The registered person must audit 19/09/06 the management of the medication rounds to make sure they are well managed and that any special instructions (e.g. before food) are followed. The registered person must ensure there is a complete and accurate list of currently prescribed medication for all residents, and of the date and time of administration. DS0000066357.V298177.R01.S.doc 4 OP9 17(1)(a) 16/10/06 Highfield House Version 5.2 Page 30 5 OP9 13(2) The registered person must ensure that the reviewed medication policies and procedures are implemented. The registered person must ensure that all medication selfadministration is assessed and supported within a risk management framework. 30/10/06 6 OP9 12(1)(b) 16/10/06 7 OP9 13(2) The registered person must audit 16/10/06 the handling of creams to make sure they are well managed. Rotas must clearly identify staff working in a caring capacity at the home, ensuring there are enough staff on duty to meet the needs of the residents. All care staff must receive up to date health and safety training including moving and handling, food hygiene and infection control. The newly appointed cook must hold a Food Hygiene certificate. All staff must attend a fire lecture at least once per year. 16/10/06 8 OP27 18 9 OP38 13 31/10/06 10 11 OP38 OP38 23 23 31/10/06 30/11/06 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 OP2 Good Practice Recommendations Residents should be issued with Eagle Care Homes Ltd contracts and/terms and conditions of their stay. DS0000066357.V298177.R01.S.doc Version 5.2 Page 31 Highfield House 2 OP9 OP9 OP9 OP9 OP13 OP16 OP18 The temperature of the medication fridge should be monitored and recorded. Handwritten entries on the medication administration records should be signed, checked and countersigned. The signature and initials list for staff authorised to administer medication should be kept up-to-date. Eye drops should be dated on first use to make it possible to check when they need replacing. Residents faith needs should be established on admission and suitable provision made to meet them. Telephone numbers should be included in the complaints procedure. A copy of the Rochdale Inter-agency Protection Procedure should be held at the home and the acting manager and care staff attend training in this area. Items identified in the report should be included in the maintenance and renewal plan. Only in exceptional circumstances and after consultation with CSCI should staff be employed without a new Criminal Record Bureau check. 3 4 5 6 7 8 9 OP19 OP29 10 Highfield House DS0000066357.V298177.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 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 DS0000066357.V298177.R01.S.doc Version 5.2 Page 33 - 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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