CARE HOMES FOR OLDER PEOPLE
Highfield House 28 Clifton Road Ashbourne Derbyshire DE6 1DT Lead Inspector
Vanessa Davies Unannounced 20 July 2005 10.00am
th 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 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 C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Highfield House Address 28 Clifton Road Ashbourne Derbyshire DE6 1DT 01335 342273 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Lou Smith - Grandcross Limited (wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Pamela Upson Care Home with Nursing 37 places Category(ies) of 37 Older People registration, with number of places Highfield House C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None. Date of last inspection 10.11.04 Brief Description of the Service: Highfield House is a large detached period property, which has been extended to 37 older people. The is a large car park with a number of steps up to the home or a driveway for wheelchair users. The home is managed by an experienced Registered Nurse. The home is situated very close to the small town of Ashbourne. Highfield House C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced. The Manager, Operations Manager and the Responsible Person were all available for the first hour of the inspection. The remainder of the inspection took place with the Manager. Information for the inspection report was gathered by, speaking with service users, speaking with management and reading documentation. What the service does well:
All service users moving to the home have a detailed assessment of need in place prior to any move and from this the manager develops care plans to address the needs highlighted. The manager regularly reviews assessments and care plans. All prospective service users are invited to visit the home prior to any move. Staff were seen communicating well with service users on the day of inspection. The relevant risk assessments and other assessments are completed in order to meet needs highlighted. Each service user is registered with a GP and other professionals are involved with the home as necessary. Service users spoken with stated that there were enough activities to do throughout the week if they wanted to be involved. Relatives visit the home without restriction. The home offers a good choice of menu and caters for specialist diets. Service users are able to chose where they eat and are not required to eat in the dining room. Relevant policies and procedures are in place to protect service users from abuse. Although currently a number of staff need training in adult protection it is planned for August 2005. There are sufficient toilets and bathrooms throughout the home, all fitted with call bells and grab rails. There is a lift and stair lift to assist access to the first floor. Highfield House C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 6 There is a training programme in place to address needs of staff and enable them to meet the needs of the service users. There are detailed policies and procedures in place. The home has a rigorous recruitment procedure in place to ensure the safety of the service users. The home is well managed by a Registered Nurse who is completing NVQ 4 Registered Managers Award. She has a good relationship with both service users and staff. The home has residents meetings. Support is offered to the manager by the Operations Manager. What has improved since the last inspection? What they could do better:
Further information is needed within the care plans to ensure that all of the service users wishes are met and that relatives have a clear understanding and awareness of their relatives condition. Service users with no relatives/representatives should be supported to access advocacy services. A number of areas within the physical environment were highlighted for improvement; carpets needing replacing, the kitchen needing urgent attention as it is currently a risk to staff and potential risk to service users. Food is currently stored in a room with no ventilation and is high in temperature. The cook is expected to take food up to the dining room by hand as the ‘dumb waiter’ (lift) has not worked for a number of weeks, this needs to be rectified as it may will have an affect on the temperature of the food when consumed. The home is below the National Minimum Standard of 50 of staff trained to NVQ 2 minimum. The manager should ensure that all staff remain up to date with mandatory training. Residents Meetings should be held more frequently to give the opportunity for feedback and comments. Highfield House C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 7 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 C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Highfield House C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,5 Detailed assessments of need and additional monitoring information provide essential information for staff, enabling them to meet the needs of the service users, providing a good standard of care. EVIDENCE: Three service users files were examined, each had detailed assessments of need and from this the manager and staff have developed care plans to address the needs highlighted. There was evidence of the manager closely monitoring the assessments of need and making relevant changes. Assessments of need and subsequent care plans are signed by the manager but not signed and agreed by the service user, relative or advocate. Staff were seen to follow the care plans and communicate effectively with the service users on the day of inspection. Highfield House C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 10 Each file had a monthly weight chart along with a chart monitoring pulse and blood pressure. The manager stated that all prospective service users and their relatives are invited to visit the home prior to any move. Highfield House C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10, 11 Service users health needs a clearly met at this home with evidence of good multi-disciplinary working taking place. Further information is needed to ensure that all service users wishes are taken into account, with a view to their care. EVIDENCE: Each of the files examined held detailed information to address the needs of the service users. Each file had a moving and handling assessment, a Waterlow pressure area risk assessment and a nutritional assessment, all regularly reviewed. In one file examined the manager had not completed the ‘Relatives understanding and awareness of condition’ There was evidence of input from the GP, chiropodist, dentist and physiotherapist to address specific needs as they arise. In addition to the assessment of need a social assessment is completed. Service users spoken with said that there were enough activities to do throughout the week and that they had the choice of whether to join in or not.
Highfield House C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 12 One file examined had a self-administration of medication form completed and signed by the GP, this is evidence of good practice and good communication with the GP. Service users spoken with felt that the staff respected their dignity. Staff always knocked on doors before entering and spoke to service users appropriately. This was apparent on the day of inspection. There is documentation to complete regarding service users wishes in the event of death and dying, however this had not been completed. Highfield House C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 13,15 Relatives are able to visit without restriction ensuring service users maintain access with their communities. The meals in this home are good offering both choice and variety and catering for special dietary needs. EVIDENCE: The manager stated that relatives were able to visit without restriction, relatives were visiting at the time of inspection. One file examined documented that the service user had no relatives, however there was no evidence of input from an advocate. The home offers a choice of menu and service users spoken with stated that the food was very good and that any specialist diets were catered for. Choices are offered and service users are able to eat where they feel comfortable. On the day of inspection one service user chose to eat in the lounge due to having a cough and a light diet was provided. The menus appeared to provide a varied and wholesome diet. Highfield House C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 14 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 standard(s) 18 Arrangements for protecting service users from abuse are improving with the provision of training for all staff, increasing the staff knowledge base, in addition to procedures ensuring residents safety and protection. EVIDENCE: The manager ensures that all staff have a POVA (protection of vulnerable adults) check and a CRB (criminal records bureau) check prior to starting to work at the home. There is an adult protection procedure in the home. Training in adult protection is planned for August 2005 for 22 staff. Highfield House C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 15 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 standard(s) 19,20,21,22,25,26 The standard of the environment within this home is poor and therefore does not present as a homely and comfortable environment for service users. EVIDENCE: A number of areas were highlighted for improvement during this inspection. A new carpet is needed in the lounge, the flooring in the dining room needs to be replaced, skirting boards throughout the home need to be repainted and the carpet outside the kitchen needs to be replaced. The Manager stated that there are plans to replace carpets and this was confirmed by the Responsible Person. The kitchen is in urgent need of refurbishment, equipment is currently being used which is not suitable for the job; for example a glass washer is used as a dishwasher and the cook has to was all dishes by hand prior to putting them in the washer. It washes for 3 minutes at 46 degrees and leaks throughout this time. The microwave has not had a portable electrical test since 2003. The kitchen is situated on the ground floor and the lift ‘dumb-waiter’ does not work, therefore kitchen staff have to take meals to service users up stairs by hand, this is not acceptable as it is not hygienic and is a health & safety risk.
Highfield House C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 16 Food is currently stored in a cupboard with no air conditioning or windows, tins and boxes were felt and were warm to the touch. There are 10 communal toilets throughout the home and 6 bathrooms, although one bathroom is not used. All toilets had hand rails and call bells. There is a lift and a stair lift to access the first floor. Service users who need pressure relieving equipment had received it. The home was clean on the day of inspection. Highfield House C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Service users welfare is protected with rigorous recruitment practices, however they could be potentially at risk due to out of date staff training. EVIDENCE: The duty rota evidenced 2 Registered Nurses and 5 care staff in the morning, 1 Registered Nurse and 4 care staff in the afternoon. There is an activity coordinator for 6 hours per week. 1 chef and 1 kitchen assistant work Monday to Friday and 1 kitchen assistant works during the weekend. 2 domestics work Monday to Friday and 1 at weekends. There are 32 care staff working at the home, 5 have NVQ 2 and 3 are due to start and 2 have NVQ 3. This is still below the national minimum standard of 50 . Only 5 staff have First Aid training, all staff have received fire safety training. 13 staff are to do Moving and Handling training August 2005. The chef has completed Food Hygiene. The home has policies and procedures in place to ensure rigorous checks are made prior to any staff appointment. All files examined had CRB checks, POVA checks, 2 written references and 2 proofs of identity. Highfield House C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,37,38 This home is well managed and the manager is able to identify and address areas requiring action to improve the quality of service provision for service users. EVIDENCE: The manager is a Registered Nurse and is completing the NVQ Registered Managers Award. She has a good relationship with staff and service users and service users came into the office to speak with her on occasions throughout the inspection. Service users spoken with stated that she was approachable and always had time for them. The manager is due to introduce a service user questionnaire for feedback. The home does have Service User meetings, although the last recorded one was January 2005. The Operations Manager visits the home on regular occasions to provide support for the manager and review the service.
Highfield House C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 19 Detailed policies and procedures are in place. Service users records were up to date and legible and kept securely. As stated previously the kitchen does not promote a healthy environment and food is currently stored in a hazardous environment. Highfield House C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 2 14 x 15 3
COMPLAINTS AND PROTECTION 1 2 3 3 x x 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 3 x 2 x x x 3 2 Highfield House C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 21 NO 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 3 Regulation 14.1 c Requirement Appropriate consultation should take place with service users when writing assessments and care plans. Arrangements must be made by training staff to prevent service users being abused. The premises must be kept in a good state of repair. The equipment provided for use by people working at the home must be maintained in good working order. Staff must receive the training needed to complete their role. Timescale for action 30.09.05 2. 3. 4. 18,28 20,25 19,38 13.6 23.2 b 23.2 c 30.09.05 30.11.05 30.10.05 5. 30 18.1 c i 30.09.05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 7 3 11 Good Practice Recommendations Areas relating to relatives understanding of condition within the assessment of need should be completed. Service users, relatives or representatives should be supported to sign assessments and care plans. Service users wishes regarding terminal illness and death should be documented.
C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 22 Highfield House 4. 5. 6. 7. 8. 13 20 19,38 33 38 Input from advocacy services should be sought for those service users without relatives/representatives. Carpets detailed within the report should be replaced. The kitchen needs to be refurbished, providing necessary equipment. Service user meetings should be held on a monthly basis. Food storage needs to be improved Highfield House C52-C02 S2118 Highfield House V237673 180705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection South Point, Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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