CARE HOMES FOR OLDER PEOPLE
Highfield House 28 Clifton Road Ashbourne Derby DE6 1DT Lead Inspector
Vanessa Davies Key Unannounced Inspection 09:30 22nd May 2006 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Highfield House DS0000002118.V294120.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Highfield House DS0000002118.V294120.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Highfield House Address 28 Clifton Road Ashbourne Derby DE6 1DT Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01335 342273 01335 346942 highfield.house@fshc.co.uk Grandcross Limited(wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Pamela Upson Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Highfield House DS0000002118.V294120.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th December 2005 Brief Description of the Service: Highfield House is a large detached period property, which has been extended to accommodate 37 older people. There is a large car park with a number of steps up to the home or a driveway for wheelchair users. The home is managed by an experienced Registered Nurse, who is currently awaiting registration. The home is situated very close to the small town of Ashbourne. Highfield House DS0000002118.V294120.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was unannounced and information for this report was gathered prior to and during the visit. The inspector spoke with residents, staff and the manager. What the service does well: What has improved since the last inspection? What they could do better: Highfield House DS0000002118.V294120.R01.S.doc Version 5.1 Page 6 Each of the files had forms for staff to complete relating to social needs of the residents, however none of this information had been gathered, therefore preventing staff meeting their needs. 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 DS0000002118.V294120.R01.S.doc Version 5.1 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 DS0000002118.V294120.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3,6 Quality in this outcome area is good. Assessments of need completed by both the manager and Social Worker ensures that all of the needs of the residents have the potential to be addressed. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: Three of the residents files were read all files had an assessment of need completed by the manager and a community care assessment. The assessments appeared to address the nursing and care needs of the residents but there was little information relating to the social needs of the residents. Each file had a completed nutritional assessment and a Waterlow assessment. The home does not offer intermediate care.
Highfield House DS0000002118.V294120.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. Policies and procedures and suitably trained staff ensure safe administration of medication. Detailed information relating to health needs ensures that needs are met, however lack of information relating to social needs potentially prevents staff meeting social needs. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: Each of the files examined had detailed information relating to the health needs of the residents. Each file had detailed documentation relating to the social and personal needs, however this information had not been completed within the files examined. Detailed information within the assessments and care plans appears to address the health needs of the residents.
Highfield House DS0000002118.V294120.R01.S.doc Version 5.1 Page 10 Medication is administered by suitably trained staff, appropriate policies and procedures are in place. Appropriate risk assessments had been completed. Residents spoken with confirmed that staff treat them with respect, knocking on doors before entering and speaking to them using their preferred name. Highfield House DS0000002118.V294120.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. Suitable and frequent activities along with a wholesome and balanced diet ensures that the home meets the expectations of the residents. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: The residents spoken with were happy with the home and felt that their needs were met and that there was sufficient activities and this was evident when checking the diary. Relatives and friends visit the home without appointment and the home has a ‘Friends of Highfield House Committee’. The home completes a newsletter to keep people informed about activities and other events and changes at the home. Residents are offered a choice of menu and any changes to the menu are documented. The menu evidences a wholesome and balanced diet. Highfield House DS0000002118.V294120.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. Appropriate policies and procedures along with staff training ensures the safety of the residents. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: The home has a detailed complaints procedure and the manager keeps a record of all concerns and complaints made and the responses. Residents spoken with stated that they were aware of how to make and complaint, who to complain to and were confident that their complaints would be addressed. The manager now organises regular residents’ meetings and provides minutes following the meetings. Staff have received appropriate training in order to recognise and report any incidents of abuse. Highfield House DS0000002118.V294120.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. Once refurbished the home will provide a modern, up to date, clean and homely environment. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: The organisation has recently organised for the home to be refurbished and this was being completed on the day of the inspection. The manager stated that the hall and lounges were being refurbished and that the kitchen and dining room had been completed. Other than the areas being decorated, the home was clean and hygienic. Highfield House DS0000002118.V294120.R01.S.doc Version 5.1 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. Adequate staffing levels and suitable training ensures that residents are safe and cared for by staff trained to meet their needs. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: The rota evidenced that there are a minimum of 2 registered nurses the morning with a minimum of 4 care staff. During the afternoon minimum of 1 registered nurse with a minimum of 3 care staff. registered nurses on duty 24 hours a day. The organisation provides training appropriate to the needs of the residents. on duty in there is a There are a range of Each of the staff files examined had 2 written references, a Criminal Records Bureau check, 2 proofs of identity; although 1 file had a birth certificate and a passport for the same person but different surnames; a marriage certificate should be present too. Highfield House DS0000002118.V294120.R01.S.doc Version 5.1 Page 15 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): 31,33,35,38 Quality in this outcome area is good. A suitably qualified manager completing appropriate audits ensures that staff are kept up to date and the care practices change along with the changing needs of the residents. This outcome has been made from evidence gathered before and during the visit to the service. EVIDENCE: The home is managed by a suitably qualified person, who has implemented lots of positive changes to the home, however she is not registered with CSCI yet and is in the process of going through registration. Highfield House DS0000002118.V294120.R01.S.doc Version 5.1 Page 16 The manager arranges staff meetings every 2 months and residents meetings 3 – 4 monthly. The manager audits care plans, activities, accident forms and health and safety issues on a regular basis. The home keeps clear financial records for all monies held, each transaction is signed by 2 staff members and regularly audited. The staff keep clear accident records. Appropriate risk assessments are completed, including risk assessments for the decorating work, however a risk of tripping was highlighted during the inspection and the manager stated that it would be dealt with immediately. All fire checks were completed as recommended and staff have received appropriate training. Highfield House DS0000002118.V294120.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Highfield House DS0000002118.V294120.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP11 OP13 OP20 OP7 OP31 Good Practice Recommendations Service users wishes regarding terminal illness and death should be documented. Input from advocacy services should be sought for those service users without relatives/representatives. Carpets detailed within the report should be replaced. The files should contain sufficient information relating to social needs of residents, enabling their needs to be met. The manager should complete application to register. Highfield House DS0000002118.V294120.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Derbyshire Area Office 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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