Inspection on 27/10/05 for Highfield House

This inspection was carried out on 27th October 2005.

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 20/07/06

Highfield House 18/05/05

Highfield House 27/09/04

Highfield House 14/04/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Highfield House 4 Highfield Road Shanklin Isle Of Wight PO37 6PP Lead Inspector Mark Sims Unannounced Inspection 27th October 2005 12.00 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 DS0000012497.V249311.R01.S.doc Version 5.0 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 DS0000012497.V249311.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Highfield House Address 4 Highfield Road Shanklin Isle Of Wight PO37 6PP 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) 01983 862195 01983 866364 teresaihl@btconnect.com Island Healthcare Ltd Ms Teresa Shirley Cornelius Care Home 23 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (23), of places Physical disability over 65 years of age (6) Highfield House DS0000012497.V249311.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18 May 2005 Brief Description of the Service: Highfield House Residential Home is located towards the mid-point of Highfield Road Shanklin, a quiet residential street situated just off Victoria Avenue as you approach the town coming from Newport. The property is a large Victorian house that has been extended and adapted to provide residential accommodation for 23 people under three registration categories, OP - Older Person, DE(E) Dementia (elderly) and PD(E) Physical Disability (elderly). A passenger lift provides easy access to both floors, although for those ambulant enough the stairs are reasonably wide and of a manageable gradient. The premises is well maintained and provides adequate communal facilities for the service users, including a large lounge and separate dining room able comfortably to sit all residents. The gardens are substantial and ramped access has been provided for ease and convenience. Off road parking is provided but spaces are often difficult to come by and occasionally diffcult to negotiate. Highfield House DS0000012497.V249311.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was undertaken unannounced and formed the second statutory inspection of the year for Highfield House Residential Home. The inspection focused on those core standards not addressed at the 18th May 2005 inspection and various sources of evidence were considered in the formulation of judgements, records, observations and discussions with service users and staff/management. What the service does well: What has improved since the last inspection? What they could do better: Just prior to the inspection the home reported that an error had occurred with the administration management of a service user’s medication. This is not the first issue to occur with regards to the home’s management of service users’ medicines and previous requirements have been made around the home taking action to address the issue. Highfield House DS0000012497.V249311.R01.S.doc Version 5.0 Page 6 In fairness to the company and the home’s management team, efforts have been made historically to address the problem, including the retraining of staff, reviews and revision of policies and procedures and direct amendments to the medication system. As a result of this incident and discussions during the inspection it was ascertained that further training has been planned, that only a core group of staff are currently undertaking the management of service users’ medications and considerations of creating senior posts to manage some issues, address communication problems and take responsibility for leading each shift. The home recently had started using a towel within the downstairs toilet, instead of paper towels, which are recommended on infection control basis. The change in practice has been brought about by several service users disposing of paper towels down the toilet and blocking the drainage, etc. As this change in practice is currently against good practice guidance it has been suggested that the management contact the infection control nurse and discuss the situation and possible options for managing the problem. The home prefers not to become involved in the management of service users’ monies and therefore is currently offering a tick system, whereby all purchases are made by the home and invoiced to the relatives, etc. Several of the accounts opened in conjunction with the tick system were noted to be heavily in the red and it is important that the home recall that it is the service user and not their relative that they are allowing to build up debt. Consideration should perhaps be given to setting an upper limit on these accounts, which would prevent people getting into debt to the home. 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 DS0000012497.V249311.R01.S.doc Version 5.0 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 DS0000012497.V249311.R01.S.doc Version 5.0 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): Standard 5 The opportunity for service users to visit the home and assess the quality of the service / facilities is available to all prospective service users. EVIDENCE: In discussion with a relatively new service user it was established that her move to the home had only occurred after she and her family had visited the home and assessed both the quality of the environment and the services provided. The service user felt that she had been given every opportunity to familiarise herself with the home prior to reaching a decision about moving into the home, including the opportunity to remain for a meal and meet with both staff and other service users. The service users stated that additional information had also been provided in the form of a brochure, which the manager confirmed also contained details associated to the service users and terms and conditions of residency. Highfield House DS0000012497.V249311.R01.S.doc Version 5.0 Page 9 Shortly after the resident had decided to move into the home the care manager arranged to visit and review the placement with her, ensuring she was happy with the service and was settling. Highfield House DS0000012497.V249311.R01.S.doc Version 5.0 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): Standards 8, 9 and 10 Service users are appropriately supported when accessing health care services. The number of medication errors experienced are continuing to cause concern. The service users seem to appreciate the efforts made to respect their rights to privacy and dignity, although some minor environmental issues could undermine the home’s good work. EVIDENCE: A service user met during the inspection was able to discuss the home’s/staff’s commitment to supporting service users with accessing and attending health services/clinics. The individual in question explained how recently she has had to attend several clinic appointments and that each of these had been supported by a staff member, who remained with her throughout her time at the clinic. She was also very positive about the support provided when accessing the services of the blind society, which she requires the assistance of staff to achieve due to the obvious restriction of her disability. Highfield House DS0000012497.V249311.R01.S.doc Version 5.0 Page 11 The same service user also commented on the politeness of the staff and how throughout their work with her they remain, caring and respectful. Records of another service user reviewed during the inspection further evidenced that the staff are adequately providing support to service users when accessing health and social care support. The running record and specific health files recorded details of how and why a person had been admitted to hospital, that regular contact was being made to monitor how the person was progressing, different members of the staff team ring to monitor the resident’s condition. The medication issue, as discussed earlier within the report, is an ongoing issue of some concern, as despite the best endeavours of management and company representatives to correct the errors, staff continually failed to adhere to the company guidelines. The last incident has produced quite a robust response from the management, with only key staff currently involved in the administration of medicines and other staff being retrained in all aspects of the home’s medication expectations. The management is also considering how to amend or revise the home’s medication system and are in the process of reviewing the various policies and procedures available to staff. As highlighted above, service users tend to feel that staff are supportive, respectful and considerate of their right to privacy and dignity, people also being noted to knock on doors before entering people’s bedrooms and communal facilities. However, one issue identified during the tour of the premises, which slightly undermines the good work of the home in this area, is the fact that several bathroom or toilet doors were found to have broken or missing locks, which could lead to people accessing an already engaged amenity. The deputy manager was to ensure this issue was addressed immediately. Highfield House DS0000012497.V249311.R01.S.doc Version 5.0 Page 12 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): Standard 14 Where possible service users are encouraged to exercise their rights to selfdetermination and choice, the risk assessment process key to this process. EVIDENCE: The home’s philosophy or ethos is to encourage people to exercise their right to choice and self-determination over as many aspects of their lives as is possible, in areas such as rising and retiring times, choice of meals, activities undertaken each day, control of finances, etc. Where some of these issues require the home to consider any potential harm or risk posed to the service user in the activity they are undertaking, etc. the home uses its risk assessment process to minimise the potential for harm. This was particularly evident with one service user who chooses to selfmedicate, despite her sight failing and her ability to identify the particular medications deteriorating. The home has identified these issues and has mapped out how they can support the client in the continuation of self-medicating. The service user is happy with the current arrangements and appreciates the need of the home and staff to safeguard both her and other service users’ wellbeing, it has been Highfield House DS0000012497.V249311.R01.S.doc Version 5.0 Page 13 reinforced with the deputy manager that the risk assessment must be regularly reviewed and updated. Highfield House DS0000012497.V249311.R01.S.doc Version 5.0 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 the following standard(s): Standards 16 and 18. The complaints process is taken seriously and details are provided to service users. Copies of all relevant documents are available to staff and training needs addressed. EVIDENCE: The company has adopted a five-day turn around for responding to complaints, which exceeds the National Minimum Standards. Details of the home’s complaints procedure and the role of the Commission for Social Care Inspection in investigating complaints is provided in both the ‘Service Users’ Guide’ and ‘Statement of Purpose’ documentation, which as already identified is shared with all prospective service users. A review of the complaints logging file revealed that no recent complaints had been recorded or investigated. The company has produced for staff an adult protection procedure that is fully compliant with the recommendations of the National Minimum Standards and reflects the guidance provided via the ‘All Island Adult Protection Procedure’, which was created in accordance with ‘No Secrets’, a Department of Health document. The company has also brought into play a ‘Whistle Blowing Policy’, created in accordance with the ‘Public Disclosure Act’, which along with the adult protection guidance is made available to staff through the staff handbook. Highfield House DS0000012497.V249311.R01.S.doc Version 5.0 Page 15 Training for staff around adult protection was delivered on 26th October 2005, with additional information disseminated via the induction programme. Highfield House DS0000012497.V249311.R01.S.doc Version 5.0 Page 16 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): Standards 20, 21 and 25. A range of well maintained and comfortable communal facilities are provided both internally and externally. Service users have access to sufficient numbers of clean and well maintained toilets. Heating / lighting and water temperatures are safe and well monitored. EVIDENCE: Highfield House DS0000012497.V249311.R01.S.doc Version 5.0 Page 17 The tour of the premises revealed that the property is well maintained both internally and externally, with the work to update and refurbish the main dining area completed recently to a good standard, as noted by service users. Externally the rear patio has been fitted with new seating, although this has been stored away for the winter, the gardens have been planted out (for winter/spring) and the lawns remain cut and tidy. Adequate toileting and bathing facilities exist on each floor with separate WCs accessible on both the ground and first floors. It was noted during the tour of the premises that locks installed in some WCs / bathrooms were not working effectively, a situation brought to the attention of the deputy manager, who quickly undertook to address the issue with the maintenance men. In conversation with service users the fact that the locks were not operating effectively on the toilets appeared not to be a concern, although people’s rights to privacy and dignity should be promoted at all times. All areas of the home are supplied with adequate means of heating and lighting, windows supply the main source of ventilation in bedrooms and communal areas, with those on the first floor fitted with restrictors to prevent accidents, limiting the distance they open, all communal bathing facilities where full body immersion is possible (baths or showers, etc.) are fitted with water temperature regulators and radiators are covered or risked assessed. Whilst touring the premises and speaking with service users, comments were passed about the home being warm and comfortable during the winter and that during the summer windows and fans could be used to maintain an agreeable room temperature. Highfield House DS0000012497.V249311.R01.S.doc Version 5.0 Page 18 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): Standard 29 The arrangements for recruiting new staff are robust and well managed. EVIDENCE: During the visit the inspector reviewed a number of staffing files and considered the policies and procedures available to the management team when recruiting new staff. It was evident, given the files inspected, that the home’s general approach to the recruitment and selection of new staff is both robust and consistent, with tracking or monitoring forms used by the administrator to ensure each new staff member’s recruitment follows a very similar pattern and that all relevant information is applied for and received. All prospective staff are required to complete an application form as part of the process, the application form designed to obtain details of the person’s employment history, educational history, medical history and references, etc. Once the application has been submitted the manager arranges to meet with the applicant for the purposes of interview and retains information relating to the outcome of the interview on file. Once an applicant has successfully completed the preliminary stages of the recruitment process they are issued with written confirmation and, subject to Highfield House DS0000012497.V249311.R01.S.doc Version 5.0 Page 19 the successful return of their references and Criminal Records Bureau check and POVA check, are invited to attend for induction. Also evident on each staff member’s file and again co-ordinated by the administrative staff are details of training events completed, training updates to be attended and additional courses undertaken, i.e. NVQs, which are generally designed to increase knowledge, skills and competence. Highfield House DS0000012497.V249311.R01.S.doc Version 5.0 Page 20 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): Standards 33, 35 and 38. The company is committed to ensuring the best interests of service users are promoted at all times. The home’s approach to supporting service users manage their finances is allowing people to go into debt. The company’s approach to health and safety ensures both the wellbeing of service users and staff is promoted. EVIDENCE: Highfield House DS0000012497.V249311.R01.S.doc Version 5.0 Page 21 The manager was unfortunately not available during the inspection, although the deputy manager was available throughout the inspection and was able to discuss the company’s recent attainment of the Investors in People Award. It was clear from discussions prior to the inspection that achieving the award had not been easy and that a lot of hard work had gone into the successful achievement of the award from the Investors team. In addition to the Investors in People process undertaken by the company, an in house quality auditing system, which is overseen by a member of the company’s management team, is also available and widely used in the process consisting of Regulation 26 visits and reporting, service user satisfaction surveys, internal auditing of the home against the standards, audits of records and record keeping and policy and procedure production and review. In conversation with service users, it appeared that a large percentage of the company’s quality assurance process is unfamiliar to them, although some people recalled filling in questionnaires about the service, staff and facilities. The home historically has refused to become involved in the direct management of service users’ finances, preferring instead to support people through the provision of a tick system, the home purchasing all items required by a service user and billing or invoicing them at the end of the month. On reviewing the individualised records maintained by the home for service users involved in this system, it was evident that some families or representatives are slow at paying bills and the accounts of several people are in the red. As technically the account belongs to the service user it is suggested that the home introduce an upper limit, which would stop people developing debt, due to families or representatives not settling the accounts. One of the company directors is trained as a health and safety advisor and takes responsibility for ensuring all aspects of health and safety legislation is complied with and that guidance is available for staff and service users as required. During the course of the visit and throughout the inspector’s time in the home no issues or concerns purporting to health and safety were identified with all reasonable steps to ensure both the service users’ and employees’ safety undertaken. Recently the director had completed a health and safety audit at a sister establishment to Highfield House and discussed his intention to shortly repeat this review process at Highfield House. Highfield House DS0000012497.V249311.R01.S.doc Version 5.0 Page 22 One issue that potentially could impact on people’s health and safety was the recent practice of using a towel within the downstairs toilet instead of paper towels, as recommended from an infection control basis. The change in practice has been brought about by several service users disposing of paper towels down the toilet and blocking the drainage, etc. As this change in practice is currently against good practice guidance it has been suggested that the management contact the infection control nurse and discuss the situation and possible options for managing the problem. Highfield House DS0000012497.V249311.R01.S.doc Version 5.0 Page 23 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 X X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X 3 2 X X X 3 X STAFFING Standard No Score 27 X 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 2 X X 2 Highfield House DS0000012497.V249311.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP9 OP35 Regulation Requirement Timescale for action 18/12/05 18/12/05 Regulation The management must take 13 every step to ensure repeated medication errors are addressed. Regulation The home must introduce an 12 upper limit to its accounting system / management of service users’ monies to ensure people are not allowed to build up too much debt. 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 Refer to Standard OP21 OP38 Good Practice Recommendations The locks on toilet doors should be reinstated / operational Advice on the use of towels in communal toilets should be sought from the infection control nurse. Highfield House DS0000012497.V249311.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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 DS0000012497.V249311.R01.S.doc Version 5.0 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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