Inspection on 28/11/08 for Highfield House

This inspection was carried out on 28th November 2008.

CSCI found this care home to be providing an Good service.

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 10/12/07

Highfield House 10/07/07

Highfield House 22/05/06

Highfield House 19/12/05

Highfield House 20/07/05

Highfield House 26/07/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 27/02/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Highfield House 28 Clifton Road Ashbourne Derby DE6 1DT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Angela Kennedy     Date: 2 8 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Highfield House 28 Clifton Road Ashbourne Derby DE6 1DT 01335342273 01335346942 highfield.house@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Grandcross Limited(wholly owned subsidiary of Four Seasons Health Care Ltd) Name of registered manager (if applicable) Hilary Clinch Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 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. An experienced person, who is currently awaiting registration, manages the home. The home is situated very close to the small town of Ashbourne. A copy of the last Inspection report was seen in the foyer. 0 Over 65 37 care home 37 Care Homes for Older People Page 4 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection visit that took place over one day. The last key inspection undertaken at this home was on the 10th December 2007. An Annual Quality Assurance Assessment (AQAA) had been completed by the service. This is a self-assessment for providers, which is a legal requirement. This assessment gives the provider an opportunity to let us know about their service and how well they think they are performing. The information provided in the AQAA is reflected within this report. At this inspection visit two people were case tracked. Case tracking is a method used to track the care of individuals from the assessments undertaken before they are admitted to a service through to the care and support they receive on a daily basis. This includes looking at care plans and other documents relating to that persons care, Care Homes for Older People Page 5 of 31 talking to staff regarding the care they provide and if possible talking to the individual. Both people case tracked were spoken with and gave their opinion of the care and services provided. Their views and the views of other people living at the home that were spoken with are included within this report. Two members of staff were spoken with at some length and their views and opinions of the care provided, the support and training given to them is included within this report. The comments provided within five surveys received from the people living at the home, four relatives/ representatives surveys and four staff surveys are also reflected throughout this report. One relative was spoken with at length and their views of the home are reflected within this report. The registered manager was available on the day of this inspection visit and provided the relevant information requested. The fees at the time of this inspection visit were as follows. For privately funded individuals requiring nursing care the fee was 510 pounds a week plus a free nursing care contribution. For funded nursing care the fee was 475.67 pounds a week with a 22 pound top up fee. For privately funded individuals requiring residential care the fee was 447 pounds a week. For funded residential care the fees ranged from 345.52 to 364.31 pounds a week The following items were not included in the above fee, personal toiletries, chiropody, dentist and hairdressing services. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 7 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to decide if the home is right for them and the assessments done before admission ensures needs can be met. Evidence: In her completed pre-inspection self-assessment, the manager stated that a comprehensive assessment of need is carried out prior to admission by trained, competent staff to demonstrate that home is able to meet needs of the individual and where possible this is carried out with a family member or representative. She also stated that individuals were given the opportunity to spend time in the home prior to admission, i.e. for lunch and in the afternoon to see the activities undertaken and ask any questions about the home. Comprehensive needs assessments were in place that identified all areas of support required.The Deputy Manager who was a qualified nurse had undertaken these Care Homes for Older People Page 9 of 31 Evidence: assessments.The dates recorded on these assessments demonstrated that they had been underken prior to admission. This enabled the home to determine that they could meet the needs of each person before they agreed on admission. In her completed pre-inspection self-assessment, the manager stated that a letter was then sent out to individuals or their representative confirming that the home was able to meet the needs of that person. Assessments were also in place for the two people case tracked that had been undertaken by their funding authority. Comments made indicated that people had sufficient information about the home to make a decision about whether it would meet their needs or the needs of their relative. Comments included, There was plenty of information. The communication here is very good. Care Homes for Older People Page 10 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care needs are met in a dignified and respectful way and the medication practices in place ensure people are supported to take their medication in a safe way. Evidence: Both of the care files seen were organised and included an index which enabled the reader to find relevant information as required. It was noted that the neither care files seen had the individuals date of admission clearly recorded, although this information was in both care files, it was agreed by the manager that this could not be identified easily. In her completed pre-inspection self-assessment, the manager stated that each person has a named nurse and the home recognises that individuals have the right to take risks in their daily lives and care plans which are evaluated monthly are based on full, complete and accurate risk assessments. Some of the people spoken with were able to confirm who their named nurse was. Care Homes for Older People Page 11 of 31 Evidence: Both of the care files seen had care plans in place that had been formulated from the needs assessment undertaken. These care plans addressed each individuals personal and health care needs and the level of support they required and this included assessment undertaken that related to mobilty, falls,personal safety, nutrition, continence and assessments that related to pressure areas and skin integrity. All of the care plans that related to personal care, health care and communication needs were detailed and this ensured that the staff had the relevant information to enable them to support people appropriately. One care plan seen related to diabetes and the information recorded included information for staff on what they should observe for, regarding low blood sugar levels, such as the signs and symptoms and the actions that should be taken. Consent forms were in place regarding the care plans that had been signed by the individual or their representative and capacity to consent assessments were also in place which identified each persons ability to make informed choices and the level of support that was required by staff to enable them to make choices. For example one persons capacity to consent assessment stated....is able to make informed choices. Staff to explain clearly to ensure ...has understood. The other persons consent form demonstrated that they had limited capacity, however this person did have a representative who would be able to advocate for them if required.In her completed pre-inspection self-assessment, the manager stated that the home employed both male and female care staff and when an individual expresses a preference the home aims to meet their request. These records were seen in the care files of the people case tracked. At the last inspection it was identified that specialist scales were not available and this had resulted in one person not being weighed for several months. These scales have now been purchased to ensure that the weight of everyone living at the home can be monitored to ensure any weight changes can be identified and the appropriate actions taken as required. Records to demonstrate that individuals were weighed monthly was seen in the files of the two people case tracked. Care plans were in place regarding social activities, however the information provided in these care plans was somwhat limited to if the individual was likely to participate and the level of participation. It did not inform the reader of their interests and hobbies. However the needs assessments undertaken before admission did provide relevant information that could be transferred to the individuals social activities care plan. For example in one persons communication assessment there was a suggestion for staff on initiating a conversation with this individual. It directed staff to ask Care Homes for Older People Page 12 of 31 Evidence: questions on certain aspects of this persons life that had been important to them. Information such as this provides staff with a more person centred picture of individuals. The manager confirmed that she had started to gather information from individuals and relatives regarding each persons life history and was able to show examples of this within other care plans. This information had not been gathered for the two people case tracked at the time of this visit. The manager confirmed this was an ongoing process. From the surveys returned and the comments on the day of this visit the people living at the home and their visitors indicated that the care and support provided was good. One relative spoken with said, I cant fault them, I dont have any concerns, my uncle always seems content, I think he is looked after very well. At the last inspection visit the Deputy manager had identified through her audits that there was no care plan for concealing medications in food. This had now been addressed and care plans were seen to demonstrate this. The medication practices at the home were looked at and were satisfactory. Medication Administration Records were recorded correctly and no gaps or errors was noted. This indicates that people recieve their medication as prescribed. The medications were stored appropriately and this included medication requiring cold storage and controlled drugs.Fridge temperature records were held to ensure the clinical fridge remained at the correct temperature for the medication stored and a controlled drugs register was in place and the records held were satisfactory. The controlled drugs for one person was checked and the records held were correct. This indicates that safe systems are in place regarding medication practices. One person living at the home had chosen to self administer their medication and a risk assessment was in place that demonstrated that they were able to do this safely. As stated above the care plans seen addressed individuals health care needs. Records seen also demonstrated that the home worked with care managers, G.P.s, Occupational Therapists and specialist community mental health teams in supporting individuals. There was also evidence seen to demonstrate that dental and eye care was also provided as required.One visitor spoken with confirmed that they were invited to the care reviews of their relative. The need to uphold principles of dignity and self-respect were recorded in the care plans.Comments from people living at the home and visitors confirmed that individuals had enough privacy, and that staff upheld their dignity and treated them with respect. Care Homes for Older People Page 13 of 31 Evidence: Comments included, staff seem to show enormous respect for individuals and always ultimate respect for residents Care Homes for Older People Page 14 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals well being is enhanced through the improved activities programme in place. The meals provided do not always cater for individuals tastes and preferences. Evidence: In her completed pre-inspection self-assessment, the manager stated that forthcoming activities are planned with the people that live at the home and they can make choices on a daily basis regarding where they want to sit, either in one of the three lounges, the dining room or the courtyard, weather permitting. Since the last inspection an activities coordinator had commenced in post working 21 hours a week. In her completed pre-inspection self-assessment, the manager stated that the new activities organiser has brought with her a myriad of new ideas to try and the home has received positive feedback from residents and relatives alike.The activities coordinator was not on duty on the day of this inspection visit, however the manager did confirm that group and one to one activities were provided by the activities coordinator. An activities board was on display in the dining room and records were kept of each person that recorded the types of activities they had participated in and when. This included activities such as story and chat, dominoes and Care Homes for Older People Page 15 of 31 Evidence: music sessions. Records were also in place for individuals who had one to one sensory activities due to their healthcare needs. These records supported that extra time was being spent on some days for people that needed one to one time to promote their social well being. As stated earlier in this report the information in care plans was limited regarding each persons interests, however this was being addressed by gathering information from individuals and their relatives regarding their life history and once this in in place for everyone the activities coordinator will be able to use this in developing the activities programme further for group and one to one activities. People living at the home had their own committee responsible for fund raising. The Christmas Fayre was due to take place the day after this visit. Funds raised were used to pay for entertainers and the home held both an Easter Fayre and a Summer Fayre raising additional funds to benefit the people living at the home. In her completed pre-inspection self-assessment, the manager stated that Holy Communion takes place once a month and a member of staff conducts a short impromptu service regularly on a Sunday morning following requests for this at a residents meeting. This was confirmed by people living at the home that were spoken with. Discussions took place with some of the people living at the home about the activities and these discussions indicated that activities at the home had improved and they felt that their social needs were met. One person spoke about external entertainers that came to the home and how they had enjoyed these events.This person also confirmed that they were a member of the fund raising committee. One visitor spoken with also confirmed that they regularly visited the home and often observed a range of activities taking place, which they said appeared popular. People spoken with confirmed that they were able to keep in touch with their family and friends and one visitor spoken with said that they were always made to feel welcome by the staff . They said Theyre great, always stop and have a chat and Im always offered a drink. People spoken with confirmed that they were able to choose when they got up each day and when they retired to bed, one person said you can get up when you want really, theres no set time, but some people like getting up early. Discussions also took place with individuals about their freedom to move around the home as they wished, they confirmed that they could go where they wanted, but said we all have Care Homes for Older People Page 16 of 31 Evidence: places were we like to sit, some people prefer to stay in their rooms a lot, others prefer company, everyones different really. Over the last few months there have been some issues regarding some of the meals provided at the home.It was confirmed by the manager that although additional assistance had been provided within the company to look at the meal choices, no training other than safe handling of food had been provided to the catering staff. Discussions have taken place with the people living at the home and it was confirmed that there had been some improvement. It was confirmed by the manager and people living at the home that some of the changes to the menu were not popular and had therefore been withdrawn. The manager stated that these changes had been made in consultation with people living at the home but felt that they had not fully understood what certain dishes would be. Such as pasta dishes, which had not proved to be very popular. It was clear from conversations held that further work was needed to address the meals provided. From the comments made on the day of this visit it appeared that on some days the meals were enjoyed, such as the day of this inspection where the main meal was fish and chips. Everyone spoken with said it was very nice. However discussions with people living at the home suggested that some days the meal quality was not as good. Comments within surveys included, they need to improve the quality of cooking and baking and meals are usually o.k and would prefer more choice of food for afternoon tea... more fruit would be appreciated. However it must be noted that these surveys were received in September 2008 and as stated above it was confirmed that there has been some improvements since this time. Two cooks were employed at the home. The manager stated that the kitchen was staffed for ten hours each day. Discussions took place with the cook on duty regarding the meals provided. The menus had recently been revised and ran over a four week period. The cook confirmed that people requiring specialist diets were catered for, such as diabetic diets and this was confirmed by one person spoken with who had a diabetic diet. Discussions took place with the cook regarding people that required soft diets. It was confirmed that the home did not use food moulds to enhance the appearance of soft diets for those people who needed them. Discussions took place with the manager and cook regarding this and it was agreed that this practice would be beneficial to people requiring soft diets. The menus provided a second option, however this option was a vegetarian dish. This Care Homes for Older People Page 17 of 31 Evidence: meant that in reality there was only one option for those people wanting a meat dish and one option for those people wanting a vegetarian dish. As it was stated that at the time of this inspection there was only one person wanting a vegetarian dish it was agreed that it would be beneficial to discuss their preferred choices on a weekly basis with them, to enable their menu to be planned according to their preferences. This in turn would then enable greater scope for the second choice available on the main menu. The manager confirmed that food questionnaires had gone out to people living at the home regarding their preferences of when they preferred their main meal and if two or three courses at the main meal were preferred. These completed questionnaires were seen and the manager confirmed that she was in the process of collating this information to look at what actions are required. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Concerns are looked into and actions are taken to put things right. Actions are taken and staff training is provided to safeguard people from abuse and neglect. Evidence: In her completed pre-inspection self-assessment, the manager stated that she has worked hard to change the ethos of the home to one that welcomes complaints and suggestions.This was reflected in the comments made in one visitors survey who said Communication is excellent at all levels, that is because the manager is always available and very approachable. Relatives are provided with regular opportunities to raise issues, ideas, ..everything is valued and considered and there is regular feedback, there is always the ultimate respect for individuals No comments were made either during this visit or within surveys received to suggest that concerns werent listened to or acted upon. As stated in the pre-inspection selfassessment the complaints procedure was clear, up-to-date, easy to understand and visible within the home. All of the people living at the home were provided with a service-user guide which contains a copy of the companys complaints policy and procedure. This was confirmed by the people living at the home that were spoken to. Records were kept of all complaints and this included the actions taken and outcome of each complaint. All complaints were recorded, including any minor concerns brought to the managers attention that had not been raised as formal complaints. This Care Homes for Older People Page 19 of 31 Evidence: demonstrates that the manager is open and transparent about any issues raised. The manager demonstrates an open and transparent approach when discussing incidents with external bodies. Information that we have received demonstrates that staff are aware of the whistle blowing procedure and have the confidence to use this when needed. In her completed pre-inspection self-assessment the manager confirmed that all staff had undertaken training in recognising and dealing with complaints. Since the last inspection visit there have been three safeguarding alerts made and the home has been transparent in their approach and information sharing. All three alerts have been investigated and are now closed. In her completed pre-inspection self-assessment, the manager stated that the policy and procedure regarding the safeguarding of adults is available to all staff and the document gives clear guidance about what action should be taken. Staff spoken with were aware of this procedure and its location within the home.The manager stated that all staff at the home had undertaken safeguarding adults training from the inhouse trainer and therefore all staff were aware of how to respond in the event of an alert. The training records seen confirmed this training had been undertaken. At the last visit it as noted that a relative had been asked for consent regarding a specialist chair that carried a degree of restraint, but this had not been acquired at the time of the Inspection.The manager confirmed that this had been requested by post on several occasions but had not been received. As this individual received funded care the manager was advised to discuss this with this persons care manager. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in an environment that meets their needs. Evidence: In her completed pre-inspection self-assessment, the manager stated that the home is clean, warm, comfortable, well maintained, well lit and appropriate for the needs of the residents who live there. A tour of the home was undertaken and in general appeared clean and tidy. On the day of this inspection visit the home had recieved a delivery of goods and due to the quantity of this delivery it had been placed in the reception area on delivery. However the access to the entrance/ exit of the home was not blocked and this delivery was put away and all boxes removed before the end of this inspection. During a tour of the building an unpleasant odour was noted in the corridor area next to the sun room. The manager said that she had also noticed this odour on the day of this visit and believed it to be coming from the carpet in a bedroom off this corridor, which she confirmed would be cleaned. People living at the home that were spoken with during the visit indicated that the home was kept clean, however there was some comments within two surveys recieved from people living at the home that disagreed with this. When asked if the home is Care Homes for Older People Page 21 of 31 Evidence: always kept clean the comments included, needs attention in some areas and toilet often needs cleaning. All toilets and bathrooms that were not occupied were looked at during a tour of the building at the begining of this inspection and all were found to be clean. However these comments do refelect the views of people living at the home and therefore should be further reviewed to ensure toilets are checked regularly. The home has three lounge areas and a dining area. As stated earlier in this report people spoken with confirmed they were able to sit where they wanted to and most people had favourite seats in certain rooms that they preferred to sit in. All of the rooms seen were light and pleasantly decorated. One person who liked to sit in a certain seat in the sun room stated that when it was windy outside there was a considerable draught by the french doors, which they could feel. This person discussed this with the manager, as there had been plans to erect a conservatory off these doors.However the manager was unsure if this was still going ahead. In her completed pre-inspection self-assessment, the manager stated that there had been the following expenditure since the last Inspection. A Malibu bath has been installed in the upstairs bathroom, all curtains in the corridor areas have been replaced. Two new signs have been erected at the bottom of the driveway to the home. Two additional emergency lights have been installed on the emergency exit route though the kitchen and staff room areas. New carpets have been laid in several bedrooms and new flooring has been laid in the hairdresser’s room. Replacement curtains and matching bedspreads chosen by the people living at the home have been put in one room. The home has purchased several items of new equipment in response to the changing needs of individuals, including a mini-lift stand-aid hoist, a rotunder, a new hoist with weigh scale attachment and a larger selection of slings. The laundry room was visited and contained the necessary facilities and equipment for safe laundering of clothes. However it was noted that the ironing board cover was worn and torn, which would make ironing difficult . The member of staff in the laundry said that the ironing board was rarely used as the ironing press was used to iron clothing and other linen. In general the comments regarding the laundry were positive and the majority of people appeared happy with the service provided.However the comments in one relatives survey said, Laundry- too many items lost. The manager did state that there had been an issue with un-identified items being placed in a basket in the laundry room, which she had requested was stopped. She confirmed that she had instructed staff that attempts should always be made to identify any unnamed clothing so that items were returned to their owners. Thereby eliminating the need for a lost property box. Care Homes for Older People Page 22 of 31 Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment practices in place ensure that the people being supported are safe and they are cared for by staff that get the relevant training to enable their needs to be met. Evidence: The home use a dependency monitoring level to assess the numbers of staff required to meet the needs of the people living at the home. At the time of this inspection visit there was thirty two people at the home.The rotas demonstrated that eight staff were on duty in the mornings, although on the rotas seen there was two days when seven staff were on duty in the morning, two of these being qualified nurses. The late shift was covered by five staff, one of these being a qualified nurse. At night one nurse and two care staff were on duty. People living at the home that were spoken with generally felt there was sufficient staff around to support them. One relative spoken with also said they thought there was enough staff.One relative had written in their survey that they felt more staff were needed for people requiring nursing care.Staff comments were generally positive regarding the staffing levels, some did say there were times when staffing levels were lower than they should be but confirmed that these shifts were usually covered by agency staff. Care Homes for Older People Page 24 of 31 Evidence: The staffing numbers on the rota seen included qualified staff but did not record the managers working patterns, which would support the amount of time she spends at the home.The training records showed that out of nineteen care staff six had an National Vocational Qualification (NVQ) in care at level 2. The manager confirmed that two other care staff were doing their NVQ2 training and two were waiting to start their training. This means that once this has been achieved the home will have met the national target set, of at least 50 of the care staff team being qualified to NVQ level 2. Thereby enhancing the skills and competency of the care staff team in meeting individuals needs. The recruitment checks seen for the two most recently employed staff demonstrated that the home did not put people living at the home at risk.The records seen demonstrated that staff did not commence employment until all of the checks required by law had been received. This ensured that they were suitable to support the people living at the home. In her completed pre-inspection self-assessment, the manager stated that Four Seasons Health Care take the training and supervision of their staff very seriously. The home has an in-house moving and handling trainer and an in-house POVA (Safeguarding Adults) trainer. This means that the training can be frequent and small scale and individualised to meet the needs of the staff. The training records showed that staff were kept up to date in all mandatory training such as moving and handling,first aid,infection control, food hygiene, health and safety, fire safety and safeguarding adults. The records also demonstrated that staff were provided with other training to enhance their skills and knowledge, such as dementia training, training in the support of death and dying, person centred care and training in the prevention of pressure ulcers.This provided the staff team with a wider knowledge base which enabled the support they provided to individuals to be enhanced. Staff comments regarding the training provided was positive and included, the training is very good and training is given to all staff and we are updated regularly. Induction records were seen for new staff employed and covered all of the required areas to ensure new staff had the confidence and skills required. Comments from staff regarding their induction period were positive, such as for the first two weeks we work with senior staff and are guided by them working hand in hand. Relatives comments regarding the staff competence and skills was very positive, such Care Homes for Older People Page 25 of 31 Evidence: as they understand the whole person and foster the ethos of extreme patience and tolerance. Care Homes for Older People Page 26 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed appropriately and in the best interests of those that live there. The health and safety practices in place ensure that people are kept safe. Evidence: As stated in her completed pre-inspection self-assessment, the manager has completed her registration with CSCI. She said she has completed the Registered Managers Award and a qualification equivalent to the National Vocational Qualification level 4 in the past. As the manager is not a qualified nurse, the deputy manager took the clinical lead. Records were seen to demonstrate that the manager and deputy manager discussed issues regarding care practices and clinical issues within the home on a regular basis. As stated earlier in this report the staffing numbers on the rota did not record the managers working patterns, which would support the amount of time she spends at Care Homes for Older People Page 27 of 31 Evidence: the home. From records seen and discussions held with some of the people living at the home there was evidence to demonstrate that quality within the home was being monitored. In her completed pre-inspection self-assessment, the manager stated that resident and relative meetings are held bi-monthly and relatives meetings are held quarterly in the evening. She said that the atmosphere at these meetings was kept informal and all those present were encouraged to contribute to the meeting and have their say. The manager felt that this encouraged those present to speak freely in the knowledge that their views were valued and any comments or criticisms addressed. Minutes of these meetings were seen and the suggestions and comments made and the action taken by the home in response were recorded. One person living at the home that was actively involved in these meetings talked about the meetings held and said, it gives everyone the chance to have their say and make suggestions. Four seasons conducted a full customer satisfaction survey in August 2008 and evidence was seen regarding the actions that had and were being taken in response to the comments made.This included food questionnaires that had gone out as stated earlier in this report.This indicates that the views and interests of those living at the home and their representatives are listened to and that actions are taken when necessary. The manager confirmed that people were supported to manage their own money where possible. One person case tracked was not able to manage their own money and therefore this was managed by the home. The records seen demonstrated that suitable accounting procedures were in place to ensure the money held for this individual was safeguarded and managed in their best interests. The completed pre-inspection self-assessment provided information to show that the equipment and appliances used at the home had been serviced or tested as required. A random sample of service records were looked at during this visit and confirmed that the appropriate health and safety practices were carried out to ensure the home was kept safe for the people living there, the staff team and visitors. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Staff should continue to gather as much information as possible relating to each persons life history. This will enable them to provide more person centered support to enhance individuals well being. Catering staff should receive suitable training to enable them to enhance their skills in catering. Food moulds should be used to enhance the appearance of soft diets Efforts to gain consent for use of the specialist chair should continue. A new ironing board cover should be purchased to replace the torn ironing board cover presently in use. The draught reported by the doors in the sun room should be investigated and appropriate repairs/ action should be taken as required. Toilets should be checked on a regular basis to ensure they are clean and suitable for use. The manager should ensure that her working patterns are recorded on the staff rota to support the amount of time she spends in the home. Page 30 of 31 2 3 4 5 6 15 15 18 19 19 7 8 26 31 Care Homes for Older People Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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