Inspection on 17/04/07 for Highfield House Nursing Home

This inspection was carried out on 17th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 Nursing Home 03/11/05

Highfield House Nursing Home 27/04/05

Highfield House Nursing Home 04/01/05

Highfield House Nursing Home 05/08/04

Highfield House Nursing Home 08/07/03

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Highfield House Nursing Home 298 Park Lane Macclesfield Cheshire SK11 8AE Lead Inspector Gill Matthewson Unannounced Inspection 17th April 2007 10.30 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 Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highfield House Nursing Home Address 298 Park Lane Macclesfield Cheshire SK11 8AE 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) 01625 511519 01625 511519 Mrs Denise Moss Mrs Denise Moss Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home is registered for a maximum of 13 service users in the category OP (Old age, not falling within any other category) Staffing must be provided to meet the dependency needs of service users at all times and shall comply with any guidance which may be issued through the Commission for Social Care Inspection 3rd November 2005 Date of last inspection Brief Description of the Service: Highfield House is a detached stone built property enclosed privately behind a high stone wall in 1/3 acre of mature gardens. It is situated within a conservation area, ½ mile from Macclesfield town centre and is on a main bus route. It is a small, family run business and the proprietors live on site. The accommodation comprises one lounge and one dining room, one single and six double bedrooms. One double bedroom is on the ground floor and the other bedrooms are on the second floor, accessed by a passenger lift or stairs. The home is staffed with Registered Nurses, carers, and domestic staff. Fees range from £473 to £675 per week, with additional charges for hairdressing and chiropody. Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit took place on 17th April 2007 and lasted four hours. The visit was just one part of the inspection. Before the visit the home owner was asked to complete a questionnaire to provide up to date information about services in the home. Questionnaires were also made available for residents, families and health and social care professionals to find out their views. Other information received since the last key inspection was also reviewed. During the visit various records and the premises were looked at. A number of residents and a GP were also spoken with to obtain their views about the service. What the service does well: Residents’ needs are fully assessed before admission to make sure the home has the resources to meet their needs. The nurses discuss with the residents the assistance they require and document this in individual care plans that give staff full instructions on the actions they need to take to make sure residents’ diverse needs are met. Residents’ health needs continue to be met to a good standard at Highfield House and they are satisfied with the care they are receiving. Social activities at the home are individual and the residents are pleased with the way the home is run and the choices they can make. Visitors are welcomed so that residents can keep in touch with family and friends. Residents also receive a varied, nutritious diet and have free choice of meals. Residents have access to a complaints procedure if they have any concerns and are protected from abuse. The home is very clean and well maintained. The home has a regular group of staff that have worked there for some time and they are well aware of the needs and personalities of the residents in their care. Staff are friendly and attentive to the residents. The registered manager is experienced and competent to ensure that the home is run in the best interests of the residents. Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have their needs assessed and are given the information they need to choose whether the home is right for them. EVIDENCE: Three residents’ care files were inspected. Each contained pre-admission assessments carried out by the registered manager covering all aspects of personal care and any specialised care that might be needed, for example physiotherapy and occupational therapy. They also contained copies of assessments carried out by other health and social care professionals under care management arrangements. Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 Page 9 One resident said she had visited the home after reading the home’s information. She said she had chosen to move into the home because the staff were so welcoming. Highfield House does not provide intermediate care. Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The health and personal care provided to people is based on their individual needs. People are treated with respect and their privacy and dignity are maintained. EVIDENCE: Three care files were looked at and all contained detailed risk assessments in relation to mobility, falls, continence, pressure area & tissue viability, nutrition and dental health. Care plans were drawn up for all areas of identified need and contained detailed instructions for staff on what they needed to do to help people meet their needs. All were up dated and reviewed on a regular basis. Residents said that their care plan had been discussed with them and records were made in the file of these discussions. Records were also made of support Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 Page 11 from, and visits by, other health professionals such as GP, optician, dentist, chiropodist, dietitian. The home was in the process of introducing a screening tool to identify any residents who could be at risk of malnutrition. The home had a good supply of pressure relieving mattresses and cushions. A visiting GP said he had never had any concerns about the care provided in the home. Medication recording, management and storage were inspected. Medicine Administration Records were examined and found to have been completed correctly. Medicines were stored and disposed of appropriately. Each resident’s file contained a list of medication they were prescribed, with a list of possible side effects, indicating which ones the doctor would need to be notified of. Residents were also assessed for their ability to self-medicate and were offered that option if they wanted to. Residents spoken with stated that they were happy with the care and attention they received at the home and felt that they are treated with dignity and their privacy respected. All the residents spoken with said the staff were very good. Staff spoken to were aware of the needs of the residents and of their likes and dislikes. Staff were observed in the routines of providing care and support. This was being done in a very respectful way. Staff were seen to address the residents in a courteous manner and there appeared to be a good rapport between residents and staff. Staff members were alert to changes of mood and wellbeing. One resident said that “the staff seem to have a sixth sense, they know when I’m in a bad mood or not well and give me what I need before I even ask.” Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are able to make choices about their lifestyle and their social and recreational needs are met. EVIDENCE: Residents choices were recorded in the care plan such as times of rising and retiring and what foods they like and dislike. Residents spoken with said that they could choose where they spend their day and who they spend their day with. Activities were based on individual choice and need and preferences were recorded in the plan of care. Activities included reading, knitting, jigsaws, drawing, crossword and puzzle books. One staff member was observed reading a daily newspaper with a resident, another resident was colouring and one was seen to be reading. Residents spoken with said that staff provided them with opportunities to pursue their interests. Two said they enjoy going out into the “lovely garden” when the weather is fine. Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 Page 13 An entertainer visits the home on a monthly basis for musical entertainment. A visitor had commented that there was a lack of privacy for visiting in the lounge. However, the deputy manager said that it says in the service user guide that arrangements can be made for privacy with visitors. These include using the dining room outside of meal times or going to the resident’s room. A menu is in place at the home and residents said that the cook discusses meal choices on a daily basis. All residents spoken with praised the meals. Those residents who required help with their meal were observed to be assisted by staff in a dignified and unhurried manner. The chef said that residents can choose anything they like for breakfast and tea, but there is a set meal for lunch. On the day of inspection this was Shepherd’s Pie with vegetables, followed by egg custard. The meal was well presented and looked appetising. Residents appeared to enjoy their lunch. They said that the chef takes into account everyone’s likes and dislikes when planning meals and if they don’t want the meal on the menu that day he will make them something else. A visitor commented “My relative seems to do as she wishes as far as possible. She stays up late when she wants and really enjoys her meals. Visitors always feel welcome. The residents can sit in the garden whenever they wish and we are encouraged to take her out in the car.” Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to a complaints procedure and are protected from abuse. EVIDENCE: Residents and relatives spoken with said that they had no complaints and that they were aware of who to speak to if they were unhappy about any aspects of the home. A copy of the complaints procedure was available in the service user guide and displayed in the hall. The home had not received any complaints for several years. A policy on the protection of vulnerable adults was in place. Members of staff spoken with confirmed that they were aware of the policy and the No Secrets guidance issued by the Department of Health. Staff had received training and this was recorded in the staff training files. Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 Page 15 The home also had a whistleblowing policy to inform staff how to report serious concerns. This included referring matters to the registered manager or provider. However, it did not inform staff that they could contact the Commission. When questioned, the staff did not know who they could refer to if they had a serious concern about the registered provider. Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 23 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is safe, well maintained and comfortable. EVIDENCE: The home provided a physical environment that met the needs of the people living there. It was comfortable and had an ongoing programme of redecoration and refurbishment. However, at the time of the inspection there was no ramp available to allow wheelchair users to use the front door, which had two steps up to it. There was a ramp from the lounge into the garden, but access from the garden to the car park involved crossing a flower bed. Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 Page 17 Residents could personalise their rooms and they and their relatives said the home is always clean. There were no unpleasant odours. The home has six double rooms and only one single room, none of which have en-suite facilities. Prospective residents are made aware of this when they make enquiries about the home. Residents spoken with said they were happy to share a room and were consulted and their wishes taken into account in relation to whom they shared with. If a bed became vacant in a double room, the remaining occupant could pay extra to keep it as a single room. All residents are able to access a bathroom that meet their needs. Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the residents. EVIDENCE: Residents and relatives spoken to said that “nothing is too much trouble for the staff.” All staff members were seen to be polite and helpful towards residents and appeared to communicate well with them. The home was friendly and welcoming. The staffing levels at the home were adequate to meet the needs of the residents. A trained nurse was on duty twenty fours hours a day supported by care staff. Domestic and catering staff were also employed at the home. Duty rotas were seen and staffing levels were being maintained. The home did not use any agency staff. Personnel records were not available at this inspection because the registered manager was away on holiday, but recruitment procedures were robust at the last inspection. Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 Page 19 Induction training for new staff was to the recognised Skills for Care standards. All staff had received essential training such as moving and handling and fire training during the last twelve months and this was recorded in the staff files. Staff had undertaken courses on infection control, basic care and nutrition in a care setting. The deputy manager had achieved the Registered Managers’ Award. One care assistant had achieved an NVQ Level 2 in Care and four more were undertaking the training. Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect. There are effective quality assurance systems in place developed by a qualified, competent manager. EVIDENCE: The owner manager of the home is a registered general nurse who lives on the premises and is registered with the Commission for Social Care Inspection. She Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 Page 21 has owned and run the home for a number of years and has previous experience of working and managing nursing homes. She also has the NVQ Level 4 in Management Award. Residents and relatives spoken with said that the manager is approachable and easy to talk to. Staff said that they were supported and that their views were listened to. Individual choices were recorded in the care plans for all residents living at Highfield House. The home had a quality assurance system in place which incorporated the residents’ comments in the form of questionnaires which were sent out to residents and their relatives and staff. Clear individual financial records were in place for all residents living at Highfield House. Receipts and withdrawals were recorded. Two of these were audited and the balances were correct. Informal supervision takes place on a daily basis by the trained staff and care staff confirmed they received regular formal supervision from the manager approximately every two months. This was backed up by the supervision records. Accidents were recorded appropriately and analysed to see whether any preventative action could be taken. The fire log book was checked. Fire systems were tested and serviced at the required intervals and staff training in fire safety had taken place and was recorded. Carers confirmed that fire safety, moving and handling, infection control and food hygiene training was carried out and they had easy access to the home’s policies and procedures in these areas. Staff were seen to maintain safe working practices while going about their duties. The pre-inspection questionnaire indicated that other equipment was checked and serviced as required. The only matter outstanding was the electrical wiring safety certificate. Following the inspection the manager informed the inspector that she had arranged for an electrical contractor to carry out an inspection. Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 Page 22 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 4 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 2 X 3 x 2 X X 4 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X 3 3 X 3 Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 Page 23 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 Refer to Standard OP18 OP19 Good Practice Recommendations The whistleblowing policy should include that staff can also contact the Commission for Social Care Inspection. The wheelchair ramp for the front door should be replaced. Highfield House Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 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 © 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 Nursing Home DS0000018774.V331064.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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