Inspection on 26/03/07 for Highfield House Nursing Home

This inspection was carried out on 26th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Highfield House Nursing Home 16/09/09

Highfield House Nursing Home 05/12/07

Highfield House Nursing Home 03/01/06

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 Highfield House Nursing Home 33 Queens Road Ryde Isle of Wight PO33 3BG Lead Inspector Jan Everitt Unannounced Inspection 26th March 2007 10:00 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 Nursing Home DS0000066320.V328116.R03.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 DS0000066320.V328116.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highfield House Nursing Home Address Highfield House Nursing Home 33 Queens Road Ryde Isle of Wight PO33 3BG 01983 811015 01983 614713 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) www.sciohealthcare.co.uk Scio Healthcare Limited Mrs Debra Sherrie Keynes Care Home 26 Category(ies) of Dementia - over 65 years of age (5), Physical registration, with number disability over 65 years of age (26), Terminally of places ill over 65 years of age (2) Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3/01/06 Brief Description of the Service: Highfield House is a registered Nursing Home providing nursing care and accommodation for up to twenty-six older people. The home is situated on the outskirts of Ryde within a few minutes walk of the main shopping centre and facilities. There are good bus links to Ryde town centre and Newport with a bus stop located close to the home. The home offers a range of single and shared bedroom accommodation located on two floors accessible to all service users by a passenger lift. The pleasant rear gardens are laid mainly to lawn with flowerbeds and paths. The area to the front of the home has been converted to provide car parking. Scio Healthcare Limited has recently purchased the home. The home’s Matron/Manager has commenced the registration process with the Commission. Fees: £586: 04 - £680:05 Additional charges Chiropody £10.00. Hairdressing £4.50-£9.00 News papers and toiletries- variable. Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit inspection to Highfield House, Isle of Wight, which was unannounced, took place over a one day period on the 26th March 2007 and was attended by one inspector who was assisted by the deputy manager. The Scio Healthcare Limited responsible individual, Mr Kevin Dannatt was present for part of the inspection visit. The visit to Highfield House formed part of the process of the inspection of the service to measure the service against the key national minimum standards for the year 2006/7. The focus of this visit was to support the information gathered prior to the visit. The judgements made in this report were made from information gathered prior to the visit; pre-inspection information submitted to the commission by the registered manager, information from the previous report, the service history correspondence and contact sheets appertaining to the service were also taken into consideration. A number of comment survey cards were sent to relatives prior to the visit of which eight were returned. They were generally very positive about the care and services. None of the service users’ surveys were returned and this was thought to be that most of the service users are mentally frail and would be unable to complete the form. Three visitors were spoken with at the time of this visit and were very impressed with the care their relatives were receiving. Responses from the surveys sent to visiting professionals to the home were not received. Further evidence was gathered on the day of the site visit. The inspector toured the home and those service users able to communicate with the inspector, gave their views on the service. All the service users stated that they enjoyed living at the home and liked the staff. Care and other records and documentation identified in the report were viewed. What the service does well: The home provides a pleasant, safe, homely environment for service users and staff. Service users and visitors confirmed that they felt social, health and care needs of the service users are met. Responses from the relatives to the survey were: ‘My daughter said she found the accommodation well above what she had seen in other homes’. ‘The home is always clean and never smells’. Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 6 ‘ The home provides a friendly, homely feel for the residents’. Appropriate numbers of registered nurses and care staff, supported by ancillary staff, are employed. Service users were complimentary about the food provided at the home, which was observed to be well presented and nutritious. Service users and visitors were very positive about the nursing and care staff employed at the home and they stated they are very polite, helpful and kind. Comments received from the surveys were: ‘We, as a family, are very happy with the care our father receives’. ‘A very high standard of nursing care, emotional support and stimulation’. ‘Very happy with the care shown to mum. Staff are lovely’. Although I find some of the duty matrons quite hard to talk to, the general nurses and carers are always helpful and kind.’ ‘Staff are very kind and friendly to all clients. ‘We would like to thank you all for what you do for our mother’ A training manager is now in post and is co-ordinating all the staff training for the three homes and has procured a variety of training to meet the staff training needs and that appertaining to the client base they care for. Staff comments from the surveys were: ‘The home provides training’. ‘Everyone works as a team’. ‘The staff work well as a team and the residents always appear content’. ‘Training is available to staff and the nursing staff work well as a team.’ What has improved since the last inspection? All beds have been replaced with new height adjustable electric beds specifically designed for providing nursing style care. The home has purchased a number of air pressure relieving mattresses. The extension to the home is nearly completed and this will allow for en-suite single accommodation throughout the home. Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 7 Care plans are now signed by the service user or their representative as evidence of their involvement and agreement to the planned care. The activities organiser has produced the social profiles for each service user and activities are designed around these profiles. The activities organiser maintains excellent records of the activities taking place and the level of participation the service users choose to give. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 8 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 DS0000066320.V328116.R03.S.doc Version 5.2 Page 9 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 DS0000066320.V328116.R03.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All potential service users are fully assessed prior to admission to ensure that the home is able to meet their needs Standard 6 is not applicable, as the service does not provide intermediate care. EVIDENCE: The inspector viewed a sample of pre-admission assessments for more recently admitted residents. They were comprehensive and covered most aspects of care. The manager or deputy manager usually goes to assess potential service users, mainly in the clinical area or from other care settings. On the day of this visit the deputy manager from another of the group’s homes, was assisting at Highfield House for a short time whilst the manager was not in the home. She was going to the local hospital that afternoon to assess a lady for admission. She reported that the son had visited the home Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 11 the previous few days and had been given the information pack and he had requested that his mother be assessed for admission to the home. The deputy was overheard making arrangements to meet the relatives at the hospital, as she reported, this was his request to be there and also she would be able to obtain a more accurate assessment of the person’s needs with the help of a relative. Pre-admission assessments are in the care plan folders. The referrals to the home are usually through care managers. Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 12 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 adequate. This judgement has been made using available evidence including a visit to this service. Not all service users have individual care plans that detail how their personal and health needs are met. Medication is appropriately managed within the home. Service users are treated with respect and core values upheld. EVIDENCE: A sample of four service users care plans was viewed. There were comprehensive assessments in place. Two of the four care plans were good and needs identified and care plans written which described the care needed to meet those needs. These had been reviewed appropriately and at least monthly. There were good social profiles of the service users written. The other two care plans were disappointing in as much as they had not been reviewed appropriately. One service user who was very unwell and whose Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 13 condition had deteriorated quickly had not had her care plans reviewed in light of her changed condition and the care plan described her being mobile with two people, but in fact she was unable to get out of bed. Her care plans did not reflect her current needs and increased dependency. The turn chart observed in her room was not maintained well and there was no record of what diet and fluids had been offered or taken. The other care plan was fragmented with no system that would be easy for carers to read and to inform their practices. For three of the service users the bedrails were in use and a risk assessment had been undertaken and bumpers covered the bedrails. The fourth service user had been assessed as needing a lap strap to prevent him from slipping from his wheelchair. The inspector observed that the care plans had been signed by the relatives or service users although due to cognitive limitations, not all service users are able to participate in planning their care. The home maintains a separate file for wound charts and these are reviewed as the dressing is done. The deputy manager reported that one nurse is allocated each day to undertake the dressing changes. The inspector toured the home and observed there was a number of residents were remaining in bed. The recent stomach bug the home had experienced and left some of the frailer service users very unwell. The home has a GP who visits weekly, and at which time service users are seen, if requested. A record is maintained of who the GP has seen and reviewed each week. The service users have the services of a chiropodist, a domiciliary optician and the community dentist, who will visit the home if requested. The deputy told the inspector that the home has been visited by speech and language therapist, one service user being fed by a PEG tube. The physiotherapist will visit the home if referred by the GP. One service user is having a private physiotherapist at the current time, which he was funding himself. The tissue viability nurse visit the home to assess wounds and give advise. The hearing aid clinic is available at the local hospital. Continence assessments are undertaken by the continence nurse who visits the home frequently. The home has purchased electrically adjustable beds. The deputy manager reported that since the last inspection the home has purchased some pressure relieving mattresses for service users whose tissue viability has been risked assessed as high, but they continue to need to ask the district nurse for the Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 14 loan of air mattresses. The inspector observed a number in use. It was identified that the service user who had become very unwell had a high waterlow score indicating that she needed an air mattress. The manager said she would try to contact the district nurse that day to borrow one. However, the home has a responsibility to ensure that it has the necessary equipment available to meet the service users’ changing needs. A delay in obtaining appropriate equipment for a service user who has been risk assessed as high could prove to be detrimental to the health and comfort of the service user. The inspector did observe a variety of pressure relieving cushions in use. The inspector viewed the medication policies and procedures. The medication is stored in an appropriate locked facility. Records are maintained for all medications received in the home and are administered by a registered nurse. The recording and secure storage of controlled drugs was also demonstrated and although there were no controlled drugs being used at the current time the recording register and facilities were appropriate. The inspector viewed the medication administration records, which, were found to be recorded fully and identified codes if the medication had been refused or not taken for some reason. This was a requirement from the previous inspection and has now been complied with. The temperatures of the small medication fridge were being recorded daily. The inspector observed some out of date eye drops in the fridge, the deputy manager removed them immediately. The home has a waste disposal contract for medications no longer in use and records are maintained of medications that are destroyed. The inspector observed large stocks of topical creams and ointments and the deputy manager reported that the home is able to bulk order certain medications. The inspector observed the practices in the home and observed nurses and carers treating service users with kindness and respect. The carers were observed to be assisting service users with their drinks is an unobtrusive way. One comment made by a carer stated that ‘the residents needs are met and they are treated as individuals with respect’. Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 15 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. The home provides recreational activities to meet the social, cultural and recreational needs of the service users. Service users are able to maintain contact with their families and the community. Service users are supported to make choices and take control over their lives. The home provides a wholesome nutritious diet. EVIDENCE: The home has engaged an activities organiser who works for the group of homes and attends Highfield House two full days a week. She was in attendance on the day of the visit and was observed to be preparing Easter decorations with a large group of service users in the conservatory. Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 16 The activities programme was advertised on the notice board and demonstrated a programme of activities for the entire coming month. Social profiles have been created for each service user, which must be commended, and the deputy manager told the inspector that they are requesting relatives to make up memory boards of old photographs for their relative. The inspector observed some of these in service user’s rooms. The activities organiser reported that she does try to organise the activities around the resident’s past hobbies and interests. The inspector viewed the records the activities organiser maintains of who attends each session and the extent of their participation and enjoyment in that activity and fully accounts for each person. One service user the inspector visited in her room said she did not participate in the activities ‘not if I can help it’. This same service user was seen by the activities organiser on a one to one basis and she reported that she would see service users individually if they do not wish to be part of a group. It was observed by the inspector that the service users choosing to stay in their rooms, were seen to enjoy reading. A staff survey response commented that ‘ I wish there were a room set aside for activities which was big enough for a table for people to sit around’. Service user relatives’ response to the survey commented that the home provides stimulation for the service users and ‘the daily activities are impressive’. The home has a visiting clergy fortnightly and one service user attends the local church each week. Outings into the community do take place when the company mini bus is available. The company director spoken with said that he anticipated the home would be getting their own mini bus once the building works are completed. The visitor’s book demonstrated that the home has regular visitors. The inspector spoke to three visitors, they all complimented the home on the care their relatives and friends receive. A comment response from a relative said ‘family and friends are always made welcome’. The inspector observed in the care plans that service users’ preferences are documented, their preferred foods and times of going to bed and getting up, which are flexible. Service users spoken to report that their choice of how they wish to undertake their activities of daily living is respected. One service user told the inspector that she preferred to stay in her room to read and another said she chose to go to the lounge later in the day and enjoyed looking out at the building works that are underway at the home. Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 17 A comment from a survey said ‘the resident’s needs are met promptly and they are treated as individuals and with respect’. The pre-inspection documents included a copy of the previous month’s menu that demonstrated a wholesome nutritious menu with choices at every mealtime. The home also submitted a copy of the menu sheet that is completed for each service user for the next day identifying what their choices are and what location they prefer to eat. The cook told the inspector that the menus are decided on by the catering manager and are discussed with her. The inspector visited the kitchen, which was observed to be clean and well organised. The inspector spoke to the cook and observed her preparing the lunchtime meal. She reported that the service users are asked what choice they would like the previous day but she is aware of service user’s preferences. She told the inspector that she has a level of knowledge about special diets but is about to go on a training course for this. She reported that she has a number of pureed diets that she presents in separate portions. The inspector observed and was also informed by the cook that the home had recently been awarded a five star rating from the Environmental Health for the quality of food and the kitchen. Comments received about the food from relatives and service users were very positive. One service user telling the inspector ‘yes the food is very good’. The deputy manager told the inspector that the service users have a dietary assessment when they come to live at the home and their weight is monitored three monthly. If a nutritional risk is identified the home are able to access a dietician from the local hospital via a GP referral. Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users or their representatives are able to complain if they are unhappy with the service provided at the home. The Matron and other staff are aware of adult protection procedures and would respond appropriately if they had concerns in relation to adult protection. EVIDENCE: The home has a policy and procedure for the investigation and resolution of complaints; this will be detailed in the new service users’ guide. Service users spoken with appeared happy to report any complaints and stated they would tell care staff, nurses or the manager. Staff surveys returned demonstrated that staff were clear that if complaints or concerns were made to them, they would talk to the nurse in charge or the manager. None of the service users spoken with during the inspection had any concerns or complaints to report to the inspector. The surveys returned from relatives indicated that they would know who to go to if they wished to make a complaint. One commenting that she had made a complaint but the ‘matron on duty’ had resolved it Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 19 The complaints book was viewed and indicated there had been one complaint recorded during 06. The home has an adult protection policy which links to the Isle of Wight Adult Protection policy and procedure, a copy of which was available in the nurses’ office. The inspector observed that the adult protection policy still quoted the NCSC as the regulatory body and this must be reviewed. Discussions with the deputy manager showed that she had an understanding of adult protection issues and was clear about responsibilities and actions that should be taken if abuse is suspected. The training co-ordinator showed the inspector records of adult protection training undertaken and planned for the home. Discussion with staff confirmed that they had received training about adult protection during both induction and NVQ courses and were aware of the actions they should take if they suspect abuse of a service user may have occurred. Adult protection training is now included in the Skills for Care Common Foundation Programme, which the home has adopted. The home encourages service users or their representatives to manage individual service users’ personal finances. Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a clean, safe well-maintained environment. EVIDENCE: The inspector toured the premises. The home was not purpose built as a nursing home, however it has been extended and adapted over the years to provide a homely environment. At the time of this visit the provider was in the process of extending the home at the back of the building to provide a large extension that would enable the home to be all single room en-suite accommodation. The provider told the inspector that the completion of this is due in October 07 and it would be of the same high standard of extensions to their other nursing homes on the Island. Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 21 There are further plans to refurbish the existing home and this will commence once the new rooms are commissioned and some service users may be moved into them to enable the old part of be refurbished. The provider explained that this must be planned carefully to cause the least disruption to the service users as possible. The inspector observed areas of the home that were in need of redecoration/repair but the refurbishment of the existing house will address these issues. Two carers had commented on the surveys that ‘more toilets are needed to allow space for standaids and hoists as toileting is sometimes hard and takes a lot of time’. The inspector observed that there was little disruption to the existing home whilst the building works were in progress and the only physical evidence was the fireplace in the dining room has been boarded up. One fire door on the ground floor has been taken out of use and this has been risk assessed and procedures amended to accommodate this. The home has a maintenance man in post that undertakes the day-to-day running repairs for the home. The inspector viewed the maintenance book that demonstrated that the snags/repairs were recorded and signed for once the task has been completed. The home has all electrical adjustable beds with built on bedrails that can be heightened if necessary. The inspector observed bumper covers for the bedrails in use. The home employs domestic staff responsible for all domestic hygiene and cleanliness issues. On the day of this visit the home was found to be clean, tidy and free from offensive odours. All toilets and communal bathing facilities were noted to have a supply of paper towels and liquid soap with guidelines available for staff around infection control and the use of chemical cleaners, which are stored in a locked environment. The commission was notified of the recent D & V outbreak the home experienced. This was reported to the public health/infection control nurse at the local hospital who gave guidance and support during this time. The inspector did observe that there were various hoists around the home, some of which needed to be thoroughly cleaned to ensure that infection control procedures are adhered to. The care staff told the inspector that a stock of gloves, aprons and paper towels are held discreetly in all service users’ bedrooms. Liquid soap dispensers are now provided in all bedrooms. Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 22 The training co-ordinator and her records confirmed that all nursing, care and domestic staff receive training in infection control. The home has a laundry located on the lower floor with industrial machines capable of washing to required temperatures. Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 23 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. The home employs appropriate numbers of registered nurses, care staff and ancillary staff to meet the needs of service users. A comprehensive recruitment process is in place to ensure the safety of the service users. An induction and training programme is in place to ensure staff should have the necessary skills required to meet service users’ needs. EVIDENCE: The inspector viewed the staff rotas that demonstrated that the home employs appropriate numbers of registered nurses, care staff, housekeeping staff and ancillary staff to meet the needs of the service users. Staffing levels were discussed with the deputy manager in light of the new extension and the dependency of the service users. There were comments from staff as to the shortage of staff one saying ‘more staff would help so we could spend more time with clients’. Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 24 Service users spoken with during the inspection reported that staff were prompt in answering call bells and that they felt care staff had sufficient time to meet their needs. The inspector identified shortfalls in the recording of care plans and some staff spoken with considered that there had been a high percentage of sickness during the D & V outbreak and staff had not been replaced and this had caused paperwork being left with the priority given to the care of the service users. The inspector met the training manager who discussed the training programmes and the plans for training in the coming year. She is in the process of collating records onto the computer of all training undertaken and due, to enable her to formulate a training matrix. At the time of this visit five staff were undertaking the NVQ level 2 training and others doing the level 3 training. The home was meeting the national minimum standard of 50 of care staff having NVQ level 2 qualifications. The training manager is very enthusiastic to ensure all staff in the group of homes are trained appropriately to meet the needs of their roles. She has sourced various organisations and free training through apprenticeships. An induction programme was viewed by the inspector and was identified as the Skills for Care Common Foundation Induction Course that, once completed, is recognised as a module for the NVQ level 2 training. The cook and kitchen staff are also undertaking the NVQ level 2 training. The organisation funds training and also pays for the time taken to do this. Staff spoken with and comments from the care worker surveys indicated that staff are satisfied with the training provided and consider their training needs are met. The deputy manager and administrator described the home’s recruitment procedure that starts with adverts in local papers or via word of mouth. All potential employees complete an application form, involving full work history, two references, Criminal Records enhanced level and POVA check and health declaration. The manager conducts the interviews. The inspector viewed a record of the interview process for a trained nurse who had been interviewed on the day of this visit. The deputy manager reported that the candidates are now contacted by letter to inform them of the outcome of the interview. The inspector viewed the personnel records in respect of five staff most recently appointed. These were found to have all the required information recorded as stated in Schedule 2 of the Care Home Regulations. However, one file demonstrated only one reference and this was discussed with the administrator who said she would investigate this being omitted. Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 25 The home uses an employment agency that ensures that staff employed from overseas have all the required documentation and permits to allow them to legally work in the UK for the Scio Healthcare of group homes. Two of the care staff from abroad were spoken with. They reported to be happy and enjoying their work and that the work is very different from ‘home’. They both reported that they have received appropriate training. Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 26 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s management structure is appropriate for the size of the home. The home cannot demonstrate a current quality assurance programme is in place to measure the service against the Statement of Purpose. Service users finances are safeguarded. The home does not have a structured programme for staff appraisal and supervision. EVIDENCE: Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 27 The registered manager, who has been in post for one year, was unavailable on the day of this visit and the deputy manager had returned that day from sick leave. The registered manager and the deputy both have achieved the Registered Managers Award. The manager is first level registered nurse and the deputy a second level registered nurse. The manager meets all the training requirements to achieve NMC Prep requirements and the training co-ordinator confirmed that any training needs identified for the manager would be accessed. The home has clear lines of management and the staff are aware they can go to the manager or deputy with any issues. The directors of the company visit the homes and one did so on the day of this visit to discuss any issues with the inspector and to oversee the building works. The policies and procedures of the home are under review in light of the newly formed company. The home is visited by one of the directors and Regulation 26 visit reports are maintained in the home. The inspector viewed two of these and they were comprehensive and covered records, talking to service users, talking to staff, environmental inspection and recorded issues that needed to be addressed as well as the positive aspects of the home. At the current time questionnaires are distributed to relatives but the home reports that most of the service users would be unable to complete a questionnaire. There did not appear to be any outcome report from the questionnaires. The quality assurance of the home must be developed further and include the stakeholders in the home and service user, who are able, should be supported in giving their views. The deputy manager reported that she does audit the care plans and MAR charts and check on the environment but does not formally document any of this activity. This was discussed with her as being an integral part of quality assurance. The administrator told the inspector that the home does not manage any service users’ monies. The comment surveys returned by staff reported varying perceptions on supervision and staff meetings. Some staff indicated they receive regular supervision others said not. Three staff have indicated that staff meetings and supervision do not take place regularly because ‘we have been short of staff’. Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 28 The training manager told the inspector that staff appraisals and supervision is not happening for all staff at the current time but that she is working on a programme of appraisal and supervision for all staff for at least 6 times per year. The fire log was viewed by the inspector who could not identify when the emergency lighting had been checked monthly. This was discussed with the administrator who reported that the records might be elsewhere. The inspector viewed a sample of servicing certificates that were current. One being the fire alarm 02/07, Electricity wiring 13/11/06. The inspector viewed the reviewed fire procedure and observed that all staff had signed to agree they had read it and understood the change in the procedure due to the fire exit being taken out of service. The accident book was viewed and these are completed appropriately and stored in a secure environment. These are not being analysed to identify any emerging themes and this was discussed with the deputy manager. Staff have received the mandatory health and safety training although it was difficult to easily identify on the training matrix produced by the training manager. Staff spoken to confirmed they had received this training and that included infection control and moving and handling. Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 29 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 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 Score X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation Reg 15(1) Requirement Timescale for action 30/04/07 2. OP33 24 (1)(a and b) You are required to ensure that the care plans reflect the changing care needs of service users and monitoring charts for that specific purposed must be kept up to date. Scio Healthcare Ltd and the 31/05/07 Manager must identify an appropriate internal quality assurance and quality monitoring system based on seeking the views of service users/representatives and monitoring the records and practices in the home. This was a requirement from the previous inspection with timescales stated 31/3/06 Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 31 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. Refer to Standard OP8 Good Practice Recommendations It is recommended that the organisation purchase more pressure relieving mattresses to meet the needs of the service users who have been identified as being at a high risk of tissue breakdown. The registered manager must ensure that staff are checking on expiry dates of eye drops and not use them past the recommended time from opening. It is recommended that the adult protection policy and procedure be reviewed. It is recommended that the hoists be cleaned on a regular basis. The supervision and appraisal programme for all staff should continue to be developed and commence as soon as possible. 2. 1. 2. 3. OP9 OP18 OP26 OP36 Highfield House Nursing Home DS0000066320.V328116.R03.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 DS0000066320.V328116.R03.S.doc Version 5.2 Page 33 - 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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