Inspection on 05/12/07 for Highfield House Nursing Home

This inspection was carried out on 5th December 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 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 16/09/09

Highfield House Nursing Home 26/03/07

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 Neil Kingman Unannounced Inspection 5 December 2007 09:50 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.V353630.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 DS0000066320.V353630.R01.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 info@sciohealthcare.co.uk www.sciohealthcare.co.uk Scio Healthcare Ltd 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) Ms Margaret Andrews Care Home with Nursing (N) 46 Category(ies) of Dementia (DE) Physical disabilty (PD) registration, with number of places Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following gender: Either Dementia (DE) Physical disability (PD). 2. The maximum number of service users to be accommodated is 46. Date of last inspection 26th March 2007 Brief Description of the Service: Highfield House is a registered Nursing Home providing nursing care and accommodation for up to forty-six older people. The home is situated on the outskirts of Ryde within a few minutes walk of the main shopping centre and amenities of the town centre. There are good bus links to Ryde town centre and Newport with a bus stop located close to the home. The home is undergoing a major development with a three-storey extension having been completed this year. It now offers a range of high quality single room accommodation arranged over three floors, accessible to all service users via two passenger lifts. Rooms in the new build have accessible en-suite wet rooms. Communal space comprises a large dining room and several lounges over the three floors, with quiet areas that afford privacy if required. There is a large central courtyard garden to be equipped with seating for use by the people who use the service. The area to the front of the home has been Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 5 converted to provide car parking. Ms Margaret Andrews manages the home on behalf of the proprietors Scio Healthcare Limited. The home provides 24 hour wakeful staffing, including registered nurses in charge of every shift. Weekly fees range between £707 and £770. A copy of the home’s service user’s guide is made available to all residents and their representatives in the main entrance foyer and in individual rooms as applicable on request. Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This report details the results of an evaluation of the quality of the service provided by Highfield House Nursing Home and brings together accumulated evidence of activity in the home since the last key inspection on 26 March 2007. Part of the process has been to consult with people who use the service. To this end we have received written responses to several surveys, i.e., eight from people who live in the home, three from visiting relatives and two from Social Services Care Managers. Included in this inspection was an unannounced site visit to the home by an inspector on 5 December 2007. The registered manager Ms Andrews was available throughout the day. At the visit we had an opportunity to speak with staff on duty, several residents who were able to give informed views about the service and two relatives who were visiting residents on the day. We also looked at a selection of records. Prior to the site visit the manager sent to the Commission a detailed selection of information about the service including an Annual Quality Assurance Assessment (referred to as ‘the assessment’ during the report), which has been used with other information to inform the various judgements made about the service. What the service does well: The home provides a comfortable, clean and safe environment for the people who live there. The rooms are spacious, well equipped and furnished and people enjoy occupying them. Staff are well managed and trained, and provide a good standard of care for people, many of whom have high care needs. The interactions between the staff and the residents are warm and friendly and staff pay a good deal of attention to respecting peoples’ dignity and privacy. Comments from residents and visiting relatives about what they consider the home does well are included in the body of the report and include: “I think Highfield Nursing Home have delivered an excellent service to its residents, and are always ready to support relatives.” Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 7 “I am very impressed with the home and staff.” “The staff, nursing, care and domestic, have always been cheerful and helpful.” “I consider it to be a wonderful home.” 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 DS0000066320.V353630.R01.S.doc Version 5.2 Page 8 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.V353630.R01.S.doc Version 5.2 Page 9 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 and 6 - People who use the 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 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, what they hope for and want to achieve, and the support they need. The home does not provide dedicated accommodation for short-term intermediate care or specialised facilities for rehabilitation. EVIDENCE: Pre-admission assessment People should know that their needs will be met when they move into a home. An important part of ensuring this happens is the pre-admission assessment process. Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 10 The manager described the home’s admissions process in general, and specifically in relation to the newest person to be admitted, less than fortyeight hours earlier: • • • • The manager or one of her deputies visits the person who may want to use the service typically at the hospital or their home address where applicable. They take with them assessment forms on which to record information concerning the persons clinical and social care needs, and dependency. The deputy manager visited the most recently admitted resident at the hospital and carried out an assessment of needs. A range of information was gathered during the process and recorded on the appropriate forms. This individual was referred through Social Services Care Management and the deputy manager held discussions with a relative, the care manager and staff at the hospital to gather as much information as possible. The manager and one of the deputies spoken with showed a good understanding of the importance of a thorough pre-admission assessment in the process of choosing the right home. • Copies of the pre-admission assessments were available on this person’s file. Significant health care professionals had been consulted in the process and the assessment had been used in the production of the initial care plan. In addition, a ‘pen picture’ of the individual’s history was included with the needs assessments. Intermediate care Highfield House does not provide dedicated accommodation for short-term intermediate care or specialised facilities for rehabilitation. However, the home has a contractual arrangement with the local authority to provide one room for respite care. Further respite care can be accommodated if there are rooms available. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • We fully assess all potential service users prior to their admission, and include relatives or other supporters in the assessment process, as the person wishes. We were judged as Good at our last inspection. We provide a pleasant safe homely enviroment for both service users and staff. We have improved our practices and procedures since the last inspection to ensure our care plan folders contain more information and there is now evidence of relatives or representatives involvement in the planned care. DS0000066320.V353630.R01.S.doc Version 5.2 Page 11 • • Highfield House Nursing Home • • • All service users have a written contract / statement of terms and conditions within the home. Our care plan folders contain details of the pre-admission assessments carried out as well as details of other pre-admission discussions and individual photographs. Contacts and copies of our letter of confirmation that we will be able to meet the assessed care needs are also available. Highfield House Nursing Home DS0000066320.V353630.R01.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 and 10 - People who use the 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 health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. EVIDENCE: Care planning – At the last inspection shortfalls were identified in the home’s care planning system. At this site visit significant improvements were noted. The manager confirmed that following a review of residents’ personal care plans a new system had been developed to provide a working tool, which is easily understood by staff and focuses on the individual health and social care needs of the person. Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 13 We looked at a sample of three plans. The intention was to look at the outcomes for people who use the service in general by assessing all areas of care for those sampled. The sample included a person with complex needs who was also the newest admission to the home, having moved in less than forty-eight hours earlier, a person with advanced dementia and a person who had been resident in the home for several years. Plans are clear, simple and person centred, with guidance for staff on how residents’ needs and wants are to be met. Each resident’s plan contains information about their needs in a number of key areas, which affect them as an individual, a sample being: • • • • • • • • Maintaining a safe environment Communication Mobility Pressure area care Personal hygiene Sleeping Social care needs Specific care plan Each key area identifies any problems, outlines the goal to be achieved, the action to be taken, evaluation, and date for review. We noted that information in the sample viewed was written in plain language and recorded in a person centred way, with particular emphasis on how people like to be treated (dignity and respect etc). Reviews are carried out at least monthly and were noted to be up to date in the sample viewed. Clinical charts specific to the individual are included in the resident’s plan. Those viewed were noted to be detailed and up to date. The home undertakes a risk assessment for each person as soon after admission as possible. We noted risk assessments were in place in the sample of plans viewed, including the person newly admitted to the home. A discussion was held with the manager about the amount of information in risk assessments. It was agreed that more information would be recorded about the reasons why people may be at risk and whether the risk is greater in a particular situation, at a particular time, or in a particular area of the home, etc. In addition, the home’s assessment makes clear that care planning continues to be developed, with plans to hold informal reviews with relatives where residents agree, and further training for care staff. All staff spoken with showed an understanding of residents’ care plans. One nurse, fairly new to the home confirmed that he had developed a plan for an Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 14 individual for whom he was the key worker. He was particularly knowledgeable of this persons care needs. One visiting relative spoken with had some knowledge of the resident’s care plan and confirmed that she had been consulted in the process. Health and access to care services The manager confirmed, and records evidenced the contacts with GPs, optician, dentist, community mental health team etc. During the site visit we had an opportunity to speak with two visiting relatives who confirmed that they were always kept informed of important matters affecting the residents they represented. They were full of praise for the staff, the standard of care, and the manager in particular. In discussions with the manager and staff it was clear that several residents were vulnerable to pressure sores. They said that staff were vigilant and the good management of pressure areas kept problems to a minimum. In addition, in response to a recommendation at the last inspection the home has increased the number of pressure relieving mattresses that are available. During the tour of the building it was noted that a range of electrically adjustable profiling beds were being used, including one of English design but made in Germany, with a Micro-stimulation System as a pressure reduction system for effective pressure sore prevention. Five responses to the service users survey indicated they are always given the care and medical support they need and three indicated usually. From the visiting relatives survey two responses indicated the home usually meets the needs of their relative and one indicated always. Both responses to the care managers survey indicated that individuals’ care needs are usually properly monitored and attended to by the home. Positive comments from the surveys were: “An excellent home that provides a high level care and loving support.” “The staff are always very quick to answer the call bell.” “The matron is always popping in to see me and have a chat.” “I think Highfield Nursing Home have delivered an excellent service to its residents, and are always ready to support relatives.” There were some negative comments: Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 15 “There are times when staff are hurried and residents are left without attendance.” “I feel that communication (at least to me) is poor.” The manager said she had been made aware of the negative issues and had met with the individual to resolve the problem. Medication Medication is given to the residents by Registered Nurses whose skills have been individually self-assessed and validated by the Home Manager. A workbook distance learning package is used to assist in achieving this outcome. Records showed and the manager confirmed that staff receive refresher training in the safe handling of medicines. Since the last inspection the home has set up a system of regular monitoring to ensure accuracy of recording and administration of medicines. The manager said that additionally an audit of medication procedures is carried out as part of the providers’ obligation to monitor the conduct of the home. During the site visit we looked at the arrangements in place and noted medicines were stored under secure conditions in purpose built metal cabinets and accurate records of receipt, administration and disposal of medicines maintained. Privacy, dignity and respect The importance of treating people who use the service with dignity and respect is covered in the induction training for new staff. On the day of the site visit we toured the building and spent time with residents in the communal areas, and in the privacy of their rooms. There were opportunities to observe staff at work. Staff spoke kindly to people and showed patience with those who are confused. The interactions between them were warm and friendly. In discussions with staff it was clear that they used the principals of dignity and respect as the basis of all the work they do with people. Residents able to give an opinion were full of praise for the staff and their approach to care and support. This was also supported by visiting relatives in our discussions with them. They had no hesitation in praising the care staff and how they treat people. Staff address people by the names that they prefer and knock on doors and wait for an answer before entering rooms. Preferred names are recorded on care plans and this was noticeable in the sample viewed. Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 16 The home has arranged for the installation of large button, hands free telephones in all bedrooms and these were noted to be in place during the tour of the building. Both responses to the care managers survey indicated the home usually respects individuals’ privacy and dignity. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • • • • Care given to our residents is person centred and individualised. Medication management is improving. Service users are treated with respect and their dignity is maintained through the sensitive care provided by our well trained and knowledgeable staff. Our care plans have all been reviewed and updated since our last inspection and are now more person centred, providing clearer guidance on what care needs people have and how these are to be met. At our last inspection we were judged as adequate - however we believe we have significantly improved our documentation in this area to support the care being delivered. We hope to be assessed as at least Good in this area at our next inspection. Introduction of new documentation for care plans has provided clearer guidance for staff delivering direct care and is more person centred, ensuring care delivered more fully meets the persons individual needs. We are planning to hold informal reviews with relatives, where this is agreed to by the person for whom we are providing care. Planning and updating of clinical procedures. Further training on documentation to be planned and addressed in supervision. • • • • Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 17 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 and 15 - People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their life style and activities are offered to suit their individual needs and expectations. The care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. People are able to keep in touch with family, friends and representatives who are made to feel welcome and can visit at any time. People have healthy, well-presented meals and snacks, at a time and place to suit them. EVIDENCE: Routines and activities – The home’s assessment showed and the manager confirmed that residents are encouraged and supported to exercise choice and control in their lives. Routines for residents are kept as flexible as possible, e.g., they have choice over where and when they have their food served, what time they like to be woken and the time they like to retire, where and when they like their breakfast served etc. This was evident on the day of the site visit when we Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 18 noted breakfast being served to people at different times according to their preference. The Company employs an activities co-ordinator for the three homes in the group and we had an opportunity to speak with her during the site visit. She explained that residents have responded positively to the monthly programme of activities that had been developed. We discussed the home’s response to people with mobility difficulties who may not be able to take part in the activities that others enjoy. It was clear that time is spent one-to-one with them in their rooms, with reading, games, reminiscence etc. It was noted that one-to-one time is scheduled on the monthly activities programme. The programmes for both November and December were available for inspection. Activities are aimed at all the senses and include amongst others: • • • • • • • • • Arts, crafts, painting and flower arranging Floor games Coffee mornings Quizzes Bingo Singing Reminiscence/nostalgia Trips out from the home Special activities with a Christmas theme On the day of the site visit a ‘bring and buy’ sale and a raffle were under way in the morning with visiting relatives taking part. They incorporated a coffee morning with the chef producing a selection of cakes and mince pies. In the afternoon a group of residents visited the local school to watch a school play. Highfield House will cater for all religious denominations and will support those who like to attend Church Services. The home receives a regular visit from the local parish clergy and those who wish can take communion either as a group or individually in the privacy of their rooms. A comment in the visiting relatives survey was, “I am especially pleased that my mother’s spiritual needs are met.” There was a mixed response in the service users survey with two indicating there are always activities arranged by the home that they can take part in, three indicating usually and two sometimes. One indicated they are unable to take part in activities. Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 19 Visiting arrangements – Details of visiting arrangements can be found in the service user’s guide and are generally unrestricted. However, visits after 8 p.m., are asked to be by prior arrangement for security reasons. Residents and their families are encouraged to treat the home as their own. People can receive visitors in their own rooms or any of the several communal areas, where peace and privacy can be assured. The visiting relatives spoken with said they were always made welcome by staff. Personal autonomy and choice – Residents were spoken with individually in the lounge and in private. Those who were able to express views said they were given choices regarding routines in the home, e.g., times of rising, going to bed, activities, meals, personal care, going out etc. The manager confirmed that all residents have either a family member or a friend to support them independently of the home. She showed a good understanding of how and in what circumstances arrangements would be made to access the independent advocacy service. People are encouraged to bring with them pictures, ornaments and personal items for their room. During the tour of the building it was noted that some rooms were very well personalised, and others less so, according to peoples’ individual tastes and preferences. The management and administration of residents’ finances is covered later in the report but in a general sense the home encourages people to manage their own affairs with support from relatives/representatives. Meals and mealtimes – We had an opportunity to observe the activity over lunch. The atmosphere in the dining room was very sociable and friendly and staff were available to assist residents as and when required. A number of individuals needed more assistance than others and staff were seen in their rooms to show patience and understanding, while providing help and encouragement. Food served looked appetising and was well presented. We noted pureed food was presented separately on the plate to preserve the individual tastes, textures and colours. People generally take their meals together in the dining area, or individually in their own rooms, according to choice and assessed needs. Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 20 Menus are arranged over a monthly cycle and show food to be varied, appealing and well balanced. The cook said that she uses fresh produce and meals are freshly prepared on a daily basis. She showed a good understanding of their likes, dislikes and special dietary needs and explained that they were working to improve their performance with food for people with dementia. Records are maintained of what residents are actually served on a daily basis. We noted that drinks and light snacks were offered through the day between meals. Two responses to the service users survey indicated they always liked the meals in the home, 4 indicated usually and 2 made no comment. Comments from surveys included: “The meals are very nice. A good choice is on offer daily.” “At mealtimes they are wheeled up to bare tables. I think that could be improved, even with table mats.” The manager was very aware of the issue relating to bare tables and had addressed it by introducing place mats at the dining tables. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • We provide a range of age related social, cultural and recreational activities to meet the wishes of people who use our service. • We encourage contact from relatives and other supporters as desired by the person using our services and we help people to maintain contact with the local community and to participate in activities at our other homes. • People are supported to make real choices about how they spend their time and to maintain as much day to day control as they wish. • We were judged as good at our last inspection and believe we have improved further in this area. Comprehensive records are kept by our activities organiser of the level of participation of service users in the various activities. • The activities organiser maintains excellent records of the activities taking place and the level of participation the service users choose to give. • Relatives have been asked to provide old photographs and other items of specific interest for the people living at Highfield House and where possible to create memory boards. • Group or one to one activities are arranged according to the individual wishes of people. Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 21 • • • We will be introducing a sensory room with specialist equipment and hairdressing salon to support the varying needs of our service users more appropriately. We hope to have our own mini-bus to increase the number of outings we are able to offer. We offer small social areas for service users, including a secure garden courtyard. Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 22 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 and 18 - People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. EVIDENCE: Complaints – The home has a complaints policy and procedure, summarised in the statement of purpose, which is given to all residents or their representatives. Contact details for the Commission for Social Care inspection have been updated following a recommendation at the last inspection. People spoken with on the day of the site visit were not familiar with the detail of the complaints procedure, but were very confident about raising any concerns with the manager. Seven of the eight responses to the service users survey indicated they knew how to make a complaint. Six responses indicated they always knew who to speak to if they are not happy and two indicated usually. Six of the eight responses indicated staff listen and act on what they say. One indicated they don’t and one sometimes. Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 23 All three responses to the visiting relatives survey indicated they knew how to make a complaint. Information supplied to the Commission prior to the site visit showed that since the last inspection two complaints had been made about the service. Both were resolved within appropriate timescales and neither was found to be upheld. The home has developed a tracking system of monitoring the progress of a complaint to include the level of satisfaction with the outcome. Safeguarding adults – The home has a Safeguarding Adults from Abuse Policy and Procedure in place, which follows local authority guidance. Staff are given training in safeguarding adults from abuse. In discussions with staff they confirmed the training in place and showed an understanding of how to recognise abuse. They were very clear about the importance of reporting issues of concern without delay. They also were aware of the home’s “ whistle-blowing” procedures. Since the last inspection there have been two safeguarding of adults referrals to Social Services, which have been investigated. The results showed that the issues were dealt with most appropriately by the home and were a demonstration of the effectiveness of the procedures in place. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • • • We are open to suggestions from those who use our services and their supporters. We listen to what they tell us and act to put things right, as appropriate or necessary. Our policy and procedure for the investigation and resolution of complaints is available to those using our service and staff are trained in the prevention of abuse and safeguarding of adults. The inspector received positive comments from service users, their relatives and staff following surveys conducted prior to our last inspection and judged us as good in this area at our last inspection. Our adult protection policy has been reviewed and the reference that needed updating has been completed following the recommendation of the inspector. Updated Safeguarding and Protection from Abuse policy in place. Tracking document in place for complaints to include level of satisfaction. Training and updating for all staff is continuing in accordance with the Skills for Care recommendations. DS0000066320.V353630.R01.S.doc Version 5.2 Page 24 • • • • Highfield House Nursing Home 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 and 26 - People who use the 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 stay in a safe and well-maintained home that is clean, comfortable, pleasant and hygienic. There is enough space, and facilities for them meet their needs. The home makes sure people have the right specialist equipment that encourages and promotes their independence. Their rooms are comfortable and they feel safe when they use them. People have enough privacy when using toilets and bathrooms. EVIDENCE: Environment Highfield House has been a nursing home for older people in Ryde for many years and while not purpose built has been developed and adapted over the years to be suitable for its stated purpose of providing a safe, manageable and comfortable environment for the people who live there. The home is located in Queens Road, and is only a short distance from the town shops and seafront. Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 25 The home has this year undergone an extensive programme of development to provide additional rooms and facilities to accommodate up to forty-six people with nursing needs. A three-story extension has been completed to a very high specification and at the time of the site visit work was being carried out to develop a new reception with sitting area on the ground floor. The manager confirmed that work had already begun to upgrade the older part of the building to reflect the high standard achieved in the new build. All areas of the building are accessible to the people who use the service, including an enclosed central courtyard garden and sitting area. There are two passenger lifts, which afford access to all levels from the lower ground floor upwards. The home is generally comfortable, well furnished and decorated. Communal areas are bright and airy. During the site visit we toured the building with the manager. We noted in the new build people’s rooms are spacious and well equipped with new adjustable profiling beds, flat-screen televisions, good quality furniture, day and night low energy lighting and fully accessible en-suite wet rooms. There is a sensory room with equipment for sight, sound and touch, which the home plans to fully develop over time. The new bathrooms are very spacious, allowing staff to access both sides of the new ‘hi-low’ assisted baths. In discussions with one of the nurses special mention was made of the new facilities, which make for safer transfer of people, especially when bathing. Communal areas comprise a large bright and airy dining room on the ground floor, and a number of lounge/sitting areas arranged on all levels. There are quiet areas, which afford privacy if required and kitchenettes on the ground and first floors for the use of residents and/or their visitors. Ample storage space was noted, for linen, stationary, chemicals and also for wheelchairs and hoists. A comment in one of the responses to the visiting relatives survey was, “I appreciate the way in which we have been kept up to date with recent building developments.” Another commented, “They are amazing in their attention to every detail.” Cleanliness All areas of the home were found to be very clean and free from unpleasant odours. As mentioned later in the report the home employs domestic staff to ensure the standard of hygiene is maintained. Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 26 While there is an existing laundry in the old part of the building work is under way to create a new fully equipped and spacious laundry on the lower ground floor. There are separate sluice rooms for effective management of soiled articles due to incontinence. The home’s assessment confirms it has policies and procedures for preventing infection, managing infection control and soiled waste disposal. During the tour of the building it was noted that all bathrooms, en-suites and WCs were equipped with liquid soap and disposable towels or hand driers. All rooms are also equipped with antibacterial hand gel and this is also available at strategic points around the home, including for use by visitors. The Essential Steps to a safe clean environment guidance issued by the Department of Health has been implemented. All responses to the service user survey indicated the home was always or usually fresh and clean. One commented, “Standards of cleanliness are always very good.” Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • The last inspection judged the outcome in this area as Good based on the original building. We have a housekeeping team and maintenance person based at the home. Observation by the inspectorate found the home to be clean, tidy and free from offensive odours. Infection Audit carried out on 24th June and action plan put in place. Infection policy initiated and infection control training programme for all staff. There is an infection resource file available for all staff in the home. Cleaning rota now in place for decontamination of equipment used for personal care within the home, including hoists, wheelchairs and commodes. We have recently opened a new purpose built extension to the Home, to include single en-suite accommodation. Assisted bathing facilities with hi-low baths with a transverse seat and nursing arms. Introduction of a sensory room with specialist equipment and hairdressing salon to support the varying needs of our service users. New laundry facilities with new anti bacterial programmes will be installed early in 2008 to replace the existing laundry facilities. • • • • • • Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 27 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): 27, 28, 29 and 30 - People who use the 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 safe and appropriate support as there are enough competent, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. EVIDENCE: Staffing levelsRotas showed and the manager confirmed that the home employs twentythree care staff and qualified registered nurses. There are two main shifts throughout the day with eight care staff on duty in the morning and six during the afternoon and evening. These were considered plentiful for the current numbers and needs of people who use the service. There is a qualified nurse on each shift with the manager and deputy working supernumerary. Overnight there is a nurse and three waking care staff. Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 28 The home employs additional catering, housekeeping, administration and maintenance staff, as well as the activities organiser. The manager and deputies showed a high level of awareness of staffing levels needed. In discussions on the day of the site visit there were no concerns raised about staffing levels, in fact staff spoken with felt that with the present occupancy they were well able to meet peoples’ needs, including those who need one-toone attention. Three responses to the service user survey indicated there were always staff available when they need them, four indicated usually and one sometimes. NVQ training – Records showed and the training manager confirmed that currently seven of the twenty-three care staff have achieved the National Vocational Qualification (NVQ) at levels 2 or above with another five staff currently undertaking the training. She explained that a significant number of new staff had joined the home in the last year. However, the Company had a NVQ training programme that should ensure when completed the standard of 50 qualified staff would be achieved. Recruitment Individual staff recruitment files were available for inspection. A sample of four randomly selected recruitment files was checked and found to be in order. Two written references and Criminal Record and Protection of Vulnerable Adults (POVA) checks are carried out on all staff before they commence working in the home. Staff training – The home continues to move forward with training opportunities for staff. Scio Healthcare Limited employs a training manager who co-ordinates staff training across all the homes in the group. We had an opportunity to meet with the training manager during the site visit. The induction programme for new staff follows the Common Induction Standards recommended by ‘Skills for Care’. All new staff are provided with a handbook and a copy of the code of conduct and practice set out by the General Social Care Council. They are also provided with a mentoring pack to support them through the six sections of their training portfolio. The training manager and staff spoken with were clear that the home provides a very good training programme using in-house, distance learning packages and some external training providers. Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 29 Training needs are identified on a computer database, which shows dates when qualifications have been achieved and when refresher training is due. This was demonstrated during the site visit and backed up with qualification certificates. Staff training includes, amongst other subjects: Manual handling Food hygiene First aid Health and safety Dementia awareness Foundations of Palliative Care Medication Safeguarding vulnerable adults Fire training Infection control In discussions the training manager demonstrated a forward thinking approach to staff training. She confirmed that she had taken part in a pilot study of training needs in the care sector and the emphasis across the Scio group of homes was essential skills training, e.g., staff at Highfield have been enrolled on courses for dementia and palliative care and MRSA. Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • • • • Recruiting appropriate skill mix of staff. Induction training programme in place. Two people interview all applicants who are contacted in writing with result of interview. Robust recruiting process in place. Recruiting process has been updated to include an interview assessment form and an administration checklist of required documentation. We aim to continue to recruit the appropriate skill mix of staff to meet our service user’s needs. Ongoing development of training programme, including training all staff from all disciplines in dementia care to reflect our categories of care provision. We will be using the knowledge and skills set from Skills for Care as our baseline and we will also be implementing other appropriate training such as that supported by the Alzheimers Disease Society, entitled Yesterday, Today and Tomorrow. A range of support materials will also be introduced for staff and service users. The manager has recently attended a 3 day conference in Harrogate entitled Dementia Care Congress and will be implementing many ideas brought back from this stimulating set of workshops and discussions with colleagues, including networking with others working in the field of practice. We will continue to build on our successful achievement of ‘Investors in People’ and to work on the opportunities for development outlined in this report. DS0000066320.V353630.R01.S.doc Version 5.2 Page 30 • • • • Highfield House Nursing Home 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, 33, 35, 36 and 38 - People who use the 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 confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. EVIDENCE: Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 31 Management – The registered manager Mrs Andrews has been in post for approximately six months. She is an experienced, fully qualified Registered General and Mental Health Nurse, having achieved the NVQ at level 4 in management. In addition, she updates her knowledge, skills and competence with periodic training in care related subjects specific to the service provided by the home. In discussions she showed a commitment to ensuring that all staff maintain a high level of skills through training and experience, especially in then area of dementia care. Staff spoken with during the site visit confirmed that regular staff meetings and formal supervision sessions were taking place. They felt the home was well managed; staff morale was high and communication was good. Comments made by staff about the home since the new manager took up the post were: “The manager is excellent and very supportive.” “The manager encourages us to strive for high standards.” “There has been an improvement with staff communication and time management. Shift handovers are good now.” During the site visit we had an opportunity to observe in a general sense the way the home functions. It was clear from the interactions between the manager, staff and the residents, and comments from visiting relatives that the manager is held in high regard. In common with the other staff she showed kindness, understanding and patience towards all the residents. The manager completed the home’s assessment thoroughly and returned it promptly. Quality assurance – Following the last inspection at which a requirement was made for the home’s quality assurance system to be developed significant progress has been made. However the manager confirmed that this was an area where there was still work in progress, e.g., the service user survey will be updated to ensure that the home’s response to equality and diversity topics are covered. The manager confirmed and records showed the measures in place that inform the home’s quality assurance: Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 32 • • • • • • • The Company has recently achieved the Investors in People Award (IIP) and an award from the Isle of Wight Chamber of Commerce. A people management and development plan is now in place. A survey of residents’ satisfaction with the service was carried out and the results analysed to identify areas for improvement. The Company is currently working on an annual development plan. There are regular in house care plan reviews. A representative of the Company carries out a monthly inspection to monitor the conduct of the home. A monthly newsletter has been produced across the three homes. Residents’ monies – The manager said the home has no involvement in the management or administration of residents’ monies, preferring that relatives/representatives take responsibility in cases where individuals have difficulty. However, there is a facility for safeguarding money or valuables on request. In addition, each resident’s room has lockable furniture. Staff supervision At the last inspection it was recommended that the home produced a supervision and appraisal programme for all staff. At this site visit the manager confirmed that the Company had set up a system of staff appraisal and supervision standardised across all three homes in the group. We saw evidence that formal one-to-one staff supervision now takes place every six weeks and staff personal development profiles are just being introduced. Staff confirmed in discussions that formal supervisions and staff meetings now take place on a regular basis. Health and safety – The home’s pre-inspection information sent to the Commission by the manager confirmed that policies and procedures are in place to ensure safe working practices in the home. A sample of records was viewed during the site visit including fire alarm tests, fire appliance test certificates, gas and electrical test certificates, Legionella checks and public liability insurance, all of which were in good order. Records also showed that a recent infection control audit identified a 52 improvement in results over five months. Staff training records showed, and staff confirmed that statutory training is given in manual handling, first aid, fire training, infection control and food hygiene. Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 33 Provider’s Annual Quality Assurance Assessment The assessment identified what the service does in this area: • Our manager is an experienced home manager with qualifications in both general and mental health nursing care and has NVQ4 in management. The judgement in this area at our last inspection was Good and we believe with the appointment of this experienced manager we have improved on this position. We ensure service users finances are safeguarded by our procedures, which include records of those with enduring powers of attorney and advocacy roles and referral to Social Services where this may be appropriate for protection reasons. One Deputy has been nominated as our Health & Safety champion and is to attend training in this field of practice when a suitable local course becomes available. Record keeping has improved, especially care plans and this is being monitored more closely. An audit of staff files has been undertaken and we are actively working to improve these. A health and safety audit has been undertaken, including the new extension and we are awaiting the final report on this. A fire risk assessment has also been completed by an independent company specialising in this field of health and safety. We are updating policies and implementing procedures. We have regular staff meetings. Staff appraisals and clinical supervision are now taking place. We have reviewed job descriptions and introduced new roles within these. • • • • • • • • • • Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 34 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 4 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 3 X 3 Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 35 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. Refer to Standard Good Practice Recommendations Highfield House Nursing Home DS0000066320.V353630.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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.V353630.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!