Inspection on 18/09/07 for Highfield House Residential Home

This inspection was carried out on 18th September 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 Residential Home 01/03/10

Highfield House Residential Home 26/09/06

Highfield House Residential Home 08/03/06

Highfield House Residential Home 14/12/05

Highfield House Residential Home 15/03/05

Highfield House Residential Home 20/12/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Highfield House Residential Home London Road Halesworth Suffolk IP19 8LP Lead Inspector Deborah Kerr Key Unannounced Inspection 18th September 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 Residential Home DS0000024415.V351186.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 Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highfield House Residential Home Address London Road Halesworth Suffolk IP19 8LP 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) 01986 872125 F/P 01986 872125 cobyd@bupa.com www.bupa.co.uk BUPA Care Homes (CFC Homes) Ltd Deirdre Ann Coby Care Home 40 Category(ies) of Dementia (40), Old age, not falling within any registration, with number other category (39), Physical disability (2) of places Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th September 2006 Brief Description of the Service: Highfield is situated close to the town of Halesworth in Suffolk. The home is owned by BUPA and is registered for 40 older people. The home is registered to provide care to people with dementia and two people under the age of 65 with a physical disability. Highfield is not registered to provide intermediate or nursing care. Highfield has easy access to the shops and is on the local bus route. It is situated within extensive grounds, with a summerhouse, sensory garden, patio and terraced areas. The home offers 32 single rooms and 3 double rooms, 28 rooms have en-suite toilet facilities and 12 have an en-suite bath or shower. Communal areas include two lounges, one with a television and one designated as a quiet room, two conservatories and two dining rooms. Highfield has produced a statement of purpose and a colour brochure providing detailed information and photographs about the home. These are available on request. People moving into the home are provided with a welcome pack, which includes the service user guide, and information about local services and services provided in the home. It also contains a copy of the BUPA terms and conditions of residence and a copy of the complaints procedure. Each person is issued with a contract, which specifies their agreed fees and how much they are expected to pay on a weekly basis. Fees are calculated depending on the needs of the resident; they range from £341 - £680 per week. These do not cover additional services for example, the hairdresser, chiropodist and personal items such as toiletries and daily newspapers. This was the information provided at the time of the inspection, people considering moving to this home may wish to obtain more up to date information from the care home. Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over seven and three quarter hours on a weekday. This was a key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection, including information obtained from the Annual Quality Assurance Assessment (AQAA), issued by the Commission for Social Care Inspection (CSCI) and a selection of residents, relatives and staff ‘Have Your Say’ surveys. A number of records were inspected, relating to people using the service, staff, training, the duty roster, medication, health and safety and a range of policies and procedures. During a tour of the home, time was spent talking to a group of people that were playing cards and with a number of residents enjoying their lunch. Time was also spent talking individually with four people living in the home, five staff, a relative and a visiting General Practitioner (GP). The manager was available and fully contributed to the inspection process. What the service does well: Highfield continues to provide residents with a friendly and relaxed environment to live in with their own possessions around them. All areas of the home are nicely presented and are comfortable, clean and tidy. Plants and ornamental flower arrangements are placed in communal areas, these additional touches helped to create a ‘homely’ environment. Feedback from relative’s surveys and discussions with people visiting the home confirmed that the staff provide a high standard of care to people using the service. Comments included “I always feel welcome they cannot do any more to make my relative feel at home” and “ I am very happy with all that they do at Highfield, all the care and services provided are well up to expectations”. The flair and creativity of the activities co-ordinator provides people with a range of age appropriate, stimulating and interesting activities. The catering arrangements continue to provide people living in the home with nutritious and balanced meals. People spoke highly of the food provided, comments included “ the food is good, we are provided with a fair choice and can choose alternatives if we do not like what is on the menu” and “the food is very good”. Discussion with the staff and examination of records confirmed staff are provided with a range of training, which provides them with the skills and experience to meet the individual needs of the people using the service. Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6, People who use the service experience excellent quality outcomes in this area. People who may use this service are provided with information they need to make an informed choice about where they live. They will have their needs assessed, which will ensure the home are able to meet their individual needs and will be issued with a contract, which clearly tells them about the service they will receive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People moving into the home are provided with a welcome pack, which includes the service user guide and relevant information about the services offered by the home. The pack also contains a copy of the BUPA terms and conditions of residence and a copy of the complaints procedure. All people moving into the home have a full comprehensive needs assessment before admission. The introduction of the new care plans has provided the service with an opportunity to reassess the needs of people already using the service. Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 9 These assessments have been completed in consultation with the individual and their relatives by the manager or a senior member of staff. The assessments focus on achieving positive outcomes for people, which included ensuring that the facilities, staffing and specialist services provided by the home meet their specific needs. The person completing the assessment forms are required to record their judgement based on the information they have obtained through the pre admission process to establish if they are able to meet the needs of the prospective person. The personal files examined reflected people had been issued with a contract and terms and conditions of residence. An individual funded by Social Services, had no copy of their contract on file. This was discussed with the administrator, who advised these are kept by Social Services. A series of themed inspections undertaken by CSCI of BUPA services identified that there was a lack of contracts issued to funded residents. As a result BUPA have implemented a new Residency Agreement for Authority Funded Residents. The administrator was unaware of the new contracts and agreed to contact head office to obtain a copy. Residents and relative’s surveys reflect people found the process of choosing Highfield and moving into the home was a positive experience. Comments included, “I moved to Highfield’s on a temporary basis to be near relative, after a few days I decided to stay”. Other comments stated “this home makes me feel safe and comfortable” and “I am very happy here” and “this is a very happy home, I am very pleased I decided to place my relative at Highfield”. The surveys reflect that people feel they receive a good service and have access to good medical care. However, they reflect that relatives were less sure about the skills and experience of the staff. 33 of the responses identified that staff are skilled and trained, where as 66 considered staff to mostly have the skills to do their job. Discussions with the staff team and staff records reflect that staff are kept updated with training relevant to their role and which meets the needs of people living in the home. All new staff are required to complete induction training, which covers the basic needs of people living in residential care and the role of the worker. Recent training has consisted of understanding dementia; Quest training, to introduce the new care plans, medication and the use and safety of bedrails. The home does not provide intermediate care. Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11, People who use the service experience good quality outcomes in this area. The health and personal care that people receive is based on their individual needs and preferences, however, the principles of respect and dignity are not always put into practice. To safeguard people using this service, the arrangements for recording and administration of medication must be strictly monitored. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA identifed that an area the home does well is making sure that residents physical and personal needs are met. BUPA has introduced new care plans, which have been designed to reflect person centred care. The plans are well organised and provide a comprehensive overview of the individuals health, personal and social care needs. They also identify the level of support required by staff, including decisions about who delivers their personal care and the support they need to be as self-managing as possible. The care plans are started from the needs assessment prior to admission and evolve as the needs of the person change. Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 11 Relevant health charts and assessments are in place, relating to moving and handling, pressure care and tissue viability, nutrition and falls. These are being reviewed to monitor and reflect the individual’s current and changing needs and where intervention is required. The daily recording notes are well documented and clearly reflect the care and general state of well being of the individual. Regular visits were documented showing that people are supported to access their general practitioner (GP) and other local health services relevant to them. Information provided in the AQAA, states that the home has a good understanding of residents needs. This was demonstrated whilst observing a senior member of staff hand over information to the visiting General Practitioner (GP) and district nurse. The GP and district nurse visited people in their own rooms, respecting their right of dignity and privacy. Resident’s and relatives surveys reflected that people feel they receive good care. Comments included, “my relative receives very good care, I am always contacted if my relative’s health changes” and “the home provides good care and understand my relative’s needs”. However, one comment card stated ‘I have the impression that medical appointments outside of the home is considered to be the responsibility of the relatives, which isn’t always easy for residents who do not have family live near by or for those residents who do not have family’. This was examined as part of the inspection, where relatives are unable to accompany their relative, an escort is provided, as is hospital transport. The home has good procedures in place for the receipt, storing and retuning medication, including controlled drugs. Staff spoken with and training records confirmed that staff responsible for administering medication have received up to date medication training. A senior member of staff was observed administering the lunchtime medication. Medication is mostly pre packed by the pharmacy into blister packs. At the front of people’s blister pack is a front sheet with their details. These include a photograph for identification purposes and a guidance sheet about their prescribed medication, and the details of why, when and how they should take their medication. Examination of the Medication Administration Record (MAR) charts identified four peoples MAR charts had gaps with no signature to identify if the person’s medication had been administered. This was investigated during the inspection. With the exception of Furosemide liquid, which was difficult to assess, all other medicines had been administered, the staff had failed to sign the charts. The controlled drugs register confirmed that the home currently have four people prescribed Temazepam. Two other people are prescribed a mixture of different controlled drugs. Controlled drugs are locked separately within the medication room. An audit of the control drugs against the register and people’s MAR charts was found to be accurate. Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 12 Resident’s surveys reflected that they felt that staff listened and acted on what they said with regards to choices and decisions about their day-to-day life within the home. There were a few minor practice issues, which need to improve, these were discussed with the staff and the manager. Overall, staff were observed treating people with respect and dignity. Individuals’ care plans had clear information, about their end of life needs. These issues had been discussed and agreed with the individual and their relatives to ensure that at the time of their death, staff will treat them and their family with care, sensitivity and respect. Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 13 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, People who use the service experience good quality outcomes in this area. People who use this service are involved in meaningful daytime activities of their own choice and receive a good standard of fresh and appealing food, however, people who require assistance to eat their meal are not always supported discreetly and sensitively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at inspection confirmed that residents are able to exercise choice and control over their lives. Discussions with the people using the service confirmed that they are given the freedom and support, where required, to make decisions about how they spend their time, keeping to their own preferred routines. They also described their experience of living in residential care. Residents felt able to have control over their daily lives and enjoyed the company of other residents. This was confirmed in residents’ surveys, for example “activities are very good, however I enjoy the peace and quiet on my own” and “I prefer to keep on my own as far as courtesy permits”. Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 14 Care plans contained information about resident’s interests, which are identified during the initial assessment. The activity information also includes a comment to describe the extent and level of individual’s participation in arranged activities or of they declined. The notice board shows information about ongoing activities, which included board games, music competitions and puzzle solving and crosswords on one to one basis or as a group. Holistic therapy includes massage and manicures, as requested. A small group of residents were observed playing whist in the lounge. Other activities advertised, included the Nutmeg Puppet Company and a trip to Norwich Football club. A group called memory joggers visit the home to host reminiscence sessions, where residents are being encouraged to complete their own reminiscence book. A sample book seen contained information about the person’s life history, photographs and cuttings of their favourite items, foods, colours and interests. The AQAA states the home is always looking for new ideas for entertainment and outings. BUPA circulated information about a themed organisational activity involving a passenger cruise ship. The flair and creativity of the activities co-ordinator was reflected in photographs displayed around the home of the event. The cruise ship theme ran for six weeks, beginning with an open day, including families and friends to board the ship. Along the voyage residents were able to take part in discussions and quizzes about the different cultures and foods of the different countries where the ship docked. The dining room was decorated to reflect the captain’s table and people were able to enjoy a five-course meal of food from that country. A children’s painting competition of the voyage was held and the residents were involved in the judging the winner. People spoken with had thoroughly enjoyed this activity. People confirmed that visitors are welcome at any time and entries in the visitor’s book confirmed that friends, relatives and family visit on a regular basis. A poster had been pinned to the notice boards advertising ‘Community Spirit Week’ which was inviting people from the community to Highfield for a coffee morning. There are a number of churches of various denominations local to Highfield. People are supported to attend services if they wish and have access to a taxi, which accommodates up to three wheelchair users. Alternatively, people are able to attend a church service held at Highfield’s on the first Sunday of the month and Holy Communion held every Friday. The catering arrangements continue to provide people with nutritious and balanced meals. People spoke highly of the food, comments included “ the food is good, we are provided with a fair choice and can choose alternatives if we do not like what is on the menu” and “the food is very good”. A menu display choices available for breakfast, lunch and supper each day. There is also a list of alternative’s available including a ‘night bite’ menu of snacks, people can choose from at any time of the day. The menu includes Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 15 colour photographs of the snacks available. The lunchtime meal was observed. Tables in the dining room were nicely laid with tablecloths and vases of flowers. The midday meal consisted of a variety of choices, which looked appetising and were nicely presented. Consideration needs to be given to the number of staff available at mealtimes in order to provide the assistance people require. A member of staff was observed assisting three people. The three people had all been sat at the same table and the member of staff had to move around the table to help the individuals eat their meal. This practice does not promote individuals’ dignity. Time was spent talking with the chef. They continue to be actively involved with people using the service. They have a fortnightly baking session with residents who wish to take part, making pastry and scones, which manipulates their fingers as well as enjoying a baking session. They have made and helped to decorate Christmas cakes and Valentine cakes. Most recently residents helped to decorate cakes of a ship and beach scene, for the cruise activity. A comment made by a resident, in the ‘Have Your Say’ stated, “I would welcome more fresh, not tinned vegetables”. This was discussed with the chef, who confirmed that all meals are ‘home-cooked’ using mainly fresh ingredients. The food store seen confirmed that the home has a good range of fresh quality food. Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18, People who use the service experience good quality outcomes in this area. People using this service are able to express their concerns and have access to a robust and effective complaints procedure and are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed that Highfield has a detailed complaints procedure. The process is described in a BUPA leaflet. The complaints log confirmed there have been no complaints made about the home since the previous inspection. Relatives and resident’s surveys reflect that 100 of people said ‘yes’ to knowing how and whom they would make a complaint to, should the situation occur. The AQAA states that issues are discussed in the first instance thus avoiding the need to action the complaints procedure. This was confirmed when talking with people living in the home, who confirmed they would raise any concerns with the manager as they occurred. The AQAA states that staff receive ongoing training to manage complaints and to recognise abuse in the home. Staff spoken with demonstrated a good understanding of what constituted as abusive practice. The policy ‘Abuse of a Resident’ deals with the management of allegations of abuse in line with the Department of Health (DH) guidance ‘NO Secrets’. Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 17 The home operates a thorough recruitment policy, which ensures all appropriate checks are obtained prior to new staff commencing employment. Staff personnel files seen at the time of the inspection, confirmed that all newly employed staff are subject to Criminal Records Bureau (CRB) and Protection Of Vulnerable Adults (POVA) checks. Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 18 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, 20, 21, 22, 24, 25, 26, People who use the service experience excellent quality outcomes in this area. People can expect to live in a home that is decorated and presented to a high standard, which is comfortable and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has previously been found to offer accommodation to a very high standard, therefore a brief tour of the environment was made. Highfield continues to offer people a home that is nicely decorated throughout. Plants and ornamental flower arrangements have been placed around the home, creating a comfortable and homely atmosphere. Furnishings and lighting throughout the home are domestic in character and are suitable for their purpose. The gardens are landscaped with terraces, patio areas and a sensory garden. These are well maintained and accessible to all residents providing a nice environment for residents to walk and sit in the nicer weather. Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 19 The AQAA states Highfield is a good quality home that people like to live in. Resident’s and relatives surveys confirmed this with comments, such as “ the surrounding’s are well maintained” and “the home always smells clean and fresh” and “the home is lovely”. People’s rooms are nicely furnished, which reflect their individual personalities and interests. The occupant of one of the larger rooms had made use of the wall space to exhibit their own paintings. People moving into the home are able to bring small items of furniture as well as other personal items such as ornaments, pictures and photographs. Lockable storage space is provided for small items of value. Highfield offers a range of communal areas, which includes two dining rooms, two lounges and two conservatories. A programme of refurbishment is in process. To date the two conservatories and a number of people’s personal rooms have been redecorated. New armchairs have been purchased for the conservatories and the blinds have been replaced. Twenty-eight of the bedrooms have en-suite facilities, twelve of which have a bath or shower, these are in the process of being replaced with assisted baths. This will ensure people are provided with specialist equipment, which will maximise their independence. There are adequate number of communal assisted bathrooms, showers and toilet facilities to meet people’s needs. Some of the bathrooms were noted to be in need of decoration. The manager acknowledged this and advised these were part of the planned refurbishment. All corridors, bathrooms and toilets are fitted with grab rails, these are positioned to provide additional support for people and to help them maintain their independence. Appropriate aids for safe moving and handling were sited around the building and evidence was seen that people are provided with aids and equipment for the prevention of pressure areas. People identified as high risk of falls had been issued with pressure mats. These are placed in the individuals room, when walked on will alert staff via their pagers that the individual has either got out bed or moving around their room. A previous recommendation stated that a risk assessment should be undertaken to assess the ability of an individual who had been instructed that they could not use their electric powered wheelchair indoors. This restricted the person to move freely around the home. This assessment has been undertaken and agreed with the individual that their current health needs prevented them from using the wheelchair. A residents ‘Have Your Say’ comment card stated that the “home is always impeccably clean”. Aromatherapy air fresheners are situated around the home, which give off a nice smell, and add to the ambience of the home. Inspection of the laundry facilities confirmed the home has good procedures in place to prevent and control the spread of infection. The laundry was clean and Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 20 tidy with appropriate equipment to launder soiled linen, clothing and bedding. Appropriate hand-washing facilities of liquid soap and paper towels are situated in all bathrooms and toilets where staff may be required to provide assistance with personal care. Random testing of water temperatures reflected that the water supply is within the recommended 43 degrees centigrade, which minimises the risk of people living in the home scolding themselves when taking a bath or shower. Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 21 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, 30, People who use the service experience good quality outcomes in this area. The home has an established staff team, available in sufficient numbers who have the skills and experince to meet the specific needs of the people living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA identified staffing numbers are appropriate to the size of the home and the needs of the residents. The home is staffed by a senior on each of the three shifts, with four care staff in the morning, three in the afternoon and two at night. In addition there are a team of domestic staff, catering staff and a maintenance person. The home does not use agency and staff spoken with confirmed that generally staffing levels were good. Occasional sickness causes problems, however the manager and deputy cover when required. People spoken with were complimentary about the staff and were confident that they met their needs. Comments in the residents and relatives survey’s included, “Staff are always willing to help” and “I am very happy here and very grateful to the considerate staff, they do a wonderful job” and “staff are always so friendly and very caring”. Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 22 Staff surveys stated that they receive good induction and training and that “Highfield’ is a lovely place to work and it is so friendly”. Other comments, included “We have a very good team of staff who are caring and supportive of all residents” and “we have a very good relationship with resident’s families, who feel able to approach us and discuss any concerns”. This was confirmed in discussion with a relative who felt well informed about their relatives care. The home has a robust recruitment process. Staff files confirmed staff are issued with a job description, terms and conditions of employment and an ‘Employee working guide to BUPA care services’. The files are well organised and contain all the relevant documents and recruitment checks, including a Criminal Records Bureau (CRB) check and a Protection of Vulnerable Adults (POVA) check. Staff spoken with confirmed they receive good training, which is relevant to their role and which helps them to understand and meet the needs of the people using the service. A relative’s survey stated, “Training appears good and well planned”. Training records confirmed staff had received training appropriate to their work role, including moving and handling, basic health and safety, protection of vulnerable adults, fire safety, infection control and food hygiene. Other training has consisted of BUPA Quest (care planning), first aid at work, safe use of bed rails and understanding dementia. Senior staff informed the inspector they have recently attended an informal session, which included discussion about their perception and implementation of the BUPA medication policy and procedure. Future training has been planned for three staff to complete the appointed first aid course. The manager and senior staff are to attend training about the Mental Capacity Act and two staff are booked to attend a three day dementia train the trainer course, which is run by the Alzheimer’s society. All new staff are required to complete induction training. BUPA has designed their own induction pack, in line with the National training organisation (NTO), Skills for Care induction. Figures taken form the AQAA reflect the home employs 22 permanent care staff and 3 bank staff. 9 permanent staff hold NVQ at level 2 or 3, 6 staff have been enrolled to undertake NVQ. When completed, the service will meet the required standard of 50 of staff hold a recognised qualification. National Vocational Qualification (NVQ) training, problems with funding previous company dissolved, Using new company to complete NVQ. Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37, 38, People who use the service experience good quality outcomes in this area. People using this service benefit from the leadership and management approach of the home, which is based on openness and respect and tested by an effective quality monitoring system. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA and verified at the inspection confirmed the Registered Manager is qualified and experienced in the running of a home. Although the manager is in day to day control there are clear lines of accountability and delegation of duties within the whole staff group. Residents, realtives and staff spoken with find the manager approachable, friendly and supportive. Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 24 Residents and relatives comment cards, provided good feedback about the manager and the management of the home. Comments included, “The home has a good atmosphere, I am very happy with all that they do at Highfield” and “all the care and services provided are well up to expectations” and “I always feel welcome they cannot do any more to make my relative feel at home”. BUPA has quality assurance and monitoring systems in place. The survey covers all areas of the service. Following the audit a plan is created to address issues that require action. The area manager regularly checks the action plan when they visit to complete their monthly check of the home. Residents and relative’s surveys are in the process of being distributed. Following analysis of the surveys, the outcomes will be published. The most recent survey available for inspection was from December 2006. 40 surveys were issued with 16 returned, providing a 40 response. The outcomes of the survey were positive, comments, included, “excellent service, very kind and cheerful carers, cleanliness is very good and the food is very good” and “carers are unfailing, patient and courteous” and “buildings and surroundings are excellent”. To ensure people living in the home have a say in how the service is managed, the home has regular meetings and has introduced a ‘resident of the day’ meeting. This is an informal discussion with a resident who are asked their opinion of the home and if they would change anything to make life better. A resident’s care plan seen had a record of such a meeting, with a record of their response. They had commented they like being here, laundry service, food, care and activities are all good and meet expectations. The CSCI finance department conducted an organisational financial viability assessment. The accounts for the year to 31st December 2006 for BUPA were reviewed and on the basis of the information available the CSCI regard BUPA as being financially viable. Historically, the home has a system in place that supports people to manage their personal allowances. Documentary evidence, previously seen reflected the system is safe and offers an audit trail. This set of standards will be inspected more fully at the next inspection to ensure that people’s financial interests are safeguarded. At the previous inspection the homes certificate of registration was found to be incorrect. The home was previously registered to provide care to 3 named people with dementia. One of these people had passed away, however, the CSCI had not been provided with this information. A requirement was made for the manager to notify the CSCI when a resident dies or, of any event in the care home that adversely affects the well being or safety of the residents. These notifications are now being received. An application for a variation to the home’s certificate of registration was approved in July 2007 to reflect that the home are now registered to provide care up to 40 people with a diagnosis of dementia Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 25 The manager produced a file with records of staff supervision. Examination of the file identified that regular supervision takes place, however all staff supervision notes are being held in the one file. The issue of confidentiality was discussed with the manager. Staff should either be given a copy of their supervision or records should be kept individual on their own separate files. BUPA has undertaken an internal health and safety audit of the home. Recommendations were made following the audit to improve some minor shortfalls, including updating risk assessments, including fire safety and the use of lap belts for wheelchair users. A recommendation was made that residents should be provided with the correct size sling for use with hoists. The manager was advised to contact an Occupational Therapist (OT) to assess each person individually. Records examined at the inspection and information provided in the AQAA confirmed action has or is being taken to implement these recommendations. The home takes steps to safeguard the health, safety and welfare of people living and working in the home. The most recent Gas and Electrical Safety Certificates, including Portable Appliances Testing (PAT) were seen and records showed that equipment and the water supply and temperatures are regularly checked and serviced. The building complies with enviromental health standards and the local Fire service requirements. The Fire alarm system is serviced on a regular basis. The fire logbook confirmed that regular training and drills take place. Time was spent with the chef, who demonstrated a good understanding of the needs of the people living in the home, the importance of good food hygiene and health and safety. All foods were being stored in accordance with food safety standards. Documentation was produced to show that the required temperature checks for fridges, freezers and food delivered to the home are being kept. Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 26 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 3 3 4 3 4 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 3 3 X 4 3 4 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 3 3 3 3 3 3 3 Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement Medication Administration Records (MAR) must be completed whenever prescribed medication is administered to a person living in the home. This will ensure that people receive the correct levels of medication. The home is conducted in a manner, which respects the dignity of people living in the home. This will ensure that each person is treated as an individual and will receive a personalised service. Timescale for action 19/09/07 2. OP10 12 (4) (a) 19/09/07 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 OP15 Good Practice Recommendations People who require assistance to eat their meal should be supported, individually, discreetly and sensitively. Highfield House Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Colchester Local Office Fairfax House Causton Road Colchester CO1 1RJ 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 Residential Home DS0000024415.V351186.R01.S.doc Version 5.2 Page 29 - 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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