CARE HOMES FOR OLDER PEOPLE
Highfield House Residential Home 67-69 Sudell Road Darwen Lancs BB3 3HW Lead Inspector
Mrs Jennifer M Turner 2 and 3
nd rd Unannounced Inspection February 2006 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 DS0000064296.V264191.R01.S.doc Version 5.0 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 DS0000064296.V264191.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Highfield House Residential Home Address 67-69 Sudell Road Darwen Lancs BB3 3HW 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) 01254 701273 01254 701273 Dhillon Financial UK Limited Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service must employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 4th October 2005 Date of last inspection Brief Description of the Service: Highfield House is a detached property set in its own grounds. It has a small garden at the front, a car parking area at the side and a small enclosed garden area to the rear. Accommodation is provided in single rooms, one of which has an ensuite facility, (W.C. and wash hand basin). There are bedrooms on both the ground and first floors. A passenger lift connects the two floors. There are two bathing facilities and one shower facility. The home is on a bus route into Darwen Town Centre, and is approximately half a mile from the main shopping centre. Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 2nd and 3rd February 2006 with the acting manager. The proprietor was in the building during part of the first day of the inspection and joined in a meeting, which had been arranged with three District Nurses, the acting manager and Senior Carer to discuss the care staff roles in respect of residents with pressure areas. The inspector was invited to join the meeting. It gave the opportunity of speaking with professionals who visited the home. Information was also obtained by talking with four other staff members, five residents and two relatives, by examining a variety of records and walking around the home. Views were obtained from residents and staff members on a variety of topics and information was also obtained by case tracking. One comment card has been returned from a relative. Views have been recorded collectively where the answers obtained were similar. Any specific or differing comments have been recorded in the main body of the report. At the time of the inspection there was an occupancy level of 12 residents. Since the last inspection the Commission for Social Care Inspection has received 4 complaints concerning the home. One was investigated separately, one was dealt with by the home and the other two were addressed during the inspection. Although separate correspondence was forwarded to the proprietor in respect of these complaints, the findings of the two investigated during the inspection have also been included within this report. Issued dealt with were either upheld, not upheld or unresolved. An Immediate Requirement Notice was issued on 04.11.05 during the time when one of the complaints was being investigated. This has since been complied with. The inspectors’ notes have been retained as evidence of the inspection. Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection?
Prospective residents are informed in writing whether staff at the home can meet their needs. This enables the prospective residents to be aware that the placement can meet their assessed needs. A number of staff who administer medication are receiving accredited training in respect of the administration of medication. This will ensure that residents are protected from careless practice. More attention is given to identifying and providing social activities and activities provided are recorded. This ensures that residents have the opportunity of spending their time more constructively and assists staff to identify any possible social isolation. Comments from residents ranged from “activities are there if we want to join in”, “I like to read”, “I like to watch” to “I join in”. Menu cards are provided on each table. This gives residents the opportunity of knowing what is to be served. Comments from residents ranged from the “food is O.K.” to “food could be presented better sometimes” to “I like the weekend cook”. The complaints procedure had been updated and residents and relatives spoken with were aware of who to complain to. Since the previous inspection there has been a great improvement in respect of the appearance in some areas of the home. Internally, repairs and decoration have been carried out making the communal areas more pleasant for the residents and staff. A number of carpets have been replaced. “Running man” fire signs have been placed in some areas of the home. A safe, hot water supply has been restored in resident’s bedrooms and in bathing and W.C. areas. This to ensures that resident’s personal needs are met. Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 Page 7 Fire procedures have been updated and the fire panel repaired. This ensures that residents live in a safe environment. 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. Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 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 Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1:3 Documentation about the home did not reflect the current management structure therefore not providing residents or families with correct information. An assessment procedure was carried out prior to people moving into the home. This meant that their needs were known and met. EVIDENCE: The Statement of Purpose was reviewed in May 2005. The Service Users Guide was reviewed in January 2005. Neither has been reviewed since the home was re registered to a new provider in July 2005. Areas relating to the Provider, registered manager, details in the complaints procedure, all need attention. Once these have been attended to a copy of the Statement of Purpose must be made available in the home to residents and relatives/visitors. A copy must also be forwarded to the Commission for Social Care Inspection. The reviewed Service Users Guide must be given to each resident and a copy forwarded to the Commission for Social Care Inspection. Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 Page 10 Referring social workers provide an “overview assessment” in respect of prospective residents. The acting manager or a senior carer visited the prospective resident in order to ascertain whether the home was able to provide the appropriate care. Prospective residents were informed in writing whether staff at the home could meet their needs or not. Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7:8:9:10 Residents’ healthcare needs were identified and met. Medication policies need to be reviewed to ensure that residents are protected from careless practice. EVIDENCE: Four residents case files were examined. Information obtained during the admission process was recorded in a summary. Residents spoken with confirmed that they were included in the review of their care plan and were asked to sign decisions reached by their key worker. A mobility risk assessment, including a “Falls Risk assessment” was seen for the most recent resident to be admitted. The acting manager was in the process of reviewing all other care plans. A record of health professional visits was kept in the care plans. Continence advice was provided for residents and records of assessments and interventions were up to date and detailed. Pressure care assessments and nutritional assessments were included in the overall care plan and reviewed accordingly. During the inspection, district nurses visited the home to hold a meeting with the management team regarding the care of residents who had pressure areas.
Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 Page 12 Records showed that seven members of staff were attending accredited training in respect of medicines management at Blackburn College. The Policies and Procedures relating to medication still needed to be reviewed in line with the Royal Pharmaceutical Society of Great Britain Guidelines. Locks were provided on bedroom doors and on the doors of bathing and W.C. facilities. There was evidence that some residents had private telephone lines in their rooms. The main telephone for residents was situated in the hall. The office telephone was used for private conversations. Staff spoken with were aware of their responsibilities in respect of protecting residents privacy. Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12:15 The social needs of the residents were being met. Social contact was maintained. Records showed that meals offered ensured that the individual dietary needs of the residents were met although there was discrepancy in relation to the quantity and what was offered. EVIDENCE: The general consensus from residents was that activities were provided if they wished to join in. An “activity book” showed which residents had taken part in which activities and information was seen recorded in individual care plans. Some residents said they were taken out or visited by their relatives. Family contact was discussed with visiting relatives. Comments from residents relating to the food was mixed. A written comment received from a relative was, “I noticed that when residents asked for certain food, it was not available.” One resident said, “we never get cabbage – its cheap enough”. Menu cards were evident on the tables in the dining room and the cook was seen to go and ask residents what they wished to have from the choices offered for their lunch and tea. Staff were observed offering assistance to a number of residents at lunchtime. The inspector joined the residents at lunch. The meal offered was well balanced, hot and well presented. One
Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 Page 14 resident said that in general the quantities “were alright” but sometimes she was hungry at night and staff “go to the chippy”. Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Residents were protected from abuse and had access to the homes complaints procedure. EVIDENCE: Four complaints had been investigated since the previous inspection. The content of each has been included in the appropriate areas of this report. The complaints procedure has been updated. Residents spoken with said that they knew whom to complain to if they had any concerns. Relatives and staff spoken with also knew who to make any complaints to. Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19:20:21:22:25:26 Ongoing repair and refurbishment had provided the residents with more pleasant surroundings although there was still further work to be done before everything was completed. EVIDENCE: Since the previous inspection there had been a great improvement in respect of the appearance in some areas of the home. Internally, repairs and decoration had been carried out making the communal areas more pleasant for the residents and staff. A number of carpets had been replaced. “Running man” fire signs had been placed in some areas of the home. The broken window in the porch door had been made secure but still needed to be replaced. It was recommended that a maintenance book be provided for staff to record any minor repairs. Window blinds had replaced the curtains in the “pink lounge.” The outside areas had received attention. Although there was one lounge and the dining room available for use by residents, the “Pink lounge” needs to be refurbished and brought back into use
Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 Page 17 as soon as possible. Activities were seen to be taking place in the dining area. One resident said that he was happy “just to watch”. Residents had access to outside areas by means of ramps. The majority of bathing and W.C. facilities had been repaired but the shower was leaking onto the cabinet in Bathroom 7 when switched on. Staff said that the bathroom was rarely used. The hot water supply was tested and had been restored to all bedrooms. The nurse call system was randomly tested and found to be working. The cover on the nurse call facility in Room 14 had been replaced but the light did not show on the unit in the bedroom when activated. The call light did illuminate over the door in the corridor. The acting manager said that this was receiving attention and the room would remain unoccupied until it was working properly. Lighting throughout the home had improved but some of the “dimness” was caused by the use of low energy bulbs not being switched on for a short period before residents went to their rooms. The acting manager said that she would look at changing the light shades in some rooms to see if this improved the situation. The window in Room 26 still did not close properly. One of the complaints received had referred to the heating levels within the home. Although some radiators were turned off on the landings, residents said that they felt that their rooms were “warm enough”. A freestanding heater was seen in one resident’s room. This should be removed and the radiator adjusted accordingly. The laundry was sited in the basement area of the home and was adequate for the number of residents. A new floor covering was required in the laundry as the seal was broken in the linoleum where water had seeped underneath from the old washing machine. The new washing machine reached the required temperature. Staff worked hard to ensure that the home was kept clean. Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27:29:30 On occasions the staffing levels did not meet the assessed needs of the residents. This could lead to residents’ welfare not being fully protected. Not enough senior care hours meant that the acting manager was covering these instead of her own duties. Not all the required records/information were available on staff files. EVIDENCE: The area of staffing formed a majority of the complaints investigated. On a number of nights the proprietor was covering the sleep in duties of the home, leaving one member of staff on waking watch. Some residents were unhappy with this arrangement as they said that they did not like a male assisting them to the commode. On one occasion only one care staff had been on duty from 8am – 5pm (18.01.06) whilst the proprietor was “in the office”. The acting manager was not being allocated full time cover to carry out her managerial duties. At the time of the inspection the proprietor withdrew from the rota and the acting manager and staff, made arrangements to cover the night time rota and for there to be experienced care staff on duty, at all times, to meet the assessed needs of the residents. Domestic hours should be addressed as there were areas of the home that had slight odour problems. The acting manager explained the process she had followed in respect of two new staff who were due to commence work the following week. She had followed a recruitment practice that covered equal opportunities and anti discriminatory practice. She was aware of the procedures in respect of Criminal Record Bureau checks and the Protection of Vulnerable Adults
Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 Page 19 clearances and used the services of an “umbrella organisation” in respect of these. Some staff files examined did not contain all of the required information and members of staff said that some staff who had left the home had “taken their files with them”. New staff received a contract of employment. Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31:33:34:36:38 The lack of managerial hours available for the acting manager meant that staff were not receiving full managerial support. There is little positive dialogue between the proprietor and the acting manager resulting in staff being unhappy in their jobs and some residents feeling unsettled. EVIDENCE: The acting manager has almost completed the National Vocational Qualification at level 3 and hopes to commence the Registered Managers Award in March 2006. She told the inspector that she does not have enough time to fulfil her managerial duties as the proprietor only allows her two days a week for managerial duties. The inspector has discussed this with both the acting manager and the proprietor. Although the proprietor spends a lot of time at the home, no reports have been submitted to the Commission for Social Care Inspection under Regulation 26 of the Care Homes Regulations 2001. The inspector explained the procedure to him.
Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 Page 21 There was no evidence that active feedback was being obtained from residents, stakeholders or family members in order to monitor the homes performance. The home was due to be reassessed in respect of the Investors In People Award. The acting manager told the inspector that she was not in possession of any petty cash funds and both herself and staff had to buy day-to-day items for the home out of their own money and claim it back from the proprietor. The acting manager and senior carer had introduced staff supervision. Documentation relating to staff appraisals was seen. Staff said that they appreciated the support that they received from the acting manager and senior care staff. One of the complaints made during November 2005 had focussed upon the policies and procedures relating to fire safety. Many of the issues raised were as a result of building work that was being carried out in the home at that time. All the issues raised have since been resolved. At the time of the inspection there was still a bad fault on the “fire panel”, and this had led to another complaint being received. However the acting manager approached the service engineer who rectified the fault during the second day of the inspection. Cleaning materials were kept securely. Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 2 2 3 X X 2 2 STAFFING Standard No Score 27 1 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 2 X 3 X 3 Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 1 OP1 4.5. The registered person must 31/03/06 Schedule ensure that Statement of 1 Purpose and Service Users Guide are reviewed to reflect the changes in the management structure of the home. 2 OP20 23 The registered person must 30/04/06 (2)(b)(g) ensure that repairs are carried out to the “pink lounge” as soon as possible, in order for it to be available for residents use. 3 OP27 18(1)(a) The registered person must 03/02/06 ensure that at all times there are suitably qualified, competent and experienced people working in the home in such numbers that are appropriate for the health and welfare of the residents. Previous timescale of 07/10/05 not met. 4 OP29 19 The registered person must 31/03/06 Schedule ensure that staff files contain the 2 information as laid down in Schedule 2. 5 OP31 26 The registered person must 31/03/06 (2)(3)(4)( ensure that visits under this 5) regulation are carried out, and reported, at least once a month. 6 OP33 24 The registered person must 30/06/06 (1)(2)(3) ensure that Quality Assurance systems are in place, as detailed within this standard.
Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 Page 24 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 OP9 Good Practice Recommendations Policies and procedures should be reviewed in line with the Royal Pharmaceutical Society of Great Britain Guidelines to address all aspects of medicines management including the provision of medication for administration outside of the home. Staff involved with the administration of medication should continue to complete accredited training in respect of medicine management. A book should be set up for staff to record any items within the home that require repair or maintenance. This should be initialled and dated when completed. The broken window panel in the outside porch door should be replaced. The shower facility in bathroom 7 requires attention to prevent it from leaking when switched on. The window in Room 26 should receive attention in order for it to close securely. Any free standing radiators should be removed from residents rooms in the interest of safety. The covering on the laundry floor requires replacing as water from the old washing machine has seeped under the existing covering The acting manager should be provided with petty cash in order to purchase “day to day” items. 2 3 4 5 6 7 8 9 OP9 OP19 OP19 OP21 OP25 OP25 OP26 OP34 Highfield House Residential Home DS0000064296.V264191.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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