Inspection on 26/09/06 for Highfield House Residential Home

This inspection was carried out on 26th September 2006.

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 18/09/07

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 Unannounced Inspection 09:00 26 September 2006 th 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.V312628.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.V312628.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 www.bupa.co.uk BUPA Care Homes (CFCHomes) Limited Deirdre Ann Coby Care Home 40 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (39), of places Physical disability (2) Highfield House Residential Home DS0000024415.V312628.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 Care can be provided to three named service users with dementia (as detailed in the application for variation dated 12 April 2005). 8th March 2006 Date of last inspection Brief Description of the Service: Highfield House is situated close to the town of Halesworth in Suffolk. The home is owned by BUPA and is registered for 39 older people. The registration certificate reflects there are three named people with dementia living at the home, however one person has recently passed away and the home are in the process of making a variation to their conditions of registration to reflect that the home provides care for two named people with dementia. The home also provides care for two people under the age of 65 with a physical disability. Highfield is not registered to provide nursing care. Highfield House 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. There are two lounges, one with a television and one quiet room and two dining rooms. The home has a statement of purpose and a brochure providing detailed information and photographs to prospective residents. Residents are issued with a welcome pack, which includes the service user guide and contains relevant information about moving into the home and the services provided and access to local services. It also contains a copy of the BUPA terms and conditions of residence and a copy of the complaints procedure. Each resident has 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 £331 – £700 per week. These do not cover additional services for example, the hairdresser, chiropodist and personal items such as toiletries and receipt of daily newspapers. Highfield House Residential Home DS0000024415.V312628.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 nine hours during 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 10 residents ‘Have your say about’ comment cards and 4 relatives comment cards. Evidence was also obtained reviewing the progress of the requirements made at the last inspection on the 8th March 2006 and other documents required under the Care Homes Regulations 2001. Additionally a number of records held at the home were looked at including those relating to residents, staff, training, medication, records relating to quality monitoring and a selection of policies and procedures. The registered manager was on annual leave on the day of the inspection. The deputy manager contacted a manager of another local BUPA home who arrived during the inspection who spent time with the inspector. Time was also spent with the deputy manager, ten residents, one relative who was visiting and two members of staff. The inspector also had the opportunity to speak with a visiting Chiropodist and National Vocational Qualification (NVQ) assessor. What the service does well: What has improved since the last inspection? Highfield House Residential Home DS0000024415.V312628.R01.S.doc Version 5.2 Page 6 Care plans have been amended to reflect the assessed needs of the residents. Necessary maintenance has been undertaken to ensure the automatic fire door release in the laundry has been repaired and the Parker bath is now fully operational to ensure there are adequate bathing facilities to meet the needs of the residents. The toilet seat in the Parker bathroom has also been repaired. A service of all baths was undertaken in February 2006. Medicines were being stored in medicine trolleys, which were located in, a small locked walk-in cupboard and in a back-up cabinet located in a nearby office room. The home has now created a new medicine storage room on the first floor. To ensure that the room does not exceed the upper limit for the storage of medicines of 25 degrees centigrade an air conditioning unit has been installed. 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 DS0000024415.V312628.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.V312628.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6, Quality in this outcome area is good. The home has detailed information and processes in place for prospective residents to make a decision to move into the home. Residents can expect to have a contract with the home and a needs assessment undertaken prior to admission, which forms the basis of their care plan. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a statement of purpose and a brochure providing information and photographs about the home, which states that a copy of the most recent report from the Commission for Social Care Inspection (CSCI) is available on request. On arrival residents are provided with a welcome pack, which includes the service user guide and relevant information about the lifestyle the home offers and details of other services, for example the local doctors surgery. It also contains a copy of the BUPA terms and conditions of residence and a copy of the complaints procedure. Highfield House Residential Home DS0000024415.V312628.R01.S.doc Version 5.2 Page 9 The care plans and personal files of four residents were inspected. Evidence was seen that all four residents had a copy of the terms and conditions of residence signed and dated by them or on their behalf by they’re relative or representative. Each file contained a pre-admission needs assessment, which identified that the home could meet the individuals needs and provided enough information to form the basis of the resident’s care plan. Evidence was seen in one resident’s care plan that they were very anxious about moving into a care home, they were afraid it would be like hospital. They were invited for an introductory visit to try out the home for one weeks respite so that they could make a decision whether or not to move into the home. The resident was spoken with and commented, “I am very happy living at the home, the staff are lovely, I am well looked after and the food is excellent, it is beautifully cooked with plenty of choice”. The home does not provide intermediate care. Highfield House Residential Home DS0000024415.V312628.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11, Quality in this outcome area is good. Residents can expect to have their personal and physical needs identified, monitored and met and have access to healthcare services. They can expect to be protected by the home’s procedures for administering medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans of four residents were inspected to track their care and the level of support they required. The care plans were easy to follow and contained information relating to all areas of the individual’s life including their health, personal and social care needs. Each of the residents had signed to say they had taken part in the discussions and implementation of their care plan. These were being updated on a monthly basis. Evidence was seen that resident’s health needs were being monitored. Where specific health needs had been identified, evidence was seen that these had been followed through to give a comprehensive overview of the resident’s general health. Where changing health needs occurred, intervention was sought from other health professionals, for example, one resident’s mobility had decreased as a result of deterioration in their condition. Highfield House Residential Home DS0000024415.V312628.R01.S.doc Version 5.2 Page 11 They had been diagnosed with brittle bone disease and a severe arthritic condition. All the necessary assessments had been carried out including moving and handling, falls and Waterlow assessments. The district nurses had been involved providing specialised equipment such as a repose mattress and a propad cushion to prevent the resident from developing pressure areas. The resident also informed the inspector they had recently seen the specialist at the orthopaedic clinic and was waiting for further information about a future operation. The care plans, daily recording notes, staff diary and a general practitioners (GP) appointment request book reflected that residents are supported to access health care services. The home has an arrangement with the local GP to conduct a home visit surgery at Highfield House every Tuesday. Seven residents had requested an appointment with the GP on the day of the inspection. The daily progress notes reflected that that all seven residents were seen by the GP, and relevant issues were passed over at the afternoon change over shift. Evidence was also seen that residents were supported to access appointments at local health care services, such as the optician and dentist and hospital appointments. Where residents were not supported to attend these by their families, arrangements were in place for staff to accompany the residents. The inspector spent time talking with a chiropodist who visits the home on a regular basis. They normally visit every eight weeks, unless they receive a request from the home to visit sooner. They spoke well of the home and the service it provides, commenting, “Highfields is a wonderful place with friendly vibrations, residents are happy and they have excellent carers”. The pharmacy inspector for Commission for Social Care Inspection (CSCI) made an unannounced visit in April 2006. Following their visit the home had introduced a new medication system called NOMAD concise. All senior staff responsible for administering medication has received training from the dispensing pharmacy to use the new system. The home has also created a new medicine storage room on the first floor. Medication trolleys were previously stored in a small locked walk-in cupboard and in a back-up cabinet located in a nearby office room. During their visit the pharmacy inspector raised concerns about the then proposed medicine room being to hot, evidence was seen at this inspection that an air conditioning unit has been installed to ensure that the room does not exceed the upper limit for the storage of medicines of 25 degrees centigrade. Temperatures were being checked and recorded daily, reflecting an average of 24 degrees centigrade. The pharmacy inspector made a requirement that medicines must be administered in line with the most recent prescribed instructions. The Medication Administration Charts (MAR) were inspected at today’s visit against prescribed medication for the residents being cased tracked and were found to Highfield House Residential Home DS0000024415.V312628.R01.S.doc Version 5.2 Page 12 be accurate and medication was being administered as directed on the Pharmacists label. It was also recommended by the CSCI pharmacist Inspector that the home developed care-planned guidance to detail clearly the circumstances in which medicines for prn (as required) should be considered for use. Evidence was seen that a care plan has been developed for all residents’ medication including regular prescribed and prn medication, which details, why, when and how the resident should take their medication. The home was also left a recommendation for more frequent risk assessments to be completed for residents that self-administer medication. Evidence was provided of the risk assessment format, which included a self-medication disclaimer form, assessment and an agreement form. The deputy informed the inspector these were being reviewed in a regular basis. Evidence was seen throughout the inspection that residents were being called by their preferred name and residents spoken with felt that staff respected their privacy and dignity. The interactions between residents and staff were observed to be friendly and appropriate. Each of the care plans seen reflected the resident’s spiritual needs and detailed their wishes at the time of their death. One resident had completed this section of the care plan themselves and had also signed and gave the details of who to contact. They stated that they had no concerns or worries about dying and that they wished to be cremated and then interned in a cemetery with their spouse. Another resident had stated that they had personal beliefs about the after life which were important to them and had made arrangements for their wishes to be carried out when they died. Highfield House Residential Home DS0000024415.V312628.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15, Quality in this outcome area is excellent. People living in the home are supported to make decisions and choices about their daily lives and have a lifestyle that matches their expectations. They can also expect to receive a good standard of fresh and appealing food with a wide variety of choice as part of their daily diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Evidence was seen that residents are able to exercise choice and control over their daily lives. The inspector spent time talking to one resident sitting outside on the patio drinking their morning coffee and reading a magazine which is delivered to them at the home weekly. The resident was happy to tell the inspector of their experience of living in the home, they explained that they paid privately and felt they received a service that is value for money with a few small exceptions, for example their personal washing often went missing in the laundry and sometimes was given other peoples clothes. They described the home as “very good, very cosy, I can’t wish for anything better”. They felt they were able to make decisions about where, when and with whom they ate their meals and when and where they received visitors. Highfield House Residential Home DS0000024415.V312628.R01.S.doc Version 5.2 Page 14 Another resident spoken with considered Highfield House to be a first rate home, they had lived at the home for four years during which time they had found the staff caring, patient and considerate. They commented, “staff are absolutely great, top notch, the food is excellent, with a varied menu”. They also described themselves as not “a mixer“ but were happy spending their time either in their room or in the quiet lounge reading, writing and listening to music. They also enjoyed walking a round the grounds and going for short walks around the village. There are several notice boards around the home, which provide information to residents, relatives and visitors. They advertise local places of worship of varying denominations and an activities list for the week. Residents spoken with confirmed that they were supported by friends and relatives to attend their local church services. A poster had been pinned to the notice boards advertising ‘Community Spirit Week’ which was inviting people from the community to Highfield House for a coffee morning, and included prize wining bingo and a buffet lunch, followed by a guest entertainer. Other entertainment included the Greatest Show on Earth, which advertised a range of music from the 1920’s through to the 1950’s, featuring West End performers. Another vocal entertainer sang Songs from Shows, promising ‘a good old knees up’. Photographs were displayed on the board in the main entrance showing the people from the home that had recently undertaken a sponsored wheelchair push and had raised a considerable sum of money, which they donated to charity. Residents receive visitors as and when they chose. One resident was seen going out for the day with their relative and entries in the visitors book reflected that a number of people visited the home on a regular basis. Evidence was seen and confirmed through discussions with residents that they were able to bring items of their own furniture and other possessions when moving into the home and were able to look after their own finances if they chose to, but preferred to have their family or power of attorney attend to their affairs. Residents and relatives meeting minutes from the 12th September 2006 were also seen displayed on the notice board. The minutes reflected that general day-to-day issues about the home had been discussed including implementation of new menus with nutritional values on the back to monitor resident’s diet and food intake. Feedback from the residents indicated that the food provided in the home is of an excellent standard. Evidence was seen that mealtimes are seen as an important part of the day. The tables in the dining areas were nicely laid with silk flower arrangements in the centre of each table. Residents are provided with a menu to choose their meal for the following day and Menu’s for the day are displayed outside both dining areas, plus a list of an additional range of foods available if the residents did not want what was on offer. Highfield House Residential Home DS0000024415.V312628.R01.S.doc Version 5.2 Page 15 These included a choice of salads, Cornish pasties, sausages, omelette, a selection of cold meats or pasta bake. The menu for the day of the inspection consisted of asparagus soup or fruit juice, minced beef pie or lasagne and broccoli, carrots and parsley potatoes, followed by pears and vanilla sauce, or ice cream and assorted cheese and biscuits. Time was spent with the chef manager. They indicated they had recently attended a nutritional chefs best course run by BUPA. They were issued with a BUPA book for nutrition and diet directory. As a result the chef manager has implemented new menus, which provides residents with choices and guidance on the nutritional value and intake of their daily diet. The chef manager had also received an Ambassador Award as part of the BUPA personal best scheme for supporting residents who had lost weight through ill health or loss of interest in their food by tempting them with different foods to help them regain weight. They were aware of the specific needs of the residents, currently only three residents who are diabetic have special dietary needs and two that required a soft food diet. Meals that were puréed were served in special plates providing sections for the food to be separated to present a more appetising appearance. The home is registered for two residents under the age of 65 and at the inspection in December 2005 a recommendation was made for residents to be consulted and have a programme of activities that were age appropriate and that would meet their assessed needs. The home has appointed a new activities co-ordinator, who has been in the post for a couple of months. They have attended a BUPA activities best conference, which focuses on implementing 5 activities a day in the home. They have introduced a number of activities, including bringing in external support for example, Memory Joggers is a reminisance group run by two people and a reflexologist visits on a regular basis. The feedback from residents was positive. Residents were observed enjoying a game of bingo before lunch. One of the residents under 65 has been helping the co-ordinator to organise quizzes, becoming the quizmaster. They have been out to the pub on several occasions including a men only trip to Yarmouth, where they enjoyed lunch and a beer in a pub. Another resident who is registered blind has been helped to play carpet bowls and join in garden activities such as darts. The co-ordinator explained that they supported the resident to join in these activities by talking and guiding them through the activity. The resident had refused to go on a trip to Kessingland Wildlife Park, as they thought it would be a waste of money, as they could not see. The co-co-ordinator encouraged them to go and helped them to touch the animals and described everything to them. The resident was able to see the day through the co-ordinators eyes and thanked them very much for a fantastic day. Highfield House Residential Home DS0000024415.V312628.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18, Quality in this outcome area is good. People living in the home can expect to have their concerns listened and responded to and be protected by the home’s procedures for dealing with allegations of abuse in accordance with the homes policies and procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a detailed complaints procedure. The process is described in a BUPA leaflet, which is issued alongside the service users guide. The complaints log was seen and evidence shows that the home has not received any complaints since September 2005. Evidence seen showed that the complaint had been fully investigated by an external member of BUPA staff. The findings of the investigation were sent to the complainant who appeared to be satisfied with the outcome. Residents spoken with were clear that they would discuss any concerns with the manager or deputy manager. The home has a compliments folder, with many cards and letters acknowledging appreciation from people thanking the home for the care of their relatives. One recent letter thanked the staff for the care and help they gave to their relative so that they enjoyed the last few months at the home which in turn helped the family to cope with their illness and states “a heartfelt thank you”. 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’. It directs staff to acquire a copy of the relevant department’s local guidelines. Highfield House Residential Home DS0000024415.V312628.R01.S.doc Version 5.2 Page 17 Evidence was seen that the home has a copy of the Suffolk inter agency policy directing staff to raise any allegations of abuse to the Customer First, Social Services team. Highfield House Residential Home DS0000024415.V312628.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25,26, Quality in this outcome area is good. Residents can expect to live in an environment that is welcoming, clean and comfortable, which meets their individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Highfield House is situated in close proximity to the town of Halesworth, originally a private Georgian dwelling it has been converted and extended to provide residential accommodation. The home is nicely decorated throughout and offers a range of communal areas, which includes two dining rooms, two lounges and two conservatories. The blinds in one of the conservatories are broken and need replacing. Decorating was in progress during the inspection, doors and skirting boards in the hallway and entrance were being painted. The carpet was looking stained and worn in places in the entrance hall and corridor, consideration should be given to replacing this in the near future. One resident spoken with commented, “The upkeep of the home by BUPA is very good”. Highfield House Residential Home DS0000024415.V312628.R01.S.doc Version 5.2 Page 19 Evidence was seen that resident’s rooms were furnished with items of their own furniture and personalised to meet their tastes, one resident who has a keen interest in cartography had a lot of maps displayed in their room. Twenty-eight rooms have en-suite toilet facilities and twelve have an en-suite bath or shower. There are additional toilets accessible to residents on the ground floor. Additionally the home has assisted bathrooms with Arjo parker baths installed. Residents were observed sitting in the garden, these are landscaped with terraces and patio areas. The gardens are well maintained and accessible to residents. Residents also benefit from a sensory garden in the summer months. At the last inspection in March 2006, several maintenance issues were raised and requirements made for these to be rectified. Evidence was seen that necessary maintenance work has been undertaken to ensure the automatic fire door release in the laundry works properly and the Parker bath is now fully operational to ensure there are adequate bathing facilities to meet the needs of the residents. The toilet seat in the Parker bathroom has also been repaired. A report from Arjo reflected that a service of all baths was undertaken in February 2006. A bathroom that was being used as a storeroom has been made into a medication room. During the tour of the building it was noted that all radiators were fitted with radiator guards. Sash windows have been fitted with bolts, which prevent sash windows opening further than 8”. These are both safety measures to protect the safety and welfare of the residents. A staircase from the ground to the first floor has a stair lift fitted. A fire exit sign above the door at the top of the stairs indicates this is used as a fire exit. Concerns about the steepness of the stairs and residents using this in an emergency were discussed with the manager over the telephone on the 11th October, following their return from their holiday. They requested a fire officer to visit the home on the 12th October to assess the fire exit. The fire officer will forward a report to comply with new legislation, but advised the manager to leave the fire exit in place for the time being. A risk assessment is in place for residents using the stair lift, providing information of the actions taken to minimise the risk to residents falling or becoming trapped. Evidence was seen that the stair lift is being serviced on a six monthly basis and was last serviced in July 2006. BUPA have completed a review of all the care homes with regards to the latest fire safety standards. They have identified and carried out work to bring each home up to standard. The Fire and Rescue Service made a visit to the home on the 20th July 2006, following the inspection the Fire Safety Officer forwarded a report to the home and to the Commission for Social Care Inspection (CSCI). The report made recommendations for the home to comply with the Fire Precautions (Workplace) Regulations 1997. Highfield House Residential Home DS0000024415.V312628.R01.S.doc Version 5.2 Page 20 The report was forwarded to BUPA’s estate manager who has responded in full to the fire safety officers report and has identified that based on information provided by the Department of the Environment the home’s fire protection physically and operationally are robust and compliant. Where required residents have bedrails fitted. These have been risk assessed and the appropriate equipment has been purchased to ensure that the rails, protectors and beds are compatible. The home provides aids and equipment to residents. They also have a pool of wheelchairs and three hoists. One resident has their own electric wheelchair. However they have chosen not to use this due to their current health problems. They told the inspector that they were not able to use the wheelchair indoors. A needs assessment must be undertaken to assess the resident’s ability to use the wheelchair to enable them to move freely around the home unless the assessment determines that their ability to manoeuvre the chair will affect the health, safety and welfare of the other residents. The home was observed to be clean and hygienic and free from offensive odours. House-keeping schedules are situated in bedrooms, bathrooms and toilets, evidence was seen these were being completed daily to reflect, the facilities were cleaned, towels changed, surfaces dusted, living areas vacuumed, beds made and bins emptied. Liquid foaming soap and alcohol gel dispensers and paper towels are situated in all the bathrooms and staff have access to disposable gloves and aprons. The laundry room was seen and had two large washing machines each with a sluice facility and two large tumble dryers. The home’s procedure for dealing with soiled linen is to use the red bags, which dissolve in the washing machine. Signs were located in the sluice room informing staff of the procedure for dealing with clinical waste. Highfield House Residential Home DS0000024415.V312628.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30, Quality in this outcome area is good. Residents can expect to be supported by a staff team in sufficient numbers that have received training and support and have the knowledge to care for them. They can also expect to be protected by the home’s recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prior to the inspection the home provided a pre inspection questionnaire, which listed all the current staff at the home. They currently employ 42 staff, 25 care staff and 17 ancillary staff, which includes an administrator, 3 housekeepers, 2 laundry assistants, 1 chef manager, 1 cook, with 7 kitchen assistants and 1 maintenance person. This information in conjunction with the staff roster seen on the day of the inspection reflects the home have sufficient numbers of staff on duty at all times to meet the needs of the residents. This was confirmed through discussion with residents and staff. The rosters seen reflected that there was five care staff including a senior on duty between the hours of 8am and 2pm. Five staff including a senior was on duty between 2pm and 10pm and three night staff were working between the hours of 10pm to 8am. The deputy manager was on duty between the hours of 8.30am to 4.30pm providing additional support to the staff. The home has one activities co-ordinator who is also the training co-ordinator. They split their time spending one day a week providing in house training to staff. Highfield House Residential Home DS0000024415.V312628.R01.S.doc Version 5.2 Page 22 They have attended a train the trainer course themselves and are trained to deliver basic training on the principles of care with in residential setting, promote the BUPA personal best and overseas staff induction training. The home has good recruitment procedures in place. Three staff files looked at showed that all the necessary paperwork and recruitment checks were in place, including a work permit for one overseas worker. One recent new member of staff spoken with showed the inspector the paperwork they were using to complete their Skills for Care Induction Standards (CIS). These standards replace the Sector Skills Council for Social Care (TOPPS) induction and foundation. BUPA have produced their own paperwork in conjunction with these standards, these were divided into sections with multiple-choice questions, learning objectives and open questions with an assessment declaration signed when the staff member had completed each section. Evidence was also seen on staff files that the home is committed to staff training. The pre inspection questionnaire reflects that 52 of staff have obtained or are working towards completion of a National Vocational Qualification (NVQ). Other training that has taken place in 2006 included, moving and handling, first aid, understanding nutrition, pressure area prevention, fire safety awareness, protection of vulnerable adults and abuse in care homes, infection control, understanding dementia and medication. An NVQ assessor arrived during the inspection to see a member of staff who was in the process of completing their level 2. The assessor confirmed that the home had a strong commitment to training, they had been visiting staff at the home for a while and were pleased to see how staff had developed and taken on new roles following completion of their NVQ. They were to take on another group of 4 staff in October this year on a 6-month programme under the apprenticeship scheme focusing on the technical and key skills including literacy and communication in preparation to complete their NVQ. Highfield House Residential Home DS0000024415.V312628.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,37,38, Quality in this outcome area is good. Residents can expect to live in a home that is run in their best interests, by an experienced management and staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Deidre Coby was interviewed and assessed as fit to become the Registered Manager of the home by the Commission for Social Care Inspection (CSCI) in June of this year. Deidre has worked at the home for approximately eighteen years during which time she has held the post of care assistant, senior carer, and deputy manager. They have attended numerous courses relevant to working with older people and undertaken relevant qualifications to manage a care setting. They have also completed BTEC diploma in management of care services, level 4 management and the D32/33 National Vocational Qualification Assessor (NVQ) award. Highfield House Residential Home DS0000024415.V312628.R01.S.doc Version 5.2 Page 24 Three members of staff were spoken with during the inspection. Each confirmed that they were well supported by the deputy and the manager. They felt that there was a good team ethic at the home. Residents spoken with felt that they were able to approach the deputy and the manager if they were concerned about anything. They felt that they were kept informed about the day to day running of the home and evidence provided in the recent residents and relatives meeting in September suggested that residents were able to have their say and have an influence when decisions about the home are made. BUPA has quality assurance and monitoring systems in place. The survey covers all areas of the service covering a range of topics, for example, the quality of service provision, friendliness of staff, staff’s knowledge of residents needs, promptness of staff response, meals, administration, laundry services, cleanliness and maintenance of the home and grounds. 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. The pre inspection questionnaire reflects that six residents look after their own financial affairs. Seventeen residents have a power of attorney; the other residents have their affairs managed by their relatives. Records were not examined at this inspection however historically the home has a system in place that supports residents to manage their personal allowances. These were inspected in March 2006 and the documentary evidence 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 resident’s financial interests are safeguarded. The home’s certificate of registration has a condition for three named residents with dementia, however the pre inspection questionnaire only listed two. On further discussion with the visiting manager, one of the named residents has recently passed away; this had not been reported to the Commission for Social Care Inspection (CSCI). To comply with the Care Homes Regulations 2001 the manager must inform the Commission for Social Care Inspection (CSCI) when a resident dies or any event in the home, which adversely affects the well being or safety of the residents. The health and safety of residents and staff is being protected, regular health and safety meetings take place. The most recent meeting took place in August this year, which identified issues of concern and training required to ensure staff have the understanding and skills to follow safe working procedures. The fire logbook was seen, which had detailed records of the fire system and fire equipment being tested and serviced on a regular basis. A record of staff training including fire drills was also recorded. Staff had received recent training on fire safety on the 5th July. Most recent fire drills took place in May Highfield House Residential Home DS0000024415.V312628.R01.S.doc Version 5.2 Page 25 early morning to include the night staff and again on the 31st August, which identified that further training for seniors was required. The incident and accident book was seen, for the period between July and September 2006, there was a record of 28 falls by residents. This was discussed with the deputy and visiting manager during feedback at the end of the inspection. Although residents have falls assessments in their care plans it was suggested that the home contact a falls co-ordinator that may be able to offer further advise and support to reduce the number of falls occurring. BUPA has their own policies and procedures in place for the management of food safety, which comply with the hazard analysis critical control points (HACCP). This is the management of purchase, storage and preparation of food. The chef manager provided evidence which showed that this is being managed well, records of cleaning, fridge and freezer temperatures were being kept as well as temperatures of chilled and frozen foods being delivered to the home. Highfield House Residential Home DS0000024415.V312628.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 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X 2 3 Highfield House Residential Home DS0000024415.V312628.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 OP37 Regulation 37 Requirement The registered person must notify the commission of any event in the care home that adversely affects the well being or safety of the residents. Timescale for action 27/10/06 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 OP19 Good Practice Recommendations The blinds in one of the conservatories are broken and need replacing also the carpet was looking stained and worn in places in the entrance hall and corridor consideration should be given to replacing this in the near future. An assessment should be undertaken to assess the ability of one resident to move freely around the home in their electric powered wheelchair. (Unless they choose not to use the chair, which must be agreed and recorded in the residents care plan) 2. OP22 Highfield House Residential Home DS0000024415.V312628.R01.S.doc Version 5.2 Page 28 3. OP26 Systems for dealing with personal laundry of residents should be reviewed to ensure resident’s laundry is missing or given to other residents. Highfield House Residential Home DS0000024415.V312628.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: 0845 015 0120 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. 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