CARE HOMES FOR OLDER PEOPLE
Highfield Manor 44 Branksome Wood Road Bournemouth Dorset BH4 9LA Lead Inspector
Trevor Julian Unannounced Inspection 20th April 2007 10:15 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 Manor DS0000046663.V336855.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 Manor DS0000046663.V336855.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Highfield Manor Address 44 Branksome Wood Road Bournemouth Dorset BH4 9LA 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) 01202 769429 F/P01202 769429 RYSA Ltd Mrs Yasmin Koussa Care Home 27 Category(ies) of Dementia - over 65 years of age (27), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (27) Highfield Manor DS0000046663.V336855.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25th January 2007 Brief Description of the Service: Highfield Manor is registered to provide care for up to 27 older people with dementia and mental disorders. The home is owned by Mr and Mrs R. Koussa, trading as RYSA Ltd. Mr and Mrs Koussa also own another care home which is in Poole. Mrs Koussa is registered as manager and is responsible for the dayto-day running of Highfield Manor. Highfield Manor is a large detached property, set back from the road and situated in a quiet residential area. It is within easy travelling distance of all the amenities to be found in the centre of Bournemouth and also Westbourne. Attractive walks are available to the nearby Coy Pond and Upper Gardens. The area at the front of the home offers car parking for visitors and further parking is always available on the road outside. To the rear of the property, the garden is laid mainly to lawn and is sheltered by shrubs and mature trees. The patio provides an enclosed sitting area. The grounds are well maintained and accessible to service users. Accommodation is provided on the ground and first floors in 19 single bedrooms (11 en-suite) and 4 doubles (2 en-suite). Communal areas, comprising a lounge, separate dining room and a large conservatory, are all situated together on the ground floor. A five persons passenger lift is available to assist residents between floors. In April 2007 the fees range between £490 - £520 per week. Additional charges were made for hairdressing, chiropody, etc. See the following website for further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choos.aspx Highfield Manor DS0000046663.V336855.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place on Friday 20th April 2007 between 10:15 and 15:30. Before the visit Mrs Koussa, the home’s registered manager, had returned a completed pre inspection questionnaire, giving general details about the care needs of the residents and management of the home. Residents, relatives and healthcare professionals were invited to give their views of life at Highfield Manor through comment cards; these had been returned to Mrs Koussa who passed them to the inspector during the visit. There were ten responses, all were extremely positive about the services provided and the support from the owners and staff. Further information was gathered during the inspection through discussion with residents, a visitor, staff and the home’s management. Evidence was also obtained through examination of records and a tour of the premises. What the service does well:
The home had continued to work hard to improve services and care to the residents. They were working to address issues identified during previous inspections. All new residents were assessed, before being offered a placement, to ensure that the identified needs could be met, this included any equality and diversity needs. Care planning and recording had improved and there was less duplication of information. The care plans showed the involvement of the resident or their representative and there was also evidence of monthly reviews. The home had arranged for local dentist to provide a service at the home and an optician continued to offer a domiciliary service. Medication was well managed and the stock was safely stored. Records were kept of the medication fridge operating temperature to ensure it was operating correctly. The records were up to date and there was an audit trail for all medication coming into the home. The comment cards showed that the visitors found the staff were kind and caring and treated residents with dignity and respect. Staff were seen offering residents support and assistance without being overbearing. At mealtimes, any help needed for individual residents was discreet and the meal was unrushed. The social and spiritual needs were considered during the admission process. In the case of two recent admissions the home was working to help the individuals rediscover previous pastimes. The home arranged a variety of
Highfield Manor DS0000046663.V336855.R01.S.doc Version 5.2 Page 6 communal activities and some of the residents enjoyed walks in the local gardens accompanied by the staff. The home had developed a “Friends of Highfield Manor” group who helped with social events in the home and were also working on the rear garden to provide an improved environment for the residents to enjoy. A visitor to the home said that he played the organ in the home and also offered an interdenominational church service for those interested, several had attended an Easter service in the home. He added that he was made welcome whenever he visited this was also evident from the other survey responses. Another regular visitor to the home reported that she was very impressed by the birthday celebrations given to all the residents and said that the staff were faultless and could not do enough for her during her visits. Food stocks were well stored and restocked daily. The food seen was of good quality and the meals were appealing. There was a choice of meals with alternatives recorded. Cooked breakfasts were available. The home had a system for people to raise concerns and all the respondents were clear that they could discuss issues with the manager. Staff knew their responsibilities in response to allegations or signs of abuse. The premises continue to be improved and provide a comfortable environment for the residents. The home was clean and there were no unpleasant odours. Staff retention had improved allowing better continuity of care for the residents. The home was well managed and the views of residents and visitors were sought to ensure the home was operated in their best interests. The home did not assist anyone with financial matters additional costs were invoiced to the person responsible for the residents’ finances. What has improved since the last inspection?
Since the last inspection in January 2007 the pre-admission assessment carried out had considered all the recommended topics. The management team had attended a training event on nutrition in care homes. They were using the assessment tool to monitor and improve the nutritional intake of people they had identified as having poor appetites. They were looking to expand the system to include all residents. Where hand written entries and amendments were made in the medication record these had be checked by a second person to reduce the risk of transcription errors. Highfield Manor DS0000046663.V336855.R01.S.doc Version 5.2 Page 7 Mrs Koussa advised that she had completed NVQ level 4 and would forward a copy of the certificate for confirmation. This had been received by the commission. 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 Manor DS0000046663.V336855.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Highfield Manor DS0000046663.V336855.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments, completed before admission, ensure that the home is equipped and staffed appropriately to meet the needs of the individual. EVIDENCE: The files of two new residents were examined both contained pre-admission assessment covering the recommended topics. There were copies of letters confirming that the home could meet the assessed needs. None of the residents were able to recall the admission process, however a visitor confirmed that an assessment had been completed before a placement was offered. Comment cards did not identify any concerns about the admission process. Highfield Manor DS0000046663.V336855.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans provided the staff with clear information about the resident and how their needs were to be met. The home links with community healthcare services to assess and meet the health needs of the individual. Improvements in the home’s medication procedures have reduced the risk of mistakes in administration. Individuals were treated with dignity and respect to ensure their basic rights were upheld. Highfield Manor DS0000046663.V336855.R01.S.doc Version 5.2 Page 11 EVIDENCE: The home had continued to develop the care plans. The files seen showed that individuals or their representatives were involved or agreed with the care plans. The plans showed monthly reviews were completed. The care records showed how the care needs were met and the involvement of community healthcare professionals. The home had arranged with a dental surgery for visits to the home to carry out examinations and routine procedures. An optician service also visits the home. Since the last inspection, the manager and her deputy had attended a training day on nutritional assessment. This had resulted in a revised nutritional screening tool being used. They had then targeted those individuals at most risk from poor nutritional intake and were working hard with one resident to increase her weight following sudden weight loss. Two people in the home required hoisting and hoists were available, however it was noted that the sling used by one resident was the wrong size and there had been no assessment, Mrs Koussa agreed to arrange an assessment through the resident’s surgery. Medication is supplied in a monitored dosage system by a local chemist. There were photographs of the residents for staff to aid identification. There were clear audit trails for medication coming into the home. The record charts were up to date and it showed who had given out the medication during a particular shift. Only staff who had completed accredited training were deemed competent to handle and administer medication. Where hand written entries and amendments were made these were checked by a second person to reduce the risk of transcription errors. Reference books were available to the staff. During the visit, the staff were observed working with residents with a calm and supportive approach. Some people were helped with food this was carried out in a dignified and unobtrusive manner. Residents doors were knocked before staff entered. The comment cards showed that the visitors felt their relatives were treated very well by the owners and staff. Highfield Manor DS0000046663.V336855.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home promotes residents’ choice in order to encourage them to maintain as much independence as their circumstances allow. The menu offers a good variety of items to help to promote a balanced and nutritious diet. EVIDENCE: The files for the two newest residents showed that the home was now considering social and spiritual needs during the admission process and they were developing the social histories for residents to help identify suitable activities and pastimes. One person was an accomplished artist and the home had put up his paintings in his bedroom they had also provided equipment and he was starting to take up his former hobby. Another person was an avid reader and the home had arranged for the library to provide her with large print books. Communal activities took place daily these included bingo, quizzes, card games, dominoes singing and dancing. Plans were underway to
Highfield Manor DS0000046663.V336855.R01.S.doc Version 5.2 Page 13 have a boat trip in Poole harbour during the summer. The home has regular interdenominational church services in the home led by one of the resident’s husband he also entertains the residents with organ recitals. The home is close to park areas and staff take residents for walks locally to enjoy the parks. The staff help the female residents with hand care and this included painting their nails. A programme of activities was posted on a notice board, which also gave information on date and weather forecasts. One new member of staff trained as an occupational therapist and was researching suitable exercise sessions to assist mobility. The visitor said that he was able to visit at any time without restriction and that the home had started a friends of Highfield Manor group which was helping to build a community spirit at the home. Families were involved in re designing the rear garden and improving the accessibility of the garden. The group also engaged in social functions in the home. The menu was displayed in the dining room. On the day of the visit most people were having fish with alternatives available. The meals seen were nutritious and appetising. Staff were seen helping some people and this was unrushed. During the morning and afternoon drinks were provided and snacks including fresh fruit was offered. One file showed that a person enjoyed a cooked breakfast and, in the evening, a glass of beer. There was evidence that this was provided. Highfield Manor DS0000046663.V336855.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s procedures for complaints and responding to allegations of abuse help protect the residents. EVIDENCE: The home’s complaint procedure was posted in each of the resident’ rooms and gave details of how to raise concerns and how they would be addressed. There had been no complaints recorded since the last inspection and none had been received by the Commission. The comment cards showed that people would raise concerns with the management team but people felt there was nothing to complain about. Staff were aware of their responsibilities to respond to signs or allegations of abuse. The home had procedures which were accessible to the staff. Highfield Manor DS0000046663.V336855.R01.S.doc Version 5.2 Page 15 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Ongoing improvements to the premises continue to help to provide a comfortable and safe environment for the residents. The home was clean and odour free helping to manage infection control. EVIDENCE: Further refurbishment had taken place and some carpeting replaced with nonslip vinyl to improve hygiene in some rooms. There was a maintenance record in place to identify planned and completed works. Recent works included a rewire of the home’s electric installation and some new furniture had been provided. A heating engineer was on site servicing the system.
Highfield Manor DS0000046663.V336855.R01.S.doc Version 5.2 Page 16 In the rooms visited, the call points were accessible to the residents. During visit the home was found to be clean and odour free. The visitor remarked that the staff worked hard to ensure that there were no unpleasant odours. The home had a laundry procedure and the staff were seen using disposable gloves and aprons. Soiled laundry was moved using water soluble laundry bags. The laundry area was sited away from food preparation and storage areas. Highfield Manor DS0000046663.V336855.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was staffed appropriately to meet the needs of the residents. Recruitment practices in the home normally ensure that only suitable staff are employed. Training and development of the staff helps to ensure that they have the skills and knowledge to deliver good levels of care. EVIDENCE: The home had continued to improve staff retention which helped continuity of care for the residents. At the time of the visit, the home was adequately staffed. The comment cards were full of praise for the work of the care staff working in the home. In addition to the care staff there is a cook and cleaning staff. New staff work through the Skills for Care induction programme and there were induction courses planned for the newest workers. An NVQ assessor was in the home and one of the carers had just completed her level 2 in care and was looking forward to starting level 3. She said she welcomed the
Highfield Manor DS0000046663.V336855.R01.S.doc Version 5.2 Page 18 opportunity to train given by the home. As stated previously Mrs Koussa was planning to meet the minimum standard of 50 of care staff with NVQ level 2 by the end of the year. This should be achieved once the current students complete their assessments. The files of three carers were checked each contained the required clearances and checks, however on one file there was only one reference. The files were being revised to make them easier to maintain and to provide consistency between files. Training had taken place and there had been manual handling and first aid training held in the home. The trainer had provided Mrs Koussa with a summary of her qualifications to demonstrate her competence. There was evidence on the files of supervision and appraisal used to identify any development needs of the staff. Highfield Manor DS0000046663.V336855.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management team were developing the skills to ensure that the home was well run and for the benefit of the residents. The home used various methods to seek the views of residents and other stakeholders to develop the business taking account of their views. The home did not manage finances or personal allowances for any resident. Generally, the home’s health and safety systems have been developed to promote a safe environment for residents and staff. Highfield Manor DS0000046663.V336855.R01.S.doc Version 5.2 Page 20 EVIDENCE: Mrs Koussa advised the inspector that she had completed the final unit in NVQ level 4 and would forward a copy of her certificate once received. This had subsequently been received. Mrs Koussa had continued to develop her own knowledge and had attended a training course on nutrition in care homes. The management team had also worked hard to develop services offered in the home with improved care recording and practice. There was evidence that the home sought the views of residents and visitors; this included surveys and meetings held throughout the year. The home also kept a file containing complimentary letters and cards from residents and their families. The information gathered would be used in May 2007 to develop the business plan for the service. Mrs Koussa stated that they did not manage finances or personal allowances for any resident. Any additional costs e.g. hairdressing, chiropody etc. was invoiced to the person responsible for funding. This was confirmed during discussion with a visitor to the home. Fire records were checked and showed the system was regularly tested and inspected and the staff trained fire safety procedures. The accident records were checked and most of the reports were serialised and matched the stubs remaining in the book. However, there were two unnumbered stubs, which could not be accounted for, and there were reports left in the pad which were out of sequence. There was evidence that the reports were normally reviewed by the deputy manager and analysed for trends. Staff had received COSHH training to ensure safe handling of hazardous materials. Highfield Manor DS0000046663.V336855.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Highfield Manor DS0000046663.V336855.R01.S.doc Version 5.2 Page 22 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 OP29 Regulation 17(2) Requirement The registered manager must ensure that two written references are obtained for staff before appointment. Timescale for action 30/05/07 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 OP8 Good Practice Recommendations The registered manager should ensure that residents have access to community health services where advice and guidance on mobility needs can be provided. 50 of care staff should have NVQ level 2 in care or equivalent by 2005. Any asserted equivalence should be confirmed by appropriate NVQ assessors. The registered manager should ensure that the accident reports are uniquely identified in order to provide an audit trail. 2. OP28 3 OP38 Highfield Manor DS0000046663.V336855.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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
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