Inspection on 25/01/07 for Highfield Manor

This inspection was carried out on 25th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Highfield Manor 20/04/07

Highfield Manor 15/05/06

Highfield Manor 05/01/06

Highfield Manor 08/08/05

Highfield Manor 13/07/04

Highfield Manor 28/05/04

Highfield Manor 16/01/04

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

CARE HOMES FOR OLDER PEOPLE Highfield Manor 44 Branksome Wood Road Bournemouth Dorset BH4 9LA Lead Inspector Trevor Julian Unannounced Inspection 25th January 2007 08:30 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.V328292.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.V328292.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.V328292.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th May 2006 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 May 2006 the fees range between £461 - £505 per week. Highfield Manor DS0000046663.V328292.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second key inspection of Highfield Manor in the inspection year. The unannounced visit started on the 25th January 2007 and was concluded on the 14th February. The purpose of the visit was to monitor progress made with requirements and recommendations made previously and to check that previous improvements in the home had been maintained. Information was gathered through discussion with residents, staff and the management of the home. Additional information was obtained through a tour of the premises and examination on some records and procedures. Since the start of the inspection, concerns had been made to the Commission that residents were being routinely got up early in the morning to help time management for the staff. This concern is considered within this report. What the service does well: The home continued to work to address issues identified previously. The owners have attended training sessions and seminars on Dementia and Adult protection. No new residents were admitted until the management team had completed an assessment to check the home and staff had the skills to meet the identified needs. The residents were seen joining in with activities and there were photomontages showing the range of activities enjoyed by the residents. One resident commented that the staff worked hard to encourage residents to join in. The residents described food favourably. The food stocks were regularly replenished and there was a good variety offered. Advice had been sought from a dietician to help improve nutritional intake for one person. There was an accessible complaints procedure allowing residents and visitors to raise concerns or issues. A copy of compliments received was retained to show the appreciation the families of residents at the home. The home was not involved in the financial maters of any resident, any additional expenditure e.g. hairdressing was invoiced to the person responsible for the residents’ finances. Highfield Manor DS0000046663.V328292.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Two files showed handwritten amendments to medication records one had been checked by a second person the other had not been checked. This could result in transcription errors and lead to incorrect medication being administered. There were a number of residents up and dressed at 06:00 on the morning of the second visit some had clearly gotten themselves up, others may have had some assistance. All were alert and chatting in the lounge and they had warm drinks. None of the care plans seen had information on sleep patterns so staff were not aware of the normal routines of the individual on admission. The pre Highfield Manor DS0000046663.V328292.R01.S.doc Version 5.2 Page 7 –admission assessment did include most topics however there was no mention of dental/mouth care. The home had started a programme of training staff to NVQ level 2 and was hoping to exceed the target of 50 of care staff having NVQ level 2 in care by the end of the year. Two members of staff have reports confirming the equivalence of overseas qualifications. Mrs Koussa is part way through the National Vocational Qualification (NVQ) level 4 Registered Managers Award. This award will help to ensure the home’s management have the skills and experience to operate the specialist service offered by the home. 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.V328292.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.V328292.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 adequate. This judgement has been made using available evidence including a visit to this service. The home completes an assessment before admission to help ensure that they have the capacity and skills to meet the assessed needs of the individual. EVIDENCE: The files of three residents were examined during the visit. Each file contained a pre – admission assessment containing most of the topics. One record showed it was carried out when the prospective resident came to the home and joined the other residents at a meal time. The assessments did not show information about dental/mouth care. None of the residents were able to recall the admission process to the home. Highfield Manor DS0000046663.V328292.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 adequate. This judgement has been made using available evidence including a visit to this service. Care plans were in place to inform staff how identified needs were to be met. The home works with community healthcare professionals to manage health needs. The home’s medication system has been improved to safeguard the residents from errors. The residents were treated with dignity and their basic rights respected. EVIDENCE: Each of the files seen had a care plan and risk assessment. One person had been assessed as needing bed rails and these were in place. The assessment was discussed and recent guidance provided to ensure that the use of bed rails Highfield Manor DS0000046663.V328292.R01.S.doc Version 5.2 Page 11 is fully risk assessed. The care plans seen contained evidence that the care plan had been agreed with the resident’s representative. The files contained information on the persons’ social history to help identify meaningful activities for the individuals. Nutritional assessments were in place and records of weights were updated monthly. Since the last inspection, a community dietician had visited the home and advice had been given. The daily records provided information about how the identified needs were met. A good level of recording was seen. During the first visit there were people going to the dining room for their breakfasts at 10:30. On the second visit, five people were in the lounge at 06:00 all were alert and some commented that they were early risers. Some of the people were able to get themselves up and dressed. Other people were seen getting up over the next couple of hours. It was suggested that the sleep patterns were included in the care plans to ensure that the staff were aware of the persons’ normal pattern and changes could then be investigated. During the tour of the premises a number of rooms of the early risers were visited, it was noted that the towels were dry or missing and the soap was also dry. This was explained by a member of staff that they remove the towels promptly ready for laundry and the soap dried on the radiators. It was noted that the residents were clean and well presented. Since the last inspection, the home had addressed the medication issues. A brief check of the stocks and records showed there was an audit trail and the stock was safely stored. The medication procedure had been updated to reflect previous advice. There were two handwritten medication records seen, one had been checked and verified by a second person to reduce the risk of transcription errors the other had not been checked. There were good levels of interaction between the staff and residents. Some of the residents said the staff in the home were helpful and supportive. There was no evidence of inappropriate language seen previously. Staff and management said the issue was a topic for regular discussion to ensure the staff were fully aware of cultural differences. Highfield Manor DS0000046663.V328292.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. Residents were supported to make choices in their daily lives. The home maintained links with the local community and encouraged friends and family to visit the home to help provide stimulation. The home provided a choice of food with consideration given to nutritional content. EVIDENCE: During the visit residents said they were allowed good levels of choice in their daily lives. As discussed above some people were early risers and this was accepted by the staff as were residents who preferred to sleep in and have their breakfast later. There were white boards in communal rooms giving the residents information on the planned activities menus and the weather etc. Gentle exercise sessions were taking place during the inspection. These were enjoyed by most of the residents and it was observed that there was no Highfield Manor DS0000046663.V328292.R01.S.doc Version 5.2 Page 13 compulsion for those who did not wish to participate. The care plans had been developed to include information on the individuals’ social history. The owners had also attended activities for people with dementia, training day, this had helped develop the activities offered. Around the home, there were many photomontages showing the residents engaged in different activities and parties. There was also a magazine available to visitors to see the range of entertainments offered. The home has also developed a team of “Friends of Highfield Manor” who get involved in the daily life in the home. They are going to develop the rear garden during the spring to improve accessibility and stimulation for the residents. The home welcomes visitors, some people had taken the time to write to the Commission to inform them of the high regard the held for the home, the staff and owners. However, due to the timings of the inspection, no visitors were seen in the home. Some residents were able to comment on the range and variety of the food in the home; they said the food was good quality with choice available they felt there was a good supply of fresh fruit on offer. Food stocks were supplied by a local supermarket with daily deliveries to help ensure freshness. Highfield Manor DS0000046663.V328292.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. Systems and training were in place to allow residents and visitors to feel comfortable about raising concerns. Adult protection procedures helped to safeguard residents. EVIDENCE: The complaints procedure had been revised with the correct information. In the bedrooms visited, the old procedures had been replaced with the latest version. One relative wrote praising the home and that he felt the owners and staff were accessible. The staff had ready access to “No Secrets” giving local information about how to identify and report allegations of abuse. Following discussion with two members of staff it was clear they knew where the document was located and their responsibilities. They had been trained in Adult Protection and the owners had attended a training event. Highfield Manor DS0000046663.V328292.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, 25 & 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 help to provide a comfortable and safe environment for the residents. The home was clean and odour free helping to manage infection control. EVIDENCE: During the first visit, it was noted that the conservatory heating was not working, although the rest of the home was warm. The deputy manager contacted their heating engineer who attended the call out within two hours and was able to rectify the problem. Highfield Manor DS0000046663.V328292.R01.S.doc Version 5.2 Page 16 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. In the rooms visited, the call points were accessible to the residents. During both visits the home was found to be clean and odour free. 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.V328292.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. At the time of the visit staffing was appropriate to the needs of the residents. Staff training showed improvement but still required further development in order to ensure that staff have relevant specialist knowledge. The home’s recruitment procedure helps to ensure that only suitable staff are employed. EVIDENCE: During the second visit two members of staff were completing the night shift and the day staff arrived for handover at 07:00. Staffing levels were appropriate to the needs of the individuals. A programme of training had started and three people had recently begun NVQ level 2 in care. Mrs Koussa had confirmation that two of the staff with overseas qualifications had the equivalent of NVQ level 2. To exceed the minimum standard Mrs Koussa planned that most of the staff will have achieved NVQ level 2 by the end of 2007. Highfield Manor DS0000046663.V328292.R01.S.doc Version 5.2 Page 18 Staff confirmed that they had been trained in core topics including Manual Handling, Health and Safety, Food Hygiene and new members of staff undertake accredited induction training. Since the last inspection Mrs Koussa had attended Dementia training and conferences this needs to be expanded to ensure that the care staff are appropriately trained. The files of two new employees were checked, each contained the required information, references and clearances. Highfield Manor DS0000046663.V328292.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 adequate. 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. The home’s health and safety systems have been developed to promote a safe environment for residents and staff. Highfield Manor DS0000046663.V328292.R01.S.doc Version 5.2 Page 20 EVIDENCE: Mrs Koussa has become the registered manager of the home and is supported by a deputy manager. Mrs Koussa was in the process of completing NVQ level 4 registered manager award and estimated that she was half way through. 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. 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 the reports were serialised and matched the stubs remaining in the book. Highfield Manor DS0000046663.V328292.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 2 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 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 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Highfield Manor DS0000046663.V328292.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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations The registered manager should ensure that all topics including dental care are considered during the preadmission assessment. Where hand written entries are made in the medication record these should be checked by a second person to reduce the risk of transcription errors. 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 person should have an NVQ level 4 or equivalent in care and management. 2 OP9 3. OP28 4. OP31 Highfield Manor DS0000046663.V328292.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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Highfield Manor DS0000046663.V328292.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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