Inspection on 05/01/06 for Highfield Manor

This inspection was carried out on 5th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Highfield Manor 20/04/07

Highfield Manor 25/01/07

Highfield Manor 15/05/06

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 Debra Jones Unannounced Inspection 5th January 2006 07:40 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.V276729.R01.S.doc Version 5.1 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.V276729.R01.S.doc Version 5.1 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 01202 769429 RYSA Ltd 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.V276729.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th August 2005 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. The registered persons have decided to run the home without a manager for the present time with Mrs Koussa assuming the main responsibility for the day-to-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. Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 12 hours and was the second of the anticipated inspections of the year. Since the last inspection in August there have been 3 additional visits. These additional visits were triggered by concerns raised about early morning routines and staffing at the home and to monitor the impact of changes that the registered people had made in response to the outcome of those visits. (Copies of additional visit letters are available on request from the Commission. These visits are dated 3 November 05, 13 December 2005 and 20 December 05.) The requirements and recommendations made at the inspection in August and subsequent additional visits were followed up to see the progress made towards meeting them. Some progress had been made although 3 immediate requirements were made. Mr and Mrs Koussa have been given copies of notes made by inspectors so that they are aware of the specifics seen. Mr Koussa has also been given a checklist for documents that must be kept on staff files (including documentation that must be in place prior to employment), information about induction training and advice about Criminal Records Bureau disclosures. The Inspectors looked around most of the building and a number of records were inspected. Mrs Koussa and staff on duty assisted the inspectors in their work. Due to the limited communication of the residents living at Highfield Manor an additional inspector spent most of the day in the communal areas observing residents and their interaction with staff to get a feel for what it is like to live at the home. Two residents spoke with the inspector about their experience of living at Highfield Manor. Comments included ‘I thoroughly enjoy myself here’ ‘The staff are all lovely’. Prior to the inspection a number of comment cards / questionnaires were sent to the home for them to distribute on behalf of the Commission to residents, relatives, visitors, health and social care professionals. GPs, care managers and staff. One came back from a resident and one from their relative, both were completed by the relative. They commented ‘ We find, my wife and I, that this is the finest home we have known. When people are as they are here it is the hardest job anyone can do. XX has been unhappy in many places. She is safe here and loves the food.’ Inspectors saw a recent letter from the husband of a recently admitted residents saying how pleased he was with her care. He was particularly pleased with the cleanliness and ambience/ happy atmosphere at the home and referred to her bedroom as being fresh and clean. ‘If I had to rate the Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 6 home between 1 and 10 I would rate it as 25’ ‘cannot praise the home highly enough.’ What the service does well: What has improved since the last inspection? The home has begun to address the concerns raised with them over the last few months. At the inspection in August concerns were raised about residents being got out of bed very early in the morning by night staff. Since then the home has changed the shift pattern at the home and day staff now start work at 7am in the morning (instead of 8am) and the morning routine appears more relaxed, with residents personal care needs being addressed throughout the morning. Rooms are now more personalised and at this inspection there were only items belonging to current occupants seen in bedrooms. No examples were found of rooms with labels on furniture for previous occupants or clothes and toiletries belonging to other people as had been at other inspections. Wardrobes were tidy and well ordered. No examples were found of rooms being used to store equipment that did not belong to them. There was more evidence to show that residents had access to the community health services to which they are entitled. More residents had been visited by their GP. Chiropodists and district nurses are regular visitors to the home. The spontaneous activities seen at the home on the day of inspection were clearly enjoyed by all those involved. The home was required to report an ex member of staff to the Department of Health Protection of Vulnerable Adults list. This has been done. Rosters are clear about who is in charge both day and night. When inspectors looked at staff records no original documents were found – just appropriate copies. Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 7 There is evidence that some training has taken place in key areas such as food hygiene, administering medicine, manual handling and dementia. Some improvement was noted in the recording of accidents at the home. What they could do better: In order that the right people get admitted to the home, fully documented needs assessments need to take place prior to admission. Written reassurances must be made to prospective residents that their needs can be met. Where terms and conditions change e.g. when residents move rooms this should be properly documented. To provide a person centred service all aspects of the residents’ needs must be assessed and planned for. Care plans must be based on the needs of the person and be kept up to date. They need to cover a variety of areas and provide the information that staff need to properly provide care and meet the needs of the residents. This is significant when looking at activities and at how residents spend their days. It would be good if there were more organised and spontaneous activities and if activities included more trips out of the home. Equipment in use must be properly assessed, used and maintained and where needed be readily available to residents. Daily and nightly notes could be fuller to show what care is actually delivered in order to help identify when care and care plans might need to be reviewed. The medicines policy needs some additions and amendments and arrangements for “when required” medicines need improving. A system for evidencing monitoring of the records and the audit trail should be introduced to ensure that medicines are given as prescribed and accurately recorded. The privacy and dignity should never be compromised e.g. in the way that staff use language, by providing screens in rooms and in assisting residents to eat. Meals should be regular and well spaced with records kept of what people choose to eat. The home must stay on top of maintenance issues to ensure that the environment is safe and comfortable for residents. A more stimulating environment is needed to give the residents more meaning to their days. It would be good if more was done in respect of orientation. The appropriate number and skill mix of staff must be employed and deployed to make sure that residents are safe and well cared for in respect of general care, specialist dementia care and basic day to day tasks such as laundry and cleaning. Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 8 Recruitment must be more rigorous and the pre employment checks required by law must always be done prior to any staff working at the home to ensure that residents are protected from unsuitable people working at the home. Staff must have the training appropriate to their work to care for residents and must be properly supervised to ensure that they always adopt best practice. It would be good if the person managing the home had a qualification in care and management and was up to date with good practice in order to direct staff. Records that must be kept by law, must be kept to underpin the service at the home. The home must be managed in such a way that promotes and safeguards the health and safety and welfare of residents to ensure that they receive consistently good care. This includes keeping policies and procedures up to date. 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 Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 9 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.V276729.R01.S.doc Version 5.1 Page 10 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): 2 and 3 (standards 1 and 4 were met at the last inspection) Pre admission practices are not robust enough to demonstrate that in all cases the home will be able to meet all the needs of the individual or assure them in writing that their needs will be met. Variations / amendments to terms and conditions are not always issued as they should be, in order that residents are clear about what is being provided to meet their needs. EVIDENCE: Pre admission assessment information was reviewed in respect of 4 residents who had moved to the home in recent months and one privately funded prospective resident who had just been assessed for the next vacancy. The forms in use covered a range of headings as listed in standard 3 needed to make a decision as to whether the home could meet all their needs. However very little information about the prospective residents was captured on these forms making it hard to establish if the home could fully meet their needs. It was not clear as to who had provided the information for these assessments, how far the prospective residents had been involved or where the assessments Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 11 had taken place. Not all files contained a written confirmation to the prospective resident that the home could meet their needs. Some residents have moved room since the last inspection. Plausible reasons for these changes were given verbally but there was nothing documented to evidence that discussions had taken place. No variations to contracts had been issued. Terms and conditions still state the rooms originally occupied by the residents in question. Some care plan files were not up to date with the room numbers of residents. Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 12 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 and 10 The care planning system in place is not robust enough to ensure that staff have the up to date information they need to meet the care and health needs of the residents. The home has systems in place for administering regular medicines as prescribed but the medicines policy and arrangements for administering and recording “when required” medicines need improving to protect residents. Some practices observed did not demonstrate that residents’ privacy and dignity are upheld. EVIDENCE: Care plans and care Care plans were sampled for 5 people whose rooms were visited, 3 of whom had recently moved to the home. A range of assessments were on file resulting in a care plan. Such assessments included self care, personal risk, falls, nutrition, physical health, behaviour, lifting and handling. Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 13 The mental health / dementia needs were thoroughly assessed around the time of admission. Not all pages of assessments had the name of the resident on them or the date. Some assessments did not say who had carried out the assessment or where the information came from. The care plans that resulted from these assessments did not reflect the very individual needs of the residents. Whilst there was evidence of reviews taking place these do not always cover all areas of need thereby not reflecting the changing needs of residents in the care plans leaving staff unclear as to the care that they are to give on a day-to-day basis. For example daily notes regularly referred to a resident being confused and distressed at being in the home but there was no individual plan as to how staff were to assist her, calm her or any reference to specific interventions that staff had found effective. Another plan directed staff to encourage a resident to be continent when they were fitted with a catheter. Daily and nightly notes are kept but some gaps were noted. These notes need to be fuller to evidence what care is given and any changes to the needs of the resident should be highlighted to inform the care plan. Some records e.g. bath and bowel charts were not being completed as intended e.g. one chart seen stopped at end of December 2005 and there was no note of the person having had a bath. Residents’ preferences were not seen– e.g. when people like to get up / go to bed / what they like to eat or what they like to do during the day etc. Where residents have equipment – mobility / pressure relieving / bed rails etc there were no assessments seen on the files that would result in the need for equipment. In the case of bed rails of the two files looked at for residents where bed rails were in use neither outlined why the bed rails were in use. In another there were references to the resident needing an air mattress – but did not say what kind. There was no information on files seen about the equipment itself and how it should be used to ensure its safety and effectiveness. One resident had an electric raiser strapped to the mattress on his bed and a pressure relieving (repose) mattress on the top of his wardrobe. Neither was referred to on the care plan and the home thought they might have been brought in by a relative, without their knowledge. Some residents have call bells in their rooms and others do not. The residents’ ability to use their call bell is not covered in risk assessments. Where residents are not able to use their bells alternative methods to alert staff as to emergencies are not documented. In two rooms there were mobility aids e.g. zimmer frames, walking sticks. The residents of these rooms were both downstairs so these pieces of equipment were not easily accessible to them. Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 14 There was evidence of community health professionals visiting residents at the home including a chiropodist and district nurses. GPs were also noted as recently seeing residents. A marked improvement on the picture seen at the last inspection. Inspectors were pleased to see that the home was keeping weight records. These showed that residents had been weighed in November and again in December 05. Some residents had gained weight whilst others had lost weight. Food supplements were available in the home but the need for this was not reflected in care plans. Generally the rooms were in a better order than at previous visits. No examples were found of wardrobes with clothes other that those belonging to the resident. The wardrobes looked into were tidy. Confusing stickers referring to previous room occupants had been removed and there were generally more toiletries for each resident available. However in three rooms dentures were found. In a communal bathroom there were two tubs of sudocreme that were not marked with the names of any residents. On one unmade bed a draw sheet was in use. These are known to contribute to the over hydration of skin and it’s breakdown. Medicines The medicines policy in the file does not give clear guidance to staff on some of the homes procedures and some additions and amendments are needed. The registered person said that the wrong policy had been placed on file. Medicines were stored securely. Repeat medicines received were recorded and a carry forward balance where appropriate. But, receipt of some new medicines was not recorded to provide an audit trail. The home tries to get all medicines printed on the MAR chart but any medicines handwritten on the MAR chart should be countersigned by a second trained person to confirm that the details are correct. Staff signed the MAR chart to record when medicines were given but the recording of some “when required” medicines did not agree with the audit trail and ways of improving this were discussed with the manager and her deputy. There was no system for documenting monitoring of the records and audit trail and this should be introduced. Records of the GP reviewing 4 resident’s medication were seen and monitoring of 3 others medication. Privacy and dignity In two of the shared rooms there was only one commode in the middle of the room. The curtain screen in place to ensure the privacy and dignity of the residents in one shared room only screened one bed. In another shared room there was no screen and in another shared room there were two. Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 15 Staff always spoke to residents with appropriate friendly tones of voice but at times their language was inappropriate. Residents must always be treated with respect and dignity and as adults. Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 16 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 and 15 (standard 13 was met at the last inspection) As not all care plans included social assessments for these people there was no evidence to show that social cultural and religious needs were being met. A menu is offered that provides a choice of food, though assistance provided does not always meet the needs of the individual. EVIDENCE: The inspection commenced at 7.30am at which time there were 9 residents in the lounges, dining room and wandering around. A TV was on in the main lounge. At this time residents in the communal areas were unsupervised. Activities Mrs Koussa said that activities included rides out, dominos, walks, puzzles, skittles and music. During the inspection one inspector spent 4.5 hours spending time with the residents in the communal areas to get a feel for what it is like to live at the home. The Inspector observed what happened in the lounges generally and noted at regular intervals what some residents in each lounge were doing. In the morning staff were mostly involved in helping people out of bed and getting ready for the day, helping with breakfast and morning drinks. There Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 17 were no structured activities. One resident spent some time with a member of staff who showed them a reminiscence folder. In the afternoon there was a concerted effort by all staff to engage residents in meaningful activities and to respond to their individual needs. A DVD of photographs of the Christmas party was on in the background in the main lounge. Music was put on in the back lounge and some residents and staff danced together. The music and dancing was really enjoyed by the residents who participated. There were attempts to engage other residents in knitting, colouring, a jigsaw and dominos. Two residents watched TV the whole afternoon but actively chose to do this. The residents were offered a local paper to read when it arrived. One resident wandered for the majority of the afternoon. Interactions between residents and staff appeared generally positive. It was clear that the majority of residents really responded well when staff interacted with them – faces would light up and look animated – they really want to engage and have things to engage in. They really appreciated staff smiling at them. The activities file was set up to have a separate record for each resident. Records of activities were sporadic. Nothing more recent than the pre Christmas events were noted. On 23 12 05 residents were noted as enjoying Christmas presents. The file contained some evidence of most recent activities i.e. Christmas decorations made by residents. Inspectors also looked for records in respect of activities for two residents who had recently moved to the home. There was no evidence to show that either resident had engaged in any activities since their admissions as there were no notes for either in the activities file. Some care files contained ‘maps of life’ which included previous interests. However care plans seen did not include activities or interests. Food Lunch was meatballs and mince with potatoes, green vegetables and swede. Dessert was bread and butter pudding with custard or fruit and ice cream. The menu was displayed on the board in the dining room. The Chef was in the dining area serving food. He clearly knew all the residents. Some residents need staff to help them eat. Only one member of staff lowered themselves to the same level as the residents when they were fed, all other care staff stood. There was some interaction with the staff feeding. One resident had to tilt her head back to accommodate the position of the member of staff feeding her. Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 18 One of the fridges is to be replaced imminently due to its poor condition. Food was properly labelled in the fridge inspected. Some dry foods are decanted into containers e.g. cereals, oats etc. The chef said that when what is in containers is finished, he washes them out and then refills then. It is not noted on the containers when food stuffs are decanted into them or any use by dates as stated on the original packets. The chef keeps records of what people eat at breakfast (8.30am), lunch (midday) and at the evening meal (5.30pm) and of the temperatures of the food that is served. The current gap between the evening meal and breakfast is over 12 hours. No note is made of what food residents have in the evenings e.g. supper. The chef said that food is left available and usually the residents eat bread, biscuits, cake and fruit. In the kitchen lists are kept of who needs soft diets, reduced sugar diets and who has allergies. A list of when residents have their birthdays is also held. Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 19 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 and 18 Arrangements for investigating complaints and protecting residents from abuse are not currently satisfactory thereby placing them at possible risk of harm. EVIDENCE: No complaints have been received by the home since August 2004. The home has a complaints procedure. The one on the policy file that is available to staff is dated January 2004 and was reviewed in December 2005. This policy is not compliant with the care home regulations and national minimum standards. The adult protection policy has also been reviewed and is no longer in line with the Department of Health and local guidance about protecting vulnerable people from abuse. Few staff have had training about adult protection / abuse and this is raised again as an area that the home needs to address. Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 20 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, 22, 25 and 26 (Standards 20, 21, 23 were met at the last inspection) The home generally provides a comfortable environment for residents though this could be improved by more attention to general maintenance issues – which impact on safety, orientation and the use of equipment. The home is generally kept clean and odours are minimised thereby making daily life for all in the home more pleasurable. EVIDENCE: New double glazed windows are being fitted in the existing wooden frames. Work was in progress and some cold air was coming in around new windows as the frames were yet to be made good. The workmen were on site and Mrs Koussa was making sure that residents were not going to suffer any temporary discomfort as a result of the upgrading of the windows. One resident commented on what a difference the double-glazing had already made. Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 21 Since the last visit to the home the bath that was damaged has been temporarily repaired while the home is waiting for their plumber to come and replace it and make good the tile work around it. Matters of general maintenance were noted on the tour of the home, these included • 3 bedroom doors did not shut properly. This is particularly important in the event of a fire. (An immediate requirement was issued.) • One of the taps to the basins in two ensuite bathrooms could not be turned off. • The covers were missing from some strip lights e.g outside room 3. • In one room carpet tiles were loose creating a tripping hazard. • The ceiling was badly marked in one bedroom due to a water leak. Water had also got into the strip light (main light in the room) cover and it looked as though there was mould in it. • In one en suite bathroom there were exposed pipes and no lampshade on the light. • Some mattresses were not long enough for the beds they were on. • There was a hole in the wall of an ensuite bathroom where a towel rail had been repositioned. • A metal bed frame had a rusty sharp edge (mid frame) that could catch the residents’ legs. Some of these have been brought to the attention of the management at previous visits. In one residents bedroom there are three doors. One is a cupboard which has a door on of the same design as the main door to the room and the ensuite. This cupboard door is kept locked at all times. T his has the potential for confusion and possible distress for the resident who has a locked door in their room. Lighting These are a number of strip lights around the home both in communal areas and residents’ bedrooms which are not homely or domestic in character. Orientation Around the home there are a number of signs intended to assist residents. Most residents have their name and picture on their bedroom doors. There are a number of clocks around the home. Most did not tell the correct time. The main lounges have some orientation aids in them to help residents know where they are and what time of day it is etc. A number of residents like to wander around the home. Aside from the communal lounges and dining area there is nothing around the home for the Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 22 residents to wander to of interest e.g. there are no seats at the end of corridors or objects of interest to look at or handle. Laundry The door to the laundry was propped open. There were no staff in the laundry. The only lock on the door was a small bolt to the top of the door. This was ineffective in keeping the door shut even when the bolt was across. An infection control policy is in place. The policy states that soiled laundry is to be placed into water soluble bags and washed separately. This is not done in practice. Dirty laundry awaiting washing was in baskets. Clothes and linen were mixed together and were being washed together in the machines. A specific laundry policy is not in place. Such a policy would to make it clear to staff how they should handle laundry in the home. The clinical waste bins were broken in two of the communal bathrooms visited. There was a stock of spare bedding and towels in the linen cupboards. The home was very warm throughout. Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 23 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 and 30 Insufficient staff of the appropriate skill mix are employed and deployed to ensure that the care needs of residents can be met. Recruitment procedures are in place but the practices of the home do not protect residents from the risk of unsuitable staff working there. Most staff have not had the essential training they need to meet the needs of residents so the assurance that they are in safe hands is not there. EVIDENCE: The inspection commenced at 7.30am. Three members of care staff were on duty. Mrs Koussa joined them a bit later, along with the newly appointed Deputy Manager. Also on duty that day were the home’s handyman / helper and the cook. The current roster was made available. This was clear about who is on duty at any time, the hours they work and who is in charge. Rosters demonstrate that by day (7am to 7pm) there are three care staff on duty plus Mrs Koussa (who is acting as the manager) and the deputy manager. They are supported by a cleaner (who works 6 days a week), a chef and handyman. At night (7pm to 7am) there are two care staff on duty. The roster did not include all those working at the home i.e. the handyman / helper. Most staff work 12 hour shifts with a 45 minute break. During the day staff usually stay in the dining area for their lunch. Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 24 Care staff have to undertake social activities with residents, all the laundry duties in the home and some cleaning tasks e.g. communal areas and the cleaning of the whole home on the days that the cleaner is not at work. Concern has been expressed at previous visits about staffing levels. Since the last inspection a deputy manager post has been created. Despite this Inspectors remain concerned about staffing levels at this home as both day and night staff, given the time available to them, are pushed to perform even the basic tasks required of them. Little time is available to spend with residents doing any activities, spending quality time talking with residents and in generally providing a stimulating environment. Inspectors are especially concerned about evenings (after 7pm) when only 2 members of care staff are on duty and have to help the majority of residents to bed. Some residents need two people to help them, leaving other residents unattended. Staff with the most experience of working at the home work at night. Of the day staff two have been working at the home since May 2005. All other day staff have started at the home after that date. Mrs Koussa said one member of care staff has an NVQ 2 although this was obtained at another home and proof of the qualification was not available at the inspection. Some staff have had relevant training in their country of origin and have been issued with visas on the assumption that their qualifications are equivalent to NVQ3. Some staff files were sampled. Files were not complete. There were gaps in the documentation that employers must keep by law. Such gaps included proofs of identification, including a recent photograph; Criminal Record Bureau disclosure certificates or Protection of Vulnerable Adults list checks (POVA 1st); documentation proving that staff have the right to work in the country / at the care home. No contracts of employment were seen so it was not clear when staff started working at the home. The dates on induction programmes indicated that in most cases Criminal Record Bureau disclosure certificates or Protection of Vulnerable Adults list checks (POVA 1st) had been received after staff had begun their induction programmes which involved working with residents in the home. (An Immediate requirement was issued). The home has a ‘Selection and Recruiting of Staff’ policy. The policy is very brief and does not go into appropriate detail e.g. there is no reference to CRBs/ POVA (and POVA 1st) checks; or any reference to the documents that must be held on file in respect of staff e.g. to meet the Care Home Regulations or to prevent illegal working. The home has a file in which various certificates are kept that demonstrate that staff have completed training. Records showed that some staff had Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 25 training in food hygiene, administering medicine, manual handling and dementia. Mrs Koussa said that first aid training and manual handling training had recently taken place and two new members of staff had attended this but the certificates had not been received yet. There was little evidence available in respect of induction training for new staff. Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36,37,38 (Standard 35 was met at the last inspection) Mr Koussa has the adequate qualifications and experience to manage the home. A robust system is not in place for the home to measure their own service delivery. A number of the homes policies and records had shortfalls thus compromising the rights and best interests of residents. The health safety and welfare of residents are not consistently promoted resulting in insufficient protection. EVIDENCE: Mrs Koussa said that she had completed her registered managers award and is waiting for certification of this. Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 27 As part of the quality assurance system comment cards are freely available in the main hallway for anyone to complete and thereby feedback their views of the home. Mrs Koussa said that she had had very positive verbal feedback from relatives, GPs and District Nurses. She also told us that a local Social Worker had been very complimentary about her paperwork. In addition the staff questionnaires sent by the Commission had been handed to all staff. No reports have been copied to the Commission this year in respect of a review of the quality of care provided at the home. A number of policies and procedures were examined. All were marked as having been recently reviewed. Areas of the policies that needed updating, or expanding were identified e.g. • Infection Control. The Health Protection Unit Infection Control Guidelines and the homes infection control policy were available. An infection risk assessment was not in place. The homes procedure had recently been reviewed but the information provided had not been updated including reference to the CDC and District Health Authority Communicable Diseases Department rather than the now well established Health Protection Unit. Adult Protection. This does not make any reference to the Protection of Vulnerable Adults list introduced in July 2004 and gives staff the wrong information as to what they should do if they suspect abuse. Disciplinary Procedure. This does not make any reference to the Protection of Vulnerable Adults list. Meals policy. This refers to samples of meals being kept on the premises for 72 hours. This was not the case in practice. The Manual handling policy was very brief. The policy is split into 2 parts. One about lifting loads. The other more specific about people – talks of using hoists. The latter does not give staff instruction about good practice when walking with people and when helping them out of a chair etc. • • • • During the course of the day a number of examples of poor manual handling practice were observed. Residents were seen being assisted out of chairs by carers pulling them up from the front by their hands. Chairs are positioned very closely together in the main lounge. Some residents were seen being lead by carers; carers linking hands with residents; carers were walking backwards and holding residents by their hands; carers were pulling residents Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 28 along and sometimes guiding two people at once. Not all staff seen helping residents about the home had proof of manual handling training. There was no evidence of formal supervision of staff. There were not photos of all residents as required by the law. A visitors book is kept that shows who has been to the home. Since August four accidents were recorded. Some were very clear about what had happened others were not e.g. It was not always clear as to the sequence of events before the accident; when the resident was last seen by a member of staff; if the accident was witnessed or if the accident happened am or pm. Regular fire training for staff takes place. The staff roster was compared to the fire training records. These showed that all staff had had fire training at appropriate intervals. Some residents in the main lounge had individual tables in front of them. They are useful for when they residents have drinks or meals. Some residents had the type of table where the frame is one continuous metal loop that comes around the back of the feet. Residents are not able to simply push these tables forward and out of the way should they wish to get up or not want to have the table in front of them. The use of such tables in such a way is an unacceptable use of restraint and they must not be used. This was raised with the home’s management twice during the course of the inspection and was subject to an immediate requirement. Furniture in the main lounge is positioned closely together which is not conducive to good manual handling practice when helping residents out of chairs. One lot of denture cleaning tablets were found in a residents’ room. Such products must be securely stored away in a home of this kind. Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 29 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 2 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 1 x x 2 x x 2 2 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x 1 x x 1 1 1 Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 30 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement Timescale for action 01/02/06 2 OP7 15 3 OP7 12 Residents must have their needs fully assessed before they move into the home and be assured in writing that these needs will be met. • Care plans must cover all 01/04/06 areas of need of the resident and be based on the range of appropriate assessments e.g. manual handling assessments, risk assessments bed rails assessments. • Care plans must be regularly reviewed and updated to reflect changing assessed needs. • Plans must take into account the choices and preferences of the resident. • The registered person must 01/02/06 ensure that the care home is conducted in such a way as to promote and make proper provision for the health and welfare of residents. (Previous timescale 1.12.05) This includes providing a safe environment DS0000046663.V276729.R01.S.doc Version 5.1 Highfield Manor Page 31 4 OP7 13 5 OP8 13 6 OP9 13 (2) e.g. only creams belonging to the person in rooms, steradent being kept safely, floor tiles being secured. (Previous timescale for action 1.1.06 not met) • Draw sheets must not be used as they are known to contribute to skin breakdown. The use of emergency systems 01/02/06 e.g. call bells must be part of the risk assessment. Where residents are found not to be able to use the system in place alternative systems to alert staff to emergencies must be put in place. • Where bed rails are in place 01/02/06 there must be a proper assessment to demonstrate their need. The assessment must be reviewed regularly. A risk assessment must be in place in respect of this equipment and appropriate permissions must be given for use. (Previous timescale of 1/9/05) • Information about equipment must be available for staff about how equipment is to be used and maintained to ensure its effectiveness. • The home must ensure that residents have access to their belongings that promote their health and independence e.g. their mobility aids. • Where residents have equipment it must be properly used, well maintained and be accessible for them to use it. e.g. mattresses, screens. The home must record the 01/03/06 receipt of all medicines, and the correct dose given if a choice is prescribed, so that there is a clear audit trail. There should be DS0000046663.V276729.R01.S.doc Version 5.1 Page 32 Highfield Manor evidence of regular monitoring of this and the medicine records to ensure that medicines are given as prescribed. 7 OP10 12 • Appropriate language must be used at all times in order that residents are always treated with respect and dignity and as adults. • Sufficient commodes and screens must be available in shared rooms in order to preserve dignity. • Activities for residents with dementia must be based on current good practice guidance and stimulate all their senses. (Previous timescale of 31.5.05 not met) • Records of residents’ activities must be kept. • The registered provider must consistently detail through care plans how activities are linked to previous history and interests. The complaints procedure must be updated to be in line with the regulations and standards. All copies of the procedure available in the home must be updated so that they are consistent with the main policy. • The adult protection / abuse policy must be updated in order that it is in line with the Department of Health - No Secrets and local guidance. • Once updated the registered person must make sure that staff understand the homes adult protection policy and what they need to do if they have any concerns about abuse. (previous timescale 1/12/05) DS0000046663.V276729.R01.S.doc 01/02/06 8 OP12 13 01/04/06 9 OP16 22 01/02/06 10 OP18 13 01/04/06 Highfield Manor Version 5.1 Page 33 11 12 OP19 OP27 23 18 13 OP29 19 14 OP30 18 15 OP31 10 The home must be kept in a good state of repair. Sufficient suitably qualified, competent and experienced people of the right skill mix must be employed and deployed at the home to ensure the health and welfare of residents. (previous timescale of 1.09.05) • The home must obtain all documents and keep all records referred to in the law in respect of all persons employed at the home. • New staff must not start work before POVA checks have been carried out and satisfactory references obtained. • Full documentation in respect of the ability to work in the country and at the home must be kept and adhered to. (Previous timescale for action of 18.1.05 not met) Staff must receive training appropriate to the work they perform. This includes induction, manual handling , infection control, adult protection etc. • The person in control of the day to day running of the home must undertake an accredited specialist training course such as person centred care or dementia care mapping to ensure that they are up to date with current good practice in the provision of care to residents with dementia. • They must ensure that they undertake such training as is appropriate to ensure that they have the skills necessary for managing the home in order that policies, procedures DS0000046663.V276729.R01.S.doc 01/03/06 01/02/06 01/02/06 01/04/06 01/04/06 Highfield Manor Version 5.1 Page 34 16 OP33 24 17 OP37 17 18 OP38 13 19 OP38 17 20 21 OP38 OP38 18 23 22 OP38 23 and training are put into practice by staff. • A system for reviewing and improving the quality of care provided at the care home must be established and maintained and a report of the review be submitted to the Commission. • Policies and procedures must be kept up to date in order to promote and make proper provision for the health and welfare of residents. All records listed in the regulations must be kept.- e.g. staff records, photographs of all residents. • Furniture must be arranged in such as way as to protect both residents and staff involved in moving and handling tasks. • Furniture that restricts the movement of residents must not be used. The home must keep a full record of all accidents to inform the accident analysis that should be carried out and documented at the home. (Previous timescale for action 1.3.05 not met) Training in moving and handling must be put into practice. Safety must not be compromised and doors must close to latch. (previous timescale for action 01.01.06 not met) The bath in the ground floor communal bathroom must be repaired / replaced. 01/04/06 01/02/06 05/01/06 01/02/06 01/02/06 05/01/06 01/02/06 Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 35 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 OP2 Good Practice Recommendations Where residents move rooms a variation / amendment to their terms and conditions should be issued. Why the move has occurred and permissions for the move should be documented. • All pages of assessments / care plans should have the name of the person on them. Assessments / care plans should be dated and the name of the person carrying out the assessment be clear. • Comprehensive notes - night and day and any forms devised by the home to evidence care (e.g bowel and bath charts) - should be maintained to assist in the provision of care to individual residents and also to facilitate the auditing and tracking of the care and support provided within the home. 2 OP7 3 4 OP9 OP12 5 OP15 6 OP22 The medicines policy should be reviewed and updated with the recommended additions and amendments. Residents should have more opportunities for activities and these should include the opportunity to go out on trips. Residents should also be supported to access the local community. • Staff should follow good practice in respect of assisting residents to eat e.g. sitting with the person and talking about what they are eating etc. • If foods are decanted into other containers the date when this happens should be noted as should any use by dates noted on the original containers. • As the current gap between the evening meal and breakfast is more than 12 hours a supper time snack should be offered and records of this snack kept. Attention should be paid to providing an optimum environment for people with dementia e.g removing confusion (clocks telling the correct time), disguising the any locked doors in bedrooms), creating areas of interest around the home for people who wander. DS0000046663.V276729.R01.S.doc Version 5.1 Page 36 Highfield Manor 7 8 9 10 11 12 OP25 OP26 OP28 OP29 OP31 OP38 Lighting in communal areas and bedrooms should be domestic in character. The home should have a laundry policy in order that staff know how to deal with laundry in the home. 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 home’s recruitment policy should be updated to reflect legal requirements. The registered person should have an NVQ level 4 or equivalent in care and management. The fridge in the kitchen should be repaired / replaced. Highfield Manor DS0000046663.V276729.R01.S.doc Version 5.1 Page 37 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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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