Inspection on 08/08/05 for Highfield Manor

This inspection was carried out on 8th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 05/01/06

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 8 , 9 10 and 16 August 2005 th th th th 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 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 D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Highfield Manor Address 44 Branksome Wood Road Bournemouth Dorset BH4 9LA 01202 769429 01202 769429 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) RYSA Ltd CRH PC - Care Home Only 27 Category(ies) of DE(E) Dementia - over 65 (27) registration, with number MD(E) Mental Disorder -over 65 (27) of places Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 13th July 2004 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 service users between floors. Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over the course of 3 days plus one early morning visit. The inspection was one of the anticipated inspections of the year but some concerns were raised with the Commission prior to and during the course of the inspection and were addressed and are commented on, as appropriate, in this report. As stated in the brief description Mrs Koussa takes the day to day responsibility for the running of the home. Discussions with Mr and Mrs Koussa are ongoing to establish the formal management arrangements for the home as Highfield Manor is now part of a limited company. On the days of inspection Mrs Koussa was not available and Mr Koussa assisted the Inspector. At the early morning visit the 2 members of care staff on duty assisted Inspectors in their work. On the first day of Inspection Debra Jones – Inspector was accompanied by Peter Downham of Immigration Intelligence – who was shadowing the CSCI Inspector to find out more about the work of the Commission. The first day concentrated on employment and recruitment of staff. On the second day Mr Koussa and Debra Jones spent time looking at records, following up requirements and recommendations made at the last inspection and the additional visit carried out in January 2005 and touring the premises. On the third day of inspection Christine Main – Commission Pharmacist, accompanied Debra Jones. On this day Debra Jones spent the time in the home meeting and talking with residents and their relatives and briefly talking with staff, while Christine Main checked medicines for six service users with the records and spoke with one service user and one carer. At the early morning visit conducted at 5.55 am on 16 August 2005, Debra Jones was accompanied by fellow Inspector Chris Gould. This part of the inspection focused on the night and early morning routine in the home. What the service does well: Highfield Manor provides a home for 27 older people who need care due to their dementia or mental disorder in a well-decorated and comfortably furnished converted and extended house. Residents and visitors comment on how kind, gentle and patient the staff who work at the home are. Visitors say they are always made welcome. Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 6 Information about what the home offers is available. The admissions procedure ensures that only people whose needs the proprietors assess can be met are offered places at the home. Thorough assessments and care plans are in place for all residents and these are regularly updated to make sure that staff have the information they need to care for those living at the home. Daily and nightly notes provide evidence to show the way that care is delivered. A range of community health professionals support the care staff in caring for residents. Residents who were able to confirmed that they felt that their privacy and dignity were respected at all times. The more able residents are able to do as they wish at the home and their independence is encouraged. The complaints procedure reassures residents that any concerns raised should be properly investigated and resolved. The home is well maintained and comfortable for the residents living there and anyone visiting. The home does not handle any money for residents. Systems are in place and records kept, that demonstrate the homes commitment to keeping residents safe. What has improved since the last inspection? The statement of purpose and service user guide have been updated. The complaints procedure has been updated and now meets the regulations and the standards. The adult protection policy has also been amended and now reflects local guidance. Written care plans are comprehensive and regularly reviewed, based on thorough assessments. Separate records are kept of community health interventions. Care notes also include information about wishes at death. Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 7 The home now has an audit trail for medicines to help confirm what medicines have been given. The home has developed a shared room policy so those living in or moving into a shared room know how vacancies that arise in those rooms will be dealt with. Thermostatic valves are in place to control the temperature of water. These are regularly checked to ensure they are working and residents are protected from scalding. A record is now made of these checks. Staff records were improved but there are still some gaps. There was some evidence to show that there had been some training of staff in key areas such as dementia care. A quality assurance system has been introduced at the home so people can contribute to the ongoing improvement agenda at the home. What they could do better: At present the home is unable to demonstrate that they are able to meet the assessed needs of residents as few staff at the home have had the essential training they need to ensure care needs will be met. The home needs to be properly staffed in respect of the number of care staff on duty at any time to ensure that the service delivered to residents is as good as it should be. Residents should not be woken up and got out of bed earlier than they wish and attention must be paid to ensuring that residents have their glasses and dentures and wear their own clothes at all times. Any practices that might further confuse residents must stop and rooms should be checked to ensure that they only contain items belonging to the occupants and nothing is labelled with any other names. Bed linen and towels should be replaced if they are found to be worn. 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 home needs to ensure that residents get the regular check ups from the community services they need, and are entitled to, and records must be made of these events. The home needs to improve: medication training for staff; records of variable doses and changes to medication; and liaison with the GP to include clear prescription directions for some “when required” medicines. It would be good if staff had training in loss and bereavement. Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 8 It would be good if there were more activities – organised and spontaneous and if activities included more trips out of the home. All people managing and working at any home must have access to information and have received training about the prevention of abuse and the local arrangements for the investigation of any suspicion of abuse. This continues not to be the case at this home which leaves residents at potential risk of abuse and of any abuse identified not being properly addressed. The registered persons must give notice to the Commission of any event in the care home, which adversely affects the wellbeing or safety of any resident. A report must be submitted to the Commission about the recent conviction of a former employee relating to theft from a vulnerable person. A referral to the Protection of Vulnerable Adults List must also be made. Suitable storage must be found for equipment not in use and residents rooms should be kept clear of equipment that is not used by them. Bed rails must only be in place on beds where the resident has been assessed as needing them. Rosters should show who is in charge of the home at any time – including at night. It would be good if staff had NVQ qualifications in care. The home must obtain the documentation required by law in respect of staff. This is in order to ensure that only the right people are employed to work there and residents are protected from potentially unsuitable staff. Any original documents belonging to staff must be returned to them. It would be good if the person managing the home had a qualification in care and management. The registered persons must ensure that care staff receive training appropriate to the work they are to perform, e.g., in subjects such as mental disorders, dementia and dealing with challenging behaviour, manual handling, first aid / emergency aid and food hygiene. Refresher courses are also obligatory to keep people up to date with practice. Not enough staff at this home are able to evidence that have had this training or are up-to-date putting residents potentially at risk of being exposed to poor practice. Accident records should be fuller and clear about when accidents happened and if they were seen to happen or if residents were found having had accidents. Where residents are ‘found’ it is important that the home find out when they were last seen prior to their accident so that measures can be put in place to ensure that residents are as safe as they can be. A written accident analysis would be a good thing. Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 9 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 D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 10 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 Standards Statutory Requirements Identified During the Inspection Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 11 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 standard(s) 1, 3and 4. 6 is not applicable to this home. The admissions procedure at the home enables prospective residents to make informed decisions about moving to the home and ensures that only residents whose needs have been assessed and who have been assured that their needs can be met by the home are offered places there. EVIDENCE: The home has a recently updated statement of purpose and service user guide. This is clearly written and both documents together give the information a service user or their representative would need to make a decision as to whether the home was suitable. The home undertakes pre-admission assessments. One was seen for a resident who had moved in a few days prior to the inspection. Mr and Mrs Koussa had visited the prospective resident and looked at the nature of their needs, completing a comprehensive pre admission assessment form. After the assessment had been completed the home wrote to the prospective resident to confirm that they felt the home was able to meet their needs. Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 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 standard(s) 7,8,9 10 and 11 The care planning system in place ensures that staff have the information they need to meet the needs of the residents. However routines at the home and the number of staff deployed dictate how the home is run rather than the individual needs and preferences of residents. This impacts adversely on care practices, compromises the safety of residents and demonstrates a lack of respect for the individuality of residents. Some residents are at risk of being further confused by practice at the home. Currently the staff group do not have the training and experience to ensure that care needs will be met. The home is supported in meeting the health needs of the residents by a range of community health professionals, although not all residents appear to have had contact with them. The home has made some progress with recording the administration of medicines but some staff, who give medicines, have not been assessed as competent, or had any medication training, which potentially puts service users at risk. Information is now collected by the home to ensure that wishes at death will be acted upon. Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 13 EVIDENCE: All residents have a written care plan which sets out their assessed needs and how the home is to meet them. Care plans were comprehensive in content and clearly outlined the way in which care is to be delivered. Language used promoted independence using words such as ‘observe’ guide’ remind’ ‘need to help with’. Care plans are regularly reviewed. One relative talked of how pleased she was with the care her husband got and of how he was happy, always looked well, his hair was smart and clean and he always smelled fresh. Daily notes support and evidence the delivery of care. These were fairly basic in content and Mr Koussa and the Inspector discussed how these could be fuller and more informative about how residents spent their days and nights and the content of the care given. Day and night staff both write reports. The Inspector was disappointed to note that for the newest resident, who had been at the home a few days, no night reports had been completed despite the fact that the resident was clearly finding it difficult to settle. At previous inspections it has been noted that in respect of meeting the needs of residents there was not evidence to show that staff had had appropriate training to do this e.g. dementia care training. This is still the case and some staff have not had training at the home in essential areas such as medication, adult protection and manual handling. The home keeps separate records for health involvement, noting when residents are visited by GPs or District Nurses or other professionals. These records showed that some people living at the home were receiving a range of support whilst others had not been seen by a GP or any other person from outside the home in respect of their health at all. It was difficult to assess whether this was a problem with recording or whether some residents really had not seen any community health professionals, which would be of concern given the vulnerability of the residents and their need for reviews e.g. in respect of medication and general health. One resident queried access to a dentist with the Inspector and when this was relayed to Mr Koussa he said that he would look into it immediately. At the early morning visit Inspectors were concerned to see unnamed dirty dentures, clearly not in use in a shared bedroom. We also saw a box of unnamed glasses, which appeared not to be in use. No service users were self-administering their medicines. Medicines that staff give were stored appropriately. Medicines for one new resident were recorded correctly according to the discharge summary received from the hospital when Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 14 they moved in. A check of the audit trail confirmed that medicines were given as prescribed and recorded. When paracetamol was prescribed with a choice of dose (1 or 2) the recorded dose given did not agree with the audit trail for 2 residents. Mr Koussa agreed to follow this up. Two service users had medicines prescribed when required and the frequency of doses had been changed recently. It was not clear who had authorised this but Mr Koussa said that it was within the doctor’s original dose directions. He agreed to liaise with the doctors to improve the labelling of these medicines. One resident had a medicine allergy according to a list in the medicines cupboard but “none known” was recorded on their MAR chart. One carer who gave medicines said she had not had any medication training and from the records other day staff who give medicines have not had any training. Mr Koussa agreed to rearrange the staff rotas so that staff who have not been trained could be supervised. Of the residents that the Inspector talked with who were able to express opinions about the care they received all were positive about the gentle caring nature of the staff and of the way they respected their privacy and dignity, always knocking on doors and performing tasks discretely. The Inspector raised a particular concern about the dignity of one resident who was less able to express their views and again Mr Koussa said he would give this immediate attention. However on the early morning visit Inspectors entered the home at 5.55am and found that 8 residents were sitting in the lounge. The light was on and so was the TV, although this was not in sight for the majority of those in this room. When we asked we were told that other residents had been washed and dressed and were back in bed. We visited one resident who was asleep in bed fully clothed to see this for ourselves. Most residents seated in the lounge were also asleep. Two members of staff were on duty. When asked they told us that they have to get all residents who need help ready for the day by 8am and in order to do this they have to start waking people and getting them up before 5am. One member of staff was upstairs getting residents up and the other was working downstairs. No staff were with the residents in the lounge. It was clear to Inspectors that some residents needed two members of care staff to assist them and they were not getting this assistance. In a shared room we saw that residents are sharing soap and there was only one toothbrush in the room. The two towels in the room were both worn. Both residents were in the lounge but the towel, soap, basin and toothbrush were all dry. Mr Koussa said that no residents have died at the home in recent months. Evidence was seen to show that information is being gathered as to the wishes of residents / representatives at death. Training has not yet taken place for staff in how to cope with loss and bereavement. Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 15 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 standard(s) 12,13 and14. Residents enjoy the social opportunities afforded by their visitors. For a number of residents at the home activities and choices are limited and control is compromised by the impact the staffing levels have on the way the home is run. EVIDENCE: The home acknowledged that activities for residents are limited and that they hoped to address this when their staff group was more experienced and settled. It is good that the home keep specific records just relating to activities. These show that people enjoy listening to music, playing board games or spending time with each other and going on trips with their visitors. There was little evidence to show that activities were lead by or involved members of staff. During the daytime inspection residents were mostly sitting in the lounges and conservatory; there was a TV on, in sight of some; some residents had papers to read, some had visitors and others were either asleep or had their eyes shut. Two residents talked of how they played dominos together daily. Mr Koussa said that the afternoons were busier and that was when residents really came alive. Three care staff are on duty throughout the day and given the needs of the resident group would have little to no time to spend doing Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 16 activities with residents. One relative commented that she thought the residents would benefit from more trips out from the home. The visitors book demonstrated that a range of visitors come to the home. The Inspector talked with visitors and they said how welcome they were always made to feel and of how there was always a cup of tea for them. Staff were seen to be very welcoming to visitors and knew them well. Some more able residents talked of how they can make decisions about how they lived their life within the home, making choices about what to eat, when to do things and how to spend their time. For those less able Inspectors did not have the same confidence that the choices made by the home for them were necessarily in their best interests and might exacerbate their confusion. The early morning visit confirmed this. Residents were being got out of bed and dressed before they were ready – as stated above. Once up residents were asleep in the lounge or returned to bed fully clothed where they slept further. We looked in the wardrobes of two residents. Many clothes were not marked with any name and some clothes were in residents’ wardrobes that were labelled with names – not of the resident or of anyone living at the home. We were further concerned that on the inside door of one wardrobe we looked in there was a sticky name label that was not the name of the resident living in the room. We also saw unnamed dirty dentures, clearly not in use and a box of unnamed glasses, which also appeared to be not in use. Being without these important personal items would also impact on the quality of a persons daily life. Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 17 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 standard(s) 16 and 18. A system is in place to deal with any complaints that might be made to the home. There has been progress on updating the vulnerable adults procedure but as staff have not had training in this area at the home this leaves residents at risk from abuse. EVIDENCE: The home has a complaints policy and procedure. This meets the standard and regulation and is clearly available for anyone who would wish to use it. Mr Koussa said that no complaints had been received since the last inspection. As stated in the summary a number of concerns had been raised with the Commission prior to and during the inspection. Mr Koussa was helpful in assisting the Inspector in the concerns raised during the days which were particularly about staffing and staff and informed the inspection. Some concerns raised in respect of staff and their contractual and living arrangements are not within the remit of the Commission and are not therefore commented on. The Commission will be passing on concerns to other appropriate bodies and those raising concerns have been encouraged to seek advice directly from other agencies such as the Citizens Advice Bureau. Concern was raised about morning routines with the Commission, which resulted in Inspectors returning to the home to carry out an early morning visit. The outcomes of which will be followed up with Mr and Mrs Koussa and further monitoring visits will take place. Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 18 Since the last inspection in July 2004 the adult protection policy has been updated. Few staff have had training about adult protection / abuse and this was raised again as an area that the home needs to address. The Inspector suggested that the adult protection policy be at least discussed in the next staff meeting. Mr Koussa also undertook to discuss with the police the referral that needs to be made to the Protection of Vulnerable Adults list that must be made in respect of the ex employee of the home who it was reported in the local press was convicted the week before of theft from a vulnerable person (s). The home is also obliged to make a report to the Commission about this affair and to confirm that the referral will be made, when it will be made, and who is to make it. Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 19 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 standard(s) 19,20,21,22,23,24 and 25. The home is well–maintained and a comfortable and generally safe environment is provided for the residents living there and anyone visiting. Bedrooms are adequately decorated, furnished and contain personal items belonging to residents. Some bedrooms are not fully individualised. Adequate facilities are available to meet the number and needs of the people living there. EVIDENCE: The Inspector and Mr Koussa toured the premises. The home is well decorated throughout. Lounges / dining areas are well and comfortably furnished. The garden is well maintained and attractive. Where minor maintenance concerns were brought to Mr Koussa’s attention during the tour of the premises maintenance staff were immediately notified e.g. where doors were sticking. There are a number of communal bathing areas in the home. Some bedrooms have en suite facilities. Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 20 A shared room policy is now in place. Mr Koussa said that the occupants of the shared rooms had not changed since the policy had been introduced. Aids and adaptations, are available throughout the home e.g. raised toilet seats, grab rails and hoists. Some residents with particular needs have their own personal equipment to assist with their independence. A hoist was seen in a shared room where it was not needed for either resident. Mr Koussa undertook to find a more suitable place for it to be stored but when Inspectors returned the following week it was still in the same place. Some residents have bed rails in place and where these are used they need to be properly assessed and their use reviewed. Documentation showed that this was the case for one but for another resident who had bed rails on their bed there was nothing on file to indicate that they were needed and Mr Koussa was sure they were not in use. Mr Koussa was asked to remove them if they were not needed and he agreed to do this. However when Inspectors returned the following week they were was still attached to the bed. Residents are able to personalise their rooms with furniture and general belongings. However Inspectors were concerned that not enough attention is given to providing an environment that minimises confusion for example on the inside door of one wardrobe we looked in there was a sticky name label that was not the name of the resident living in the room. At the inspection last summer concerns were raised about the condition of the bedding in the home. At this inspection towels were seen that were worn. There is a passenger lift in the home, enabling easy access between the floors. There are emergency alarm bells throughout the home. Thermostatic valves are in place to control the temperature of water. These are regularly checked to ensure they are working and residents are protected from scalding. A record is now made of these checks. Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30. Insufficient care staff are employed and deployed to ensure that the care needs of residents can be met. Recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home but there are still some gaps in the staff records kept at the home. Most day staff have not had the essential training they need to meet the needs of residents so residents may not be in safe hands. EVIDENCE: Visitors and residents praised the current staff employed at the home talking of how kind they were generally and how gentle they were in performing care tasks. Some expressed concern at how hard staff had to work. Rosters are clear and show who is on duty at any time and in what capacity. However it is not clear on the roster who is in charge at night. Three care staff are on duty during the day and two at night. Staff are usually supported in the home by Mrs Koussa (who acts as manager 5 days a week), a chef, a cleaner (working 6 days a week) and a handyman. Care staff have to undertake all the laundry duties in the home and some cleaning tasks. Concern has been expressed at previous inspections about staffing levels. These are repeated at this inspection as both day and night staff given the time available to them are pushed to perform the basic tasks required of them Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 22 and have little time to spend quality time with residents. Inspectors were extremely concerned at the practices at night / early morning when residents were being got out of bed to be washed and dressed from before 5am and in some cases returned to bed fully dressed until breakfast time. Inspectors were told that this is the time night staff have to start doing this given that there are only two of them; that some people need 2 people to assist them; and in order for everyone to be ready for when the day staff come in, as required by the management. During this time residents are left unattended in the communal areas compromising their safety. This practice is completely unacceptable, must stop and the home be adequately staffed. No care staff currently working at the home have NVQ level 2 in care, although some staff have qualifications in care from other countries. Evidence was seen that training had taken place at the home in areas including dementia, moving and handling, food hygiene. However given the changes in staff not many of the staff still working at the home, or the new staff had benefited from this training. Some training had been planned for staff e.g. thorough induction courses run by the local authority. Key areas of training that must be addressed were discussed with Mr Koussa who appreciated that this must happen to ensure that residents are in safe hands e.g. training in medication, adult protection, moving and handling, dementia. Staff need to feel confident in their competence to do their work to ensure that residents get the best care. The Inspector expressed concern that the roster was being devised without consideration to the experience or training of staff i.e. newly employed, inexperienced staff with little evidence of training in essential areas (such as medication, dementia, emergency aid, moving and handling) were working alongside each other while the longer standing staff -who had both experience of working at the home and who have higher levels of training - worked together on other shifts. Mr Koussa agreed to look at this again and address it. The Inspector looked at staff files to see how the home handled recruitment. A high number of staff have been recruited to the home in recent months. At the additional visit made by Inspectors in January 2005 staff records were noted as being inadequate. These were significantly improved at this inspection, although there were still some incidences of records being incomplete, with some proofs of identity missing from files, one Criminal Record Bureau disclosure (CRB ) not having been applied for (a copy of a previously obtained one was on file) and no proof of POVA first checks having been obtained where it was clear that staff had started work prior to their full CRB certificate being returned. One residence visa was seen that had expired and one student was working in excess of permissible hours. Some original documents were found on staff files. Mr Koussa was asked to return these and any others he was aware of. Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,35 and 38. Whilst there are a number of systems in place to protect residents and provide them with a safe environment the home is not being managed in such a way as to ensure that residents receive consistent quality care. This results in some practices that do not promote and safeguard the health safety and welfare of the people using the service. EVIDENCE: Mr and Mrs Koussa are Proprietors of RYSA Ltd of which Highfield Manor is a part. Mr and Mrs Koussa are currently discussing with the Commission the long term arrangements for managing the home. Mrs Koussa currently acts as the manager and is currently studying for her NVQ level 4 in management. A quality assurance system has been introduced and residents and their relatives were asked to complete questionnaires. Those returned were very positive about the service saying ‘staff have a lot of patience’ ‘I am well Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 24 satisfied that the staff and management are the best’ ‘I am more than satisfied’ ‘any small problems which arise are quickly dealt with.’ Mr Koussa was advised to date responses. Mr Koussa showed the Inspector the report he had compiled as a result of the survey. This is kept in the main hallway and is therefore accessible to any interested parties. (Comments are made in the above report about the concerns Inspectors have about the home not being run in the best interest of residents in respect of staffing arrangements and the impact this has on the care of the residents.) Mr Koussa said that no money is held for residents and that he is not involved with any finances. He explained that the home pays for anything the residents need and whoever holds their money is then invoiced. Records relating to fire safety were examined. These were up to date and showed that fire equipment had been checked at appropriate intervals – both by the home and by contractors - and staff had received fire training. Accident records were also inspected. These showed that not many accidents had occurred. The Inspector suggested that ‘incidents’ were also recorded where they impacted on residents health and well-being. Records were not always clear about the time of day of the accident i.e. if am or pm. Most were clear as to whether the accident had been seen or the resident just found. The home is encouraged to be clear in all cases. Most of the accidents noted were recorded as happening in the morning between 6 and 7.30am in residents’ bedrooms. Mostly residents had been ‘found’. The Inspector was concerned that the records did not give any indication of when the resident was last seen prior to the accident and so the length of time they might have been waiting for assistance was not known. Mr Koussa undertook to raise the standard of the recording of accidents, and learn from accidents to minimise future risk. It was suggested that data product sheets (or copies) for cleaning products used in the home be kept near to where these substances are stored / used. During the tour of the premises denture sterilising tablets were found in some rooms. The Inspector alerted Mr Koussa to their potential risk to residents and he requested a member of staff to ensure that they were removed from all rooms. Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 25 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 1 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 x COMPLAINTS AND PROTECTION 3 3 3 2 3 2 3 x STAFFING Standard No Score 27 1 28 1 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 2 2 x x 3 x x 2 Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 26 yes Are there any outstanding requirements from the last inspection? 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 7 Regulation 4 Requirement The registered person must be able to demonstrate the homes capacity to meet the assessed needs of individuals admitted to the home. (previous timescales for action 30.11.04, 30.6.04, 31.01.04 and 31.8.03 not met) The registered person must ensure that the care home is coducted in such a way as to promote and make proper provision for the health and welfare of residents. The registered person must ensure that all residents have access to community health professionals. The home must ensure that residents have access to their belongings that promote their health and independence e.g their dentures and glasses. Staff must be trained in the home and assessed as competent to give medicines before they do this unsupervised. In addition they must have training on how medicines are used and how to recognise and deal with problems in use. Timescale for action 1.12.05 2. 7 12 1.12.05 3. 8 13 1.10.05 4. 9 13 (2) 31.8.05 Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 27 5. 9 13 (2) 6. 14 12 7. 18 13 8. 18 37 9. 10. 22 22 23 13 11. 24 12 12. 27 18 When there is a choice of dose the dose given must be accurately recorded and medicine allergies must be accurately recorded on the MAR chart. Residents must be enabled to make decisions with respect to the care they are to receive and their health and welfare and take into account their wishes and feelings whilst always respecting their privacy and dignity. 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. The registered person must make a report to the Commission without delay in respect of the ex employee convicted of theft and inform the Commission about the arrangements for the referral to the Protection of Vulnerable Adults list held by the Department of Health. Suitable arrangements must be made for the storage of equipment in the home. Bed rails must only be in place for residents who have been assessed as needing them and where documented permissions are in place. Rooms must be checked to ensure that they only contain items belonging to occupants and any misleading labels must be removed. Sufficient suitably qualified, competent and experienced people must be employed and deployed at the home to ensure the health and welfare of residents. 31.8.05 1.9.05 1.12. 05 1.9.05 1.9.05 1.9.05 1 9 05 1.9.05 Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 28 13. 29 19 14. 30 18 15. 16. 30 38 19 17 The home must obtain all documents 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 timescalefor action of 18.1.05 not met) The home must obtain all documents 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 timescalefor action of 18.1.05 not met) Original documents belonging to staff must be returned. The home must keep a record of all accidents. This must be clear about the time of the accident and the circumstances of the acident e.g. if the accident was seen happening. Where residents are found to have had accidents the last time they were seen needs to be ascertained to inform the accident analysis that should be carried out and documented at the home. (Previous timescale for action 1.3.05 not met) 1.10.05 1.12.05 1.9.05 1.9.05 17. Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 29 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 7 Good Practice Recommendations Comprehensive notes - night and day - 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. When the GP changes medication the date and name of the doctor responsible should be recorded on the MAR chart. For medicines prescribed “when required” the GP should be asked to include the dose frequency on prescriptions so that this is included on the medicine label and the MAR chart, and the symptom or reason for use should be on the MAR chart or in the resident’s care plan. Residents should have more opportunities for activities and these should include the opportunity to go out on trips. Residents should also be be supported to access the local community. Staff should undergo training in how to cope with loss and bereavement. Staff should undergo training in adult protection and a record be kept of this training. Linen - bed linen and towels should be checked regularly and where it is found to be worn it should be replaced. 50 of care staff should have NVQ level 2 in care or equivalent by 2005. The roster should show who is in charge of the home at night. The registered person should have an NVQ level 4 or equivalent in care and management. 2. 9 3. 12 4. 5. 6. 7. 8. 9. 11 18 24 28 29 31 Highfield Manor D55 S46663 Highfield Manor V243468 080805 Stage 4.doc Version 1.40 Page 30 Commission for Social Care Inspection Unit 4 New Fields Business Park Stinsford Road Poole Dorset 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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