Inspection on 03/05/07 for Highfield Nursing and Residential Home

This inspection was carried out on 3rd May 2007.

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

The inspector 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 Nursing and... 20/05/08

Highfield Nursing and... 29/06/06

Highfield Nursing and... 06/01/06

Highfield Nursing and... 08/08/05

Highfield Nursing and... 04/01/05

Highfield Nursing and... 07/07/04

Highfield Nursing and... 31/03/04

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

CARE HOMES FOR OLDER PEOPLE Highfield Nursing and Residential Home Mandeville Road Saffron Walden Essex CB11 4AQ Lead Inspector Neal Cranmer Key Unannounced Inspection 3rd May 2007 10:00 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 Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highfield Nursing and Residential Home Address Mandeville Road Saffron Walden Essex CB11 4AQ 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) 01799 524936 01799 526116 Tronicgold Limited Manager post vacant Care Home 60 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (60), of places Physical disability (3), Physical disability over 65 years of age (25) Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Persons of either sex, aged 50 years and over, who require nursing care by reason of a physical disability (not to exceed 3 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 25 persons) Persons of either sex, aged 65 years and over, who only fall within the category of old age (not to exceed 60 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 11 persons) The total number of service users accommodated must not exceed 60 persons 29th June 2006 Date of last inspection Brief Description of the Service: Highfield Nursing & Residential Home was opened in 1990 and consists of a two-storey building with newer purpose built single storey accommodation. It is located in a quiet cul-de-sac within walking distance of the centre of the North Essex town of Saffron Walden. Highfield is accessible by road and rail and the nearest station is in Saffron Walden. Parking is available in the visitor’s car park and in the adjacent road. There are 42 single en-suite bedrooms and 9 double bedrooms. 8 of the double rooms are en-suite. There are two passenger lifts. The home has several small courtyard gardens that are attractive and accessible to wheelchair users. All ground floor rooms that face onto the courtyard garden have French windows to give the residents access to the gardens. Highfield Nursing & Residential Home provides nursing and personal care with accommodation for up to 60 residents. This includes provision for 3 adults over 50 years with a physical disability; 25 persons over 65 years who require nursing care for a physical disability; 11 older persons over 65 years who require residential care due to a dementia; and 21 older persons over 65 years who require personal care only. Tronicgold Ltd privately owns Highfield NH, which is part of Carebase Ltd. Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection visit to the home which took place on the 3rd may 2007, which lasted seven hours, the inspection included discussion with residents, the manager and staff, seven surveys were returned in respect of the service and comments from these have been included with the main text of this report. During the site visit the premises were toured including the grounds. A range of records were sampled, as were residents care plans. On the day of the visit the home was clean and tidy and was free of any unpleasant odours. This inspection covered all twenty-one of the key standards. The acting manager and her staff approached the inspection in a cooperative manner that was focussed on achieving best practice to meet the needs of the residents. What the service does well: What has improved since the last inspection? The medication administration practice at the home has been improved, so that records now only contain current medications, and ensure that all changes made to the records are dated and signed. Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 6 Staff now have a better understanding of the requirements for safe working practices, specifically related to CoSHH (Control of Substances Hazardous to Health). The activities coordinators hours have been increased to facilitate more activities for people living in the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Documentation reviewed during this inspection demonstrated that people’ needs are adequately assessed prior to a service being provided. Standard 6 does not apply, as the home does not provide intermediate care. EVIDENCE: The assessment process used in the home is comprehensively detailed, all assessments are undertaken by the acting manager, the assessment of one person admitted to the home since the last inspection was viewed and found to be well documented. This home does not provide intermediate care, and there continues not to be any intention to offer this level of care in the near future. Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Care documentation continues to require further development, however health and personal care needs are well catered for in this home. Residents can expect their health and personal care needs to be addressed with consideration given to their privacy and dignity. EVIDENCE: Four peoples care plans were sampled during the course of the inspection, none of those seen had any evidence of monthly reviews being undertaken, and subsequently were not reflecting peoples changing needs, all of the care plans were very brief, with care objectives being very vague e.g. to keep safe, “to meet her needs”. Health care records continue to be sparse, with the only record kept relating to visits from the General Practitioner. All of the people living in the home continue to be supported by the services of a retained General Practitioner. On a very positive note a survey returned by a G.P indicated that since the Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 10 appointment of the new manager the home has been very proactive in improving care, and was keen to point out that they had been invited to assist in one particular aspect of the home’s care. The staff skill mix in the home ensured that the health care needs of people were being met. The home’s medication practice was sampled, records seen were found to be in order, with no evidence of any omissions. Nighttime sedation continues to be stored in the controlled medicines cabinet and records relating to these were recorded appropriately. The medication room is small and very compact, however during discussion with the acting manager it became evident that plans are in place for this room to be expanded, this was further confirmed during discussion with one of the home’s nursing staff. Procedures to ensure the privacy and dignity of people living in the home were observed to be good throughout the home. Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The level of activities within the home has been increased, to ensure that people are stimulated in their day-to-day lives. Meals provided are varied, nutritious and well balanced to cater for the dietary needs of people living in the home. EVIDENCE: Activities within the home have improved significantly, the activity persons hours have since the last inspection been increased to enable them to work flexibly across the week to meet the needs of people. The coordinator was seen on the day of the inspection carrying out 1.1 sessions with people as well as group activities. All of the people living in the home are on the electoral register and they are consulted on how and if they wish to vote. Two of the people spoken with during the course of the inspection felt that they all the day-to-day choices that they required. Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 12 Discussion with people living in the home indicated that the meals are very good, with each main meal being preceded by a glass of sherry; people spoke of having the choice of taking their meals in the main dinning room or on trays served in their rooms. The dinning area of the home was quite large, but never the less pleasantly set out. During the course of the inspection discussion took place with the home’s cook who appeared to have a good knowledge of peoples particular likes and dislikes. The kitchen facilities were adequate if a little hotel like, however as with the home’s medication room it is scheduled for complete renovation. Sampling of the home’s food stocks found them to be adequate. Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has in place robust policies and procedures relating to Adult Protection and Complaints, which ensure the protection and safety of people living in the home. EVIDENCE: Three complaints have been received since the last inspection, all relating to issues about the home’s fees, both of these complaints were referred directly to the home. All complaints were logged appropriately, investigated and responded to within the relevant timescale. Two of the complaints were substantiated and one was not. People living in the home spoke of knowing who to raise any concerns with. There have been no Adult Protection referrals since the previous inspection, and all staff have received training in this area, the acting manager is in the process of discussing Adult Protection as part of monthly team meetings. Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a well cared for environment that is decorated and maintained to a good standard. EVIDENCE: There has been no change to the fabric of the building since the last inspection, however plans are in place for a number of areas within the home to undergo refurbishment e.g. the medication room and kitchen. The whole of the home was toured at the time of the visit, and was clean and tidy, and generally well decorated and maintained throughout, with no evidence of any unpleasant odours. The laundry facility at the home is small for the size of the home, but is tidy and well run ensuring that dirty laundry does not come into contact with clean Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 15 laundry. Disintegrating red bags are used for foul laundry to help reduce the risk of infection. The washing machines and dryers are industrial in nature, with the washing machine having a sluicing facility, although the home does benefit from having a separate sluice room facility. Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staffing levels, staff recruitment and training in this home are all good, ensuring the safety of people living in the home. EVIDENCE: Staffing numbers were in line with the number of people living in the home and their dependency needs. The staffing levels are 9 carers in the morning consisting of one registered nurse, 3 seniors and 6 carers, in addition the home has recently appointed a care service manager who works flexibly to meet the needs of people living in the home. The acting manager works in a supernumerary capacity on a flexible basis, determined by the needs of people. The acting manager is supported in their management role by an administrator who works 35 hours per week. 7 carers made up of 1 registered nurse, 2 seniors and 5 carers cover the afternoon shifts. 1 registered nurse and 3 care staff cover nights. In addition to these staff the home employs a number of ancillary staff including: Cooks, domestics, laundry person, and caretaker. Staffing is reviewed centrally at least annually, although the acting manager spoke of keeping staffing levels under review periodically and of there being a process to trigger a review centrally earlier if necessary. Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 17 The home employs 17 care staff, of which 3 are qualified at N.V.Q level 3 in care, a further 4 are signed up to start the award, more course continue to accessed for other staff as these become available. Four staff personnel files were reviewed during the inspection of the home, and all contained all of the required information. Staff commence working I n the home in a fully supervised capacity until such time as their Criminal Records Bureau Checks are received. Evidence observed during the inspection demonstrated a good practice in respect of recruitment practice. Staff training records sampled evidenced that the following training had been undertaken since the last inspection of the home: • Manual handling • Fire safety • Adult protection • Food hygiene • First aid • Medication administration All new staff appointed by the home are appointed on a six months probationary basis, with the first week spent shadowing experienced staff, they are then commenced on light duties, until such time as they have received training in manual handling. There is an induction programme in place, but this has yet to be rolled out. Scheduled training is planned for the following: • Care planning • Fire awareness • Dementia training • Health and safety • Food hygiene • Manual handling • Palliative care training. Staff spoken with during the course of the inspection spoke of access to training as being good and relevant to the needs of the people living in the home. Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 38. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Quality assurance and supervision arrangements continue to require improvement to ensure that staff have the skills necessary to provide appropriate care. EVIDENCE: The current acting manager has been in post since last year and clearly recognises that there are a number of areas where improvement to the service needs to be made. Although the acting manager has significant previous care experience, as yet they have not been registered with the Commission for Social Care Inspection. Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 19 One of the surveys received was very complementary about the acting manager and her concern for people living in the home and their families. The manager spoke of their belief that there was a quality assurance system in place, but a t the time of the inspection this was unavailable. Meetings are held with people who live in the home bi-monthly, the last one being held in April 2007. Records reviewed during the inspection evidenced that the home’s safe working practices are in order, with equipment and utilities being serviced as and when required. Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X X X X 3 Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 21 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 OP7 Regulation 15(2b-c) Requirement Care plans should be reviewed regularly and appropriate changes made, to ensure that residents needs are met as they would wish. (Timescale of 30/03/06 and 30/09/06 were not met). Care plans must contain details of the actions needed to care for all the residents’ care and nursing needs, to ensure their assessed needs are met. (Timescale of 30/03/06and 30/09/06 were not met.) Timescale for action 31/07/07 2. OP7 15 31/07/07 3. OP28 18(1a& c) Arrangements must be made for 31/07/07 further care staff to commence National Vocational Qualifications, to ensure that residents are cared for by staff with the appropriate skills and knowledge. (Timescale of 30/12/06 was not met.) Provision must be made for the appointment of a person to be registered to manage the care home, to ensure that staff have DS0000015401.V341290.R01.S.doc 4. OP31 8 31/07/07 Highfield Nursing and Residential Home Version 5.2 Page 22 5. OP36 18(13a&b) clear leadership to support residents. The registered person must ensure that all staff receive regular supervision. (This will usually be on at least 6 occasions each year.) (Timescale of 30/09/06 not met.) The registered person must ensure that a quality assurance plan for the home is developed, which is based on the views of people living in the home and other interested stakeholders. The previous timescale set of the 30/09/06 was not met. 31/07/07 6. OP33 24(1a-b) & (2-3) 31/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Highfield Nursing and Residential Home DS0000015401.V341290.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!