Inspection on 06/01/06 for Highfield Nursing and Residential Home

This inspection was carried out on 6th January 2006.

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 Nursing and... 20/05/08

Highfield Nursing and... 03/05/07

Highfield Nursing and... 29/06/06

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 Lysette Butler Unannounced Inspection 08:45 6 to 25 January 2006 th th 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.V272242.R01.S.doc Version 5.0 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.V272242.R01.S.doc Version 5.0 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 Mrs Wendy Ann Pike 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.V272242.R01.S.doc Version 5.0 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 require care by reason of dementia (not to exceed 11 persons) Persons of either sex, aged 65 years and over, who only fall within the category of old age (not to exceed 60 persons) The total number of service users accommodated must not exceed 60 persons 8th August 2005 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 visitors 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. Highfield is privately owned by Tronicgold Ltd, which is part of Carebase. Highfield Nursing and Residential Home DS0000015401.V272242.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took ten hours during January 2006. Twenty of the thirty-eight National Minimum Standards were inspected during this visit. It was found that many of the standards had been met or partially met. The overall care and well being of the residents was good; staff and residents were welcoming and happy to speak to the inspector. During this visit the inspector spoke to residents; relatives/ visitors; a number of staff members including the administrator; housekeeping staff; the laundry person; one of the activities coordinators; a visiting chiropodist: registered nurses and care assistants. The inspector also spent time with the registered manager. Residents and their relatives expressed satisfaction with the care they received and with the quality of the food offered. All the National Minimum Standards were assessed at the two statutory inspections for the year 2005/6. Information on any standards not assessed at this unannounced inspection can be found in the report dated 8th August 2005. What the service does well: What has improved since the last inspection? A new activities coordinator has been employed which is offering the residents a bigger variety of activities. Extra housekeeping hours has improved the overall cleanliness of the home and there are considerably less malodours throughout the home. The manager has instituted a monthly newsletter for residents and their relatives to inform them about changes in the home, upcoming events and general news items. A key worker system has been started, both staff and residents spoken to said that they found the system helpful. The residents felt that the interactions with their key worker were good; resident said that having a specific person to speak to made them feel more integrated within the home. All statutory training was up-to-date at the time of this inspection and the matrix given to the inspector at the time of this inspection showed a balanced approach to the subjects offered. National Vocational Qualification training had been commenced with plans to start further care assistants on a course over the next few months. The communication and general care of the residents during meal times was much improved and far more relaxed. Highfield Nursing and Residential Home DS0000015401.V272242.R01.S.doc Version 5.0 Page 6 Senior care assistants had been trained to administer medications and now administer all medications to the residents in the dementia unit. It is planned that they will also administer the medications to the residential clients in the future. 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. Highfield Nursing and Residential Home DS0000015401.V272242.R01.S.doc Version 5.0 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.V272242.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 & 5 The care aims of this home are explained in the statement of purpose & residents guide, supported by appropriate staff training and individually arranged trail visit EVIDENCE: The statement of purpose and residents guide had been updated since the last inspection and both documents contained all information required to explain their services to appropriate individuals. Both documents were supplied to the inspector following the inspection and are kept on file at the local office of the Commission for Social Care Inspection. The manager had completed reassessments of all the current residents to ensure that they were being cared for appropriately. Regular dementia training is offered to all staff, to meet the needs of those residents who have an ongoing mental deterioration. Staff spoken to who work in the dementia unit are generally enthusiastic about the residents and the care they offer. Trial visits are offered and arranged on an individual basis, although not many prospective residents take up the offer. They are offered half day visit, including a meal, or respite with a view to extend the stay if they feel Highfield is the right home for them. All admissions are reviewed after four to six weeks. Intermediate care is not offered at home. Highfield Nursing and Residential Home DS0000015401.V272242.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9 The indicators examined during this inspection suggested that the residents’ health and personal care needs were well catered for at this home, although the documentation of care is poor. EVIDENCE: Five resident care plans were reviewed during this inspection. The overall standard of the care plans were poor and the inspector spoke directly with two of the registered nurses during this inspection. Although the plans were being reviewed fairly regularly, there was very little evidence that appropriate changes were being made to the plans to take into consideration the changing needs of the residents. At the time of the review a number of resident photographs were missing from the files or were out of date and did not represent a current likeness of the resident. The manager arranged for the majority of these pictures to be taken before the end of the inspection. The need for bedrails for some residents had not been adequately assessed, but other forms of protection had not been tried first. Care plans had not been signed, but residents and their relatives are enabled to review the files at any time they wish. Risk assessments were generally poor or incomplete. The complete care plan ‘package’ was present in each file, but many sections were either empty or incomplete. Some care plans did not contain all the care needs of the individual resident. Highfield Nursing and Residential Home DS0000015401.V272242.R01.S.doc Version 5.0 Page 10 The skill mix of the staff ensures that the health needs of the residents are met. The home retains a local GP, however documentation showed that individual residents were registered with at least five different GP’s. A GP visited the home during this visit to see five residents. A chiropodist attends the home fortnightly. The inspector was enabled to speak to the chiropodist at this visit. She stated that the staff always treated her very well and that they identified those residents who had requested, or needed to see her. The chiropodist felt that there had been a high turnover of staff recently, but that new staff were still ‘kind’ to the residents. All rooms have a locked medication cabinet, or lockable draw in the bedside cabinet. However no residents were self-medicating at the time of this inspection. Senior care assistants have now received medication training, to enable them to administer medications to the residents in the dementia unit, who do not have any nursing needs. In the future if the home is rearranged to have a unit for residents who do not have nursing needs, it is envisaged that the senior care assistants will administer the medications to these residents. Medication stock levels, policies & procedures were good throughout the home. Highfield Nursing and Residential Home DS0000015401.V272242.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 14 Activities are more varied. The emphasis is now on residents joining in and undertaking activities that they wanted to do. Resident choice was an important principle throughout the home. EVIDENCE: A new activities coordinator for sixteen hours a week has been employed by the home since the last inspection. She predominantly works with the residents who have nursing and residential needs only. The activities for the residents in the dementia unit are organised by the care staff. The range of activities has improved with more emphasis on residents joining on, rather than just being ‘entertained’. One relative spoken to was concerned that their relative was not getting enough stimulation. So it was suggested that the activities coordinator should spend some time with them to find out exactly what they would like to do. The documentation of activities undertaken by the residents remained generally poor, but the inspector was informed that this would improve once the coordinator was further settled into the job. The manager had instigated monthly newsletters to the residents and their relatives since the last inspection, which kept everyone up-to-date with activities, changes to staff and changes to the day to day running of the home. There were also three monthly relatives meetings that usually had a fair attendance. There was open visiting in the home and no residents had requested any individual restrictions on their visitors. Highfield Nursing and Residential Home DS0000015401.V272242.R01.S.doc Version 5.0 Page 12 Residents spoken to felt that they were given as much choice in their day-today lives as they wished. No residents were handling their own finances at the time of this inspection or using the services of an advocate. Highfield Nursing and Residential Home DS0000015401.V272242.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 17 The protection and rights of the residents was inherent in the way the staff cared for them. EVIDENCE: The company policies & procedures were clear and detailed; they had all been reviewed since the last inspection. There had been only one written complaint since the last inspection. The residents and their visitors told the inspector that the current manager was ‘very visible’, so they felt that they could approach her about anything and that it would get sorted out. All residents were on the electoral register at the time of this inspection. Highfield Nursing and Residential Home DS0000015401.V272242.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 The overall environment in this home is good and is safe for the residents. EVIDENCE: There had been no change to the fabric of the building since the last inspection. The home was generally clean and tidy on arrival of the inspector. There were no malodours throughout the home during this visit. Some room carpets had been replaced and there were plans to replace some of the corridor carpets. The gardens were tidy and well tended. The kitchen was due for refurbishment at the time of this inspection. Highfield Nursing and Residential Home DS0000015401.V272242.R01.S.doc Version 5.0 Page 15 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 & 30 Staffing numbers were at agreed levels to ensure the safety of the residents. EVIDENCE: The current staff rosters showed staffing at agreed levels. However night staffing levels need review. Since the last inspection extra housekeeping and laundry hours have been added to the rota. Consequently there is two housekeeping staff on every weekday and one on weekend days. At the time of this inspection there were no agency staff being utilised at the home. Since the last inspection four care assistants had commenced National Vocational Qualification training with a further three to four care assistants due to start their training on the next available course. Staff training was up to date and mental health training was taking place in the home at the time of this inspection, which meant that all the staff had been updated. Protection of Vulnerable Adults training had been offered at the home the day before this visit. The trainer was very ‘up beat’ and enthusiastic; the staff felt that the training was good and fulfilled their needs. The training matrix showed a wide range of statuary and related subjects were offered. Highfield Nursing and Residential Home DS0000015401.V272242.R01.S.doc Version 5.0 Page 16 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): 34, 35, 36, 37 & 38 The management and administration of the home was good, protecting the needs of the residents. EVIDENCE: The manager of this home had been registered with the Commission for Social Care Inspection since the last inspection, however the inspector has subsequently been notified that the manager has resigned her post, therefore a new manager will have to be engaged and registered with the commission. Financial procedures within the home were good and all appropriate insurance certificates were valid. However the certificates were not displayed for visitors’ scrutiny, so that they can be assured that the residents and all in the home are adequately covered. No residents were looking after their own finances at the time of this inspection. No resident allowances were kept on the premises. The home do not act as appointee for any of the residents. All transactions are paid for by the home and then the relevant person is invoiced on a monthly basis. There were no resident financial problems highlighted during this visit. The inspector Highfield Nursing and Residential Home DS0000015401.V272242.R01.S.doc Version 5.0 Page 17 was able to speak to the regular chiropodist who invoiced for her services directly to the residents or their relatives; we discussed who is responsible for making the decisions regarding if the residents want to take advantage of her services. At the time of this inspection staff were not receiving supervision or had regular appraisals. Record keeping, excepting care planning (see NMS 7), was good throughout the home. Security of records was good throughout the room. The majority of health and safety certificates checked during this inspection were up to date and complied with the standards. Three were ‘just’ out of date at the time of this inspection. The companies responsible for supplying the servicing for two of the matters were contacted to arrange a visit date whilst this inspection was in process. Completion certificates were forwarded to the local office of the Commission for Social Care Inspection following the visit. Highfield Nursing and Residential Home DS0000015401.V272242.R01.S.doc Version 5.0 Page 18 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 3 3 X 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 X 3 X X X X X X X STAFFING Standard No Score 27 2 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 2 3 1 3 3 Highfield Nursing and Residential Home DS0000015401.V272242.R01.S.doc Version 5.0 Page 19 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 OP7 Regulation 13(4c) Requirement Care plans must contain appropriate risk assessments to ensure the safety of the residents. (Timescale of 31/12/05 not met) Timescale for action 30/03/06 2 OP7 15(2b-c) Care plans should be reviewed every month and appropriate changes made. (Timescale of 31/12/05 not met) 30/03/06 3 OP7 15 4 OP28 18(1a&c) 5 OP36 18(13a&b) Care plans must contain details of the actions needed to care for all the residents’ care and nursing needs. The manager must arrange for further care staff to commence National Vocational Qualifications at level 2 or above, to meet the 50 trained care assistants, requirement All staff must receive regular supervision. (This will usually be on at least 6 occasions each year.) 30/03/06 30/06/06 30/06/06 Highfield Nursing and Residential Home DS0000015401.V272242.R01.S.doc Version 5.0 Page 20 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 2 3 Refer to Standard OP27 OP34 OP36 Good Practice Recommendations The manager should consider reviewing the night staffing numbers and skill mix. Valid insurance certificates should be displayed in a publicly assessable area to allow visitors to review. All staff should have regular appraisals of their work. Highfield Nursing and Residential Home DS0000015401.V272242.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. Extracts may not be used or reproduced without the express permission of CSCI Highfield Nursing and Residential Home DS0000015401.V272242.R01.S.doc Version 5.0 Page 22 - 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!