Inspection on 08/08/05 for Highfield Nursing and Residential Home

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 Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Highfield Nursing and... 20/05/08

Highfield Nursing and... 03/05/07

Highfield Nursing and... 29/06/06

Highfield Nursing and... 06/01/06

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 8 August 2005 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 Nursing and Residential Home I56-I05 S15401 Highfield V242490 080805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Highfield Nursing and Residential Home Address Mandeville Road Saffron Walden Essex CB11 4AQ 01799 524936 01799 52611 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) Trongold Limited 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 I56-I05 S15401 Highfield V242490 080805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 Persons of either sex, aged 50 years and over, who require nursing care by reason of a physical disability (not to exceed 3 persons) 2 Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 25 persons) 3 Persons of either sex, aged 65 years and over, who only fall within the category of old age (not to exceed 60 persons) 4 Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 11 persons) 5 The total number of service users accommodated must not exceed 60 persons Date of last inspection 4th January 2005 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 small car park and in the adjacent road. There are 42 single en-suite bedrooms and 9 double bedrooms, of which 8 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 service users access to the garden. Highfield Nursing & Residential Home provides nursing and personal care with accommodation for up to 60 service users. 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 older persons over 65 years who require personal care only. Highfield is privately owned by Tronicgold Ltd. Highfield Nursing and Residential Home I56-I05 S15401 Highfield V242490 080805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took eight hours during August 2005. Twenty-one of the thirtyeight 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, residents and visitors were welcoming and happy to speak to the inspector. During this visit the inspector spoke to six residents; five relatives/ visitors; four staff members including one of the housekeeping staff; two Registered Nurses and two care assistants. The inspector also spent time with the acting manager. Following the inspection survey questionnaires were received from one of the residents and five relatives. Residents and their relatives expressed satisfaction with the care they received and with the quality of the food offered. At the time of this inspection the new manager had only been in post for a few weeks. She had previously been the manager of a home in London. She was aware of the changes needed within the home to meet all the standards. What the service does well: What has improved since the last inspection? 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 I56-I05 S15401 Highfield V242490 080805 Stage 4.doc Version 1.40 Page 6 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 Nursing and Residential Home I56-I05 S15401 Highfield V242490 080805 Stage 4.doc Version 1.40 Page 7 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) 3 & 6 The assessment of prospective residents ensures that their needs can be met by the home. EVIDENCE: The new manager was undertaking all assessments at the time of this inspection using a format that she had developed in a previous post. She demonstrated a good knowledge base and understanding of the needs of prospective residents. She also demonstrated a need to take into consideration the needs of the residents who already live at the home when admitting a new resident. The new manager was also in the process of reassessing all the current residents at the time of this inspection to ensure that they were all correctly placed. Intermediate care is not offered at home. Highfield Nursing and Residential Home I56-I05 S15401 Highfield V242490 080805 Stage 4.doc Version 1.40 Page 8 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, 10 & 11 The indicators examined during this inspection suggested that the residents’ health and personal care needs were well catered for at this home. EVIDENCE: The inspector reviewed three residents care plans during this inspection. The new manager was in the process of reviewing the care plans of the residents as she was reassessing their needs. In conversation it was clear that she was aware of the general quality and content of the plans in the home. 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. One of the files reviewed contained a photograph of the resident that did not represent a current likeness of the resident. The need for bedrails for some residents had not been adequately assessed and other forms of protection had not been tried first. Care plans had not been signed but residents and their relatives had been sent a letter outlining their right to review the files at any time they wished. At the time of this inspection all the residents looked clean and tidy, dressed in age appropriate clothing. Residents and visitors, spoken to all stated that the staff were approachable, helpful and respected resident privacy and choice in all aspects of care. The written induction programmes included a section regarding privacy & dignity. Married couples occupy most of the double rooms Highfield Nursing and Residential Home I56-I05 S15401 Highfield V242490 080805 Stage 4.doc Version 1.40 Page 9 in the home. There is access to either permanent ceiling to floor curtains or mobile screens in all the double rooms. The new manager is planning to put up permanent curtains in all rooms. Policies & procedures regarding terminal care were good and were observed to work well. One of the residents died unexpectedly during this inspection. The staff showed resourcefulness in locating the residents’ relatives and great sensitivity towards them when they arrived at the home. The staff knew who to call and how to make appropriate arrangements. The documenting of funeral arrangements and terminal care wishes had generally improved since the last inspection. Highfield Nursing and Residential Home I56-I05 S15401 Highfield V242490 080805 Stage 4.doc Version 1.40 Page 10 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 & 15 Activities were not varied enough to include all residents wishes, but the choice of meals is good and the food is presented well. EVIDENCE: This home offers various activities throughout the month, a list of which is displayed at various places in the home. Local groups and performers attended the home to contribute various activities. However the minutes of the last residents/relatives meeting held in July showed that it was felt that there was not enough variety of activities particularly within the dementia unit. There was only one part time activities coordinator who concentrates mainly on the dementia unit. Some of the activities were offered for all of the residents and some were specific to the dementia unit. A dedicated activities coordinator would increase the variety of activities and would ensure that they were more individualised. At the time of this inspection the residents told the inspector that they would appreciate more one to one type activities. The documentation of activities undertaken by the residents was generally poor. The residents were offered two hot meals a day with the option of a cooked breakfast as well. Snacks and fluids were available on request and the standard of food was generally high. There was a choice of meals at most meal times but some residents told the inspector that they do not always like the food offered. The care assistants served all meals and helped the residents that needed feeding. However one of the residents who needed help with their meals told the inspector that they often had to wait quite a while to be helped as the care assistants had to serve the meals first. Highfield Nursing and Residential Home I56-I05 S15401 Highfield V242490 080805 Stage 4.doc Version 1.40 Page 11 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) 18 The policies & procedures followed in this home protect the residents from abuse. EVIDENCE: The protection and rights of the residents was observed to be inherent in the way the staff acted. There had been one Protection of Vulnerable Adults incident since the last inspection, handled by the previous acting manager, which had been handled well. There had been a further incident a few days before this inspection that had been handled well by the present acting manager and was sorted out whilst the inspection was being carried out. The new manager is very clear on abuse issues, has a very comprehensive knowledge of the Essex Protection of Vulnerable Adults procedures and her requirements as a manager. Protection of Vulnerable Adults training had been continued; the new manager was planning to extend the scope and up take of the training for all staff. Highfield Nursing and Residential Home I56-I05 S15401 Highfield V242490 080805 Stage 4.doc Version 1.40 Page 12 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, 25 & 26 The overall environment in this home is good and is safe for the residents. EVIDENCE: There had been no changes to the fabric of the building since the last inspection. The home was generally clean and tidy on arrival. The maintenance man was in the process of decorating one of the bedrooms in time for a new admission. The new manager had reviewed and ‘updated’ the list of tasks that the maintenance person was undertaking on a day-to-day basis. The dividing door between the dementia unit and the main home had been maintained securely. Some carpets were in need of replacement and the manager had been in discussion with the proprietors regarding an action plan to deal with this. The grounds were in the process of being trimmed and tidied at the time of this inspection. However the grounds were still accessible by all the residents. The communal areas of the home were varied and well kept. Some areas in the communal areas were in need of repair and redecoration, including the lower doorframes in one of the lounge areas, however the manager was aware Highfield Nursing and Residential Home I56-I05 S15401 Highfield V242490 080805 Stage 4.doc Version 1.40 Page 13 of this. The home is still lacking in storage areas but what there are, are well utilised. The call bell system was functional throughout the home. All decoration and furnishing in the home was domestic in character. Rooms were well supplied with furniture, but there was also evidence that residents had brought in their own furniture and belongings. Some of the window restrictors in the home were in need of repair. (Also on the manager’s list of repairs needed.) At the time of this inspection there were no unpleasant odours. However there was only one domestic on duty who was struggling to keep up with the whole home. The laundry was clean and tidy and running well. Highfield Nursing and Residential Home I56-I05 S15401 Highfield V242490 080805 Stage 4.doc Version 1.40 Page 14 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 Staffing numbers were in need of review in respect of the dependency of the residents. EVIDENCE: The current staff rosters showed staffing at agreed levels, but there is a need to review these levels. As stated earlier the manager is reassessing the existing residents, as part of the assessments she is already reviewing the staffing numbers and skill mix on each shift. She is expecting to recruit more staff at all levels over the next few months. The manager and inspector discussed the needs of the service in line with the various recommendations as discussed in other National Minimum Standards. There is a need to increase the domestic staff and consideration of the employment of extra Housekeeping staff to help with serving of meals. Four of the relatives survey forms returned and the residents’ form returned to the Commission for Social Care Inspection, following this visit, mentioned the general shortage of staff available in the communal areas. Visitors spoken to at the time of this inspection felt that the dependencies of the residents had increased which meant that the staff were “more stretched, than they have been in the past.” At the time of this inspection none of the care assistants in post had completed National Vocational Qualifications. However the new manager is an assessor for the qualifications, which will increase the levels of trained care assistants in the future. The manager discussed the problem of a number of care staff who do not wish to undertake National Vocational Qualifications at either level. We discussed ways of improving care staff motivation to undertake this further training. She will look at this with the care staff as a group and on an individual basis. At the time of this inspection there were no agency staff being utilised at the home. The manager was aware of the need to acquire Highfield Nursing and Residential Home I56-I05 S15401 Highfield V242490 080805 Stage 4.doc Version 1.40 Page 15 adequate/complete documentation regarding any agency staff who are used within the home. Three personnel files were reviewed during this inspection. They were all complete and had been rearranged into a more user friendly order. The general layout and content was much improved since the last inspection. The Criminal Records Bureau declarations had been filed alphabetically in a separate file and the inspector signed all the original declarations available on the day. The hairdresser, chiropodist and entertainers had undertaken Criminal Records Bureau checks. Nursing & Midwifery Council registrations were checked a minimum of every three months. There were no volunteers at the home at the time of this visit, but the manager intended to actively recruit some. She was fully aware that she needed to recruit the volunteers to the same level as the permanent staff. Highfield Nursing and Residential Home I56-I05 S15401 Highfield V242490 080805 Stage 4.doc Version 1.40 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 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 & 32 The management and administration of the home was good, protecting the needs of the residents. EVIDENCE: The new manager had previously been a manager of a 60 bedded home in South Essex, for five and a half years. She is a registered nurse, National Vocational Qualification assessor and has a number of relevant post basic qualifications. She has also completed the Registered Managers Award at National Vocational Qualification level 4. The inspector reviewed her portfolio during this visit. The manager was looking to change the management structure in the home that would distribute the workloads more evenly. The present structure is clear to the staff. The staff spoken were very happy with the “stability that the new manager has brought to the home.” One registered nurse stated that “the last six months without a permanent manager has been very stressful. The new manager is very good. She keeps us informed about what is going on in the home and within the company as a whole. She’s very open, which is refreshing.” The Highfield Nursing and Residential Home I56-I05 S15401 Highfield V242490 080805 Stage 4.doc Version 1.40 Page 17 manager herself has some excellent ideas to take the service forward. She has initiated more frequent staff, resident and relatives meetings. She has an ‘open door’ policy for everyone. Highfield Nursing and Residential Home I56-I05 S15401 Highfield V242490 080805 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 1 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 3 3 x x x x x x Highfield Nursing and Residential Home I56-I05 S15401 Highfield V242490 080805 Stage 4.doc Version 1.40 Page 19 No 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 13(4c) Requirement Timescale for action 31st December 2005 31st December 2005 31st December 2005 31st December 2005 2. 3. OP12 OP27 4. OP28 The care plans must contain appropriate risk assessments to ensure the safety of the residents. 16(2m-n), The choice of activites offered in the home must be increased and coordinated. 18(1a) An increase in domestic hours throughout the home is needed to ensure good levels of cleanliness and hygiege are maintained. 18(1a) The registered manager must supply the Commission for Social Care Inspection with an action plan detailing how the 50 requirement for this standard is to be achieved. 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. Refer to Standard OP7 OP12 Good Practice Recommendations Care plans should be reviewed every month and appropriate changes made. The registered person should consider increasing the I56-I05 S15401 Highfield V242490 080805 Stage 4.doc Version 1.40 Page 20 Highfield Nursing and Residential Home 3. 4. OP12 OP27 amount of activities hours generally available in the home. (This is a repeat recommendation.) The documentation and evaluation of activites undertaken should be improved. Consideration should be given to employing extra housekeeping staff during meal times to enable the care staff to consentrate on helping the less able residents to eat. 5. Highfield Nursing and Residential Home I56-I05 S15401 Highfield V242490 080805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection 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 I56-I05 S15401 Highfield V242490 080805 Stage 4.doc Version 1.40 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. 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