Inspection on 25/08/09 for Highfield Nursing Home

This inspection was carried out on 25th August 2009.

CQC found this care home to be providing an Adequate service.

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 Home 08/09/08

Highfield Nursing Home 11/09/07

Highfield Nursing Home 07/02/06

Highfield Nursing Home 17/03/05

Highfield Nursing Home 15/07/04

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Highfield Nursing Home Scarthingwell Park Barkston Ash Tadcaster North Yorkshire LS24 9PG Lead Inspector Anne Prankitt Key Unannounced Inspection 25 and 28 August 2009 09:15 DS0000058827.V377218.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highfield Nursing Home Address Scarthingwell Park Barkston Ash Tadcaster North Yorkshire LS24 9PG 01937 557724 01937 557155 highfield@barchester.com www.barchester.com Barchester Healthcare Homes Ltd 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) Mrs Mandy Jane Daniel Care Home 55 Category(ies) of Old age, not falling within any other category registration, with number (55), Physical disability (55) of places Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing, Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following categories: Old Age, not falling within any other category, Code OP - maximum number of places 55 2. Physical Disability, Code PD, maximum number of places 55 The maximum number of service users who can be accommodated is: 55 8th September 2008 Date of last inspection Brief Description of the Service: Barchester Healthcare Ltd own Highfield Care Home. It provides nursing care for older people and for individuals with physical disabilities. The home is located near the village of Barkston Ash, approximately five miles from Tadcaster, in North Yorkshire. It is a two-storey building, set in its own extensive well-maintained grounds, with a view of a lake and wooded areas for people to enjoy. The bedrooms are on both levels, with a vertical passenger lift to aid access. There are parking facilities next to the house. Details provided on 25 August 2009 outline the weekly fees as between £484 and £1200. This does not consider the registered nursing care contribution, which is assessed for each individual and deducted from the fees if applicable. Additional charges are made for hairdressing, and individual items like newspapers and toiletries. A copy of the Statement of Purpose, Service User guide and the latest report written by our predecessor, the Commission for Social Care Inspection, is available at the home for people to read. Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The key inspection included a review of the following information to provide evidence for this report: • • Information that has been received about the home since the last inspection. A self assessment called an Annual Quality Assurance Assessment (AQAA). This assessment told us how the registered manager thinks outcomes are being met for people using the service. It also gave us some numerical information about the service. Comment cards sent to people (six returned), their families (two returned), staff (three returned) and health professionals (three returned) A site visit to the home carried out by one inspector, which lasted for approximately ten and a half hours. • • During the visit to the home, several people who live there, some staff and the registered manager were spoken with. Three people’s care plans were looked in depth, and a fourth to look at some specific information. As well as this, two staff recruitment files, some other staff records, and some records about health and safety were looked at. Time was spent watching people, and how staff interacted with them, to get an idea about what it is like to live at Highfield. The registered manager was available throughout the site visit, and was given feedback at the end. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this inspection report as recommendations – but only where it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the service does well: People are properly assessed before they are admitted. This helps everyone to decide whether Highfield will be the right place for the person to live, and receive the care they need. Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 6 People’s care plans are written in an individual way, which expresses their personal needs and wishes. This helps to make care personal, and right for the person concerned. People say staff are kind, and that they respect them. People get a range of activities which the co-ordinator is trying hard to tailor to their individual needs and interests. They can have their families and friends to visit whenever they wish, and staff understand that some people may wish to choose when they do and do not want to have visitors. People have pleasant dining facilities, and staff organise themselves well so the mealtime experience is not rushed. Staff are getting a range of training to underpin the work they do, and to help make sure that they work in a safe and consistent way. There are a range of ways in which people’s views are collected. This information is important when deciding how the home should be run in their best interests. The premises is kept maintained so people can be assured that they live in a safe environment. What has improved since the last inspection? What they could do better: Information about people, including risks to them, could be given further consideration when deciding how these needs and risks can best be supported. And people’s daily records could be written in more detail, so they are more personal to them. Some improvements could be made to the way that medication is stored and audited to that risk to people is kept to a minimum. Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 7 When complaints or allegations are made, these could be managed better, so that people can be assured that their concerns and welfare is taken seriously. The staffing levels could be reviewed to make sure that staff are available at the right time, and in the right numbers, so people living in the home, and staff, can be assured that everyone will receive their care in a timely way. The availability of hoisting equipment could be reviewed, to satisfy that there is sufficient available, in the right place, when it is needed. Work could be done to improve staff accountability at the home, and clarity of roles. This could include better formal supervision arrangements, so that identified issues can be reflected upon and monitored during the course of each individual’s employment. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 8 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 Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People using the service experience good quality outcomes in this area. People are properly assessed before they are admitted. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: When people are first referred to the home, the registered manager or another senior staff member visits them, and completes a written assessment after speaking to them and their families about their current needs. She also gets information from other professionals who have already played a part in the person’s care. For instance, from the person’s care manager, or hospital staff. She uses all of this information to decide whether the home has the resources to meet the person’s needs successfully. Those assessments seen were good, because sufficient information had been collected about current needs, any equipment required, and any risk to the person. This sort of information helps staff who are caring for the person to get this care right as soon as the admission takes place. Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 10 As part of the assessment visit, people are given written information about Highfield. Although they are also invited to look round the home before deciding whether they want to live there, the written information gives those who are unable to do so, the opportunity to see what the home provides. This helps people to also decide whether it will be suitable for them. Five out of six people who returned their surveys said they got enough information to help them to decide whether Highfield was the right place for them. One person could not remember. The home does not provide intermediate care. It does however provide respite care, where people are admitted for a short break. Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People using the service experience good quality outcomes in this area. People are happy with their care, and their care plans reflect their needs. Some areas of risk need further attention so they are managed better. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Following admission, staff completed an information sheet, where people’s needs are looked at in further detail, and more information gathered about how they would like these needs to be met. Information about professionals who already support them is also noted, so staff are aware from the outset who is involved in the person’s care. An initial assessment is then completed which looks at people’s physical, social and mental health needs. All of this information is used when staff begin to complete the care plans. People and/or their families had been involved in the subsequent upkeep of the care plans, and had signed them to show that they had agreed the content. Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 12 One person’s assessment explained about their long term emotional needs. This information had been included in the care plan, but the way staff should support this person was not discussed. Further detail in the care plan would help staff to support the person consistently and sensitively. The care plans seen though, generally contained good information, and matched with the verbal accounts given by staff about the support they give to people each day. Staff had written down people’s needs in a very personal and individual way. This made the plans very interesting to read, and a good tool to help staff to understand how people like to get their care. For instance, one plan said ‘likes the clock to face her when she is sitting in the armchair to keep track of the time’, and ‘likes to eat her breakfast in her room sitting in her armchair and in dressing gown’. People’s right to dignified care had not been forgotten when staff explained how their needs were to be met. Risk to people from falls, poor nutrition, moving and handling issues and pressure sores is assessed, and the assessment is reviewed monthly, along with the care plan. A care plan is completed to show what staff must do to reduce the risk for the person concerned. However, there were two occasions where the risk assessment had been completed, but the action taken had not been sufficient to reduce the risk. One issue was around a person who fell regularly. Although further advice had been sought from other health professionals, the falls continue to happen. The manager was advised to ask for advice from the falls assessor. We were advised on the second day that this has now been done. The second was around pressure area care. Although the individual had been assessed before they arrived, a risk assessment completed, and a mattress supplied to reduce the risk from pressure sores, the person had developed further skin problems which had required medical input following admission. Since then a higher specification mattress had been provided. However, staff should make sure they are very clear before people are admitted about the equipment the person is currently using. This way staff can be sure the correct mattress is available for the person when they are admitted. We asked the registered manager to seek further advice from the tissue viability nurse, and have been informed that this has now been done. Staff write daily records to show what care has been provided each day. Entries could have been more personal, and could have reflected better the experiences of the person that day. Comments like ‘Changed wet pad’ or ‘assisted to wash and dress’ does not explain how the person has been supported to maintain their independence, when they have received this support, or how their care has been different from anyone else’s. People spoken with said that staff treat them well, and that they like them. Those who returned their surveys said that they ‘always’ or ‘usually’ get the Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 13 care that they need, and that staff ‘always’ or ‘usually’ listen and act on what they say. When we asked what the home does well, they made comments like ‘Care for patients’, Provide the care I need’, and ‘Most things’. Those people spoken to on the day agreed, and said things like ‘Staff are kind’, ‘It’s nice here – the people are lovely’, ‘I’m very happy here’, and ‘The carers are very good’. Relatives made comments like ‘I have no issues with the care here’, ‘The care here is good’, ‘Treats each resident for their wide ranging individual needs. Always friendly, attentive and caring’, ‘Provide the care on a good level’. One said the home has provided an excellent service in helping through the transition from independent living to supported living. Health professionals made comments like ‘Highfield aims for a good level of comfort. This is largely achieved’, ‘Provide good support for my customer’, and ‘Staff know the residents and make you feel welcome when visiting’. Staff look after everyone’s medication because it has been decided that people are not able to do so themselves. The medication is stored in three areas of the home. Trained staff administer it. The systems were generally well managed, and medication kept in the treatment rooms was being stored appropriately. Care staff apply prescribed creams for people as they help them with their personal care. Because of this, the creams are stored in the person’s room, but not securely. Staff were asked to lock these creams away, so that people who may enter the room do not have access to substances which may cause them harm. It is also the case that the care staff who applies these creams, is not the same person who signs to say they have been used. The nurse does this instead. This practice should change. Whoever applies the cream should be the person who signs to confirm they have done so. The registered manager told us on the second site visit that this has been addressed. The record of stock balance of three separate medications did not tally with the number left when these were counted. This suggests that staff do not count the tablets each time this record is made. They need to be more thorough when carrying out this audit. This will make it easier for the registered manager to track back errors, and address this with the staff member concerned. Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People using the service experience good quality outcomes in this area. Care is taken to meet people’s social needs, and to encourage links with those who are important to them. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There is an activities person employed at the home who has worked there for a number of years in different capacities. This has allowed him to get to know the people living there very well. He explained how he refers to people’s care plans regularly. He looks at their previous life history when planning with them what interests or activities they would like to do now. He explained how he considers the needs of people who cannot, or do not wish to, join in the group activities. He has also tried to anticipate the social needs of those who are no longer able to express these, and has thought of ways to make their days more fulfilled and interesting. He has devised a range of group activities which are advertised. This allows people to see in advance what is available for them to attend. The activities included dominoes, music, flower arranging, regular visits from the hairdresser and also weekly trips out. Clergy visit the home, and there is a Roman Catholic Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 15 church in the grounds, which people of all denominations are welcome to attend. One person living at the home does so every week, as it has been recognised that this is an important part of their life. People on the day said there was usually something to do. One said ‘We go on shopping trips on the bus’. They said they liked this. Of those who returned their surveys, five out of six people agreed that there were ‘always’ activities for them to join in. The sixth said this was ‘usually’ the case. On the afternoon of the site visit, people attended a ‘Resident’s meeting’, which the registered manager also attended. People can have their visitors whenever they choose. One visitor spoken with explained that they come and have lunch there every day, and that it is like ‘hotel service’. One person’s care plan explained how they liked to be informed before they receive visitors, so they can decide whether or not they wish to see them. This is good, because it shows that people have continued control over this aspect of their life, and shows that their right to privacy is respected. People also said that they could make some choices about when they do things, like when they go to bed, when they get up and where they eat. For instance, one person explained how they have decided they no longer want to eat in the main dining area. This choice has been respected, and they now get their meals served by staff in their room. Staff spoken with said they try very hard to meet people’s choices, despite being very busy. There is a four weekly menu which provides choice. People decide at each mealtime what they want to eat. We were told by the chef that there is a regular delivery of fresh meat, vegetables and fruit delivered. They were satisfied that there is always sufficient food to provide a good nutritious meal. People are provided with drinks in between meals, and sandwiches are provided at supper time. These are not suitable for people who required a soft diet. These people may want something to eat before they go to bed as well as those who can manage sandwiches. This was brought to the attention of the manager, who said that she will look into this further. Entries were seen in someone’s care plan which showed that during the night they had been offered a cup of tea and biscuits, which shows that if people are hungry or thirsty during the night, staff will provide them with a snack and a drink. People appeared to enjoy their meal. The dining room has been refurbished since the last site visit. There is now a hot servery area, so that the temperature of the food remains hot. The tables were very nicely set, and there were plenty of staff to support, discreetly, those who needed help. Staff were organised so that those who eat in their rooms were served and assisted as needed. The majority of those who retuned their surveys said that they ‘always’ or ‘usually’ like the meals. Those on the day said they liked the food, and had no complaints about it. Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience adequate quality outcomes in this area. The management of complaints and safeguarding matters, and the subsequent monitoring of shortfalls in staff practice, needs further serious attention if people are to be assured that they will be protected from harm, and that their complaints will be taken seriously. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Everyone who returned their survey said they knew who to speak to informally if they were not happy. Four out of these six people knew how to make a formal complaint. The relatives who returned their surveys also knew how to complain, and said the home ‘always’ or ‘usually’ responds appropriately. Two health professionals said the home ‘always’ responds appropriately if they raise any concerns. One said this is ‘sometimes’ the case. On the day, people said they felt confident that, if they complained to the registered manager, their concerns would be looked into. One said they would ‘go to staff’ if they had any problems. And a relative said they ‘would complain to Mandy (the registered manager)’. They continued ‘She’s very good’. Although none of these people said they had needed to raise any concerns. There have, however, been five written complaints made direct to the home in the last year. The registered manager had told us that four of these were Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 17 upheld. The complaints records gave insufficient information to show what had been done in response to each complaint. In one complaint around care, the registered manager had reported that, following discussion, the complainant was happy with the outcome. However, it was not clear what investigation had taken place, what the outcome was, and what action had been taken as a result. In another, about poor communication between staff who had not followed written instructions, there was insufficient information to tell what the issue was about, and the registered manager had trouble recalling the detail of the actual complaint. This makes it difficult, when monitoring complaints, to learn from past mistakes. In the third, about staff attitude, there was insufficient investigation done to follow up information collected within statements. There were no written supervision notes to show whether staff involved had been questioned, or that their practice had been monitored by the registered manager, to whom the complaint had been passed to for completion. And there was no record as to whether the person making the complaint was now satisfied with the outcome. The final two more recent complaints were recorded more thoroughly, and it was possible to see what had been done by the home to resolve these, and how this information had been fed back to the complainant. There have also been meetings between the home, the local authority and the commission, to discuss some serious safeguarding matters reported about the home within the last year. The reports, made by the area manager when she visits each month, showed that safeguarding matters are discussed during these visits. This is good practice, because the way the home has handled such issues in the past has not been satisfactory. Although the most recent investigation is completed, this inspection evidenced that the registered manager has not been proactive in moving the staff team forward, and in completing tasks discussed within these meetings, so that improvements are made and maintained. For instance: • The registered manager was told during the investigation that we would expect to see that staff, who had not checked supervision records which they had been instructed to do, had been supervised, and reminded about the seriousness of their responsibilities. This has not been done, although she said she has spoken to staff as a group. The registered manager could not find the records concerning an investigation that the safeguarding team had asked her to complete, although she said she had done this. This means we could not confirm that the matter has been properly addressed, and how it will be monitored in the future. She said on the second visit that these had been DS0000058827.V377218.R01.S.doc Version 5.2 Page 18 • Highfield Nursing Home • found. However, information like this should be readily available to refer to. There had been a delay of a month in sending off information to the body who decides whether care staff can continue to work with vulnerable people. On the day of the site visit the registered manager said she would get this done. We were told at the second site visit that this had now been done. We spoke to some staff, who were very clear about their responsibilities in reporting to the manager concerns, allegations, or wherever they believe a person living at the home has been abused. They all knew that they could not keep secrets, and that they must pass on any information without delay. They all knew about the role of the local authority, who they have been given contact numbers for so they can phone them direct, if for any reason they do not want to go to a more senior member of the company with their concerns. Evidence suggests though, that since the last site visit, but before the most recent events, information passed to the management has not been referred to the local authority for investigation by them. And concerns were raised that some staff were worried that information or concerns they passed on got ‘leaked’. A comment was made that this could stop staff from reporting things. Senior staff must take their responsibilities seriously, and must be very clear that they must, without fail, pass on all safeguarding information to the local authority for investigation, and must support staff who pass on information to them. In summary, failure by senior staff in being proactive when staff pass on information, in keeping good records, and in following up individual issues with staff, increases the risk of complaints and safeguarding matters not being treated by the staff team with the seriousness they require, and does not keep people protected from abuse. A more recent event show that the registered manager is better now at recognising what constitutes abuse, and that she reports these incidents more quickly to the local authority. This will help to protect people. However, everyone needs assurance that if they make a complaint, they will be listened to, and that their concerns will be taken seriously. The registered manager and her team of senior staff need to manage this better in the future. And staff need to know, through the actions taken by senior staff, that, in order to assure good, safe care, shortfalls in staff practice will be taken seriously and monitored closely. Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,22 and 26 People using the service experience good quality outcomes in this area. The environment is clean and warm, and is satisfactory to meet people’s needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The premises are situated in well tended grounds in a rural area. The accommodation is provided on two floors. A passenger lift or stair lift provides access to the first floor for ease of access. Some redecoration and refurbishment has taken place since the key inspection last year. The dining and sitting areas have been swapped round. There is now a large, newly decorated dining area which provides enough seating for everyone who lives there. On the ground floor there are now two sitting areas situated next to each other. Again, these had been decorated, and new furnishings had been Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 20 provided. A small number of people sat in these areas. However, many people remained in their rooms in between meals. From a further hallway used as a sitting area, there is a patio provided with seating for people. This had been decorated with flowers which we were told that the people living there had planted. On the first floor there is a further large sitting area off which bedrooms, a nurses’ room and other storage rooms are situated. People have a choice of bathing facilities, including assisted baths and a ‘wheel in’ shower room. Communal toilets are available around the home, and on the day of the site visit they were provided with plenty of toilet paper, soap and hand drying facilities to reduce the risk from cross infection. The home looked clean, and there were no unpleasant smells. People who returned their surveys said that this was ‘always’ or ‘usually’ the case. Three comments were made that people’s bedrooms could sometimes be very warm. The registered manager needs to monitor this, to make sure that they remain comfortable for the person who accommodates the rooms. Since the last inspection, a number of radiators have been covered to protect people from the risk of burns caused by hot surfaces. There is a programme in place to provide bedroom doors with locks, to allow people to lock their room should they wish to do so. This means that no one can enter the room unless the occupant wishes them to. Some of the corridors are very narrow. Staff have to consider this when moving equipment round. Comments were made that more hoisting equipment would ease problems when people wanted help at similar times to move. The registered manager believes there is sufficient equipment. A comment was also made that more wheelchairs would be useful, especially when some of these were taken out with people on the weekly bus trips. The registered manager should check whether any improvements could be made to the way the equipment is allocated so it is easier to access, or whether more is needed. The rooms of the people whose care was tracked were looked at with their permission. People said they liked their room, which contained some of their own belongings. This helps people feel more ‘at home’. People had access to a call bell, which could be removed from the wall and placed next to the person when they were not in bed. This means that they can attract the attention of staff more easily if they need help. The laundry facilities are separate to where food is prepared. Linen is sorted before it is collected for laundering, so anything which needs to be handled with care is kept separate. Staff working there were supplied with gloves and aprons. The laundress had received training in infection control. These measures help to reduce the risk from cross infection. People’s clothes looked nicely cared for, and there were no complaints at this inspection to suggest that their clothes were not handled with care, and returned to the person they belong to once laundered. Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People using the service experience adequate quality outcomes in this area. Further work is required to make sure that the staffing provided is sufficient to meet people’s needs. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The staff numbers are adjusted as the number and dependency of people living at Highfield changes. People who returned their surveys said that staff were ‘always’ or ‘usually’ available when they were needed. Staff thought that there could be more of them. In their surveys, all but one, who answered ‘never’, said there were only ‘sometimes’ enough staff to meet people’s needs. When asked what the home could do better, they made comments like ‘I think sometimes there could be more staff in order for residents to have more one to one time with their care worker’, and ‘Employ more staff as we haven’t enough time to spend with residents’, and ‘We don’t have enough staff and we have not enough time to do quality care in the morning shift’. Staff spoken with on the day said they have raised these matters with the management, but felt that the response they received, that there were sufficient staff, did not always satisfy them that their views were taken seriously. Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 22 On the day, people said things like ‘Staff are kind, but there aren’t enough of them’, ‘The staff are nice, but we need more – they’re getting rushed. When we want to go to bed we have to wait for staff – it’s sometimes a long wait’. Someone else commented that on a morning ‘the buzzer is non stop’. Two people spoke more positively. One said they ‘don’t have to wait too long’ before their call bell is answered, whilst another person said there were ‘enough staff’ for them. On the day of the site visit, staff did appear busy, and didn’t have a great deal of time to spend with people, other than when they were providing care. Staff said they try to remain flexible so that people can still receive the care they need when they want it, although said this was sometimes difficult to achieve. Visiting professional’s views about whether staff had the right skills and experience to support people’s social and health care needs differed. One said this was ‘always’ the case, one answered ‘usually’, and one ‘sometimes’. A comment was made that there were often too few nurses, and that the communication and knowledge of modern expectations was sometimes not good. The records showed that new staff are thoroughly vetted before they are allowed to provide care to people. This is good, because it protects people from unsuitable workers. Staff spoken with, and those who returned their surveys, said that they had a good induction. This means that they are not expected to provide care until the feel confident and safe to do so. Staff currently completing their induction keep their paperwork with them, but there was evidence to show how a long standing staff member had gone through this process. Following on from induction, care staff are encouraged to complete National Vocational Qualifications in care. There is a rolling programme in place so that this is achieved across the care staff. As well as compulsory training, other training is also provided, such as customer care, and person centred care. Training was organised to help staff understand nutritional people’s nutritional needs. We were told that some of the training staff do is completed on the computer, and that they need to do this in their own time. As there is only one computer for their use, they found this difficult sometimes, and that those less familiar with the computer found this more difficult. Trained staff also get opportunities to update their skills, and to maintain their qualification. One explained that they have completed a course to help them understand the needs of people with multiple sclerosis. Staff have link role responsibilities, so they can pass on their expertise to others. The staff member spoken with was due to attend a course about managing continence. They have also received training in stoma care, and the use of air mattresses. Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 23 The registered manager said in their Annual Quality Assurance Assessment that ‘Staffing is monitored and adjusted according to the numbers and dependency level. When staff expressed a difficulty in working, particularly on a morning shift with odd numbers of staff as many service users need two to attend to their cares – this was addressed by increasing the number of staff to enable working in pairs’. The comments about staffing as part of this key inspection reflect that further work is needed to make sure that there are sufficient staff to provide individualised care. It must be reviewed further. Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 People using the service experience adequate quality outcomes in this area. The management systems need to be strengthened so that people and staff know that the home is being run in the best interests of those who live there. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager has worked at Highfield Nursing Home for eleven years. She is registered with the commission, and has completed a management award to underpin her skills. Positive comments made about her input were ‘We get plenty of support from the manager’, that she ‘always has an open door’, and ‘Good support from the management’. However, less positive comments were also made, like ‘Things can be flagged up to the management then we don’t always get feedback’, ‘Sometimes you feel like you’re not getting backup from Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 25 the manager’, and ‘The manager could walk round each morning to check that residents and carers are OK’ From general evidence gathered during this key inspection, it appears that more could be done to establish and maintain clear lines of accountability at the home. Systems established by the registered manager are not always maintained in her absence, and staff are not completely confident that matters concerning them about how the home runs are taken seriously and acted upon. This could cause staff to lose faith in the management, which could, in turn, have detrimental effects on how the home runs in people’s best interests. More structured supervision may assist in this being achieved. Currently, nursing staff have only group supervision, and notes from those individual supervision sessions held with care staff are not kept. This makes it more difficult to reflect on what has been discussed, and what staff and their supervisor have signed up to at each session. This means that issues raised by either party about work practice may get ‘lost’, because they have not been written down. Members of the company that owns the home carry out regular audits to check that standards do not fall. A written report is provided by the Regional Operations Manager, which show what has been done as part of their monthly visit, whether they have spoken to staff and people living there, and what has been checked as part of the visit. The manager keeps a copy of this report to refer to. The views of people, their families, staff, and health professionals visiting the home are also collected annually, to see what they think the home does well, and where it could improve. At the point of this inspection, the registered manager was waiting for the results from head office following the return of the most recent surveys. So the results of this, which will be published, were not yet available. Meetings are held for people at the home in between, so their views can be sought more informally. All of this information will help decide whether any changes need to be made based on people’s views. The home does not handle people’s money, although locked facilities are provided in bedrooms should they wish to manage their own. Information provided by the registered by the registered manager, and records seen on the day of the site visit, showed that the building is kept safe. Action is being taken to meet the requirements made by the fire officer at his recent visit. And the kitchen staff keep records to show that this area is monitored to make sure that food is being stored and served appropriately. Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 26 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 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 3 X X 3 X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 3 Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 27 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 15 Requirement Timescale for action 30/09/09 2 OP8 13 3 OP9 13 4 OP16 17 (Schedule 4) Care must be taken to make sure that the care plan includes information about how staff should support people’s emotional needs. This will make sure that support in this area of their care is not forgotten. The right advice must be sought, 30/09/09 and the right equipment obtained, where people are identified as being at risk, or where action already taken to reduce risk has been unsuccessful. This will help to keep the risk to these people minimised. Medication must be stored 28/08/09 securely, so that people do not have access to substances which may cause them harm. Records about complaints must 28/08/09 give more detail to include the details of the complaint, the investigation, the outcome, the action taken where shortfalls are identified, and whether or not the complainant was satisfied with the response. This will make it easier to identify trends of DS0000058827.V377218.R01.S.doc Version 5.2 Highfield Nursing Home Page 28 5 OP18 13 dissatisfaction, and will also assure people that their complaints and welfare have been taken seriously, and lessons learnt. Safeguarding Adults referrals must be made in line with North Yorkshire Social Services Guidelines so that people are protected from harm. The commission must be notified of any event, which affects the well being or safety of people living there. Timescale of 11/09/07 not met Prompt and robust action must be taken where the home has been given responsibility to take part in any safeguarding investigation. This so that people are properly protected from abuse by a staff team who understand their responsibilities. The staffing levels at the home must be reviewed, taking into account the views of the people who live there, and also the staff who care for them. This will ensure that the right number of staff are available at the right times, based on their feedback. The lines of accountability must be made clearer regarding the management arrangements at the home, so that people with an interest in the home can be assured that it is well managed at all times, and improvements made in meeting identified shortfalls can be maintained and built upon. 28/08/09 6 OP18 12 28/08/09 7 OP27 18 30/09/09 8 OP31 12 30/09/09 Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 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 2 Refer to Standard OP7 OP9 Good Practice Recommendations More detail should be given in people’s daily records so they give a better picture of when and how people have received their care. The way daily stock checks of medication are performed should be more thorough, so that it is easier to track back errors, and address these with the staff member concerned. People who need a soft diet should be catered for at supper time, so they too can enjoy a snack before they go to bed. A review of the hoisting and wheelchair equipment available should be carried out, and staff consulted, to check that there is sufficient, and that it is located in the right places throughout the home. This will help to make sure that the right equipment is available for people when they need it. Consideration should be given to providing all staff with formal supervision at least six times a year. This would help the create a more common understanding and agreement about: • • • All aspects of practice Philosophy of the care home Career development needs. 3 4 OP15 OP22 5 OP36 Highfield Nursing Home DS0000058827.V377218.R01.S.doc Version 5.2 Page 30 Care Quality Commission Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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