CARE HOMES FOR OLDER PEOPLE
Highfield Nursing Home Highfield Nursing Home 36-38 Bromley Road Catford London SE6 2TP Lead Inspector
Rossella Volpi Unannounced Inspection 26 August 2005 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 Home DS0000007027.V251631.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 Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Highfield Nursing Home Address Highfield Nursing Home 36-38 Bromley Road Catford London SE6 2TP 020 8488 3970 020 8488 3970 lorna.lang@excelcareholdings.com 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) Excelcare Holdings Ms Grace Ebun Ale-Olurin Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 45 patients, frail elderly persons aged 60 years and above (female) and 65 years and above (male) 23rd March 2005 Date of last inspection Brief Description of the Service: Highfield is a care home with nursing for a maximum of 40 older service users, who are physically frail. The overall stated aim, shared with other homes run by the same provider, is that of offering care in a home from home setting, recognising and meeting individual needs. To this end, Highfield says that they strive to offer sensitive and conscientious nursing and personal care, in a comfortable and safe environment. The home aims to deliver a service based on a thorough assessment of needs, in collaboration with the appropriate health professionals and involving the users and their families. Recruitment and training would be targeted to ensure that staff are competent and committed. The registered provider is Highfield Healthcare, a company associated to an organisation called ‘Excelcare’, who runs over thirty homes in England. A director, to whom all the staff are ultimately accountable, directs the service. The day-to-day running of the home is delegated to a care manager, who works full time at the home and who leads a team of staff. Accommodation is provided in a large building, divided into three smaller units, one on each floor. There is a lift. Bathrooms and toilets are located on each floor. None of the bedrooms have en-suite facilities. Over 50 of places had been in shared (double) bedrooms, but this is changing with double rooms being used as single when vacancies arise. There is a large back garden, mostly laid to lawn, with raised flowerbeds and a rockery. The front of the premises is paved to allow parking for visitors and staff. The front and back doors are accessible to people in wheelchairs, with ramps being provided to enable access to the garden. The premises are located on a main road close to the centre of Catford. The area is served by public transport and has a selection of shops and a supermarket. Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and included a day visit conducted in August 2005. The inspection included discussion with residents, one relative, the home’s manager, the regional manager, other members of staff, a tour of the premises, inspection of records and general observations. After the inspection, but before this report was drafted, a serious allegation was made by a resident against staff. The appropriate authorities are conducting an investigation under the adult protection procedures and the outcome is not yet known. What the service does well:
The comments received during the inspection from the residents interviewed were positive about the care and support that staff at the home provided. For example residents said that they were treated well, that they felt safe, that they could speak to the manager about any concern, confident that she would address them, that they liked living at the home. Comments from a relative, who was at the home during the inspection and from staff also confirmed that what residents said was representative of the experiences of the residents (as had been related to them or from their observations). Two staff said that if their mother were to live in a care home, they would be happy for her to come to Highfield. The home recognised the importance of a full assessment of needs by the relevant professionals before admission, to ensure that the home could meet the identified care needs of people coming to live at Highfield. Prospective residents were able to visit the home and spend sometime there, so that they could assess the facilities and the service provided. Contact with family and friends was supported by the home and this enabled residents to maintain personal and family relationships. There was a complaints’ procedure. Residents and a relative were aware of the procedure and said that they would feel able to raise concerns with the manager. Two residents commented that they appreciated that the manager went around the home and spoke to all the residents daily (and often twice per day), asked how things were and encouraged them to make suggestions. Care plans addressed health needs and discussion with staff, managers and residents gave evidence that residents’ health was monitored and they had access to a range of appropriate healthcare. Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 6 Residents could exercise their right of access to their records and information kept about them by the home. Individual records were kept secure in locked cabinets. The home was clean and well maintained. Efforts had been made to support residents to personalise their rooms. What has improved since the last inspection? What they could do better:
Although care needs were assessed, care plans and reviews concentrated on physical and health care. They needed to better address social, emotional and cultural needs and contribute to the enhancement of choice and participation. Although staff were committed to promoting residents’ privacy and dignity, the premises were not always supporting staff in fully achieving their aims. The home had a large number of double bedrooms. There were curtains to screen the areas around the two beds from each other, to enable some privacy. In some cases doing so would result in residents no longer being able to see out of the window and in having daylight substantially reduced. There was not always an appropriate way to ensure privacy when using hand washbasins. Residents needing commodes had been sharing rooms, even though there were no means to ensure privacy at all times when the commode was being used. All the above was raised at the September 2004 inspection, but the response from the provider did not satisfactorily address the issues. However, in response to the placing authority’s recent stipulation, that they would expect single rooms only, the provider assured that they would be converting double rooms to single occupancy, as vacancies arise. Although food was satisfactory regarding quality and quantity, it was not always tailored to the cultural needs and preferences of all the residents.
Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 7 The facilities for staff were unsuitable and not conducive to staff being able to properly relax during their breaks. This was a serious issue, especially considering that some of the staff worked long hours in a very demanding job, many care workers had limited experience, were still largely unqualified and, as many care staff were paid minimum wages, supposedly quite junior. Although there was no evidence to demonstrate that this had directly affected the service, this and similarly related issues could render the adult protection safeguards less effective in any home and could affect care practices if not addressed. This would be because the quality of care that can be offered is influenced by the calibre and expertise of the staff team, the support they receive and the resources available. Furthermore there had been a high turnover of managers, with three home managers and two of their direct supervisors having changed in the past 12 months. 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 Home DS0000007027.V251631.R01.S.doc Version 5.0 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 DS0000007027.V251631.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5 (standard 6 is not applicable) The home recognised the importance of a full assessment of needs by the relevant professionals before admission, to ensure that the identified care needs of residents could be met. Prospective residents were able to visit the home and spend sometime there, so that they could assess the facilities and the service provided. EVIDENCE: Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 10 Residents interviewed were satisfied about the care and support that staff at the home provided. Residents referred by the local social services department had been admitted following a care assessment, which had been made available to the home. In addition, the manager said that she or a senior member of staff would visit prospective short-term residents, to assess their care requirements and ensure that the home would have the resources to meet them. This information was then translated into care plans following their admission. For longer-term admissions, the manager’s assessment would start usually by discussing needs and expectations at the introductory visits, arranged after the care assessment would have been received. The five care files seen contained an assessment of needs. At the previous inspection a requirement was imposed regarding the information given to prospective and actual residents. The home had started to work on this and a draft statement of purpose was submitted to CSCI soon after the inspection. This will need to be discussed with the home at a future occasion, before a proper assessment can be made, so that consistency with how the home operates, with the service users’ guide and associated policies can be ascertained. It was noted that overall the managers had been addressing the matters previously pointed out and therefore the requirement is not imposed again, pending a fuller assessment. Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10 Care needs were assessed, but care plans and reviews concentrated on physical and health care. They needed to better address social, emotional and cultural needs and contribute to the enhancement of choice and participation. Staff were committed to promoting residents’ privacy and dignity, but the premises were not always supporting staff in fully achieving their aims. EVIDENCE: At this inspection, the files for two residents who had been staying for a shortterm placements were looked at. There was evidence of a comprehensive assessment that provided the basis for the care to be delivered. This included a risk assessment. The manager said that all care plans had been drawn with the involvement of the resident or their representative. Three longer-term care plans were looked at. The manager assured that the home was working towards making care planning holistic, consistently with the principles of person centred care. (This was following recommendations made to the provider at previous inspections of other homes run by the organisation). The managers discussed how they were approaching this and the training they would be making available to the staff, in the near future, in collaboration with external specialists.
Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 12 The main issues were that the information on the care plans and reviews related mainly to physical needs, rather than giving a holistic picture, with equal emphasis to emotional, cultural and spiritual needs. Guidelines were to be drawn for staff supporting residents to achieve their goals. Responsibilities of individual staff and the way to support residents were not clear. Therefore needs could be overlooked and other priorities of work might result in residents not receiving the support consistently on a daily basis. The manager explained that her priority had been to train staff again in care practices and to ensure that they would understand the reasons for what was expected of them, to enhance professionalism. That would then lead to a review of care planning and of how to assess, with the individual residents, the effectiveness of the support. It was discussed that for holistic care planning and reviews to be fully operational, the time scale proposed of six months may not be sufficient, but that at least some positive changes should be noticeable by then. The time scale would then be reviewed and extended if necessary. Discussion with staff, managers and residents confirmed that residents’ health was monitored and they had access to a range of appropriate healthcare. At previous inspections reference was made to the high number of residents admitted to hospital. The home was required to conduct a review of the reasons for admission with an assessment of whether the accidents could have been avoided. The managers gave evidence that such assessments had been conducted regularly, particularly in relation to falls. Advice from appropriate specialists regarding falls had been sought and the incidence of falls had been reduced. Comments from the residents, relative and staff indicated that staff were committed to promote residents’ privacy and dignity. The managers spoke of their high expectations of staff in this area and of the monitoring and support they gave staff to ensure that they could, in turn, support the residents appropriately. As stated in the previous report, the premises were not always supporting staff in fully achieving their aims and did not ensure that this standard could be consistently met. The home had a large number of double bedrooms. There were curtains to screen the areas around the two beds from each other, to enable some privacy. In some cases doing so would result in resident no longer being able to see out of the window and in having daylight substantially reduced. There was not always an appropriate way to ensure privacy when using hand washbasins. Residents needing commodes had been sharing rooms, even though there were no means to ensure privacy at all times when the commode was being used. All the above was raised at the September 2004 inspection, but the response from the provider did not satisfactorily address the issues. However, since then, in response to the placing authority’s stipulation that they would expect
Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 13 single rooms for residents placed there, the provider agreed to convert double rooms to single occupancy, as vacancies arise. After the inspection, but before this report was drafted, a serious allegation was made by a resident against staff, which was directly relevant to privacy and dignity. The appropriate authorities are conducting an investigation under the adult protection procedures and the outcome is not yet known. Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 15 Contact with family and friends was supported by the home and this enabled residents to maintain personal and family relationships. Food was satisfactory regarding quality and quantity, but was not always tailored to the cultural needs and preferences of all the residents. EVIDENCE: Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 15 Residents were able to have visitors as and when they wanted. The home encouraged and supported links with family and friends, unless it was a choice of the resident not to see particular people. (All the residents with whom this was discussed during the inspection, a visiting relative and staff confirmed this). The home operated a four-week menu, which included at least two cooked meals a day. Hot and cold drinks and snack meals were available as required. There was a choice of food each day. Comments from residents, a relative and staff generally indicated that residents found the food satisfactory regarding quality, presentation and quantity, but that cultural preferences were not satisfactorily met. In particular it was raised that African Caribbean food was not provided on a daily basis and some residents had to rely on relatives bringing that from home. It was pointed out that some residents did not have relatives who could visit often enough to bring the food. Residents and the relative also said that as the home stated that it offered a home from home service, they would have expected better provision to be made for African Caribbean residents, regarding their food. Residents clarified that when African Caribbean food was provided (usually at week-ends) it was good, but they would have wanted to have it on a daily basis and not just occasionally. They pointed out that Highfield was their permanent home and their meals there their main source of food. This was discussed with the managers during the inspection who agreed to act on the comments received. At the inspection of September 2004, a resident had suggested that fruit was not freely available and that such had implications for fully meeting dietary needs. At this inspection residents confirmed that fruit was freely available. Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 Residents felt safe at the home and able to speak to the manager, so that they could feel confident that their views would be taken seriously. The effectiveness of the complaint and adult protection procedures needed to be closely monitored by the provider to ensure that they would not be weakened by other shortfalls in the service, which could impinge on protection. EVIDENCE: There was a complaints’ procedure, which, the managers said, had been discussed with residents and their representatives. Residents and the relative (with whom this was discussed during the inspection) were aware of the complaints’ procedure. They said that they would feel able to raise concerns with the manager and were confident that she would address them. Two residents said that they appreciated that the manager went around the home and spoke to all the residents daily (and often twice per day), asked how things were and encouraged them to make suggestions or comments. The home had an agreement with Age Concern to provide advocacy to residents. A serious concern had been raised, during the past year, by relatives of a former resident regarding care. This was investigated by the placing authority and, the managers said, was found to be unsubstantiated. The managers did not know whether the relatives accepted that or whether they would explore other avenues. Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 17 The supporter of a resident at the home has been raising some dissatisfactions (and informed CSCI of their concerns). This was discussed with the managers during the inspection. They assured of their commitment to work with the supporter to address concerns, including those relating to delays in responding or to some explanations / answers given by the home, which the complainant considered to be insufficient or inconsistent at times. The above issues, if not resolved, may affect the assessment of the standard regarding complaints, which is at present considered met. Residents said that they felt safe at the home. The relative and staff interviewed also confirmed that. The home had policies and procedures on dealing with suspected abuse and liaised closely with Lewisham Social Services, to whom any allegation would be immediately referred. Procedures regarding residents’ money precluded staff from assisting in or benefiting from a resident’s will. The standard on protection is therefore considered met. However the provider needed to consider that the effectiveness of any adult protection policy (and of the quality of care that can be offered) is also closely influenced by the calibre and expertise of the staff team, the support they receive and the resources available. As mentioned in the report, aspects of the premises did not fully support staff in promoting dignity and privacy. There had been a high turnover of managers, with three home managers and two of their direct supervisors having changed in the past 12 months. The provider had invested in training, but the care staff were mostly still unqualified. Furthermore they worked long hours in a very demanding job, yet the staff facilities did not provide a suitable environment for relaxation during their breaks. Although there was no evidence to demonstrate that this had directly affected adult protection, these and similarly related issues would render the adult protection safeguards less effective in any home if not addressed. After the inspection, but before this report was drafted, an allegation of abuse was made by a resident against a member of staff. The home had informed the responsible authority who was leading an investigation under the adult protection procedure. The outcome of the investigation is not yet known. Therefore it is not yet possible to consider the implications, if any, for the home and for the assessment of the standard on protection. Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 18 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, 24, 26 The home offered a clean and well-maintained environment for the residents, satisfactorily furnished. The facilities for residents were not always supportive of the aims of the service regarding privacy, dignity and choice. The facilities for staff were unsuitable. EVIDENCE: The main reason why the standard regarding premises in general is considered not met is that the facilities for staff were unsuitable. The facilities for residents were not always supportive of the aims of the service, although some progress was being made. (This is discussed above in the report under the heading: ‘Health and personal care’ in the context of privacy, dignity and choice). Although the main floors were accessible by lift, there were several steps to access some bedrooms in areas of the premises between the main floors. Therefore, if the mobility of residents in those rooms should deteriorate, they would have to move to a different room. The provider had redrafted a statement of purpose to explain this and also that an alternative room would
Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 19 be made available. (This would be followed up at a future inspection with the manager to ascertain how this could be ensured). The facilities for staff were unsuitable. They consisted of an area in the basement, access to which was via steep and narrow steps. Access did not feel safe. The area had two boilers, which, staff said at a previous inspection, rendered the place uncomfortably hot at times. In some parts the ceiling was too low to enable standing or walking without lowering one’s head. There was, therefore, a risk of injury. Discussion with staff, at a previous inspection, revealed that they found the facilities uncomfortable and considered access to pose a risk of falls. Staff would only have 45 minutes for lunch and it was not often feasible for them to leave the home. The manager’s office was a conservatory like extension of the main sitting room on the ground floor. It could get very hot and uncomfortable even in moderate warm weather. All the above was raised at the September 2004 inspection, but the response from the provider did not satisfactorily address the issues. It was recommended at that inspection that the provider should invite environmental health to advise on provision and maintenance of a safe environment. The provider had acted on that, but, the manager said, environmental health declined to visit. However it remains a concern that the provider had not acted to improve the staff facilities, except for putting some visual aid to highlight some risks in the staff room. The bedrooms looked at during the inspection had the essential items of furniture normally to be found in a bedroom (as stipulated in the national minimum standards). It was clear that efforts had been made to assist the residents to personalise their rooms. Issues arising from the sharing of rooms are discussed above in the report in the context of privacy, dignity and choice. The premises looked clean. The laundry had machines with appropriate washing and drying cycles, including high temperature cycles. Staff said that they used protective clothing when necessary and the home had a contract for the disposal of clinical waste. Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 20 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): 28, 29 The home expected to reach the target for at least 50 of care staff to achieve a vocational qualification by the end of 2005. This would enhance the skills of staff to appropriately support the residents, if stability can be maintained in the staff and managers team. There was a recruitment procedure to assess suitability of staff. The manager had been taking action, but not yet completed it, to strengthen the process so as to better protect the residents. EVIDENCE: The organisation was taking steps to ensure that at least 50 of care staff in their homes would achieve a care national vocational qualification (NVQ) by the end of 2005. At the inspection of September 2004 the managers had said that they were aiming for all existing care staff to achieve this during 2005. It was understood at this inspection that this had not been possible as some of the requirements for acceptance into NVQ courses precluded a number of staff at Highfield from attending. This was mainly because the home employed a large number of students from abroad, who did not satisfy some of the criteria regarding the number of years they needed to have resided in this country. The manager assured that this had not caused a high staff turn-over and that she was preparing individual training plans for each staff, had given emphasis to in-house training, that all staff had attended adult protection and the identified mandatory health and safety training and that other course were being discussed with the external professionals supporting the home.
Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 21 This would be followed up at future inspections. However this is another reason why the consistency of management at this home would be crucial (as discussed below in the report). Discussion with the managers about the recruitment policy confirmed that new staff would not start work until all the statutory checks would be satisfactorily completed. New appointments were subject to a probationary period. At the September 2004 inspection, examination of staff files showed that in some cases there was no evidence that all previous work and education history had been obtained and any gaps explored. There were also some weaknesses regarding references and, in one case the CRB disclosure related to a standard check only, as opposed to an enhanced one, as required. The managers then assured that they would rectify the above as a matter of urgency. However the managers then left. The current manager said that since she started she has been reviewing staff files, as previously required. She gave evidence that she had rectified a number of gaps in the recruitment process. Existing staff were made aware that they could not continue to work at the home unless they supplied all the information to enable all statutory checks to be completed. It was understood that the provider was going to set up a recruitment agency to deal with all staff recruitment. Inspection of a random selection of four staff files demonstrated that the required checks were being conducted, but gaps in employment or education had not always being followed up or explained yet. A time scale of three months was agreed at the time with the managers, for them to finish reviewing all existing staff files and address any gaps. Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 22 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): 31, 37, 38 A manager had been appointed with experience in care and management and relevant qualifications, so as to ensure that the home would continue to be managed on the day to day by a competent person. Staff facilities did not give evidence that the health and safety of staff was promoted. EVIDENCE: Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 23 There was not yet a registered manager. A new manager had been appointed and had started since the previous inspection. She has applied for registration, as required by law. The assessment by CSCI for suitability to be the home’s registered manager had not yet been conducted, but from the discussion during the inspection she demonstrated competence and relevant expertise for the position. She had experience in care and management and was a qualified nurse. A fuller assessment would be made as part of the registration process. Additionally, for the standard regarding management of the home to continue to be met, the provider must ensure consistency of management. This will be monitored at future inspections to ensure that residents benefit from a home that is consistently well managed by a competent person. There have been three different managers since last September; furthermore the person who was newly appointed then, as the direct supervisor of the home’s manager, left that position within a short time. A new regional manager has recently started. The manager was aware of the records required by regulation. Residents could exercise their right of access to their records and information kept about them by the home. Inspection of random extracts of records regarding health and safety showed that they were up to date. The home had a health and safety policy. Environmental health (food hygiene) and the fire officer had visited during 2004. Records also showed that regular checks of the fire alarm call points were being made; hot water outlets were checked on a weekly basis and accidents were recorded. As discussed above and also in the report of September 2004, facilities for staff were not suitable and this is subject to requirement. It is of concern that the provider had allowed this situation to protract for such a length of time and this is the reason why the standard on health and safety is considered not met. Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 24 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 1 x x x x 2 x 3 STAFFING Standard No Score 27 x 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x x 3 1 Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 25 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. Standard OP7 Regulation Requirement The registered provider must audit the way care plans are recorded and reviewed, to ensure that they are holistic and consistent with the stated ethos and values of the organisation. In particular that: - Care plans give a picture of the person as a whole, with emphasis also given to cultural and other identity issues. - Guidelines are developed for staff supporting residents with maintenance and developmental goals. - Developmental and maintenance objectives are separated from tasks, to enable clearer monitoring, evaluation, review and update of objectives. - Recording includes what is learnt from supporting the resident. - When there are communication issues, (to help establish how the resident can best be supported), information is kept around what the person does, what the staff think it means and
Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 26 Timescale for action 1 15(1), (2) 01/03/06 when it happens. OP10andOP 24 2 12(4) and 23(2) The registered provider must continue to take steps to ensure that the use of the premises does not impede residents’ right to privacy, dignity and choice being consistently upheld. (Previous timescale of 1 March 2004 not met, but action started subsequently) The registered provider must ensure that: - Food provided on a daily basis reflects the individual and cultural preferences of the people residing at the home. - That people coming to live at Highfield can continue to enjoy the range of food that they were used to at home. The registered provider must provide suitable facilities for staff. To this end, the registered provider must: - Designate an alternative room within the home that can provide comfortable and safe facilities for staff to relax during their breaks. - Ensure that the present staff room is no longer used for that purpose, unless the provider can 01/11/05 demonstrate that an expert opinion (from environmental health or comparable independent specialist) deems that room to be suitable. - Ensure that the manager has an office that can be maintained at a comfortable temperature constantly. (Previous time scale of 1 December 2004, for similar
Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 27 01/10/05 3 OP15 16 (2) 01/10/05 4 OP19andOP 23 (3) (5) 38 requirement, not met) The registered provider must ensure that all statutory checks, to ensure suitability of staff, are conducted and inform the decision to appoint. OP29 5 19(1)(2)(3) (4)(5) To this end existing files must be reviewed and appropriate steps taken, if necessary, to ensure that the checks are consistent with the requirements and the home’s own policy. (Previous time scale of 1 December 2004 partly met) 01/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP18 Good Practice Recommendations That the effectiveness of the adult protection policy is reviewed by the home in relation to the calibre and expertise of the staff team, the support they receive and the resources available. To this end the following should also be considered: - How the premises support staff in promoting dignity and privacy. - The turnover of home managers and regional managers. - The expertise of care staff and the training provided. - The hours worked and other conditions of work for care staff. - Whether the staff facilities provide a suitable environment for work and for relaxation during their breaks. Highfield Nursing Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 28 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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 Home DS0000007027.V251631.R01.S.doc Version 5.0 Page 29 - 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!
