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Inspection on 30/08/06 for Highfield Nursing Home

Also see our care home review for Highfield Nursing Home for more information

This inspection was carried out on 30th August 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The majority of service users spoken to were happy with living at the home and the care they were receiving. One service user spoken to said," I like it here, they look after me pretty well". Another service user commented, " It`s a nice home, we eat well here and get exactly what we want". A relative spoken to said, with regards to staff, "Staff are very pleasant". All service users have a care plan drawn up with them that is reviewed on a regular basis and health care needs are generally well met. The home has an effective medication system that ensures service users receive their medication consistently. Service users personal care needs are generally well attended to with a hairdresser that regularly visits the home. Staff at the home welcomes visitors. The home ensures that the spiritual needs of service users are met by having a local priest and vicar visit the home. Although there needs to be improvements in activities the home has regular outside entertainers coming into the home. There is a varied menu that always offers a choice of meals and specific needs of service users including their cultural needs are accommodated. There is an appropriate complaints procedure in place and information is made available for service users or relatives on how to access independent advocacy services if required. The home is generally well maintained and is clean and hygienic. The home`s recruitment practices ensure that service users are protected. Service users are asked for feedback by the home to ensure it is being run in their best interests.

What has improved since the last inspection?

The registered manager is carrying out a re-assessment of the needs of service users when they have been admitted to hospital and being made ready for discharge to ensure that the home can still meet their needs and prevent a readmission to hospital. The home is in the process of recruiting more female care staff but is also maintaining its commitment to ensure that male care staff are chaperoned by a female care staff member when attending to the personal care needs of female service users. The home has carried out all the repairs identified at the last inspection. Shared rooms are continuing to be reduced by the home. All service users have had a risk assessment carried out with them regarding their suitability to being given a key to their room and those assessed as suitable have had their locks changed and a key issued. Many of the staff have obtained National Vocational Qualifications (NVQ) in care and the remainder of the staff are being supported to obtain a qualification so they can meet the needs of service users more effectively.

What the care home could do better:

Although the home does meet the health care needs of service users this is not always clearly reflected in service users care plans and this needs to be improved. The staff must ensure that fall risk assessments are carried out for all service users shortly after their admission as possible. There needs to be more activities provided to service users on a group and individual basis that are also more appropriate to the needs of those service users suffering from dementia, for example more reminiscence sessions. Also, records on activities held with service users need to be maintained. Although some staff have received training on adult abuse this needs to be extended to ensure all staff receive training in this area and are clear about procedures to follow if abuse is suspected or identified. Gaps in staff training specifically where staff have not received mandatory training in areas such as manual handling, infection control, first aid need to be addressed and annual appraisals with staff need to be carried out to identify any specific training needs that staff may have to enable to meet the needs of service users more effectively.

CARE HOMES FOR OLDER PEOPLE Highfield Nursing Home 36-38 Bromley Road Catford London SE6 2TP Lead Inspector Ornella Cavuoto Unannounced Inspection 30th August 2006 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.V310197.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highfield Nursing Home Address 36-38 Bromley Road Catford London SE6 2TP 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) 020 8488 3970 020 8488 3955 lorna.lang@excelcareholdings.com Highfield Healthcare Ltd Mrs Yvette Elizabeth Owens 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.V310197.R01.S.doc Version 5.2 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) 27 March 2006 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 need, 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.V310197.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over one day. The registered manager was present for the duration of the inspection and was helpful in facilitating the inspection process. In addition, six service users, one relative and two staff members were spoken to. Other methods used included inspection of care records and a tour of the premises. What the service does well: What has improved since the last inspection? The registered manager is carrying out a re-assessment of the needs of service users when they have been admitted to hospital and being made ready for discharge to ensure that the home can still meet their needs and prevent a readmission to hospital. The home is in the process of recruiting more female care staff but is also maintaining its commitment to ensure that male care staff are chaperoned by Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 Page 6 a female care staff member when attending to the personal care needs of female service users. The home has carried out all the repairs identified at the last inspection. Shared rooms are continuing to be reduced by the home. All service users have had a risk assessment carried out with them regarding their suitability to being given a key to their room and those assessed as suitable have had their locks changed and a key issued. Many of the staff have obtained National Vocational Qualifications (NVQ) in care and the remainder of the staff are being supported to obtain a qualification so they can meet the needs of service users more effectively. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 &4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service All service users have been issued with a statement of terms and conditions with the home. Service users who have been admitted to the home have had their needs assessed. A re- assessment of service users’ needs is being carried out when service users are admitted to hospital and due to be discharged to ensure the home is still able to meet their needs. EVIDENCE: Five service user files were inspected and all had a written statement of terms and conditions that were signed by the service users. Subject to a previous requirement the statement of terms and conditions had been altered to ensure it included the room number as well as the fees charged. All service user files looked at included evidence that a full needs assessment by the referring local authority had been obtained to ensure that the home Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 Page 9 would be able to fully meet the needs of service users being admitted to the home. There have been concerns in previous inspections about the number of hospital admissions form the home. The home provides information on a quarterly basis of all service users admitted to hospital and generally these have reduced in number. However, it was identified at the last inspection that some service users were admitted to hospital only to be discharged very quickly and had to be re-admitted shortly after. Subject to a requirement that the registered manager must work with the hospital discharge team to ensure that the home can continue to meet the needs of service users who have been admitted and then discharged, the manager reported that all service users now have a reassessment of their needs prior to being accepted back to the home to ensure that a clear discharge plan is in place with any additional support arranged prior to their return. This requirement will not be restated but will continue to be monitored at future inspections. Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service All service users had a care plan in place that generally address in good detail their personal and social care needs. Although generally there was evidence that health care needs are being met, this was not always clearly reflected in service users care plans. Service users are protected by the home’s policies and procedures for dealing with medicines. Service users consider they are treated respectfully and their right to privacy maintained but the home needs to continue to reduce their double rooms to ensure all service users have a choice of having their own room. EVIDENCE: Five service user files were inspected. All had a care plan in place in which the personal and social care needs of service users were addressed in good detail. All service users had information included on file about their life history, their interests and preferences around daily routines. However, it was noted that aspects of service user ‘s health care needs were not included in individual care plans, for example one service user was a diabetic and this had not been Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 Page 11 addressed in their care plan. Furthermore, in respect to health care needs one service user had not had their weight monitored monthly. It was also noted for one service user that there were charts contained in their file such as a fluid chart and a toileting chart that had been left blank. On pointing this out it was reported that these were not relevant to the care needs of the service user. It is recommended that where charts or assessment forms are not required that these be removed from the service users’ files (See Requirements & Recommendations). All care plans had been reviewed monthly. A new format for writing up care plans has been introduced to the home. Those service users who have more recently been admitted with whom the new format has been used were signed by either the service user themselves or a relative to indicate their understanding and involvement in the care planning process. The old care plans format did not accommodate this. Although there was evidence of risk assessments that looked at the prevention of falls, these had not been completed for two service users. However, subject to a previous requirement a risk assessment had been drawn up with regards to a service user who has mobility difficulties whose bedroom has access via a flight of stairs with no lift access. This was previously shared with another service user who has since been moved to another more suitable room (See Requirements). Subject to a previous recommendation there was evidence that information regarding the benefits and drawbacks associated with the use of cot sides/bed rails have been given to service users and/or relatives when asking for them to give their consent for them to be used. The home has a robust medication policy and procedure that covers all aspects of handling, administration and storage of medicines. Only qualified nurses administer medication to service users. At present none of the service users take responsibility for taking their own medication. A sample of Medication Administration Record (MAR) sheets were checked and all were found to be accurate. Service users were generally observed as being well dressed and groomed although two service users’ appearance was noted as being slightly unkempt. This was pointed out to the registered manager who explained that care staff were aware of this but despite encouragement from care staff these service users were resistant to being supported with their personal hygiene. One of the service users’ care plans was looked at and this issue had been clearly addressed. The majority of service users spoken to were satisfied with how they were supported by both care and nursing staff with their care needs and considered that their privacy and dignity are maintained. At the last inspection concerns were noted about the high percentage of male carers working at the home and how this can at times make providing carers of the same sex Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 Page 12 difficult for the home. At this inspection the registered manager reported that there is a commitment to recruit more female care staff and there were three female carers waiting to start working at the home. Also, the home continues to ensure that where male care staff support female service users with personal care that they are always chaperoned by a female member of staff. One service user spoken to did express concern having to be supported by male care staff with their personal care. There was evidence on their care plan this had been discussed with the service user’s relative who expressed they were happy with the arrangement in place. However, it is advised that where a preference is stated by a service user on who they would like to support them with personal care then this should be adhered to where possible. The previous requirement in this area is not to be re- stated but this area will continued to be monitored at future inspections (See Recommendation). In respect to a previous requirement regarding the home ensuring that all service users have the option of having their own room there are still three shared rooms but the home continues to eliminate these as appropriate circumstances arise. Therefore the previous requirement continues to be partially met (See Requirements). Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service The home needs to ensure that service users have access to a more varied range of group activities and also that individual time is spent with service users. Service users are able to maintain contact with family and friends. Service users are supported to exercise choice and control over their lives where possible. There is access to a sufficiently varied menu that provides a well balanced diet and meets specific cultural needs. EVIDENCE: Since the last inspection the home has recruited another activities co-ordinator the previous activities co-ordinator having left the post after approximately ten weeks. However, it was reported that the new activities co-ordinator went on sick leave after only being in post for three weeks and it is not clear whether they will be returning to the work at the home. In the interim period that the activities co-ordinator returns or another one is employed the registered manager has given one of the carers the responsibility for ensuring that an activities programme is delivered to service users. The current programme only runs three days a week and includes painting, arts and crafts, one to one Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 Page 14 work, bingo, music, sing-a-longs, exercises and hand massages. On the day the inspection was held bingo was played with the service users who appeared to enjoy this. However, in terms of evidence of the other activities held with the service users this was limited. There were individual activity records for service users but these had not been kept up to date. In addition, activities appropriate to the needs of those service users in the more advanced stages of dementia were not being held such as reminiscence sessions. This is despite the fact that some of the staff have received training on reminiscence by the Pump House who it was reported attended the home earlier this year and carried out six reminiscence sessions with service users. This needs to be addressed as well as the home ensuring that time is spent with those service users who are bed bound. Consideration should be given to using the key worker system to ensuring individual time is spent with service users (See Requirements and Recommendations). The home has an open visiting policy and visitors were observed coming to see their relatives during the inspection. The home supports service users to maintain links with the local community by having a range of local entertainers coming into the home on a regular basis. A local priest and a vicar also come into the home to see those service users who maybe Roman Catholic or Church of England to enable them to take communion if they wish. None of the service users living at the home manage their own finances. However, service users can bring in their own personal possessions and it was observed that individual service user bedrooms had been personalised. The home holds resident and relative meetings approximately every two months to encourage service users to have an input in the running of the home and to give them an opportunity to express their views and preferred choice on specific issues. Minutes of these meetings were seen and topics such as activities were discussed. Finally, it was observed on the notice board in the main corridor of the home that information had been provided for service users on how to access independent advocacy support. The home has a varied menu that provides a choice of food to service users. There is also a separate menu providing African-Caribbean food. Special diets, for example pureed food, are also provided where required. Cold drinks are made available in the dining area throughout the day. The chef has been working at the home for many years and is very familiar with the particular likes and dislikes of service users. The lunch- time was observed and this was relaxed with service users being able to take their time to eat. Service users were also observed being assisted to eat their meals by staff in an appropriate manner. Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 Page 15 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&18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service Service users spoken to had not made any complaints but were aware of whom to speak to if they had any concerns about living in the home. Service users are not being fully protected from abuse. EVIDENCE: The home has a robust complaints policy that addresses the stages and timescales for the process. All complaints are logged both formal and informal. There have been two complaints made since the last inspection both in respect to the same service user and involved concerns about the care needs of the service user not being adequately met by care and nursing staff. Records demonstrated that the complaints had been thoroughly and appropriately investigated and found to be fully substantiated. Both social services and the Commission for Social Care Inspection (CSCI) were informed. The majority of service users spoken to stated they did not have a reason to complain but said they would talk to the staff or the manager if they were unhappy with anything. It was also noted that service users and relatives were encouraged to raise and discuss complaints as part of the relatives and residents meetings that have been held. There are robust policies and procedures in place in respect to adult protection and whistle blowing. The home has not had any adult protection investigations since the last inspection. At the last inspection it was noted that staff needed Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 Page 16 to have some updated training around the issues of adult abuse. At this inspection it was reported that eight of the staff had received adult abuse training that was provided in –house by the adult protection worker employed within the organisation. Staff spoken to had knowledge of the different types of abuse that can occur but one was not clear about what procedures follow if abuse was suspected or identified. It is evident that all staff working at the home need to receive training in this area (See Requirements). Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 Page 17 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, 20,21,24 &26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service The home offers a homely and generally well -maintained environment with suitable communal facilities and well- decorated and suitably personalised bedrooms. The home is clean and hygienic. EVIDENCE: The home occupies a large Victorian house on a main road. It is generally well -maintained and overall is suitable for its stated purpose. However, the structure of the building makes some of the bedrooms inaccessible for service users with mobility difficulties who cannot climb stairs, as these rooms are accessed by a small flight of stairs with no lift access. At the last inspection it was noted that two residents one of whom was no longer able to mobilise occupied one of these rooms. In addition, a hoist could not be used to assist with lifting due to issues with the stairs. The other service user mobilised with a zimmer frame and needed support to access her room. At this inspection it Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 Page 18 was reported that the service user who has particularly poor mobility had been moved to another room whilst as mentioned previously in respect to standard 7 a risk assessment has been completed in respect to the other service user. Service users have access to safe and comfortable communal spaces. There is a main lounge area and separate dining room on the ground floor. The lounge area has been divided to create smaller seating areas. The dining area is large and spacious. There is a garden at the rear that is attractive and well maintained. It is wheel chair accessible and has seating for service users to sit outside. There are sufficient toilet and washing facilities for service users. At the last inspection a few minor repairs needed to some of the floor tiles in two of the downstairs toilets were identified which have since been rectified. One of the first floor bathrooms needed the pull chord to be changed to make it easier for service users to find and to grasp. This had been done. Service users’ bedrooms were suitably personalised and the rooms contained the required items of furniture. At the last inspection it was identified that one of the service users did not have an armchair in their room but this had been addressed. Also, the lino belonging to a service user in room 14 was bubbling in areas making the surface uneven potentially placing the resident at an increased risk of falls, this had been sorted out. Furthermore, it was identified that many of the rooms were not lockable by key and it would not be possible to offer the occupants of these rooms keys if they wanted them and were able to manage them. Subject to a previous requirement risk assessments had been carried out with all service users about their ability to manage holding a key to their rooms and also if they wanted one. It was identified that it would be safe for two of the service users to hold keys and the locks to their rooms have been subsequently changed. As mentioned in respect to standard 10 the home is continuing to reduce the number of double rooms to ensure all service users will eventually have access to their own room. The home was clean and free from offensive odours on the day of the inspection. The home has suitable laundry facilities and as identified at the last inspection the bottom shelving and floor of the laundry room damaged by water penetration has been fixed. In respect to the registered manager’s and administrator’s office that is situated in a part of the conservatory, it was identified at the last inspection that this becomes uncomfortably hot at times. As previously recommended blinds have been placed in the office and an air cooler purchased although at this inspection the heat still remained a problem. It is advised that the temperature of the office is monitored to ensure it complies with health and safety requirements for safe working conditions (See Recommendations). Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 &30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service There were sufficient staff on duty to meet the needs of service users living at the home. The home has achieved 50 of their care staff having or attending level 2 NVQ training or above. Service users are protected by the home’s recruitment practices. Generally staff working at the home are competent but there are gaps in mandatory training such as manual handling that needs to be addressed. EVIDENCE: The rota was checked and found to be accurate with sufficient staff on duty to meet the needs of service users. There were 27 service users living at the home at the time the inspection was held. There are four care staff and two nursing staff on duty for the morning and afternoon/evening shifts and one nurse and two care staff on duty at night. At the last inspection it was found that almost 50 of the night staff were male potentially posing problems for the home to maintain its commitment to ensure that male staff are always chaperoned when providing personal care to female service users. At this inspection the registered manager reported that there are now two male carers that work nights and four female carers out of the six permanent night care staff so make staff being chaperoned should not be an issue. Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 Page 20 At the last inspection it was identified that only 35 of the care staff had a NVQ Level 2 qualification and there were several staff that made up the night staff that could not access free NVQ training. At this inspection the registered manager reported that out of eighteen care staff eight had achieved a NVQ Level 2 whilst two of these staff had also completed a NVQ Level 3. In addition, ten care staff were presently in the process of undertaking a NVQ Level 2 or 3. As a result the home has now achieved the 50 target required of staff having completed or being in the process of achieving this qualification and this requirement is deemed met. In respect to recruitment, a sample of staff files were inspected and all were found to have obtained all the documents required by regulation including an up to date Enhanced Criminal Record Bureau checks, two references and appropriate identification prior to staff being allowed to commence working at the home. Although there was evidence on staff files that they had undergone an induction this did not meet with Skills for Care specifications. The registered manager provided evidence that she has recently completed the training on the Skills for Care induction programme and reported that all new staff recruited should now receive an induction that meets with these specifications. In terms of training, the registered manager carries out regular teaching sessions with staff on a range of different topics including personal hygiene, dementia, communication, malnutrition amongst others that staff spoken to said they found very helpful. The manager is also a qualified manual handling trainer. Generally, staff receive training in –house and also on occasions from Lewisham Partnership. However, it was noted that staff did have gaps in mandatory training such as manual handling, first aid, infection control and health and safety. Also, annual appraisals have not been completed. This would help to identify gaps in training and also help to identify any specific training needs for staff that would contribute towards the development of an annual training plan and ensure the individual needs of service users were being met (See Requirements). Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 Page 21 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): 31,33,35 &38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service Service users live in a home that is well run and managed. Overall, the home is run in the best interests of service users. Although generally service users financial interests are safeguarded further measures need to be taken to ensure their finances are being fully protected. The health, safety and welfare of service users and staff are generally promoted although the home must ensure all maintenance and safety certificates are up to date. EVIDENCE: The registered manager is a qualified general nurse and also holds qualifications as a manual-handling trainer, a NVQ Assessor and has completed the NVQ Level 4 in management. She has previous management experience working as a team leader in a home for older people with dementia and overall Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 Page 22 has the necessary skills and experience to ensure the home is well run and managed. In relation to quality assurance the registered manager completes a number of audits to ensure that standards within the home are maintained, for example weekly care plan audits and weekly audits of service user finances are carried out as well as monthly health and safety, medication and housekeeping and cleanliness audits. Monthly provider reports are also completed and copies have been sent to CSCI. A customer satisfaction survey was issued to service users on 25th August 2006 seeking their views on their home. Evidence of the survey was seen. It was reported that responses are due back by 11th September 2006. Surveys are also to be sent to relatives and other stakeholders such as professionals who regularly visit the home by Head Office. Also, as mentioned relative and resident meetings are held to gain the views and feedback of service users and their relatives. As mentioned previously none of the service users manage their own money and the home takes responsibility for managing the personal allowance for the majority of service users. The registered manager, the home’s administrator and one of the senior nursing staff only have access to service user finances. The provider has also introduced a new policy that all service users should only have a maximum of twenty pounds held on the premises at all times with any excess finances being held at Head Office. The home needs to make a request to Head Office if additional finances are required. As well as weekly audits carried out by the home, Head Office also does regular monthly audits. A sample of service user finances were checked and all found to be correct. However, it was identified that receipts are not kept for all transactions, for example when the hairdresser visits the home a list of service users who have received a service are given to the registered manager who pays from their individual finances but does not keep a receipt just records this on their individual balance sheet. This needs to be addressed with individual receipts kept that the hairdresser signs as a record of receiving payment. Receipts are issued to relatives when they hand money to staff but the staff member only signs this. It is advised that the relative also signs the receipt (See Requirements and Recommendations). The registered manager supervises the qualified nurses and the nurses in turn supervise the care staff. Supervision records were checked and found to be carried out on a regular basis. For carers supervision tends to involve them being observed by the nursing staff and then being asked questions about their practice. Generally the health, safety and welfare of service users were found to be protected with comprehensive health and safety policies and procedures in place. As mentioned monthly health and safety audits are carried out. There were up to date maintenance certificates in respect to fire equipment, the passenger lift, hoist equipment. Water temperatures have been checked Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 Page 23 regularly but the home did not have a recent certificate for the testing of Legionella. This needs to be addressed. Also as mentioned in relation to standard 30 staff have not all received training in mandatory topics such as manual handling and health and safety (See Requirements). Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 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 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 2 18 X 3 3 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 3 X 3 Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 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. 1. Standard OP7 Regulation 12(1) Requirement Timescale for action 31/03/07 2. OP8 12(1) &13 (1) (b) 3. OP10 12(4) &23(2) 4. OP12 16 (2)(n) The registered person should ensure that a risk assessment with particular attention to the prevention of falls is carried out for all service users living at the home. The registered person must 31/03/07 ensure that service users’ health needs are comprehensively addressed in their care plans and reviewed on a regular basis. The registered provider must 31/03/07 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 01/03/04 and 01/10/05 and 01/08/06 partially met) The registered person must 31/03/07 ensure that a varied and appropriate activities programme is provided to service users both on a group and individual basis and specifically more reminiscence work is carried out with service users. Also that records of activities carried out DS0000007027.V310197.R01.S.doc Version 5.2 Highfield Nursing Home Page 26 5. OP18 13(6) 6. OP30 18(1) 7. OP35 16(2)(l) 8. OP38 23(2) (p) with service users are maintained. The registered person must ensure that all staff working at the home receive training around adult abuse /protection. The registered person must ensure that all staff receive mandatory training and this is regularly updated. Also, that all staff receive an annual appraisal to identify any gaps in individual training needs. The registered person must ensure that receipts for all financial transactions made on behalf of service users are issued and maintained. The registered person must ensure that an updated certificate for the testing of Legionella is obtained. 31/03/07 31/03/07 31/03/07 30/11/06 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 OP8 OP10 Good Practice Recommendations The registered person should try to make sure that all assessment forms and charts not relevant to the care needs of individual service users are removed. The registered person should try to make sure that where specific service users request a female or male carer to attend to their personal care needs this should be accommodated wherever possible. The registered person should try to use the key worker system to make sure that individual time is spent with service users particularly those that are bed bound. The registered person should consider monitoring the temperature of the office to ensure it complies with health and safety requirements for safe working conditions particularly during warm spells of weather. DS0000007027.V310197.R01.S.doc Version 5.2 Page 27 3. 4. OP12 OP19 Highfield Nursing Home 5. OP35 The registered person should try to make sure that when relatives hand money to staff for service users that both the staff member receiving the money and the relative sign the receipt form Highfield Nursing Home DS0000007027.V310197.R01.S.doc Version 5.2 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. 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