Inspection on 08/09/08 for Highfield Nursing Home

This inspection was carried out on 8th September 2008.

CSCI 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 25/08/09

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 20/03/2009.

CARE HOMES FOR OLDER PEOPLE Highfield Nursing Home Scarthingwell Park Barkston Ash Tadcaster North Yorkshire LS24 9PG Lead Inspector Anne Prankitt Key Unannounced Inspection 8th September 2008 10:00 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 DS0000058827.V371881.R02.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 DS0000058827.V371881.R02.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/oulton 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.V371881.R02.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 11th September 2007 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 5 miles from Tadcaster in North Yorkshire. It is a two-storey building, set in its own extensive wellmaintained 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 8 September 2008 outline the weekly fees as between £487.06 and £1200. This does not consider the registered nursing care contribution, which is assessed for each individual and deducted from the fees as necessary. Additional charges are made for hairdressing, chiropody services and individual items like newspapers and toiletries. A copy of the Statement of Purpose, Service User guide and the latest report about the home, written by the Commission for Social Care Inspection, is available at the home for people to read. Highfield Nursing Home DS0000058827.V371881.R02.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 were sent to the registered manager to distribute to people and visiting professionals. Four were completed and returned by relatives on people’s behalf. One was returned from a visiting professional. Some people had been given the wrong survey, so not all of the questions were applicable. A site visit to the home carried out by one inspector over approximately eight hours on 8 September 2008. • • During the visit to the home, several people who live there, some staff and the manager were spoken with. Four people’s care plans were looked at in detail, as well as two staff recruitment files, some policies and procedures, and some records about health and safety in the home. Care practices were observed, where appropriate. Some time was also spent watching the general activity to get an idea about what it is like to live at Highfield. The registered manager was available throughout the day, and feedback was given to her 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 report as recommendations - but only when 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: The home is situated in lovely peaceful grounds. People benefit from views over the countryside. Highfield Nursing Home DS0000058827.V371881.R02.S.doc Version 5.2 Page 6 Everyone gets their needs assessed before they move in. This helps staff to check whether the home will be suitable for them, and also for the person to decide whether they want to live there. People agree that staff generally provide them with the care that they need, in the way that they want. Although some have to wait for a while before they get this care when staff are busy. Both group and individual social activities are being offered to people. People say these are improving, and that their personal interests are considered when activities are planned. People can also maintain important contact with friends and family who can visit them and be involved in their care if they wish. People do not have to choose in advance what they want from the menu. This means that they can pick what most appeals to them at the mealtime, rather than having to choose in advance. Staff get a range of training, which should help them to provide care in a safe and consistent way. What has improved since the last inspection? What they could do better: People could have a completed care plan and assessments, which fully consider risks to their safety and welfare. They could be involved in drawing the plans up, so that they are included in decisions that are made about their care, and how it will be provided. The way that staff look after people’s medication could be checked more thoroughly, so that shortfalls in practice which may affect them can be identified quickly and put right. The right people could be alerted by the registered manager about potential ‘abusive’ incidents which have occurred in the home. This will make sure that those who have been given the responsibility to do so undertake the investigation, to ensure right action is taken to protect people. People could be asked about where they think the staffing levels could be improved. This would keep them involved, and would make sure that changes Highfield Nursing Home DS0000058827.V371881.R02.S.doc Version 5.2 Page 7 to the way staff are provided are made in direct response to their needs and wishes. The way staff are recruited could also be better, to make sure that they are not able to provide direct care unsupervised until all the necessary checks have been returned, and their employment history fully explored. The company could look at more stringent ways of making sure that slippages do not occur when making improvements at the home. This should benefit the people who live there, who should, in turn, be given feedback about what is being done in response to their collective comments and views about the service. People’s health and safety could be given more attention. For instance, by making sure that equipment, such as bed safety rails, is safe for use. 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. The summary of this inspection report can be made available in other formats on request. Highfield Nursing Home DS0000058827.V371881.R02.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.V371881.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People who use the service experience good outcomes in this area. People are always assessed before they are admitted. But more specific information could be asked to make sure that the person’s stay at the home will be successful in the long term. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: People are assessed by staff prior to them being admitted, and before a decision is made as to whether the home will be able to meet their needs. Sometimes people are admitted from hospital following an acute physical illness. They too have an assessment completed by the home. Where people are admitted from other parts of the country, staff from a nearby Barchester home carry out an assessment on behalf of Highfield. This normally works satisfactorily. However, the pre admission assessment documentation does not ask sufficient information about people’s mental health needs, which may become the main focus of their care once their acute symptoms have subsided. In one case, the registered manager agreed that information discovered after an admission took place could have changed the Highfield Nursing Home DS0000058827.V371881.R02.S.doc Version 5.2 Page 10 decision about whether the person’s needs could be met. Staff should ask for this information, so that the ability of the home to meet people’s likely long term needs can be fully considered at this stage. People can have a look round the home to see what it is like before they decide whether they want to live there. One person said ‘I came and had a good look round before moving in here’. A relative said that they were very impressed with the welcome, friendliness and cleanliness. They said that they were given a full tour, and they had a one to one talk with the deputy manager. People said they got enough information about the home before they were admitted, although were not always sure that they had received a contract. The registered manager said that those admitted before the present company took over ownership would not have a contract. This needs to be organised so people can see their terms and conditions of stay, their breakdown of fees, and who pays for what aspect of their care. The home does not provide intermediate care. People do stay for respite care, which involves a short stay at the home. Highfield Nursing Home DS0000058827.V371881.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People who use the service experience adequate outcomes in this area. Although people are satisfied with their care, risk to their health and safety is not properly monitored. Shortfalls in care planning increases the risk of care being given in an inconsistent way which does not meet personal needs and wishes. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The company has provided paperwork so that all care plans can be set out in the same way. This includes assessments to determine risk to people from, for example, poor nutrition and pressure sores. After admission, people have an in depth assessment which considers the information that the home already has about them, and any other information collected since they were admitted. Care plans are then developed, although there was little evidence to suggest that people and their families were involved in this process. The quality of the care plans varied. This suggests that they are not being audited consistently. A care staff spoken with said that they do not rely on the care plans for up to date information – they said they would rather deal with people directly, and they get information about current care from the daily Highfield Nursing Home DS0000058827.V371881.R02.S.doc Version 5.2 Page 12 reports that they get before each shift. If the care plans were to be completed, they too could be used as a good source of information when learning what people’s current needs are. One care plan looked at was very good, because it explained the person’s individual’s needs, what affected their wellbeing, and how dignity and privacy was important to them. The staff member who had completed the plan said that they had spent time with the person to get to know them, so that the plan properly reflected their personality as well as their physical needs. Another person, admitted for short term care, had some care plans in place, but not all had not been completed. The areas affecting the person’s safety had not been given priority. So despite their assessment identifying that they were at risk from falls, there was no risk assessment completed, and no care plan drawn up to show how staff could assist the person to maintain their mobility in the safest way. A risk assessment for the use of bed safety rails had not been completed, despite them being used. And no information had been collected to give staff some idea about what the person’s social needs were. The registered manager was not aware that a person, admitted seven weeks previously with very complex needs, had no care plans in place at all. Although she had told us that everyone now has protective bumpers for their bed safety rails, this person did not have any. And the risk assessment completed by staff said they did not need them. This decision contradicted the information they were given before the person was admitted. This is poor practice, because it increases the chance of staff not working consistently when providing care, and of the person’s care not being safe. These shortfalls about how to manage risk are similar to those raised at the last inspection. They have not been addressed satisfactorily. At the last survey completed by the company, 100 of people said that they were treated with dignity and respect. On the day, staff spoke to people with respect and good humour. The activities organiser mixed with people, and provided them with social support. Care was given in private. Comments from people included ‘I’m fine – no problems – the staff are good’, ‘I know someone else who lives in a home but it’s not as posh as this’, ‘The home is fine for me – I like it’, ‘Staff are good – they respect my privacy’, ‘I’m very happy here. The staff look after me. I’m in the right place. I couldn’t ask for better’. One person said ‘Some staff are better than others’. They said that some staff were ‘abrupt’ when they were busy, but that most are ‘OK’. A visitor said that they were generally satisfied, and pleased that they were able to visit regularly to contribute to their relative’s care. Another said that staff always act and listen to what their relative says say, and overall they are happy with level of care. Although they commented that there are times when Highfield Nursing Home DS0000058827.V371881.R02.S.doc Version 5.2 Page 13 this ‘breaks down completely’. One commented that on the whole they are pleased with the care, but that the service could improve by giving more one to one attention. One further relative said that they are ‘quite satisfied’ and they have ‘no complaints or concerns’. The home has changed medication suppliers since the last inspection. Staff are still working with the new supplier to get everyone’s medication organised better so that only one system is in operation. The medication is kept locked away, although the storage arrangements could be improved upon. In one area, medication trolleys are stored in an unused communal bathroom which is kept locked, but documentation is kept in a separate room. The registered manager said that none of the people living at the home look after their own medication. Staff look after it on their behalf. They try to keep medication times separate from mealtimes. This helps to make the mealtime occasion more social, and less institutionalised. The following shortfalls were discussed with the manager: • Although staff record to say when they have given people their medication which is taken by mouth, they rarely sign to show that they have applied creams that the person’s doctor has prescribed. This makes it difficult to judge whether they have been given and by whom. Tablets still supplied in boxes were counted, but the stock balance had not been recorded on the current medication sheet. This makes it more difficult for staff to check whether and when medication has been given, at a time where there are already two systems in operation. A staff member had signed to say they had given someone their medication when it was still in the blister pack. Another tablet had been given over the course of the month, but had not been signed for by any of the staff. This suggests that they are not following the medication record sheets when giving out medication, and increases the risk from error. • • • Consideration must be given as to how these shortfalls can be better monitored when the medication is audited. Highfield Nursing Home DS0000058827.V371881.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People who use the service experience good outcomes in this area. Although not yet written down, better attention is being paid to people’s individual social needs, which should improve their quality of life. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: A new activities person has started working at the home, after a long spell without. People who responded to their surveys said that sometimes there was little to do. The registered manager said that the new organiser is now getting to know people’s social needs, and is in the process of making the activities more individual. Therefore their views about the activities may now be more positive. One person said ‘I wish there were more activities’. But they said the new activities person was ‘great’, and that he is ‘always around and about’. On the day of the site visit, people enjoyed a film show. Others went for a walk with their family. One person said that they see the activities person individually every day. Another said that a new activity had been organised especially to meet their social interests. They really appreciated this. There is a separate activities area on the first floor of the home. This means that people who do not wish to join in with the group activities do not need to be disturbed by those who do. Highfield Nursing Home DS0000058827.V371881.R02.S.doc Version 5.2 Page 15 People are told about forthcoming events. They also get a newsletter which tells them about the success of previous events which have taken place both inside and outside the home. However it is some time since the last newsletter was completed. A trip to Thornton le Dale had taken place the previous week. People said they like the trips, although some surveys indicated they would like more opportunity to go out, even if into the grounds for a walk. There is a Roman Catholic church in the grounds. The priest welcomes all denominations to the services. A ramp has recently been provided to make access to the church easier for those who need to use a wheelchair. A toilet has also been provided. This means that more people can attend services to have their spiritual needs met. Visitors are welcome to the home at any time. One spoken with said that they visit every day, and are pleased that they are involved in their relative’s care. The said staff are very pleasant and friendly. This approach will make visitors feel more at home when they arrive to see their family. People say they have some choice in their daily lives. They said they can choose when they get up and go to bed. One person said ‘Staff are good and respectful – I get choice’. The kitchen looked very clean and well organised. The chef told us they get fresh meat, vegetables and fruit delivered to the home regularly, and that there is sufficient budget to provide a varied menu. There are three meals each day, and supper is provided for those would like it. Drinks and snacks are served in between. The chef gets information about people’s likes and dislikes, and any dietary needs, when they are first admitted. This will help to make sure that people always get a meal which they like, and which is suitable. People have a good choice of menu, and generally like the food. One person said ‘The food is nice and there’s always a choice. We get fresh veg delivered to our tables every day’. Another thought that there were a lot of chips on the menu. The chef said that although there are a variety of fried potatoes served, they are not repeated every day, and there is always an alternative. Some people told the company in their last survey that their meals were not warm enough. The registered manager said that new hot trolleys have been provided so this can be improved. During our visit we saw people had to wait at the table for a long time before they were served their lunch. Some sat for over half an hour even before they were asked what they would like to eat, because staff were assisting others to the table. One person commented that this was a long time to wait. The registered manager did not think that the mealtime could be organised any other way to make the wait shorter. However, further thought should be given as to how staff could be organised so their wait can be reduced. Highfield Nursing Home DS0000058827.V371881.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience adequate outcomes in this area. Agreed policies and procedures about safeguarding are not followed. This leaves people at greater risk from poorly conducted investigations and unsatisfactory outcomes. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed in the reception area, and tells people what will happen if they want to make a complaint about the home. The procedure is also written in the service users’ guide. People can have a copy of this to keep. People’s comments included ‘I’m very confident that issues would be dealt with if I brought them to the staff’s attention’. There is also information available about advocacy service. This gives people the opportunity to voice any concerns or queries they may have to someone independent if they wish to. Ten complaints have been made to the home since the last inspection took place. These involved issues about staff practice and attitude, shortfalls in people’s bedroom facilities, insufficient crockery and the inability to access the garden area. There were details kept of each complaint. However, the action taken by the home to make the situation better and the subsequent outcome was not always clear. Staff knew what action they must take if they suspected that someone living at the home was not being treated properly, or if they thought they were being Highfield Nursing Home DS0000058827.V371881.R02.S.doc Version 5.2 Page 17 abused. They knew they must report this straight away, and that under no circumstances could they keep their concerns secret. The registered manager also told us the correct action she must take should she be alerted that people at the home have not been treated properly. She knew that such information must be passed onto the local authority for investigation. However, although there were four recorded incidents brought to her attention since the last inspection, neither the local authority nor the commission were told about them. Instead, the registered manager dealt with each concern herself. She accepted at the site visit that these matters should have been referred under agreed safeguarding procedures. A similar shortfall was noted at the last inspection. It is it is of concern that such issues have arisen again, and that proper steps have not been followed to inform the right people about incidents which may have adversely affected vulnerable people. Highfield Nursing Home DS0000058827.V371881.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience good outcomes in this area. People benefit from a clean and tidy home which is kept maintained. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The home is set in lovely grounds in a rural area in North Yorkshire, not far from the main road between Leeds and York. The accommodation is situated on two floors with a passenger lift to the first floor. The home was clean and tidy, and free from unpleasant odours. This helps to make the accommodation a pleasant place to live in. There is some shared accommodation available at the home. However, the registered manager said this is only used as such when people make a positive choice to share. Four rooms are currently being shared. Otherwise, all rooms are used for single occupancy. People can bring in their own belongings to make their room more personal. They have a call bell in their room, which can be removed from the wall, and taken with them to where they are sitting in Highfield Nursing Home DS0000058827.V371881.R02.S.doc Version 5.2 Page 19 their bedroom. Not everyone can access the call bells in the communal areas. But the registered manager gave assurance that staff attend these areas on a regular basis to check that no-one needs help. None of the people living at the home said they had any specific problem in this area. The company has an ongoing plan for refurbishment which includes plans to fit radiator covers. This work will be completed in the near future, and will help to reduce any risk to people from the risk of burns. Until this work is completed, the registered manager was confident that people living at the home were not currently at risk. Staff were seen wearing gloves and aprons. Laundry is sorted by care staff and delivered to the laundry in separate bags which can be transferred straight into the machines, so the soiled linen does not have to be handled unnecessarily. We were told by the registered manager that all staff have completed infection control training. Up to date training and appropriate equipment reduces the risk from cross infection. Highfield Nursing Home DS0000058827.V371881.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 People who use the service experience adequate outcomes in this area. Staff get training to help them provide good safe care. But the way that they are deployed may not fully satisfy people’s individual needs and routines. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: There are currently staff vacancies at the home. The registered manager is in the process of interviewing for these positions. She said that agency staff have been used more frequently, especially at night. However, she hoped that this would improve once the new staff were checked and in place. Comments from people living at the home about the staff varied, and included ‘Most staff are OK – some are abrupt when they are busy’, ‘There are sometimes not enough staff – mainly in the evenings – but they are pretty good, and I normally get a choice of bed time – and they try to get me up when I want to be up’, ‘I’m fine here, but staff are often in a rush; the young ones especially when first starting’, ‘Staff are usually available and very friendly and helpful’. One visitor said their relative complains that ‘staff are often too busy’ to see to them, ‘especially in the evenings and at bed time’. They said they often have to wait for assistance. But ‘if patient, gets it in the end’. Comment from staff included that they found the current staffing levels ‘quite stressful’ because people’s dependency is ‘high’. They said they could do with more care staff so that essential paperwork relating to people’s care could be completed properly. Another said that staffing was ‘difficult’ in the afternoons, and that it would ‘be nice to have more time to spend with people socially’. Highfield Nursing Home DS0000058827.V371881.R02.S.doc Version 5.2 Page 21 As stated previously in the report, people had to wait a long time at the table before their meal was served. Thought should be given as to how the routine of the home could be improved so that people can be assured that their dining experience is satisfactory to them. Bearing in mind the above comments, it would be good practice to formally seek people’s views, to see where they themselves think improvements can be made to the staffing arrangements. Two recruitment files were looked at. One file showed that the person had been properly recruited. The second file identified that the staff member had started to provide care after the company had carried out a POVA First check to make sure the person was not barred from providing care, but before the full police check was returned. This arrangement is permitted in exceptional circumstances where people would be left vulnerable because of staff shortages. However, they must be supervised at all times. There was no evidence in the staff file to show how this had been achieved, although the registered manager confirmed that this was always the case. The registered manager must also make sure that people’s previous employment history is fully explored, so that gaps can be explained. This acts as another check to make sure that there is no reason why the staff member should not work with vulnerable people. The registered manager told us that all new staff receive a four day induction before they begin working alone. This comprises of two days of theory, and a further two days working alongside another more experienced staff member. They then commence the full induction which takes a number of weeks to complete. A new staff member was being shown the fire procedure on the day of the site visit so they would know what to do if the fire alarm went off. There is an ongoing programme for care staff to achieve National Vocational Qualifications in care. This helps to keep staff informed about good practice in providing care. There is also an ongoing programme overseen by the training co-ordinator to make sure staff keep up with training they have to have by law. Where the records showed this was not up to date, the registered manager said that they knew, and that plans were in place to get this done soon. More specialised training is also being organised for staff, such as dementia care training, and in a staff file seen there were certificates to show they had attended courses in customer care, nutrition and POVA (protection of vulnerable adults). Staff spoken with had been given a range of training to help them provide care in a safe way. Highfield Nursing Home DS0000058827.V371881.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People who use the service experience adequate outcomes in this area. Continued shortfalls in health and safety processes may put people at risk. We have made this judgement using a range of evidence including a visit to this service. EVIDENCE: The registered manager attends periodic training which helps to keep her up to date with good practice. She has recently attended training to update her management qualification. She has also attended a seminar on dementia, to discuss how people’s care can be made more individual. Staff commented that the manager is ‘approachable’. One said that she ‘tries to spend a lot of time with people’. Another said that she ‘listens and acts’. The registered manager provided the commission with an improvement plan after the last inspection, to tell us how identified shortfalls would be addressed. Despite this, some similar shortfalls were noted at this inspection, which raises Highfield Nursing Home DS0000058827.V371881.R02.S.doc Version 5.2 Page 23 questions about how improvements are made and maintained. These include issues about how vulnerable people are safeguarded, and how they are kept protected from avoidable risks. This needs to be looked at during the monthly visits made to the home by the company to make sure that slippage does not occur. The company sends people annual questionnaires to see how satisfied they are with the service. They are also sent to their relatives, and visiting professionals. The results are not published, but should be, so that people can see that their comments have been taken seriously. They will then be able to see what improvements are being made based on their views. The registered manager said that those who attend the ‘residents’ meetings’ are told about the results verbally. The home does not handle people’s money, although people would be supported if they wanted to manage their own affairs, and provided with lockable facilities should they want to keep valuables in their own room. The company makes sure that the major equipment, such as the electricity and heating services, is kept well maintained. This helps to keep the environment a safe place to live. The home has a fire safety risk assessment which the registered manager said the fire officer looked at during their most recent visit. There were no recommendations made following the visit. The Environmental Health Officer has visited the kitchen and said that some food could be stored in a better way. The company however has recently completed an audit and has commended the home on their overall ‘excellent standards’. They have reviewed the way that the items are stored, which the registered manager said they now deem satisfactory. Checks done in house need to be equally stringent. For instance, there were some water supplies to which people could have access which were too hot. Although the registered manager was confident that this was not a risk to people in the area, because they were not mobile, the temperatures had not been adjusted to a safer temperature when the problem was found. Also, the monthly routine check of people’s bed safety rails was sometimes not recorded, so there was no evidence that this had been done. This needs to be kept up to date to confirm that a suitably qualified person has checked to make sure that the equipment remains safe for people to use. Finally, the staff had recorded in one bed safety rails assessment that the person using the bed was at a high risk from entrapment from the gap between the rails and the mattress. But there was no recorded action taken, and the registered manager was not aware that this had been identified as a risk. She took immediate action to check that the bed was safe once we brought this to her attention. This sort of identified risk must not be overlooked, as it is potentially dangerous for the person concerned. Highfield Nursing Home DS0000058827.V371881.R02.S.doc Version 5.2 Page 24 Highfield Nursing Home DS0000058827.V371881.R02.S.doc Version 5.2 Page 25 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 1 8 3 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 3 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X N/A X X 1 Highfield Nursing Home DS0000058827.V371881.R02.S.doc Version 5.2 Page 26 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(2) Requirement People must have a comprehensive care plan, which describes how all their health and personal care needs are to be met. This will make sure they are cared for in a consistent manner. Timescale of 30/11/07 not met. All people assessed as at risk of falling must have a plan of care detailing how this risk is to be minimised. This is to show that the home is doing all it can to keep people safe. Timescale of 31/10/07 not met As discussed at the site visit: People requiring bedrails must have a risk assessment in place identifying need and consent, so that people can be kept safe. This should include an assessment where bumpers are not used, so that the person is not put at risk. Highfield Nursing Home DS0000058827.V371881.R02.S.doc Version 5.2 Page 27 Timescale for action 31/10/08 2 OP7 13(4) 08/10/08 3 OP7 13(4) 08/09/08 4 OP9 13 Timescale of 31/10/07 not met The medication system must be audited more thoroughly so that shortfalls in practice can be addressed quickly with the staff concerned, and the risk to people from error minimised. To include: Checking that staff sign to show that they have applied creams that the person’s doctor has prescribed. • Making sure the stock balance has been recorded on the current medication sheet. • Addressing when staff have signed to say they have administered medication which is still in the blister pack. • Checking that staff record all medication administered to the person as prescribed by their doctor. As discussed at the site visit: Safeguarding Adults referrals must be made in line with North Yorkshire Social Services guidelines so that people are protected from harm. The Commission for Social Care Inspection must be notified of any event, which affects the well-being or safety of people living there. Timescale of 11/09/07 not met As discussed at the site visit, the hot water accessible to people must be maintained within safe limits to reduce the risk from DS0000058827.V371881.R02.S.doc 08/10/08 • 4 OP18 13(6) 08/09/08 5 OP38 13 08/09/08 Highfield Nursing Home Version 5.2 Page 28 6 OP38 13 scalds. As discussed at the site visit: Someone competent to do so must check bed rails on a regular basis, and a record must be kept to show that this has been done. Where risk is identified from the use of bed rails, action must be taken straight away to minimise the risk to the person. 08/09/08 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 OP3 Good Practice Recommendations To make sure that they are fully considered during the pre admission assessment, more information should be sought about people’s long term needs which will prevail once any acute problems they may have subside. People and or their families should be given the opportunity to help draw up and review their plan of care. This will help to make sure that agreement is reached about the care they need, and when and how they get it. People’s social needs should not be overlooked when writing their care plans, as a good understanding by staff of these can improve a person’s well being. The way that the care plans are audited should be improved, so that people can be assured they will be of good quality, and contain the right information about their needs, and risks to their welfare. More thought should be given as to how the routine at mealtimes could be changed so people do not have to wait at the table for long lengths of time before their meal is served. The registered manager should make sure staffing levels are sufficient to meet the diverse needs of the people who live there. People’s views should be sought so that a better DS0000058827.V371881.R02.S.doc Version 5.2 Page 29 2 OP7 3 OP15 4 OP27 Highfield Nursing Home 5 OP29 6 OP31 7 OP33 idea about where they would like to see improvements in staffing can be had. To protect people from potential unsuitable workers, formal arrangements should always be in place so that it is clear who is responsible at any time for supervising care staff who have not yet had a full police check returned. Clarity should be sought regarding the management arrangements and lines of accountability and staff roles and responsibilities within the service, so that improvements made in meeting identified shortfalls can be maintained and built upon. The results from satisfaction surveys in which people have been involved should be published, so people can see that their views and opinions about the service, including where they would like to see improvements, are being considered and acted upon where appropriate. Highfield Nursing Home DS0000058827.V371881.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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