Inspection on 26/05/09 for Highfield Residential Care Home

This inspection was carried out on 26th May 2009.

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

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

Other inspections for this house

Highfield Residential Care Home 15/01/10

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

Key inspection report CARE HOMES FOR OLDER PEOPLE Highfield Residential Care Home Culver Street Newent Gloucetsershire GL18 1JA Lead Inspector Sharon Hayward-Wright Unannounced Inspection 26th May 2009 09:55 DS0000072593.V375420.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Highfield Residential Care Home DS0000072593.V375420.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Highfield Residential Care Home DS0000072593.V375420.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highfield Residential Care Home Address Culver Street Newent Gloucetsershire GL18 1JA 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) 0208 922 5945 Accommodating Care (Newent) Limited Mrs Christine Mary Richards Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Highfield Residential Care Home DS0000072593.V375420.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code OP to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 27 New registration Date of last inspection Brief Description of the Service: Highfield House is a converted and extended Victorian property located approximately half a mile from Newent town centre. The Care Home provides accommodation and personal care for up to 27 elderly people on three floors. A shaft lift is available to assist those unable to manage the stairs. In addition, a variety of aids and adaptations that include hoists and hand rails are provided throughout the property to assist those living in the Home. The communal facilities comprise of a large lounge and dining area, plus a conservatory overlooking the attractive garden. There are additional smaller sitting rooms provided on the ground and first floors. The majority of the bedrooms have en-suite facilities; many have the advantage of delightful views over the surrounding countryside. The fees for this home are from £340.85 to £440.55 per week. Additional services not included in the fees are chiropody, newspapers and hairdressing. The home makes available to people a copy of our reports and their Statement of Purpose and Service Users Guide. Highfield Residential Care Home DS0000072593.V375420.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out by one inspector on one day in May 2009. Before we visited the home we sent surveys to the home in order to obtain the views of people who use the service and staff. We received one back from a person who uses the service and three from staff. The results of these have been used in the report. We requested an Annual Quality Assurance Assessment (AQAA) prior to this inspection and we received it on time. The AQAA contained brief and mainly bullet point information about how the home feels they are meeting the needs of people who use the service and any plans for areas they wish to improve over the next 12 months. The AQAA also contains Dataset which is numerical information. We looked at other information we have received from or about the service from other stakeholders. This includes where the home notifies us of any incidents that affects the well being of people who use the service. We looked at a number of systems the service has in place to include care records, activities, food provision, staff supervision and training, complaints, medication and maintenance records. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: The home has a system in place to make sure people are assessed prior to admission so they are able to provide confirmation that they can meet peoples assessed needs. People who use the service who were spoken with during the inspection all praised the staff in the home saying they are hard working and very good. Highfield Residential Care Home DS0000072593.V375420.R01.S.doc Version 5.2 Page 6 People spoken with at the inspection all said they enjoy the food provided and they are offered a variety of foods. The home exceeds the recommended 50 of care staff with or undertaking an NVQ qualification in health and social care. What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Highfield Residential Care Home DS0000072593.V375420.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 Residential Care Home DS0000072593.V375420.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective people are assessed prior to admission so the home can make sure they can meet their assessed needs. EVIDENCE: This is the first key inspection for this home with the new Registered Provider. Following the inspection copies were sent of their Statement of Purpose and Service Users Guides. People who use the service have a copy of the Service Users Guide in their bedrooms. We examined the pre admission assessments of two people who were recently admitted to the home. Both people had a full assessment of their needs Highfield Residential Care Home DS0000072593.V375420.R01.S.doc Version 5.2 Page 9 completed by the Registered Manager prior to admission. One person was admitted to the home from hospital and discharge information was also available. A copy of the letters sent to both people confirming the home can meet their assessed needs was seen. We spoke to one of these people and they explained their family had helped them to find this home as they wanted to be in Newent and they were very happy with their choice. Highfield Residential Care Home does not provide intermediate care and therefore Standard 6 does not apply. Highfield Residential Care Home DS0000072593.V375420.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care that people receive is based on their individual needs; however the care records do not reflect this. Some improvements are needed with the medication system to make sure people are not placed at unnecessary risk. EVIDENCE: The care of two people was examined in detail and this includes reading care records, speaking to the person if able, speaking to staff and observing any interactions between staff and the two selected people. Both people had an assessment of needs completed on admission and from this care plans are devised. The Registered Manager said they are looking to alter the format used as they need to introduce an ongoing assessment of needs. We found that care plans were not always in place for all peoples assessed needs for example one person has an overhead hoist in place and needs to be turned frequently Highfield Residential Care Home DS0000072593.V375420.R01.S.doc Version 5.2 Page 11 for pressure area care and for personal relief but this was not documented. One person is also having creams applied but this was not in their care plan. We discussed with the Registered Manager that care plans need to contain more personalised information about people needs and they should include people’s choices. Words like ‘regularly’ should not be used as they need to be more descriptive and provide staff with detailed instructions on how to meet people’s needs. Reviews of care plans were not always taking place monthly for example some had not been reviewed since March 2009. Risk assessments were in place, for example, moving and handling and nutrition. Some of these had not always been reviewed monthly. Another person who uses the service has bedrails in use and the home must undertake a risk assessment. We strongly recommend they obtain guidance from the Health and Safety Executive about how to use them safely to make sure people are not placed at risk. Staff complete daily records for each person and these are contained in their care records. People have access to external health professionals to include Community Nurses, General Practioners, Chiropodists and Continence Advisor. We spoke to a number of staff about the care of these two people and they were able to demonstrate very good knowledge of the care they give to these two people. From this we found that the staff are actually providing more care than what is documented in these two peoples care plans. We asked staff in the surveys we sent for them to the home, are you given up to date information about the needs of the people you support or care for (for example, in care plan), two staff said ‘always’ and one said ‘usually’. The home’s AQAA states that in the next 12 months they have plans to include people’s key workers and their families in the reviews of peoples care. In the survey we received from one person living at the home we asked them, are the staff available when you need them, they said ‘usually’, we also asked do the staff listen to you and act on what you say, they said ‘always’. Another question we asked was does the home make sure you get the medical care you need, they replied ‘usually’. A comment they made was “would like more baths as they only have 2 per week”. People we spoke with during the inspection were happy with the standard of care they receive. The system the home has in place for the management of medications was examined. Not all staff administer medications, only those who have received training. A trolley is used to transport the medication around the home. A signature and initials list is in place for staff that administer medication. We examined all the Medication Administration Records (MAR). Records were in place for medications received into the home. We found that there were some gaps in the signing of the administration of some people’s medication. Highfield Residential Care Home DS0000072593.V375420.R01.S.doc Version 5.2 Page 12 For example we found that one person was prescribed a weekly medication but this was not signed as being given, however when we checked the medication it had been. Some people had been prescribed creams but they were not being signed as being given. We also found that hand written prescriptions were not always being checked and signed by a second member of staff as this is required to prevent any errors with transcribing. It was found that on one person’s MAR that one medication was out of stock and the home were waiting for it to arrive from the pharmacy. The Registered Manager said this was due to an issue with the pharmacy and not the home. The home has a system in place to return any medications that are no longer required. Since the last inspection the home has introduced a stock level record sheet for medications that are not included in blister packs, which is good practice. Dates of opening were seen on boxed medications, eye drops and creams. However we did find that one persons eye drops were being used passed the manufacturer’s 28 days timescale once opened. This is unsafe practice. We also found one tube of cream that was also passed the manufacture’s recommended timescale once opened. During the tour of the home we found several containers of cream that had no date of opening on them and in some cases the label was faded and it was difficult to read if the cream was still within the safe recommended timescale for use. We also found that one person had a cream that was prescribed for another person. This is unsafe practice and the staff must not use cream that was prescribed for one person on another. The system the home has in place for the management of controlled medication was examined; some medication was waiting to be returned as the person no longer required them. Records were in place and correct. For medications that are prescribed for ‘prn’ or as required care plans must be in place, however this was not always the case. One person did have a care plan in place for the use of pain relief but it requires more details about how and when it is to be used and if the person is able to request it. The home needs to consider bringing some of the principles of the Mental Capacity Act 2005 into their medication system for example discussing with people where they would like their medication administered. A medication reference book is in place for staff to use. The Registered Manager confirmed that staff do not administer medication until they have received training and that recent updates have taken place and more are planned. From discussions with people who use the service the staff in the home respects peoples privacy and dignity. We observed staff knocking on peoples bedroom doors prior to entering and speaking to people in a respectful manner. However the home is using seat covers on armchairs in communal rooms, this is institutional practice as must cease as with proper continence care these are not required and do not promote people’s dignity. Highfield Residential Care Home DS0000072593.V375420.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their daily lives and have access to an activities programme based on their choices, abilities and interests. EVIDENCE: One member of staff is designated to provide activities for people with assistance at times from other staff. The activities hours are about ten per week. Each month a list is devised of planned activities and these are given to people and displayed in the home. External entertainers visit the home on a regular basis. People told us the hairdresser visits about every two weeks. One person entertains other people in the home with their musical instrument. Where able people can go out and they have access to the local Dial a Ride. One person was going out for lunch on the day of the inspection. Highfield Residential Care Home DS0000072593.V375420.R01.S.doc Version 5.2 Page 14 Communion takes place monthly at home and a representative from the Catholic Church also visits regularly. A meeting also takes place about every two weeks at a local Church and people can attend this is they are able. Visiting to the home is not restricted and a number of people spoken with confirmed this. People spoken with said they were happy with the activities provided. We asked people in the surveys does the home arrange activities that you can take part in if you want, and the one person said ‘sometimes’. The AQAA does not contain information about any outings for people. It does state that they are planning to provide further training for the activities coordinator. During a tour of the home we viewed a number of bedrooms belonging to people who use the service and they had their personal belongings on display. People confirmed that they are able to make choices about their daily lives to include times of rising and going to bed, meals, activities and how they wish to spend the day. Information about advocacy is provided in the home. The cook was spoken with and she said the home works on a four week menu rotation that is devised by the Registered Manager. Records are maintained of food provided and alternatives that are offered. Both cooks are aware of people’s likes and dislikes and can cater for people who require therapeutic diets. Evidence was seen of health and safety checks taking place and the last Environmental Health Department (EHO) visit was 2003. None of the cooks have undertaken the training provide by the local EHO department in ‘safer food better business’. It is recommended they attend this training. We observed a mealtime and people were given the choice of where they would like to eat their meal. Some people chose to sit in the dining room, others stayed in their rooms and one person wanted to sit in front of the television in one of the communal rooms and staff accommodated this. Where people were transferred to the dining room some people were left to sit on transfer chairs and were not assisted to sit on the dining chairs, which would be good practice. People were served drinks with their meal. Staff wore protective clothing when serving meals and assisted people discreetly. We observed that people were offered alternatives to the menu. Each table was laid with a table cloth and condiments for people to help themselves and people were chatting to each other. People we spoke with said that the food was good; one person said that the portion sizes are large. Another person said you don’t get a choice but the food is good. In the survey we asked do you like the meals at the home and the person said ‘usually’. We observed people being offered hot drinks at intervals during the day with snacks and in the afternoon this was accompanied by cakes. People are able to have cold drinks in their bedrooms and people are also offered these in the communal rooms. Highfield Residential Care Home DS0000072593.V375420.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns and have access to a complaints procedure. Systems are in place to help protect people from possible risk of harm or abuse. EVIDENCE: The Registered Manager said they have not received any complaints since the new Registered Provider took over the running of the home. A copy of the home’s complaints procedure is display. One person said the Registered Manager is very good at dealing with any issues and other people confirmed they would speak to her or a member of staff if had any concerns. We asked in the survey we sent to people, is there someone you can speak to informally if you are not happy, and they said ‘yes’ and they said they also knew how to make a complaint. People we spoke with said they have no concerns and are happy with the care they receive. The three members of staff that returned our surveys were asked if they know what to do if someone has concerns about the home and all said ‘yes’. Highfield Residential Care Home DS0000072593.V375420.R01.S.doc Version 5.2 Page 16 The home has policies and procedures in place to help safeguard people and these include abuse, use of restraint, managing challenging behaviour, whistle blowing and harassment. Staff have access to these policies and procedures. The Registered Manager has completed training in Mental Capacity Act 2005 (MCA) and Deprivation of Liberty (DOL’s) provided by the local County Council and has plans to send team leaders on this training. We would also recommend that all care staff attend this training. The home has information about the DOL’s and the MCA available for staff and people who use the service and they obtained this from the Department of Health. As mentioned in Health and Personal Care Standards we found that one person is using bedrails and these can be classed as a form of restraint if the appropriate consent and risk assessments are not in place. Highfield Residential Care Home DS0000072593.V375420.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is not a purpose-built facility but people on the whole live in a comfortable environment. However improvements are needed to some parts of the home to make it pleasant and pleasing place for people to live. EVIDENCE: Highfield Residential Care Home is not a purpose-built facility, however aids have been provided to assist people who use the service to include a shaft lift, assisted bathing facilities, grab rails and toilet frames. A tour of the environment took place with a number of bedrooms belonging to people viewed with their agreement. The entrance path to the front of the home needed weeding and the bushes at the side could also be trimmed back. On entering the home we found a strong odour of urine. We also found that room Highfield Residential Care Home DS0000072593.V375420.R01.S.doc Version 5.2 Page 18 32 was also odorous. The carpets in the main entrance are starting to look worn in places and the Registered Provider would need to consider a replacement. We found that in places around the home the décor is looking tired and the paint work is damaged. One person commented in the survey we sent them that their room needs a coat of paint and a new carpet. Toilet number 8 requires a toilet roll holder, bathroom 29 was out of action but the Registered Manager had been on leave was going to find out why. Rucks were found in the carpet by room 25, which is a trip hazard so needs to be addressed. The Registered Manager said that the home does not have regular maintenance hours each week and this could be why we found the above issues. We did not view all people’s rooms so we would recommend that this done by a member of staff and a list made of any areas that need attention. The Registered Manager said that outside contractors maintain the gardens which we did not walk round but saw from the windows. During the tour of the home we observed that the bedrail bumpers were used to prop open room 15 door whilst the domestic was in there, this is poor infection control practice and must cease. We spoke to a number of people who said they were happy with their rooms and the cleanliness. People also confirmed that they were warm enough. The AQAA states that six staff members have been trained in infection control and we would suggest that all staff undertake this training. We did find that a bag was left on a toilet floor with a used continence pad in it; this is unsafe practice and could place other people who use the service at risk. It is possible that a person left this on the floor but staff need to make sure they are checking the toilet areas especially near the communal rooms. The laundry area was examined and it was tidy, well organised and a system is in place to manage soiled linen. In the surveys we sent to people we asked is the home fresh and clean and the one reply we received said ‘usually’. The AQAA states that the future plans for the next 12 months are to devise a redecoration and maintenance programme. Highfield Residential Care Home DS0000072593.V375420.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are trained and in sufficient numbers to meet the assessed needs of people who use the service. Staff have access to an ongoing training programme that will help to maintain and provide them with new skills to support the smooth running of the service. EVIDENCE: Prior to the inspection we received the homes Annual Quality Assurance Assessment (AQAA) and included in this is numerical information for example how many people need help with washing and bathing. The AQAA was dated March 2009 and at that time the home had 27 people who required assistance with washing and bathing; however at the inspection the home had 23 people in residence. We examined the duty rotas with the Registered Manager and she was confident that the numbers of staff on duty are meeting the needs of people who use the service. Ancillary staff are available to assist care staff, however care staff do undertake non care duties to include laundry and evening meal preparation. The home is using agency staff to fill any vacancies in the duty rota. We spoke to a number of people and they all praised the staff in the home saying they were ‘very friendly and helpful’. However one person did express Highfield Residential Care Home DS0000072593.V375420.R01.S.doc Version 5.2 Page 20 some concerns about the manner of one member of staff and this was relayed to the Registered Manager. We asked in the survey we sent to people are the staff available when you need them, and the one person who responded said ‘usually’. In the staff survey we asked, are there enough staff to meet the individual needs of all people who use the service, all three responded ‘usually’. We also asked do you feel you have enough support, experience and knowledge to meet the different needs of people who live at the home, one said ‘always’ and two said ‘usually’. Comments were received in the staff surveys, “we give great care to people”, “we look after the residents and their differing needs well”. One other comment from a member of staff was “to nip problems in the bud before they become too large and this relates to staff”. Staff spoken with at the inspection all said it is a nice place to work and the staff on the whole work well as a team. Some members of staff have worked at the home for a number of years. The number of staff with an NVQ in Health and Social Care and who are undertaking this exceeds the recommended 50 which is excellent. We examined the recruitment records of three staff that have started work at the home in the last few months. One member of staff had all the required recruitment checks in place prior to them starting work at the home and this included a full Criminal Records Bureau Disclosure (CRB) and Protection of Vulnerable Adults (POVA) list check. One staff member had all the required checks in place to include a POVA check but their full CRB had not been returned, this is expectable providing the staff member is supervised at all times. An error had occurred with reference for another member of staff and they started work at the home prior to its return. We did see evidence that this is not the normal practice when recruiting new staff and other staff records seen had all references in place prior to starting at the home. The Registered Manager said the home uses an external training provider for part of their induction programme and a booklet was seen. We were told that this training provider’s induction training is based on Skills for Care Common Induction Standards. The home also has an in house induction programme and we examined a checklist for this. A training matrix is in place and training is on-going for all staff. External providers are used and some training has been provided by the Care Home Support team. Staff have access to training for mandatory subjects for example moving and handling and other areas for example, dementia, managing aggressive behaviour, report writing and person centred care. Training is planned for continence care and first aid. The AQAA states that four staff have received training in malnutrition. Staff spoken with at the inspection and from feedback in the surveys confirmed they have access to training. Highfield Residential Care Home DS0000072593.V375420.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A qualified and competent person manages the running of this home; however improvements are needed to the quality assurance systems used to make sure the home is run in the best interests of people who use the service. EVIDENCE: The Registered Manager has been working at the home for a number of years and has undertaken all the relevant training required for her role. She said that she undertakes training with other staff and was able to list training she has attended and this includes equalities and diversity. People and staff said she is Highfield Residential Care Home DS0000072593.V375420.R01.S.doc Version 5.2 Page 22 approachable and they can discuss any concerns they might have with her. This is the first key inspection for the new Registered Provider of the home. The system the home has in place for quality assurance was examined. The Registered Manager said that questionnaires were sent out to people in March this year but she needs to collate the results and devise an action plan if needed. Some audits are taking place and these include medications and health and safety but the Registered Manager said they need to improve this area. We saw minutes of staff meeting and meetings for people who use the service. Letters and cards thanking the home for caring for people were seen from a number of relatives. As the Registered Provider is not in day to day control of the home Regulation 26 visits must take place,(this is where the Registered Provider or a representative on their behalf visits the home unannounced and undertakes an assessment of the home) monthly and a copy of the report sent to us at our Newcastle address. We received the homes AQAA on time it, was brief and contained mainly bullet points but it contained areas where the home felt they do well and where they are looking to improve. Numerical information was also provided in the Dataset part of the AQAA and this provides us for example information about how many people are living at the home, how many staff and when policies and procedures were last reviewed. The home has a safe system in place for the management of people’s monies and where able the staff encourage people manage this. The Registered Manager said that she needs to look at putting a staff supervision programme in place. We examined the training records in relation to mandatory training for staff and this includes moving and handling, fire, infection control, first aid, food hygiene and health and safety. The Registered Manager was able to demonstrate that this is ongoing with training booked for new staff and updates for other staff in several of these areas to include first aid. We examined records of checks on equipment and services in the home and these were all up to date. Monthly checks are undertaken on hot water temperatures but a number were above the recommended safe limited of 43˚C and this should be addressed. Checks were also in place on window restrictors. Checks are taking place for fire equipment to include fire alarm testing and emergency lighting. A fire risk assessment is in place but the home needs to devise an evacuation procedure for people so that staff are aware of the assistance they would require if a fire was to break out. Highfield Residential Care Home DS0000072593.V375420.R01.S.doc Version 5.2 Page 23 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 1 X 2 Highfield Residential Care Home DS0000072593.V375420.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement The registered person must make sure that people have care plans in place for all assessed needs. Care plans must current and provide staff with detailed information on how to meet people’s needs. Ongoing reviews must also be in place. This will help to make sure that staff are provide with detailed information about how to meet peoples assessed needs and that they are up to date. The registered person must make sure that accurate records are maintained of all medication administered in the home. This will provide a detailed record of when people receive their medication. The registered person must make sure that staff do not administer medication that is passed its manufactures shelf life. This will help to make sure that people are not put at risk by the Highfield Residential Care Home DS0000072593.V375420.R01.S.doc Version 5.2 Page 25 Timescale for action 22/11/09 2 OP9 13(2) 30/08/09 3 OP9 13(2) 26/05/09 4 OP9 13(2) actions of staff. The registered person must make sure that people who are prescribed ‘prn’ or as required medication have a care plan in place, that provides staff with details of how the medication should be used. 30/09/09 5 OP10 12(4a) This will help to make sure a consistent approach is used by all staff when using this medication. The registered person must 26/05/09 make sure that the staff promote and protect people’s privacy and dignity. This particularly relates to the use of seat covers on armchairs in communal rooms. The registered person must undertake unannounced monthly visit to the home and complete a report. A copy of this report must be sent to us at our Newcastle address. This is to make sure that the home is run in the best interests of people who use the service. 6 OP33 26 30/09/09 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 3 Refer to Standard OP7 OP7 OP9 Good Practice Recommendations Care plans should include people’s choices and wishes. Care plans should be linked to risk assessments where appropriate. The home should incorporate some of the principles of the Mental Capacity Act 2005 into their medication system. DS0000072593.V375420.R01.S.doc Version 5.2 Page 26 Highfield Residential Care Home 4 OP17 The home should consider sending all staff on the Mental Capacity Act 2005 and Deprivations of Liberty training provided by the local County Council. Highfield Residential Care Home DS0000072593.V375420.R01.S.doc Version 5.2 Page 27 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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