Inspection on 01/11/06 for Highfield Resource Centre

This inspection was carried out on 1st November 2006.

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

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

Other inspections for this house

Highfield Resource Centre 08/07/08

Highfield Resource Centre 29/05/07

Highfield Resource Centre 10/01/06

Highfield Resource Centre 06/09/05

Highfield Resource Centre 24/02/05

Highfield Resource Centre 01/09/04

Highfield Resource Centre 30/01/04

Similar services:

Snydale Care Home

Abbey The

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Highfield Resource Centre Wawne Road Sutton on Hull Kingston upon Hull East Yorkshire HU7 4YG Lead Inspector Unannounced Inspection 09:15 1 November 2006 st 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 DS0000034522.V315934.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000034522.V315934.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highfield Resource Centre Address Wawne Road Sutton on Hull Kingston upon Hull East Yorkshire HU7 4YG 01482 826199 01482 833588 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) Kingston upon Hull CC Heather Woods Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Learning registration, with number disability over 65 years of age (30), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (30), Old age, not falling within any other category (30) DS0000034522.V315934.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Those service users admitted to the home in any category other than OP must have a primary need similar to those in the category of Old Age. The home can provide care for 6 service users aged 60 - 65 years whose primary needs are those related to old age. 10th January 2006 Date of last inspection Brief Description of the Service: Highfield is a care home offering accommodation and personal care to 30 persons who are subject to a wide range of primary conditions and are experiencing difficulties associated with the aging process. The accommodation is purpose built over two floors that are joined by a passenger lift. The home is used for multiple functions such as long term and respite care, intermediate care and day care. The residents’ rooms are all single and there is a good range of communal facilities available for long-term residential residents. The home is situated in the Sutton area of Hull and is near to some local facilities, it is approximately 8 miles from the city centre. It is built within large grounds with good car parking facilities. The Local Authority own and run the home with some assistance from the local Health Authority. All new residents are given a service user guide explaining what the home will provide. The weekly fees range between £77.00 and £639.00, this information was provided by the registered provider during the inspection visit. Additional charges are made for hairdressing, toiletries and chiropody when private. DS0000034522.V315934.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit was part of the key inspection process and took place over one day and took a total of 8 hours. Prior to the visit surveys were posted out to; 18 residents and 7 were returned, 11 to relatives and 10 were returned, 52 were sent to staff members and 1 was returned, of the 20 sent to health and social care professionals 2 were returned and 7 were sent to care managers 2 of which were returned. The registered provider returned the pre-inspection questionnaire and this gave some details about the service including staffing. From this information the decision was made about which staff and resident files would be looked at. The previous requirements were discussed with the manager and the majority have now been met, it should be noted that the staff and manager have worked very hard in order to improve the standards offered at the home. Some of the environmental and care practice issues that relate to the intermediate and day care residents have not yet been addressed by higher management in the Local Authority and this reflects upon the overall rating of the home. Following a meeting was held on 18/10/05 at Brunswick House an agreement was reached for Roger Grey, Locality Manager to discuss with higher management the long term action plan in relation to the day care and respite service offered at Highfield, a timescale for response was 1/12/05, as yet nothing has been received by CSCI. During the visit several of the residents, three staff members and two relatives were spoken to this was to find out what it was like for people who live here. A tour of the building was undertaken, some of the records looked at included the medication, complaints, quality assurance procedures, 3 resident files, 3 staff files and other paperwork relating to the maintenance of the home and the care of the residents. A discussion with the manager occurred regarding diverse needs and in particular how the residents are currently supported to follow their religion of choice and practise their faith. Training courses have being undertaken to ensure that all residents are treated equally and not excluded because of a diverse need. The registered manager was present throughout the inspection and was told how the inspection had gone at the end of the day. The inspector would like to thank the residents, manager and staff for welcoming her into the home and contributing to the content of this report. DS0000034522.V315934.R01.S.doc Version 5.2 Page 6 What the service does well: The home continues to offer a very high standard of accommodation to the long term and respite residents and the environment is clean, hygienic and the atmosphere is friendly and welcoming, which makes Highfield a very nice place to live. Some residents said, “my room is lovely, I have everything I need”, “my room is very nice and my family can visit whenever they want to”, “the staff and manager are friendly and helpful”. All of the 10 surveys from relatives were extremely complimentary and spoke highly about the care, staff and management of the home, some comments included; “I have been very impressed by the standard of care, the staff are attentive and do their very best for the residents”, “This is the best home in Hull”, “Staff are excellent, always appear happy and caring towards the patients/relatives”, “I can’t thank the staff enough for taking such good care of my mum”. The care offered maintains and promotes independence, residents are supported to carry out activities/hobbies. From speaking to some of the residents it was clear that they have good relationships with the staff, some comments included; “the staff are wonderful, always helping us”. Staff were observed interacting with the residents throughout the day and this was done in a non-judgemental, but supportive and enabling way. The menu is nutritious, wholesome and choice is offered, some comments from residents included; “the food is very good, lots of options are offered”. The home has a good complaints procedure and from speaking to residents and relatives they are confident in the management when dealing with any issues. The home protects the residents from abuse and has clear procedures in place to deal with this, staff receive training and fully understand the needs of the residents. Staff are well trained, experienced and competent therefore ensuring that residents’ needs are fully met and understood. The home’s quality assurance system ensures that residents and other people who visit the home have their say about how it is run, what is good and what needs changing. DS0000034522.V315934.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Individual resident files require further development, all of the newly introduced paperwork requires implementing and care plans or daily living plans although these cover a lot of areas, these are not in-depth or prescriptive, nor do they give clear direction to staff about what action or assistance is required and when. Risk assessments have been updated since the last inspection, these are not specific about the risk, what action is require and when. The structure, teamwork, facilities and stimulating activities for residents receiving intermediate or short-term care should be improved, in order to ensure that the intermediate residents receive the same quality of service and accommodation that the long term residents receive. An action plan must be produced to ensure that the specialist services receive an improved level of input through increased staffing levels, integrated teamwork and designated or specialist staff. If care staff were involved in the assessment process for the intermediate care residents, the home would be able to offer a complete rehabilitation programme. The intermediate care rooms are in need of redecoration, some flooring and furniture requires updating or renewing to ensure that all residents live in the same standard of accommodation. The door to the shower room and toilet near to the intermediate care bedrooms is very heavy and has to be wedged open therefore limiting or restricting the rehabilitation programme, this may also compromise dignity. DS0000034522.V315934.R01.S.doc Version 5.2 Page 8 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. DS0000034522.V315934.R01.S.doc Version 5.2 Page 9 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 DS0000034522.V315934.R01.S.doc Version 5.2 Page 10 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all residents are assessed prior to or following admission, the intermediate care facility lacks the range of facilities necessary for active rehabilitation and the care staff work in parallel to the health authority staff. This lack of multidisciplinary teamwork will not assist residents in maximising their independence. EVIDENCE: Standards 1,3 & 6 were looked at. The home has developed a statement of purpose and service user guide and copies of the guide were seen in resident’s rooms. From speaking to residents, relatives and staff it was clear that this information is given to prospective residents and that the information was easy to read and understand. The manager confirmed that they have a large print version and DS0000034522.V315934.R01.S.doc Version 5.2 Page 11 if a different language is spoken then Brunswick House, Social Services Headquarters will produce this in the appropriate language upon request. This information ensures that residents fully understand what care and support they would receive whilst living in the home. During the inspection visit three of the resident’s files were looked at and there was evidence confirming that the permanent and respite residents all have a community care assessment undertaken prior to or within a few days of admission. A care plan is then drawn up detailing what action is to be carried out by the care staff, the home works with this document for the first 6 weeks after admission at which point a review is held to discuss whether all needs have been identified. The home continues to work with the care plan and develops their own care plan. There was evidence in place to confirm that regular reviews are undertaken, usually on a six monthly basis. From speaking to residents and relatives it was clear that they were fully involved in the assessment process and this was explained to them. One resident stated; “I couldn’t look after myself anymore and the staff came to see and asked about what I could do for myself and what I liked to do”. As stated in the last inspection report of 10.1.06 the health authority staff assesses the intermediate care residents. Staff stated that sometimes intermediate care residents arrive at very short notice and they may only have a name with no other details. Some comments included; “staffing levels are usually ok for the long term residents, but when the four intermediate care beds are full this can put a real strain upon us, especially if all of those residents require two carers to assist with all care”, “Intermediate care residents have more needs that the long term residents and this puts strain upon the staff group, sometimes this means that the long term residents do not get as much time as they would like or need”. The nursing and other specialist workers (physio and occupational therapists) do liaise with the care staff, but this is to give direction as to the intervention they have decided is appropriate and they develop the care plan. Senior members of the care staff being involved in the assessment process could assist the integration of these two processes to ensure that the residents’ needs are fully met. The intermediate care unit can accommodate four residents, three of whom are placed together in the home. The unit has facilities for the movement and handling of residents, but has no designated facilities for the social rehabilitation of residents such as a kitchen and lounge facilities. This will hinder the rehabilitation of service users. None of the care staff are designated to the unit or specialise in rehabilitative care. There was no evidence of any staff receiving training in rehabilitative processes. This does not make best use of the resources available to the unit. Interviews with staff confirmed that they are only asked to provide basic physical care for residents and there is no evidence of plans for their active involvement in the rehabilitative process, which is done by nurses and other DS0000034522.V315934.R01.S.doc Version 5.2 Page 12 medical ancillaries working in the community. There was no evidence of multi disciplinary teamwork or case review on this unit. This will not enable the rehabilitation of service users to be maximised. From speaking to several staff members, the manager and information received prior to the visit-taking place, it was clear that there had been a level of mismatching of residents needs to the intermediate care unit. Therefore not all of the residents’ needs are assessed either prior to admission or involving the home’s staff and this may be reduced if the homes staff were involved in the assessment process. As stated in the last inspection report this combination of factors indicates that the best use of resources is not made on the intermediate care unit in order to assist service users to return home. DS0000034522.V315934.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care planning system for residents receiving long term and respite care is good, however some work needs to be done to improve the intermediate care functions in the home. The medication procedure is adhered to ensuring that medication is given in a safe way. Residents are able to live in the home experiencing respect and privacy. EVIDENCE: Standards 7,8,9 & 10 were looked at. During the inspection three of the residents’ files were looked at and each file contained a photograph of the resident, personal information and details of DS0000034522.V315934.R01.S.doc Version 5.2 Page 14 any specific need such as dietary, diabetic or other health or social care needs. From speaking to the manager and from looking at written evidence it would appear that the care plans have been improved since the last inspection. The files are now segregated into sections and are much easier to read and find information. All files contained a referral and admission checklist and this identifies needs, medication, physical, emotional etc. The manager explained that from the community care assessment a daily living plan is developed for each person and although this covers a lot of areas, it is not in-depth or prescriptive, nor do they give clear direction to staff about what action or assistance is required and when. Evidence was seen confirming that the residents receive regular healthcare checks for optical, chiropody, dental, nutritional screening is undertaken at the point of admission and residents’ are weighed on a monthly basis. The registered manager explained that this would be increased if a problem had been identified and appropriate professional advice would be sought. Charts for bowel movement and an assessment re self-medication have been developed, but as yet have not been fully implemented. The home operates a key worker system and from speaking to several residents it was clear who their worker was and what support they would offer. Some comments made by residents included; “the staff are lovely, always polite and friendly”, “my family and friends are welcome at any time and they are always offered a cup of tea”, “my key worker comes to see me whenever she is on duty and I enjoy our chats”. There was evidence in place confirming that regular reviews are undertaken, the residents are involved in this process and have a chance to give their views. One person said, “I have just had a review where everyone attended, I told them I love it here and could not wish for a better place to live”. The risk assessments have been reviewed and updated since the last inspection and although they cover both environmental and individual risk, they are not specific or in depth enough to give clear direction to staff about how to manage the risk. Overall the management of risk is adequate, but again some of the paperwork requires attention. One risk assessment in relation to moving and assisting a resident was looked at and stated that no assistance was required, when investigating further it was evident that the resident could ‘weight bear’ or stand unassisted, but could not get in and out of the bath alone and therefore the risk assessment was not accurate and did not state that two staff were needed to assist the person onto bath chair. Regular reviews take place for the permanent and respite residents, sometimes respite and intermediate residents may not have a review undertaken as they may not return or have a very brief stay at Highfield. The intermediate care residents have brief aims and goals and these plans are developed by the health workers, none of the care staff are involved in this process. The registered manager explained that the intermediate care residents are DS0000034522.V315934.R01.S.doc Version 5.2 Page 15 reviewed on a weekly basis and care staff now attend this meeting and give their views. Nursing staff pop in on a daily basis to visit the residents and are available via telephone contact at other times day and night. The home has a medication policy and procedure and staff interviewed confirmed that they had undertaken the medication training offered by the Local Authority and felt confident when dealing with the medication. The medication system was observed and records were in good order, staff follow the procedures correctly and therefore the residents receive their medication in a safe way. From speaking to several residents and two relatives it was confirmed that the staff show respect to the residents, maintaining privacy and dignity at all times. Some comments included; “staff always talk to me when they are helping me, this makes me feel better”, “I need help to get in and out of the bath, the staff are very supportive and understanding”. Three staff members were spoken to about their roles and responsibilities confirming that the general aim of the home was to make sure that residents needs were attended to and to enable residents to maintain their independence for as along as possible. Staff spoke about the induction training and explained that part of this covers treating people with respect and dignity, all staff displayed a good level of understanding in relation to privacy and dignity. Eleven surveys were returned to the Commission from relatives and all of the comments were extremely positive about the care offered. These included; “I have been very impressed with the standard of care”, “the staff are attentive and do their very best for the residents”, “my mother has settled in well”, “staff are excellent, always appear happy and caring towards the residents”, “I can’t thank the staff enough for taking such good care of my mum, and for making the family welcome”. DS0000034522.V315934.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. A range of recreational activities is provided in the home and resident’s preferences are accommodated. Daily choice for residents is enabled and contact with friends, local community is encouraged. Residents have choice, diversity and experience a very high standard in the meals provided. EVIDENCE: Standards 12,13,15 & 15 were looked at. During the visit several of the residents’ were either spoken to or given the opportunity to talk to the inspector about what it was like for them living in the home, some of the comments included; “staff always talk to me, they are polite, friendly and make my family welcome”, “I cannot praise the staff and manager enough, nothing is too much trouble”, “we have lots of activities going on, I go out on a weekly basis to the Willow Club”. A discussion with the manager took place about the level of activities occurring in the home. She explained that the home has an identified staff member who attends the DS0000034522.V315934.R01.S.doc Version 5.2 Page 17 residents’ meetings in order to discuss and plan the activities. She also stated that residents who have more complex or higher level of need are offered inhouse activities such as hand and feet massage, staff have 1-1 time with residents reminiscing, projector evenings. Written evidence was seen confirming this and from speaking to the residents it was clear that activities are a big part of everyday life in the home, some spoke about being involved in all activities and confirmed that this was their choice and others stated that they only took part in some activities. One resident said, “I came to the Bingo today because I like that, I get to play the game but also chat with others which I enjoy”. “Today some people from the community club nearby come and join us for Bingo”. The home has an activities log and other events have included a Halloween Party, trips to Hull Fair, Hornsea and Scarborough, residents confirmed that they are involved in the decision making about where they go and what activities happen in the home. Several residents commented about the Halloween Party that had taken place the previous night, “the party was good and there was a singer”. Other planned events include Christmas lunches and a trip to see the Christmas lights being turned on. From speaking to both residents and relatives it was confirmed that visitors are made welcome and at any reasonable time. One relative stated, “I always feel welcome when I visit, the staff are very kind”. A resident said, “my relations can visit whenever they want to and they always get offered a cup of tea”. It was clear that the residents are supported in maintaining relationships both inside and outside of the home. The home operates a four-week rotating menu and this is displayed, also the menu for that day is written in large print on a white board. The home has developed a menu folder that offers various choices and options to residents from different cultures including; Croatian, Turkish, Cypriot, Iraqi, Jewish and Middle Eastern. A picture menu has been developed since the last inspection and the staff and manager confirmed that this has helped residents choose what they would like even if they have limited speech or memory impairment. The manager explained that she and the staff felt it was important to develop information in the event of a resident being admitted who had diverse needs due to their beliefs or culture. Lunch consisted of beef or turkey roast dinner, there were several options if required, dessert was summer fruits pie and custard or peaches and cream, it was very well presented, plentiful and tasty. From speaking to the Registered Manager it was clear that fresh produce is used and the menu is varied, nutritious and wholesome. Some comments from residents and relatives included; “the food is lovely here”, “I have never seen such good food in a home and the portions are big”. The home employs 5 cooks and all have their food hygiene certificates. There are no outstanding requirements from the Environmental Health Department. DS0000034522.V315934.R01.S.doc Version 5.2 Page 18 Drinks are available throughout the day and evening, there are also set times when the tea trolley goes around the home. Fresh water dispensers are available in various parts of the home for residents to use. DS0000034522.V315934.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure, which meets the needs of residents who feel their views are listened to. A vulnerable adults procedure and policy is available and staff are formally supervised and trained in order to protect residents from abuse. EVIDENCE: Standards 16 & 18 were looked at. The home has a robust complaint policy and procedure. There have been no complaints since the last inspection, but a folder containing several compliments was seen. From speaking to residents it was clear that they were confident that if they had the need to complain that this would be listened to and taken seriously. The home has a multi-agency policy and procedure for the prevention of abuse, staff demonstrated a good understanding of this and training is mandatory. Three staff members were spoken to and they confirmed their knowledge about what the Protection of Vulnerable Adults procedure entailed, all staff have undertaken the training. Staff were able to talk about different types of abuse, signs and symptoms and what they would need to do about it. DS0000034522.V315934.R01.S.doc Version 5.2 Page 20 From discussion with the manager it was clear that she had a very good understanding of the protection of vulnerable adults procedure and how and when this must be implemented, in order to protect the residents from abuse. Since the last inspection the risk assessment process has been reviewed and the use of bedrails is agreed within a multi-agency setting. DS0000034522.V315934.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall the homes environment does meet the needs of the long term residents, some areas in particular the intermediate care rooms require renewal and updating. The home provides a safe, comfortable and clean environment for residents, which is pleasant and homely. EVIDENCE: Standards 19,21,22,25 & 26 were looked at. A tour of the building was undertaken confirming that the previous high standards of cleanliness have been maintained. Overall the standard of the environment is very good, there were no offensive smells throughout the building and during the visit the domestic staff were observed to be very hard working and conscientious about their job. The home has a separate laundry DS0000034522.V315934.R01.S.doc Version 5.2 Page 22 room and there are good infection control procedures in place, all staff have received infection control training. During a walk around the building several residents were spoken to confirming that they had everything they needed in their individual rooms, some comments included, “I have a lovely room”, “my room is very nice and I have brought some of my ornaments and pictures with me”, “I have everything I need”. Surveys returned from relatives indicated that the home was very clean and hygienic. Surveys from residents also commented about the cleanliness of the home. The intermediate care resident’s rooms are suitable in meeting their basic needs and all have a wash hand basin, there is scope to create en-suite facilities that would enhance the rehabilitation programme. The décor and floor covering require some attention to ensure that the rooms are homely, warm and comfortable for the intermediate care residents. There are no communal lounge or rehabilitation kitchen for the to use they share the communal space offered to the permanent residents. During the last inspection visit the registered manager spoke about the possibility of a conservatory extension being erected and for the day care provision currently offered to be reduced and eventually withdrawn, this would enable the lounge and rehabilitation kitchen to be used for the intermediate care residents. This has not evolved and during the inspection visit the locality manager was contacted with regard to the long-term plan, he stated that he would forward a written response to the CSCI. There is a toilet and shower room that has located near to three of the intermediate care beds, but the main door was very heavy and is usually wedged open. From discussion with the manager it was identified that this is not a fire door as it is situated in a protected corridor, but that this may compromise the resident’s dignity if left open during personal care and it does not promote independence and therefore may prevent or hinder the rehabilitation of residents. All of the water outlets have regulators fitted ensuring that the hot water distributes at a safe temperature. Several of the outlets were checked during the visit and found to be acceptable. The home has sufficient toilets and bathrooms in order to meet residents’ needs. All toilets and bathrooms are clearly signed in both written and picture format. In February 2006 the home reported that several residents and staff had been taken ill with a diarrhoea and sickness bug, the public health department offered advice and direction, the water system tested positive for Legionella, this was attended to immediately and the system completely flushed. There have been no outbreaks since then and the infection control in place meet with the public health and health and safety departments. DS0000034522.V315934.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is staffed to provide a good level of basic care for a group of persons with problems associated with aging requiring long term care. However this staffing level and the training staff receive must be critically examined in order to ensure that all the needs of persons of multiple categories and high dependency levels can be met in the variety of forms of care that are on offer at the home. Issues related to this matter are commented on in all areas of this report directly related to residents care. The recruitment process is robust and offers protection for the residents in the home. EVIDENCE: Standards 27,28,29 & 30 were looked at. As stated in the last inspection report dated 10.1.06 whist the staffing level is appropriate if the home contained only resident’s with long-term care needs. It does not support the variety of designations and specialism declared in the homes statement of purpose and recommended for the specialism in the DS0000034522.V315934.R01.S.doc Version 5.2 Page 24 National minimum standards. Evidence is presented in previous sections of this report on this issue, which indicates a shortfall in care needs of the short stay group of residents. The service provider needs to critically examine the staffing level to ensure that all the needs of residents can be met. During the inspection visit three staff files were looked at confirming that the recruitment procedure is adhered to, all files contained a photograph and identification for the individual and evidence that a current Criminal Records Bureau check had been obtained. Evidence was seen that confirms staff have undertaken training in relation to the mandatory courses including moving and handling, first aid, infection control, protection of vulnerable adults, health and safety and food hygiene. All staff receive induction and foundation training that meets the Skills for Care specification. Three staff members were spoken to about their role and responsibilities, all were able to describe what their role was and how they support the residents. The staff demonstrated a good knowledge regarding the care needs of residents and stated that if they felt that additional training was required in order to fully understand the needs of the resident then this is supported by management. One staff member said, “training is excellent, the induction is thorough and covers lots of areas including the protection of vulnerable adults”, “I have discussed specific training in supervision and have been supported to undertake training in relation to diabetes and dementia”. There was written evidence confirming that 62 of staff have now achieved NVQ level 2, which exceeds the minimum required amount of 50 , it also ensures that residents receive support from a well-trained, knowledgeable and qualified staff group. Staff spoken to were able to describe methods of good practice and had a clear understanding of the needs of the long term residents, they stated that they do not receive any training in relation to intermediate care or rehabilitation techniques and feel that staffing levels are insufficient when the home is at full capacity with the intermediate care residents who require two or more staff to assist with personal care. The registered manager explained that the long term plan for the home is to reduce the day care provision and are currently not taking any new referrals, eventually the day care to be discontinued and the care hours utilised within the home and the facilities to be used as the intermediate care communal and rehabilitation areas. A request has also been made to higher management for a conservatory extension to be granted, as yet no decisions have been made and an action plan has not been submitted to the CSCI. The manager confirmed verbally that the day care provision had reduced to a maximum of 8 per day. She also stated that when there are 4 or less day care clients attending one of the care staff can help out in the DS0000034522.V315934.R01.S.doc Version 5.2 Page 25 residential part of the home, but this is not on a regular or consistent basis. DS0000034522.V315934.R01.S.doc Version 5.2 Page 26 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home is carried out with leadership and appropriate guidance; ensuring residents receive a quality of care and a resident centred ethos is promoted within the home. Resident’s financial affairs are safeguarded by the homes policy. Overall the health, safety and welfare of residents and staff are promoted and protected, the individual and generic risk assessments require further development to ensure staff are fully informed about any risk to residents. EVIDENCE: Standards 31,32,33,35& 38 were looked at. DS0000034522.V315934.R01.S.doc Version 5.2 Page 27 During the inspection visit a discussion with the manager occurred about the long term plan the Local Authority has in relation to the provision of day care and intermediate care within Highfield. The manager stated that the day care provision had reduced to 8 places and no new referrals were being taken and she said that the numbers vary between 4 and 8 clients per day. The manager contacted the locality manager during the visit to ascertain if a written response had been prepared or submitted to the CSCI, it was confirmed that this had not been responded to as yet. It should be noted that the manager has limited control over some decisions and that overall the residents’ benefit from the ethos, leadership and management approach of the home. Since the last inspection the manager confirmed that she had achieved NVQ level 4 in both care and management. She has also undertaken other training including moving and handling, fire safety, basic food hygiene, first aid, mental health and infection control. Since the last inspection the quality assurance system has been further developed and surveys are now sent to various people including; residents, staff, relatives, other professionals (GP’s, social workers, district nurses). The information is collated twice yearly and a report was produced in April 2006 giving the results, this was shared with the residents and a copy was forwarded to the CSCI. The home has a residents committee that fund raises in order to subsidise outings and activities. Some comments from residents included; “I am on the committee and we discuss what we would like to do or where we want to go to, we have trips planned to see the Christmas lights and Christmas lunches already”. Evidence was seen that regular residents’ and staff meetings are held. Compliments are also recorded and these are considerable in numbers. All of the surveys that were returned to the CSCI before the inspection visit were all extremely positive about the home, stating that a very high standard of care was offered and that the staff had excellent attitude and manner with the residents. The home has achieved the Charter mark Award from Central Government in relation to how the home serves its customers and community. The home has also achieved Parts 1 & 2 of the Local Authority Quality Development Scheme. Residents’ money and financial interests are safeguarded and written transactions are maintained. During the visit it was confirmed from speaking to the manager and staff and from looking at written evidence that the home offers a range of support to people with diverse needs. The home is registered for people over the age of 65 with their primary need being old age. It also has a variation to it’s registration that allows the home to care for people aged between 60-65 whose needs may include dementia, learning disability or mental disorder, but whose main or primary need remains similar to those of old age. From speaking to both staff and the manager it was evident that appropriate DS0000034522.V315934.R01.S.doc Version 5.2 Page 28 training has been undertaken by staff to ensure that they fully understand diverse need and know how to deal with it. All staff have undertaken equality and diversity training as this is mandatory training offered by the Local Authority. One staff member said, “I have been on the equality and diversity training and here at Highfield we try to accept people for who they are and treat people equally, I have also attended training for mental health and dementia as I am key worker to someone with mental health problems”. The manager stated that currently there are no residents who have a different culture. Religious beliefs are fully supported and in conversation with several residents this was confirmed. The home has developed a menu folder containing meals that would be appropriate for people who have a different culture, religion or belief system these included; Asian, Mediterranean, Jewish, Turkish and Croatian. This shows forward thinking on behalf of the home and demonstrates how the home is developing in terms of offering a service to the wider community ensuring that certain individuals or groups are not excluded. Overall the health and safety of the residents is ensured by having all of the appropriate maintenance certificates in place, regular checks on these take place and evidence was seen confirming this. Staff undertake all health and safety courses within the first 6 months of employment ensuring that the staff are knowledgeable and have the necessary skills to deal with emergencies. All accidents and incidents are reported and recorded appropriately; regulation 37 notices are forwarded to the Commission for Social Care Inspection. Unannounced monthly visits are undertaken by the Local Authority to ensure that the standard of care is maintained and copies of the reports are kept in the home. The fire risk assessment has been updated and approved by the Fire Department since the last inspection. All staff receive annual fire safety training and the fire alarm and equipment are checked and maintained. The generic and individual risk assessments have been reviewed, and although there are risk assessments in place for almost every eventuality these require further development. This is to ensure that staff are given clear information about what the risk is, how it can be managed and what intervention they would need to take, in other words they need to be specific, give direction about who does what and when. DS0000034522.V315934.R01.S.doc Version 5.2 Page 29 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 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 2 2 X X 3 4 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 X 3 X X 2 DS0000034522.V315934.R01.S.doc Version 5.2 Page 30 Yes Are there any outstanding requirements from the last inspection? 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 OP3 Regulation 14 Requirement The care staff must become involved in the assessment and care planning process for intermediate care residents. The service provider must develop multi-disciplinary teamwork and short-term review of residents on the intermediate care unit. Rehabilitation facilities and equipment must promote independence; the door to the shower room and toilet next to the intermediate care bedrooms must be accessible to residents. Care plans must be developed for all residents including the intermediate care unit. That the registered person produce an action plan to ensure that having regard to the size of the care home, the statement of purpose and needs of the residents will ensure that at all times suitably qualified DS0000034522.V315934.R01.S.doc Timescale for action 01/04/07 2 OP6 14,15 01/04/07 3 OP6 23 01/04/07 4 OP7 15 01/04/07 5 OP27 18 01/04/07 Version 5.2 Page 31 competent and experienced persons are working in the home in such numbers as are appropriate for the health and welfare of the residents paying particular attention to the intermediate care beds. The action plan to be submitted to the CSCI. (Previous timescale - 1.12.05) (Previous Timescale 10/03/06 – not met.) 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 OP6 OP6 OP21 Good Practice Recommendations Social rehabilitation facilities should be developed for the intermediate care unit. Specific care staff should be designated to or specialise in the work of the intermediate care unit. The registered person should consider creating en-suite facilities in the intermediate care residents’ rooms to promote and assist with re-integration. The registered person should give consideration to the development of communal space/rehabilitation kitchen and lounge areas for the intermediate care residents. 4 OP22 DS0000034522.V315934.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. Extracts may not be used or reproduced without the express permission of CSCI DS0000034522.V315934.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!