Inspection on 29/05/07 for Highfield Resource Centre

This inspection was carried out on 29th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 01/11/06

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

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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 Angela Sizer Unannounced Inspection 29th May 2007 09:30 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.V341470.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.V341470.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.V341470.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. 1st November 2006 Date of last inspection Brief Description of the Service: Highfield is a care home offering accommodation and personal care to 29 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 and intermediate 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 5 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 Primary Care Trust. 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.V341470.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 7 hours. Prior to the visit surveys were posted out to 22 of the residents and 7 were returned, 14 to relatives and 10 were returned, 15 were sent to staff members and 1 was returned, of the 14 sent to health care professionals 3 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. A discussion occurred with the manager about the requirements made during the last inspection visit and it was identified that all but one has been met. The one outstanding requirement and recommendations are all in relation to the Intermediate Care provision within the home. As stated in the previous report 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 may reflect upon the overall rating of the home. During the visit several of the residents and two staff members were spoken to this was to find out what it was like for people who live here. The residents and staff were informed that an observation would be taking place in one of the lounges to find out what it was like for people living in the home, no one objected to the observation-taking place. The observation took place in a small lounge on the ground floor of the home. It was well decorated warm and comfortable, and had seating available for 6 people. This lounge was chosen because of the dependency level of the service users who use this area. A tour of the building was undertaken, some of the records looked at included the 3 resident files, 3 staff files and other paperwork relating to the maintenance of the home and the care of the residents. This was to ensure that the needs of the residents are properly assessed and there are individual plans of care in place for each person. It is also to make sure that the building is run in a safe way. 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. DS0000034522.V341470.R01.S.doc Version 5.2 Page 6 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. What the service does well: The home continues to offer an excellent 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. Ten surveys from relatives gave the home excellent reviews and stated how well the home was run, how clean it was and that the staff were excellent. Some comments included, “it is clean, respects privacy, promotes healthy diet and is a very happy place”, “I am very pleased the high standard of care also pleased that everyone is treated as an individual”, “I cannot fault the home, it is spotless, the residents’ are well looked after with caring staff. “it seems excellent in every way I cannot fault it”, “the level of care and attention is excellent. It is a credit to all those involved”, “considers the needs of all residents, all the staff get involved it is a very happy, clean caring environment”. The ethos of the home is to maintain and promote independence and for the residents to be treated as individuals. Respect and dignity are a high priority for the manager and staff and this was confirmed by speaking to several residents. Residents are supported to carry out activities/hobbies of their choice. From speaking to some of the residents it was clear that they have good relationships with the staff, some comments included; “It is excellent”, “no bother just ring the bell and someone will help you”, “the staff are excellent”, “they are more than excellent especially me being a diabetic for a number of years”, “staff always fantastic”. The menu continues to be nutritious, wholesome and the choice offered is excellent. Some comments from residents included; “the food is excellent, I love it here”, “I am happy with the food, there is always a choice of two things”. The home has a very 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 DS0000034522.V341470.R01.S.doc Version 5.2 Page 7 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. What has improved since the last inspection? Since the last inspection visit the home’s statement of purpose has been updated to include information about meeting the specific needs of individuals who have a learning disability as well as age related problems. It gives clear information about the residents it is able to support and also explains what facilities and support residents can expect to receive whilst living in Highfield. Some of the paperwork has been improved including an audit of the risk assessment process. It is much clearer now and easier for staff to follow the risk management plan and therefore the residents’ safety is better ensured. All residents now receive nutritional screening upon admission and subsequently on a monthly basis to make sure that all of their dietary needs are being met. The assessment and care planning process for the Intermediate Care residents has improved. From discussion with the manager it was clear that when referrals are taken again that these will be appropriately screened jointly with the Intermediate Care Team manager and therefore a more joined up service will be offered to the residents that will involve the residential staff too. The home has developed palliative and end of life care information, also any funeral arrangements and religious/cultural beliefs are recorded and information sought confirming any specific requirements following the death of a resident. The level of activity has been improved since the last inspection due to the reallocation of the day care hours. The manager stated that the home has an identified staff member who liaises with residents and attends the 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 in-house DS0000034522.V341470.R01.S.doc Version 5.2 Page 8 activities such as hand and feet massage, staff have 1-1 time with residents reminiscing, projector evenings. New light fittings have been fitted in lounges, corridors, bathrooms and some bedrooms, these were domestic in style and appearance and made the environment more homely. Since the previous inspection visit the staffing levels have increased as the day care provision has ceased. The hours have been allocated to implementing an excellent activities programme that involves all residents including the Intermediate Care and those who have communication or specific difficulties. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000034522.V341470.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.V341470.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): 1,3,5 & 6 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home’s assessment process ensures that new residents are admitted only on the basis that a full assessment of need has been undertaken by people competent to do so. However, the intermediate care facility lacks the range of facilities necessary for active rehabilitation and this will not assist residents in maximising their independence. EVIDENCE: DS0000034522.V341470.R01.S.doc Version 5.2 Page 11 Since the last inspection visit the home’s statement of purpose has been updated to include information about meeting the specific needs of individuals who have a learning disability as well as age related problems. It gives clear information about the residents it is able to support and also explains what facilities and support residents can expect to receive whilst living in Highfield. There is also information about the staffing levels and what experience and training they have undertaken and the general aims of the home. There is a service user guide that is given to all residents upon admission. It contains clear details about policy and procedure in relation to the health and safety of residents, but it also gives information about how the home ensures privacy and dignity and highlights other services such as Advocacy support. Both the statement of purpose and service user guide are well-developed and give clear information about what a person coming to live in the home can expect. From speaking to residents, relatives and staff it was apparent that the home clearly explains what they can expect from their stay and there was written evidence confirming this. The manager confirmed that they have a large print version and if a different language is spoken then Brunswick House, Social Services Headquarters will produce this in the appropriate language upon request. The service user guide is not currently available in picture format or a format that would be understood by those residents who have a learning disability. This would promote inclusion for all of the residents and promote participation within 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 also formulates and develops a more personalised plan of care, this forms part of the ongoing reviewing cycle. There was evidence in place to confirm that regular reviews are undertaken, usually on a six monthly basis and the management also undertakes regular checks of the files. From speaking to several of the residents and from information received from relatives and other professionals it was clear that they were fully involved in the assessment process and this was explained to them. All 10 surveys stated that information pack was given before admission and some comments included; “considers the needs of all residents, all the staff get involved it is a very happy, clean caring environment”. A discussion was held with the registered manager in relation to the Intermediate Care beds and she gave an update on the current situation. There have been no Intermediate Care admissions since February 07 due to the current refurbishment of the building and the relocation of the DS0000034522.V341470.R01.S.doc Version 5.2 Page 12 Intermediate Care Team to Highfield being imminent. The manager explained that after the Intermediate Care Team has moved into the accommodation, which will be separate to the residential unit, the four Intermediate Care beds will be used again, but these have been relocated to the first floor. She also went on to state that meetings have been held with the Intermediate Care Team Manager and an agreement has been reached that when referrals are identified then the assessed needs and care plan will be looked at prior to admission and a joint meeting will be held with either the registered manager or a shift leader attending to ensure that all needs can be met. The nursing and other specialist workers (physio and occupational therapists) continue to liaise and advise the care staff and from speaking to the care staff it was apparent that the situation with regard to communication and staffing levels had improved somewhat since the last inspection. The manager also explained that since the last inspection the home no longer offers day care facilities and the staffing hours that were allocated for that purpose have been relocated to ensure that activities occur on a daily basis and the programme now includes the Intermediate Care residents. The home 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 and therefore will remain in the report as recommended good practice to ensure that all of the needs including intermediate care residents are met. From speaking to the residents it was evident that prior to coming to live in the home they were able to visit, enjoy a meal and meet the other residents and staff. This would ensure that prospective residents are able to make an informed decision about whether they would like to move in or not. Several surveys received from relatives indicated that they had visited with their family member before the person was offered a place. DS0000034522.V341470.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): 7,8,9 & 10 People who use the service experience excellent outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The care planning system for residents receiving long term and respite care is very good and is currently being developed in relation to the Intermediate Care residents. People who use the service receive their medication in a safe way. Staff treat people with respect and privacy is promoted within the home. EVIDENCE: 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 any specific need such as dietary, diabetic or other health or social care needs. DS0000034522.V341470.R01.S.doc Version 5.2 Page 14 The files are well organised into sections and it is easy to 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 covering a variety of areas including; personal hygiene, dressing, continence, mobility, sleeping, social, hobbies/interests, religious and cultural needs. These were very good and contained in-depth information that would give a clear idea of what the need is and how this would be met. These are much improved and overall give clear direction to staff about what action or assistance is required and when. The manager stated that since the last inspection the Intermediate Care residents also have a daily living assessment and care plan developed. Each person had a pen picture about their life, likes, dislikes, preferred times to get up and go to bed and this gives staff a good idea about what life used to be like for that person before they came to live in the home. The home operates a key worker system and the photograph of the worker is displayed in each of the resident’s rooms. There was evidence in place confirming that regular reviews are undertaken, the residents if they are able to are involved in this process and have a chance to give their views. Residents are able to partake fully and express their views and this was confirmed by looking at the review paperwork and also from speaking to the residents themselves. Some of the residents are unable to verbally communicate either due to their level of memory impairment or learning disability, but the home involves their family/representatives in the process and this was confirmed by several of the surveys received from relatives and other professionals. Comments received, “it is clean, respects privacy, promotes healthy diet and is a very happy place”, “I am very pleased the high standard of care also pleased that everyone is treated as an individual”, “I cannot fault the home, it is spotless, the residents’ are well looked after with caring staff”, “it seems excellent in every way I cannot fault it”, “the level of care and attention is excellent. It is a credit to all those involved”. One survey was received from a staff member commenting about the home’s aims and the way residents should be treated; “communicating and encouraging and listening to the residents”, “respecting choices and decisions”. This was also re-affirmed when speaking to two staff members during the visit to the home. 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 and implemented. Since the last inspection the home has developed palliative and end of life care information, also any funeral DS0000034522.V341470.R01.S.doc Version 5.2 Page 15 arrangements and religious/cultural beliefs are recorded and information sought confirming any specific requirements following the death of a resident. The manager did state that this was in the development stage, “recently we have been collating information regarding wishes after death, funeral arrangements or specific religious requirements. It is not always easy to discuss this area, but we are developing this as part of the assessment process to ensure that all of the needs are addressed”. This shows that the home is thinking about diverse needs of individuals and is promoting equality within the service. The risk assessments have been reviewed and updated since the last inspection and they cover both environmental and individual risk including pressure sores, bathing, using the lift, road safety and mobility. They are much clearer and details how and when staff must intervene and how to manage the risk. The manager confirmed that every risk assessment has been updated and stated, “all of the risk assessments have been reviewed and the one that was highlighted in the last report in relation to moving and assisting a resident was re-assessed immediately following the last inspection visit and now clearly states what the risks are and how many staff are required to assist”. 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 registered manager explained that the intermediate care residents are 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. The medication system was observed and records looked at were in very good order, staff follow the procedures correctly and therefore the residents receive their medication in a safe way. From speaking to the shift leader who was administering it was clear that only staff who have undertaken the training offered by the Local Authority administer medication, she explained “this is usually the shift leaders, but some of the care staff who have undertaken the training are able to administer if required”. There is a controlled drugs cabinet and a controlled drugs register, two staff always signs when administering the controlled medication. There is a refrigerator for medication only and the temperature is recorded on a regular basis. The home undertakes a risk assessment with each resident with regard to self-administration and written evidence confirming this was seen. The home returns all refused medication, it is placed in an envelope with the residents’ name, what the medication is and the dosage and is returned to the Pharmacist at the end of the month. From speaking to several residents it was confirmed that the staff treat people with respect and are courteous at all times and also maintaining privacy and DS0000034522.V341470.R01.S.doc Version 5.2 Page 16 dignity at all times. Some comments included; “the staff are excellent, everything is excellent, I cannot fault it”, “I am very happy here”, “I looked after myself until I was 90 and then I couldn’t manage any more, I like it here and I am happy”, “the staff are friendly, they are my friends”. Two 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. Comments made by the staff members included; “we ensure that the residents live in a safe environment and that there well-being is maintained and their care needs are met”, “I feel we enable the residents to remain as independent as possible, one person has cancer and is in the latter stages and as a result is having more accidents, but staff try to offer reassurance and tender loving care”. Ten surveys were returned to the Commission from relatives and all of the comments were extremely positive about the care offered. These included; “it is clean, respects privacy, promotes healthy diet and is a very happy place”, “I am very pleased the high standard of care also pleased that everyone is treated as an individual”, “I cannot fault the home, it is spotless, the residents’ are well looked after with caring staff”, “it is a credit to all those involved”, “mental stimulation of residents”, “excellent food/catering, always a good choice”, “nothing is too much trouble for staff”. DS0000034522.V341470.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 People who use the service experience excellent outcomes in this area. We have made this judgement using a range of evidence, including a visit to the 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, so therefore all of their dietary needs are met. EVIDENCE: A discussion with the manager took place confirming that the level of activity has been improved since the last inspection due to the re-allocation of the day care hours. She explained that the home has an identified staff member who liaises with residents and attends the 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 in-house activities such as hand and feet DS0000034522.V341470.R01.S.doc Version 5.2 Page 18 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. Some comments from residents included; “we have lots going on, I love it here”, “we had a party on Monday, with an entertainer and a buffet”, “there is an activities room and I often go to what is on, we have quizzes and arts and crafts or a sing-a-long” From to the residents and from information received in surveys from relatives it was confirmed that visitors are made welcome and at any reasonable time. Comments included, “I am always made welcome, the staff are very friendly and polite”. Residents are supported in maintaining relationships both inside and outside of the home. The residents and staff were informed that an observation would be taking place in one of the lounges to find out what it was like for people living in the home, no one objected to the observation-taking place. The observation took place in a small lounge on the ground floor of the home. It was well decorated warm and comfortable, and had seating available for 6 people. This lounge was chosen because of the dependency level of the service users who use this area. Overall the interaction was good, there was very little time that the service users were alone with the staff spending time in the lounge chatting and having a cup of tea with the service users. The service users were consulted about whether they would like to join the formal activities taking place up stairs, which they declined. Staff enquired if the service user were ok and waited for a response and responded appropriately to the answer given by the service users. The service users were consulted about what they wanted to do with their time for example “would you like to go for a walk?” “Watch TV or listen to music? And negotiations were undertaken about their choice of TV program; for example if there was a difference of opinion the staff suggested that “we’ll watch Max Bygraves then listen to Jim Reeves”, in an attempt to please all those in the lounge. It was obvious that some of the interaction with the service users was therapeutic especially with one service user who has difficulty with her speech; this was done sensitively and quietly with the service user responding positively. One observed interaction was quite fast for the service user and the staff member didn’t seem to be giving the service user time to think about what had DS0000034522.V341470.R01.S.doc Version 5.2 Page 19 been said or to gather her thoughts to formulate an answer, this was further exacerbated by her speech difficulties, the outcome was positive however and the service user did not seem to be upset by the staffs practise and the conversation was amicable. There was interaction with other service users and this was amicable and friendly. All the service users including those not part of the observation were dressed appropriately and presented well obviously used to the interaction between themselves and the staff. During the observation the staff made sure that the service users had plenty to drink and offered biscuits on a regular basis. During the 2 hours the lounge was busy with the staff coming and going a lot checking on service users wellbeing, there was only one occasion were one of the service users being observed slept and this was for less than the period of the observation (5 mins.). 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 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 braised steak, mashed potato, cabbage and carrots or there were several options if required, dessert was summer fruits flan and cream, it was very well presented, plentiful and tasty. From speaking to one of the cooks it was evident that fresh produce is used in the main and that the residents are consulted about the content of the menu. The menu is nutritious and wholesome. Some comments from residents and relatives included; “the food is excellent, I love it here”, “I am happy with the food, there is always a choice of two things”. The home employs 5 cooks and all have their food hygiene certificates. There are no outstanding requirements from the Environmental Health Department and a recent visit has upgraded the home to a grade A or excellent. The home has recently applied for the Heartbeat Award that is awarded to homes who offer a healthy and nutritious diet. 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.V341470.R01.S.doc Version 5.2 Page 20 Residents were observed to be individual in their style of dress. The atmosphere was relaxed and homely. From speaking to two staff members it was evident that they had developed a good understanding of the needs and wishes of the residents and could describe in detail what the residents liked or disliked and what approach should be taken. One staff member stated, “I have undertaken various training courses including mental health and learning disability modules, I feel that I am more competent when dealing with the residents, I didn’t realise how different the needs of our long term residents and those who have learning disabilities were”. The home has a relaxed, comfortable and homely feel and all of the residents were content and settled. The registered manager explained that advocacy support is now offered on a regular basis from Mencap for those and other residents who have learning difficulties. Overall the evidence seen and information gained from residents, relatives and a two-hour observation in the home confirms that social contact and activities are promoted. Residents enjoy a varied activity programme and take part in outings and external activities on a regular basis. Community contact is maintained and several of the residents attend a local community centre, others go out for pub lunches or enjoy a walk with a member of staff. DS0000034522.V341470.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience excellent outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home has a very good complaints procedure in place that ensures that all complaints are dealt with in a fair and thorough way. The home has policies, procedures and staff receive training in relation to safeguarding adults, and therefore people who live in the home are protected from abuse. EVIDENCE: 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. The manager stated that she looks at the complaints and analyses the information every six months, this ensures that any problem areas are addressed and practice is altered if required. Nine surveys were received from relatives confirming that they were aware of the complaints procedure and 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. DS0000034522.V341470.R01.S.doc Version 5.2 Page 22 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. Two 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. There have been no safeguarding issues since the previous inspection visit. 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. The home maintains records for the personal finances of residents. The records were checked and were found to be in order and up to date. There are two staff signatures for every transaction in addition to the resident’s signature; receipts are kept with the documentation. Residents have their own individual bank accounts and several of the residents’ families take care of their finances. DS0000034522.V341470.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,22,24 & 26 People who use the service experience adequate outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Long-term residents live in a safe and well-maintained environment; intermediate care residents do not have their own communal areas or en-suite facilities that would promote independence during the rehabilitative period. All residents live in a clean and hygienic environment. EVIDENCE: 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. No offensive smells were detected during the visit. The home has two laundry rooms, one on the ground and one of the first floor. DS0000034522.V341470.R01.S.doc Version 5.2 Page 24 There are good infection control procedures in place, all staff have received training in this area and this ensures that disease and illness are managed in a safe way and residents receive the support they require without being placed at risk of contracting infectious diseases. Several of the residents spoke about their rooms and how much they enjoyed living in the home and some comments included; “it is a very happy, clean caring environment”, “the home looks very nice and clean accommodation”. 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 are no en-suite facilities that would enhance the rehabilitation programme. 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. The day care provision has now ceased, but a decision has been made by the Local Authority to utilise the lounge and rehabilitation kitchen as office space for the Intermediate Care Team and a Domiciliary Care Agency. There is a toilet and shower room that is located on the corridor near to the dining room, as identified in the previous report the main door was very heavy and is usually wedged open. The manager stated that funding has been approved for the door to be fitted with an automatic opening device and is awaiting fitting, once complete this will enhance the resident’s dignity and privacy. A discussion occurred with regard to the new smoking legislation that comes into effect from 1.07.07. The manager explained that a recent Health and Safety visit has highlighted the need for the smoke room to be fitted with an automatic opening door with a window to ensure that smoke drift does not occur. 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. The water system has been tested recently and there was no trace of Legionella. Overall the general condition of the home and its facilities is very good. There is a maintenance plan and work is prioritised, the manager said that funding had been granted for all the lounges and main entrance and corridor to be DS0000034522.V341470.R01.S.doc Version 5.2 Page 25 redecorated. New light fittings have been fitted in lounges, corridors, bathrooms and some bedrooms, these were domestic in style and appearance and made the environment more homely. The residents’ individual bedrooms are nicely decorated and personalised with their belongings including pictures, teddies, books, TV, photographs etc. From speaking to the residents it was obvious that they enjoy living in the home and feel that the standard of accommodation is excellent. Some comments included; “the care home keeps my father clean, comfortable, well fed, a home from home environment. There are no restrictions, staff who give 100 care and attention”, “very efficient and kind staff at Highfield”, “considers the needs of all residents”. Some of the commodes were old and stood out from the rest of the furniture in bedrooms, it is recommended that these be replaced to ensure that the environment is domestic and homely in style. DS0000034522.V341470.R01.S.doc Version 5.2 Page 26 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 People who use the service experience excellent outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Staffing levels are currently sufficient and therefore residents receive the support they need, but these will be need ongoing monitoring once the Intermediate Care beds are utilised again. The home operates a robust recruitment procedure that ensures the residents receive support from properly vetted staff. The home has a well-trained staff group that ensures they fully understand the needs of the residents. EVIDENCE: Since the previous inspection visit the staffing levels have increased as the day care provision has ceased. The hours have been allocated to implementing an excellent activities programme that involves all residents including the Intermediate Care and those who have communication or specific difficulties. DS0000034522.V341470.R01.S.doc Version 5.2 Page 27 The manager explained that there are usually five care staff and one shift leader on duty throughout the day and two care staff with one shift leader on duty throughout the night. Currently the four ICT beds are not being used. When the ICT beds are used the staffing complement will require reassessment and sufficient staffing hours maintained to ensure that all the residents’ needs are met. During the visit a two-hour observation took place to find out what it was like for the residents living in the home and it was found that overall staff interacted very well with the residents and gave them time to respond. It would appear that professional and caring relationships have been formed with the residents and comments made by them also confirm this. Some comments were; “It is excellent”, “no bother just ring the bell and someone will help you”, “the staff are excellent”, “they are more than excellent especially me being a diabetic for a number of years”, “staff always fantastic”. 62 of the care staff have achieved the NVQ level 2 or above in care. Five of the shift leaders have obtained NVQ level 3 and two are currently working towards achieving the qualification. The home has a static and committed staff team who welcome training and view this as an essential part of their role and also as a personal development opportunity. One staff member stated; “the training is very good, you cannot learn too much, I have done some of the learning disability training and found this very useful”. This ensures that residents receive support from a well-trained, knowledgeable and qualified staff group. 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. Two 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, I have attended lots of training in the last year including mental health and learning disability awareness”, “if I feel that I need to attend any specific training then I discuss this in supervision and usually we are able to go on it”. The home has a training plan and evidence was seen confirming that this is kept up to date and covers all of the mandatory training. There are written DS0000034522.V341470.R01.S.doc Version 5.2 Page 28 records in place confirming that all staff have undertaken first aid, fire safety, safeguarding adults, medication, health and safety, moving and assisting, infection control and food hygiene. All staff undertakes induction and foundation training that meets the Skills for Care specification, so therefore residents receive support from a well-trained, experienced and skilled team of staff. DS0000034522.V341470.R01.S.doc Version 5.2 Page 29 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 & 38 People who use the service experience excellent outcomes in this area. We have made this judgement using a range of evidence, including a visit to the 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. The health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: 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 DS0000034522.V341470.R01.S.doc Version 5.2 Page 30 and intermediate care within Highfield. The manager stated that the day care provision had ceased and the long-term plan is to move the Intermediate Care beds to another of the Local Authority’s care homes. 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. The registered manager has many years experience in care field and she has achieved NVQ level 4 in both care and management. Since the last inspection the manager stated that she had undertaken refresher training in relation to fire safety, moving and assisting, equality and diversity, mental capacity, first aid and smoking awareness. From observation it was evident that the manager is approachable and welcomes residents into her office. Both residents and staff requested help and support from the manger during the visit and this was given in a supportive and caring way. Staff commented about the manager, “she is approachable and friendly”, “any issues are dealt with quickly and efficiently”. The home has a very good quality assurance system, surveys are given out to residents and relatives on a regular basis, other people connected with the home also receive surveys including GP’s, social workers, district nurses. The information is collated twice yearly and a report was produced in April 2007 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; “the committee discusses what we would like to do or where we want to go to”. 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. Some comments included, ““it is clean, respects privacy, promotes healthy diet and is a very happy place”, “I am very pleased the high standard of care also pleased that everyone is treated as an individual”, “I cannot fault the home, it is spotless, the residents’ are well looked after with caring staff”, “it seems excellent in every way I cannot fault it”, “the level of care and attention is excellent. It is a credit to all those involved”, “mental stimulation of residents”, “there are no restrictions, staff who give 100 care and attention”, “very efficient and kind staff at Highfield” 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. The home has applied for the Heartbeat Award and is awaiting assessment. Residents’ money and financial interests are safeguarded and written transactions are maintained. DS0000034522.V341470.R01.S.doc Version 5.2 Page 31 Supervision is offered to all staff and looking at records and speaking to two staff members confirmed this. 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. From speaking to both staff and the manager it was evident that appropriate 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. The manager also stated that, “our staff have undertaken additional training looking at autonomy of prejudice”. Dementia care mapping has recently taken place in the home and staff received feedback in relation to their interaction with residents. One staff member said, “I have been on training for care planning in relation to our new residents who have learning disabilities, it was very good and made me realise how different our long term residents needs are to those who have a learning difficulty”. The manager also confirmed that further training has been identified as a need for staff and dates are awaited, this is to enable staff to deal with any difficult to manage situations without the use of restraint. From looking at records and speaking to staff it was clear that some staff have undertaken Epilepsy training and others have booked a place. 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. During lunch residents who have communication difficulties use time the picture menu and this ensures that their choice is not restricted. 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. DS0000034522.V341470.R01.S.doc Version 5.2 Page 32 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 there are assessments in place for almost every eventuality. These give clear direction to staff and explain how to manage the risk. DS0000034522.V341470.R01.S.doc Version 5.2 Page 33 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 2 X 3 X 3 2 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 4 10 4 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 4 17 X 18 4 2 X 2 2 X 3 X 4 STAFFING Standard No Score 27 3 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 3 X 3 DS0000034522.V341470.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP6 Regulation 23 Requirement Rehabilitation facilities and equipment must promote independence, in particular for the Intermediate Care residents. (Previous timescale – 1/04/07 unmet) Timescale for action 29/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP2 OP6 Good Practice Recommendations If the service user guide was produced in a picture format this would ensure inclusion for all residents, in particular those who have communication difficulties. Social rehabilitation facilities should be developed for the intermediate care unit. It is recommended that the commodes are updated to ensure that they are domestic in style and fit into the environment. 3 OP22 DS0000034522.V341470.R01.S.doc Version 5.2 Page 35 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.V341470.R01.S.doc Version 5.2 Page 36 - 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. 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