Inspection on 08/07/08 for Highfield Resource Centre

This inspection was carried out on 8th July 2008.

CSCI found this care home to be providing an Excellent service.

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

Other inspections for this house

Highfield Resource Centre 29/05/07

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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Larchfield Manor

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Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

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 8th July 2008 9:30 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 Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Highfield Resource Centre DS0000034522.V368296.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 (30), Old age, not falling within any registration, with number other category (30) of places Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age Date of last inspection 29th May 2007 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 and intermediate care. People living in the home all have single rooms and there is a good range of communal facilities available for people staying there on a long-term basis. 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. Upon arrival people are given a service user guide explaining what the home will provide. The weekly fees range between £92.00 and £672.00, this information was provided by the registered provider during the inspection visit. Additional charges are made for hairdressing, toiletries and chiropody when private. Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means that the people who use this service experience excellent quality outcomes. The site visit was part of the key inspection process and took place over one day and took a total of 9 hours. Prior to the visit surveys were posted out to; 10 people living in the home, none were returned, 15 were returned from relatives, 10 were sent to staff members and 4 were returned, none of the health and social care professionals were returned. The registered provider returned the Annual Quality Assurance Assessment (AQAA) and this gave some details about the service including training, staffing levels, what improvements had been made and what barriers there were. From this information the decision was made about which staff and files of people living in the home would be looked at. The previous requirement and recommendations were discussed with the manager and an update given. During the visit several of the people living in the home, two staff members and one relative 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, safeguarding adults and complaints, paperwork relating to the maintenance of the building, accident/incidents, 3 files of people living in the home and 3 staff files. A discussion with the manager occurred regarding diverse needs and in particular how people are currently supported to follow their religion of choice and practise their faith. Training courses have being undertaken to ensure that all people are treated fairly and equally and not excluded because of a diverse need. The manager explained that since the floods last June there has been a change of usage to some rooms. Four rooms that were previously used as offices have been converted back into bedrooms. She said, “the reason being is that these are more spacious and when someone needs moving and assisting there is more room to operated a hoist”. Four rooms situated on the first floor are no longer in use as this ensures that the home does not go over the number of places it is currently registered for. If the home wanted to use those extra four rooms an application to increase the registration would need submitting to CSCI. Highfield Resource Centre DS0000034522.V368296.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 people living in the home, manager and staff for welcoming her into the home and contributing to the content of this report. What the service does well: 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 dignity at all times. Some comments included; “the staff are wonderful, nothing is too much trouble”, “it’s a real home from home”, “it was the best decision I have ever made”. Staff were observed throughout the day and carried out their duties in a professional, yet caring and attentive way. Fifteen surveys were returned to the Commission from relatives and all of the comments were extremely positive about the care offered. These included; “I cannot fault the home”, “it is an excellent care home providing excellent care”, “my father is well cared for, he is very content and settled”. People’s needs are fully assessed prior to admission so the individual and the home can be sure the placement is appropriate. The care planning system is very good, people have their health care needs fully met and are treated with respect and dignity. From looking at the files of people in the home it was clear that they have their needs and care plans reviewed on a regular basis. People living in the home are consulted about what they wanted to do with their time. Staff were observed interacting and communicating with people in an open, friendly and non-judgemental way. People living in the home receive a range of recreational activities; daily choice and contact with the local community is encouraged. Dietary needs are met as a varied and nutritious diet is offered. The home has a very good complaints procedure in place that ensures that all complaints are dealt with in a fair and thorough way. Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 7 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. People live in a safe and well-maintained environment. People are supported by staff that have been recruited appropriately and receive induction and foundation training that meets the required standard. Staff are employed in sufficient numbers that ensures that people have their needs fully met. The management of the home is carried out with leadership and appropriate guidance; ensuring people receive a quality of care, have their finances safeguarded, health and safety maintained and a person centred ethos is promoted within the home. What has improved since the last inspection? During the site visit the manager stated the service user guide had been updated to include information about meeting the specific needs of individuals who have diverse needs as well as age related problems. It gives clear information and also explains what facilities and support people can expect to receive whilst living at Highfield. A discussion was held with the registered manager in relation to the Intermediate Care beds and she gave an update on the current situation. The number of beds specifically for Intermediate Care has been reduced to one. 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 home has achieved the Heartbeat Award that is awarded to homes who offer a healthy and nutritious diet. Since the last inspection some of the commodes have been replaced and these fit in with the environment and are domestic and homely in style. Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 8 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. Highfield Resource Centre DS0000034522.V368296.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 Highfield Resource Centre DS0000034522.V368296.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): 1,3,4,5 & 6 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s needs are fully assessed prior to admission so the individual and the home can be sure the placement is appropriate. However, the intermediate care lacks the range of facilities necessary that would promote rehabilitation and independence. EVIDENCE: During the site visit the manager stated the service user guide had been updated to include information about meeting the specific needs of individuals who have diverse needs as well as age related problems. It gives clear information and also explains what facilities and support people can expect to receive whilst living at Highfield. There is also information about the staffing Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 11 levels and what experience and training they have undertaken and the general aims of the home. 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. During the visit some of the people living in the home and a relative were spoken to confirming that they knew what to expect from their stay. 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 people who have a communication problem. The manager explained, “I am in the process of developing a picture format service user guide for those people with communication difficulties”. This would promote inclusion and promote participation within the home. During the inspection visit three of the files for people living in the home were looked at and there was evidence confirming that people staying there on a permanent or respite basis 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. Information was received prior to the site visit from relatives and other professionals, it was clear that the person was fully involved in the assessment process. 11 of the surveys stated that information pack was given before admission and some comments included; “great care is taken to keep me very well informed”, “I think Highfield is an excellent home”. A discussion was held with the registered manager in relation to the Intermediate Care beds and she gave an update on the current situation. The number of beds specifically for Intermediate Care has been reduced to one. 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 Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 12 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 people such as a kitchen and lounge facilities. This will hinder the rehabilitation and therefore will remain in the report as recommended good practice to ensure that all of the needs including intermediate care are met. From speaking to relatives and surveys received 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 people are able to make an informed decision about whether they would like to move in or not. Highfield Resource Centre DS0000034522.V368296.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 good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The care planning system is very good, people have their health care needs fully met and are treated with respect and dignity. Medication is given in a safe way, but the home needs to ensure that medication that is not needed or required is discussed with the GP and the prescription changed, as this would ensure that people receive the correct medication and the stock control or wastage is reduced to a minimum. EVIDENCE: Prior to the site visit the Annual Quality Assurance Assessment (AQAA) was received and stated that the medication systems and records kept are in good order, clear concise files containing relevant easy to find information relating to individuals health care. All people receive regular health checks and that the home liaises with outside agencies. Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 14 Fifteen surveys were received from relatives and some comments included; “all the staff give 100 to keep all the residents of the home clean, comfortable and well cared for in all ways”, “my father is very settled and contented”, “they always ring if we are needed”, “great care is taken to keep me very well informed”, “my sister is very well looked after and it would be difficult to improve upon the standard”, “I think Highfield is an excellent home”, “the care is excellent, we are always welcome when visiting and well informed”. During the site visit three files of people living in the home were looked at. Each file contained a photograph of the person, information and details of any specific need such as dietary, diabetic or other health or social care needs. 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. 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 individual bedrooms. There was written evidence confirming that regular reviews are undertaken. From speaking to some of the people living in the home it was clear that they are supported to express their views and opinions and have the opportunity to do so on a regular basis. Some people 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. Evidence was seen confirming that people receive regular healthcare checks for optical, chiropody, dental, nutritional screening is undertaken at the point of admission and individuals 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. There is information about palliative and end of life care, also any funeral arrangements and religious/cultural beliefs are recorded and information sought confirming any specific requirements following the death of a person. Four surveys were received from staff members and some comments included; “we provide an excellent level of care for individual clients”, “good partnership and communication with other agencies”. Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 15 The home has developed risk assessments, which cover both environmental, and individual risk including prevention of falls, personal care, prevention and management of pressure sores, using the lift, road safety, choking on food and mobility. These give detail to staff about when to take action and how to manage the risk. People also have a moving and handling risk assessment undertaken with them and written evidence of this was seen. From looking at the files of people in the home it was clear that they have their needs and care plans reviewed on a regular basis. The home operates a key worker system and from speaking to people it was clear they knew who their key worker was and also confirming that they spent some quality time with their key worker on a regular basis. The home has a medication policy and procedure. The medication system was observed and records looked at were in good order, on the whole staff follow the procedures correctly and therefore people receive their medication in a safe way. From looking at staff records it was confirmed that all staff that administer medication have undertaken appropriate training. It was noted on two occasions that medication had been prescribed for three times a day and it was actually being given as and when required, the home needs to ensure that medication that is not needed or required is discussed with the GP and the prescription changed, as this would ensure that people receive the correct medication and the stock control or wastage is reduced to a minimum. The home has two medication trolleys and one metal filing cabinet where the medication stock is stored. The home does not have a controlled drugs cabinet or register that would meet the new guidelines for care home. However, controlled drugs are stored in a locked cupboard inside the metal cabinet and there is a book that the home has developed in relation to recording the administration of controlled drugs and this has two staff signatures in place. 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 persons’ 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 dignity at all times. Some comments included; “the staff are wonderful, nothing is too much trouble”, “it’s a real home from home”, “it was the best decision I have ever made”. Staff were observed throughout the day and carried out their duties in a professional, yet caring and attentive way. Fifteen surveys were returned to the Commission from relatives and all of the comments were extremely positive about the care offered. These included; “I Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 16 cannot fault the home”, “it is an excellent care home providing excellent care”, “my father is well cared for, he is very content and settled”. Highfield Resource Centre DS0000034522.V368296.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. People living in the home receive a range of recreational activities; daily choice and contact with the local community is encouraged. Dietary needs are met as a varied and nutritious diet is offered. EVIDENCE: Prior to the site visit information was gained from surveys and the AQAA that was returned by the home confirming that recreational activities take place and visitors are made welcome. Comments included, “excellent leisure programme”, “I am in a wheelchair, but I do get to go out with the girls and I join in with what’s going on in the home”, “we play Bingo and go to the Willows Club every week, I really enjoy that”. One relative said, “could do with more social activities and a few more outings would be appreciated”. The AQAA stated that regular activities take place both inside and outside of the Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 18 home. There is an activities programme in place and a member of the care staff has been identified as the co-ordinator. People living in the home are consulted about what they wanted to do with their time. Staff were observed interacting and communicating with people in an open, friendly and non-judgemental way. During the site visit the activities co-ordinator was spoken to confirming that there is a plan of what activities are offered to people. She said, “we try and do an activity each day, there is a group of staff who are responsible for activities”. Evidence was seen confirming that various outings and social events had taken place in the home and these included celebrating birthdays and special occasions, going out to Burnby Hall, Beverley Westwood and Bridlington. The manager said, “we do try to take different people on each outing, last time we took six people who could walk and two who required assistance”. Several people had been on a trip to Hornsea the day before the site visit and said how much they had enjoyed their fish and chips. The activities co-ordinator said, “we have ball games and sensory activities, this helps to include everyone”. The home continues to offer a very high standard of meals and operates a four-week rotating menu that 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. Lunch was observed and consisted of sausages, mashed or new potato, peas or ham with salad, dessert was semolina, fruit salad or jelly. The dining room is pleasant and tables are set for meals, the food was well presented, plentiful and tasty. Fresh produce is used in the main and people living in the home are consulted about the content of the menu. Some comments from residents and relatives included; “balanced diet and menu”, “the food is excellent, I eat everything”, “it is still very good”, “very nice”. There are no outstanding requirements from the Environmental Health Department and the home has a rating of grade A or excellent. The home has achieved 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. People living in the home were observed to be individual in their style of dress. The atmosphere was relaxed and homely. Staff offer support and assistance to people in a sensitive way, one person who was been assisted with their lunch was spoken to by the staff member throughout the process. Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 19 From speaking to the manager and one staff member it was clear that the needs of the people living in the home were fully understood and staff could describe in detail what they were. Overall the evidence seen and information gained confirms that the home continues to promote social contact and activities. Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 20 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 good 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: Prior to the site visit the AQAA was received and stated that complaints are acted upon and analysed to ensure that good practice is promoted. The manager said, “I look at all of the complaints or issues raised and analyse the results on a regular basis, this is then shared with service users and improvements are made if necessary”. During the site visit it was confirmed that the home has a robust complaint policy and procedure. There has been one complaint since the last inspection and this was dealt with in accordance with the home’s procedure, the Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 21 complainant was responded to in writing informing them of the outcome. A folder containing several compliments was seen. Fifteen surveys were received from relatives and the majority confirming that they were aware of the complaints procedure. From speaking to one relative and some people living in the home it was it was evident that complaints were listened to and taken seriously. Some comments included; “any issues I have had have been sorted quickly”, “I am aware of the complaints procedure”, “I have had no complaints, but minor things have been sorted quickly”. The home has a multi-agency policy and procedure for the prevention of abuse and all staff has undertaken the training. There have been two safeguarding issues since the previous inspection visit, both of which were acted upon quickly by the manager and referrals made to the appropriate Social Services Team. One resulted in a staff member being dismissed following a disciplinary hearing and the second resulted in a staff member being offered re-training, extra support and supervision. The action taken by the manager-prevented people living in the home from being placed at risk and these two situations were managed well. From discussion with the manager it was clear that she had a very good understanding of the protection of the safeguarding procedure and how and when this must be implemented, in order to protect the people from abuse. The home maintains records for the personal finances of people living there and two person’s 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 person’s signature; receipts are kept with the documentation. People have their own individual bank accounts and several of the families take care of their finances. The records and money are kept locked and in a secure environment. Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 22 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): 19,22,24 &26 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live in a safe and well-maintained environment; people receiving intermediate care do not have their own communal areas or en-suite facilities that would promote independence during the rehabilitative period. 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. There are good infection control procedures in place, all staff have received Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 23 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 people who live in the home were spoken to about their rooms and what facilities were available. Some comments included; “it’s a real home from home”, “it’s lovely and clean”, “I have everything I need”. Surveys returned from relatives indicated that the home was very clean and hygienic and some comments included; “maintains high environmental standards”, “provides pleasant surroundings with a homely atmosphere avoiding institutionalised feeling”, “ensures good hygiene standards”. The intermediate care room is suitable in meeting basic need and this has 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 people living permanently in the home. A discussion occurred with the manager in relation to the smoking legislation that came into effect from 1.07.07. Currently the smoke lounge is situated off the downstairs corridor and the door is kept open, there is one person who smokes, but other non-smokers use the room. The manager should liaise with the Environmental Health department to ensure that the room fully meets the minimum requirement. Overall the general condition of the home and its facilities is very good. There is a maintenance plan and work is prioritised. Individual bedrooms are personalised with their belongings including pictures, photographs, furniture, teddies, books, and televisions. From surveys received and from speaking to people during the site visit it was evident that they enjoy living in the home and feel that the standard of accommodation is excellent. Since the last inspection some of the commodes have been replaced and these fit in with the environment and are domestic and homely in style. The manager explained that since the floods last June there has been a change of usage to some rooms. Four rooms that were previously used as offices have been converted back into bedrooms. She said, “the reason being is that these are more spacious and when someone needs moving and assisting there is more room to operated a hoist”. Four rooms situated on the first floor are no longer in use as this ensures that the home does not go over the number of places it is currently registered for. Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 24 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. People are supported by staff that have been recruited appropriately and trained, however, some training requires updating to ensure that staff maintain their knowledge. Staff are employed in sufficient numbers that ensures that people have their needs fully met. EVIDENCE: During the site visit the manager stated that the staffing levels had remained the same since the last inspection was undertaken and had increased on occasion to ensure that the diverse needs of people were fully met. She said, “the staffing levels have remained the same and at times they have been increased to meet the needs of all people”, “due to the floods last year Highfield had to take some people with high level needs and training was looked at for staff in particular, mental health, dementia and memory impairment”, “the long term plan is to provide in-house training that covers diverse need, such as values and attitudes, memory impairment and dementia and would help staff in dealing with difficult situations. This would enable them to feel more competent and confident when undertaking their duties”. Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 25 “We have had a couple on in-house safeguarding adults training sessions, this was additional to the mandatory training”. Some comments received via relative surveys included; “staff are good”, “always someone available for questions”, “staff appear very caring, considerate and dedicated”. One negative comment in relation to the staffing levels was received, “there are people with high level needs and staff do not always appear to know what to do and you don’t see staff for 30 minutes at a time”. The manager also confirmed that the Intermediate Care beds had been reduced from four to one, therefore reducing the pressure placed on care staff as these people usually need intensive support for a short period. She also said, “there are usually 6 or 7 care staff on duty during the day with one shift leader in addition to this, at night there are 3 care staff and one shift leader”. From speaking to people living in the home and observation it was apparent that the current staffing levels are sufficient in meeting the needs of the people living in the home. The actual care hours for the week were 1035 which exceeds the minimum required by the Residential Forum and shows that the home maintains an excellent level of staffing at all times. In addition the home employs two domestics and two cooks offering auxiliary support. From speaking to the manager and looking at written evidence it was confirmed that 70 of the care staff have achieved the NVQ level 2 or above in care. All the shift leaders have obtained NVQ level 3 and two are working towards achieving NVQ level 4. 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; “training and updates are offered to us on a regular basis”, “training helps us maintain our skills and knowledge”. 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. The home has a training plan and evidence was seen confirming that on the whole this is kept up to date and covers all of the mandatory training. There are written 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. The local authority has an induction and foundation training package that meets the specification of the Skills for Care targets. Some staff have also undertaken more specialised training in relation to Dementia care and person centred care planning, learning disabilities, mental health problems, caring for people affected by strokes, feeding and swallowing, therapeutic crisis intervention. However, not all of the mandatory training has been kept up to date, one file looked at showed that first aid training was undertaken on 28.2.02 and no refresher has been undertaken since that time, moving and handling was undertaken on Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 26 6.10.05 and one person had never undertaken first aid or fire safety training. Regular updates should be undertaken to ensure that the staff group are skilled and knowledgeable about the needs of people who they offer care and support to. Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 27 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 people receive a quality of care, have their finances safeguarded, health and safety maintained and a person centred ethos is promoted within the home. EVIDENCE: Information gained from the Annual Quality Assurance Assessment stated there is an annual quality assurance process that seeks the views of all people Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 28 who come into contact with the home. There are robust financial procedures in place to ensure that customer’s finances are managed correctly. Data protection principles are followed at all times. There are clear lines of accountability. There is a training programme that ensures the staff are regularly updated in training in key areas. The home is compliant with health and safety legislation. During this inspection visit evidence was seen confirming all of the above stated are being carried out. During the site visit a discussion with the manager occurred about the longterm plan the Local Authority has in relation to the provision of 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 and currently there is one bed allocated for intermediate care. The manager said, “we have reduced the intermediate care down to one bed and this is more manageable”. The registered manager has many years experience in care field and she has achieved NVQ level 4 in both care and management. From information received before the site visit and from speaking to people living in the home and relatives, it was clear that the manager operates an open door policy and is available. The manager was observed throughout the inspection and she communicated very well with people living in the home and she has developed a very good understanding of the needs of the people living there. There are clear lines of accountability within the home and with external management. Some comments from people included; “if I have asked for things to be done, then they have been and generally the staff are helpful”, “the manager is always available”, “I believe that overall Highfield are doing their best and I am not sure if any improvements are required”, “by enlarge I would give the home 9 out of 10 and the management have been fine”. The home continues to have a very good quality assurance system, surveys are given out to people who live in the home 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 2008 giving the results, this was shared with the people living in the home and a copy was forwarded to the CSCI. The manager said, “the surveys are analysed and recently we have changed the choice of menu”, “the results of the surveys are put into our newsletter and displayed on the notice board”. The home has a residents committee that fund raises in order to subsidise outings and activities. 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 overall positive about the home confirming that a very good standard of care was offered and that the staff were professional, trained and competent and some comments included, “the home keeps me informed about how my father is doing”, “yes they always let me know when there are problems”, “the care offered is of an excellent Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 29 standard, they do all they can”, “it’s a real home from home and I always feel welcome”. 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 recently received the Heartbeat Award for offering a nutritious and healthy diet. People living in the home have their money and financial interests are safeguarded and written transactions are maintained. Two records of people living in the home were checked during the site visit and found to be up to date and accurate. Supervision is offered to all staff and looking at records and from speaking to the manager it was confirmed that this is not always as regular as it should be. 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. Other training undertaken by staff includes understanding dementia, epilepsy, mental health and depression and the Mental Capacity Act. Some comments received from staff included; “training and updates are discussed in supervision and are always given to us as we strive to improve the service”, “we provide excellent care and support to the service users, all members of staff take up regular training to update our skills and knowledge”. Religious and cultural beliefs are fully supported and speaking to relatives and the manager evidenced this. 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 meal times people who have communication difficulties use time the picture menu and this ensures that their choice is not restricted. Overall the health and safety of people 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. However, as mentioned earlier not all of the training is as up to date as it should be. All accidents and incidents are reported and recorded appropriately; regulation 37 notices are forwarded to the Commission for Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 30 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. Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 31 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 3 3 2 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 3 2 X X 2 X 3 X 4 STAFFING Standard No Score 27 4 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 2 X 2 Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13 (2) Requirement Medication that is not needed or required must be reviewed by the GP and the prescription changed, as this would ensure that people receive the correct medication and the stock control or wastage is reduced to a minimum. The home must have a controlled drugs register and a controlled drugs cabinet that is in accordance with the Royal Pharmaceutical Guidelines and the Misuse of Drugs Act Regulations 2001 (as amended). As this would ensure that the home is adhering to the required legislation and regulation. Mandatory training including first aid, fire safety and moving and assisting must be kept up to date and refresher courses undertaken. As this would ensure that people living or working in the home have their health and safety maintained. Timescale for action 08/10/08 2 OP9 13 (2) 08/10/08 3 OP30 OP38 17, 18 08/10/08 Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP2 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. Rehabilitation facilities and equipment would promote independence and return home for the people receiving Intermediate Care support. With regard to the smoking lounge the manager should liaise with the Environmental Health department to ensure that the room fully meets the minimum requirement. Supervision should be offered to staff at least six times per year, to ensure that people living in the home receive support from staff that are properly supported and supervised. 2. OP6 OP22 OP19 3. 4. OP36 Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Highfield Resource Centre DS0000034522.V368296.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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