CARE HOMES FOR OLDER PEOPLE
The Highgate Nursing Home Northgate House 12 Hornsey Lane London N6 5LX Lead Inspector
Jill Marriott Unannounced 18 April 2005 10:30am 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 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. The Highgate Nursing Home G58 s10326 Highgate v169582 140405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service The Highgate Nursing Home Address Northgate House 12 Hornsey Lane London N6 5LX 020 7281 3511 020 7281 8412 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Goldsborough Limited Susan Roberts Care Home with Nursing 55 Category(ies) of Care Home with Nursing - 55 places registration, with number of places The Highgate Nursing Home G58 s10326 Highgate v169582 140405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: 34 beds for elder care - 17 beds for continuing care 18 years plus - 4 beds for pallative care 18 years plus. Date of last inspection Brief Description of the Service: The Highgate Nursing Home provides care with nursing for up to 55 service users as follows; 34 beds for elder care 17 beds for continuing care. (18 ) 4 palliative care beds. (18 ) The purpose of the home is to provide 24-hour care with nursing to meet the identified needs of all service users.A range of services are available including Physiotherapy, Occupational Therapy, Dental Care and Chiropody other services can be supplied on request. The Highgate Nursing Home is owned by Goldsborough Limited. The home is situated in the London Borough of Islington close to shops and local amenities. The Highgate Nursing Home G58 s10326 Highgate v169582 140405 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first statutory visit for the year 2005/6 the inspection was unannounced and took place at 10.30am on 18/4/05. The inspection took 5 hours. The inspector spoke with the service manager two members of staff and three service users. The inspection included a tour of the home. The homes records, medication system and a selection of staff and service user files were made available during the visit. What the service does well:
Service users are able to make an informed choice about moving into the home. Each prospective service user is sent a brochure and information about services and prices. The Highgate is a residential care home with nursing where service users are looked after extremely well. Prior to moving into the home an assessment of need is undertaken by a qualified nurse usually the manager or deputy manager. Following the assessment service users and families are encouraged to visit the home before making a decision about moving in. Planning and reviewing care is thorough and service users are aware of the plans in place for them. There is a range of activities available each week for all service users who wish to take part. The home has a complaints policy and procedure two complaints were recorded and both were being dealt with, in accordance with the homes procedure. The home environment is good all areas of the home are clean hygienic and completely free from any odours. The home has a qualified nursing team and an experienced team of care workers who understand the needs of the service users. Three service users spoken to said they received excellent care and support throughout the day and night. The homes manager is registered with the Social Care Commission and has the appropriate qualifications and experience to manage the home. Monitoring visits are made to the home monthly by a representative of the Responsible Person. A copies of the report of the visits is kept in the home and another is sent to the commission.
The Highgate Nursing Home G58 s10326 Highgate v169582 140405 Stage 4.doc Version 1.20 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Highgate Nursing Home G58 s10326 Highgate v169582 140405 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Highgate Nursing Home G58 s10326 Highgate v169582 140405 Stage 4.doc Version 1.20 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 2 3 4 5 and 6 Service users are given a range of appropriate information to make an informed choice about moving into the home. The information provides service users and prospective service users with a clear and accurate view of the Highgate. All service users have a full needs assessment prior to a decision a being made about placement. The home has a Statement of Purpose and Service User Guide, which is in need of review. The home does not provide intermediate care but ensures through care planning that all service users both permanent and respite placements are supported to maintain as much independence as possible. EVIDENCE: Information seen during this inspection showed that the Highgate provides a range of useful and appropriate information for prospective service users prior to moving into the home. Three service users told the inspector that information given to them both written and verbal has helped them to make a decision about the placement. The homes statement of purpose was seen during the inspection. This document has not been reviewed for over a year and needs to be updated in the near future.
The Highgate Nursing Home G58 s10326 Highgate v169582 140405 Stage 4.doc Version 1.20 Page 9 Prior to moving in to the Highgate a written contract stating the terms and conditions of the placement is agreed with and signed by each service user. Copies of contracts are kept on service users files. Referrals are assessed by a qualified nurse usually the manager or deputy manager prior to moving in. The assessment procedure is used to ensure the home can meet the prospective service users needs or where appropriate to assist the referrer to find a more suitable placement. The initial assessment is used to inform the service users care plan. Care plans are kept on files these are monitored and reviewed monthly or more often if necessary. The service users who spoke to the inspector said that they had all been given the opportunity to visit the home prior to moving in. The Highgate does not provide intermediate services however service users placed for short periods of time are supported to maintain their independence as part of their care plan. Six standards were assessed five standards were fully met and one standard was partially met. The Highgate Nursing Home G58 s10326 Highgate v169582 140405 Stage 4.doc Version 1.20 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 8 9 10 The Highgate has a clear and consistent care planning system in place, which provides staff with the appropriate information needed to meet the needs of service users. The plans for service users include all aspects of health and social care. The home has a clear medication policy and procedure for the administration of all medication including self-medication. Personal care and support is offered in a way that promotes and protects service users privacy and dignity. EVIDENCE: Service user files were seen during the inspection and care plans appeared detailed and covered all areas of health and social care. The home is visited regularly by health and social care professionals including, District Nurses, the Tissue Viability Nurse, Physiotherapists and the local G.P. Where appropriate social workers are also involved. Care plans seen were up to date and evidence showed that they had been reviewed on a monthly basis. Documentation showed that service users health and care needs are met by a team of experienced care workers and qualified nurses. Two service users self medicate.
The Highgate Nursing Home G58 s10326 Highgate v169582 140405 Stage 4.doc Version 1.20 Page 11 The home has an appropriate medication policy and procedure in place, which protects all service users and ensure the safety of those self-medicating by using risk assessments where necessary. Three service users said that they have been treated with dignity and respect throughout their stay at the Highgate. Indirect observation of practice confirmed this. Standards 7, 8, 9, and 10 were assessed as met during this inspection standard 11 was not assessed. The Highgate Nursing Home G58 s10326 Highgate v169582 140405 Stage 4.doc Version 1.20 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 The home offers a range of social activities to meet the social, cultural and religious needs of service users. The meals in this home are good offering both choice and variety and catering for special dietary needs. EVIDENCE: Three service users said that their experience of the home matched their expectations. The home provides a range of activities and arranges outings to the shops the local park and other facilities as requested. The kitchen was seen during the tour of the building. It was clean and hygienic. The menu was seen and showed that a choice of foods, alternative meals, fresh fruit and vegetables were available. Service users said that the food was good with a wide choice of meals to choose from. Standards 12 and 15 were inspected and fully met the required standard. Standards 13 and 14 were not assessed on this visit. The Highgate Nursing Home G58 s10326 Highgate v169582 140405 Stage 4.doc Version 1.20 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The home has a satisfactory complaints system with evidence that service users feel that their views are listened to and acted upon. Most of the staff have a knowledge and understanding of adult protection issues, which protect service users from abuse. Improvements have been introduced to ensure staff all receive Adult Protection Training. EVIDENCE: The home has a complaints policy and procedure, which was seen by the inspector. Two complaints have been recorded since the last inspection and these are being investigated according to procedure. Service users said that there is a section regarding complaints in the handbook and they would know how to complain if necessary. Three service users felt that they would be listened to if they raised any concerns Staff do have some adult protection training as part of their induction process and this is also covered in the NVQ training. There was a days training for all staff on adult protection in October last year. There has been no accredited adult protection training since. During discussion with the homes manager it became clear that staff who have come into post since October 2004 (11 in all) have not had any accredited adult protection training. The manager has now negotiated a rolling programme of adult protection training with Islington Primary Care Trust. Training will take place every six months. Two standards were assessed at this inspection both standards were fully met. The Highgate Nursing Home G58 s10326 Highgate v169582 140405 Stage 4.doc Version 1.20 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 20 21 22 23 24 25 26 The standard of the environment within this home is high. Service users are provided with a homely and safe place to live. The home provides service users with appropriate furniture, fixtures and fittings and any specialist equipment identified during the assessment process. Service users rooms are pleasant, clean, safe and comfortable. EVIDENCE: From touring the building, discussion with service users and staff and from the homes records it was clear that the home is safe and well maintained both inside and out. There are toilets available on each landing and en-suite facilities in each room. During the referral process service users health and social needs are assessed any necessary equipment is made available from the beginning of the placement. Service users needs are reviewed on a monthly basis or sooner if necessary. Service users rooms were seen during the inspection they were comfortable and hygienic. Service users said they are positively encouraged to bring their own possessions to the home with them. Health and safety policies and
The Highgate Nursing Home G58 s10326 Highgate v169582 140405 Stage 4.doc Version 1.20 Page 15 procedures are in place. Up to date fire records showed that the last fire drill took place in January 2005, electric and gas certificates were seen. PAT testing takes place yearly. The Highgate has very high standards of cleanliness and the building is pleasant and hygienic throughout. All standards were assessed and met the requirements. The Highgate Nursing Home G58 s10326 Highgate v169582 140405 Stage 4.doc Version 1.20 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 29 30 The home provides a good staff team of qualified nurses and experienced cares. The arrangements for the induction of staff are good with the staff demonstrating a clear understanding of their roles. All members of staff undertake a range of appropriate training and the procedure used for ensuring Adult protection training takes place has improved. The home has an appropriate recruitment policy. EVIDENCE: Service users are supported by both nursing and care staff. Rotas show that there are sufficient numbers of appropriately qualified and trained staff on duty throughout each twenty-four hour period. All staff are either qualified nurses or are care staff who have or will in the near future undertake NVQ level 2 or above training in care. 3 Service users told the inspector there was a high standard of care at the Highgate both day and night. The cleanliness throughout the whole building show that there are sufficient numbers of domestic staff to ensure that the home is clean hygienic and free from unpleasant odours. 47 of the care staff have gained an NVQ certificate another 8 members of the care team are completing the course at present. The Highgate has an appropriate recruitment policy and procedure and all staff have two written references and a CRB disclosure prior to taking up post. Staff files were seen. All staff receive appropriate induction training and the home provides a training and development programme, which is linked to the yearly staff appraisals. The development plan is reviewed yearly. All new staff
The Highgate Nursing Home G58 s10326 Highgate v169582 140405 Stage 4.doc Version 1.20 Page 17 undertake a thorough induction programme within six weeks of the start of their employment. The Highgate induction training meets the National Training Organisation specifications. Staff said that they receive induction training, which includes safe care, manual handling, and health and safety. Staff who spoke to the inspector appeared competent and knowledgeable about their roles and responsibilities. Adult protection training has in the past been limited but the manager has just discussed and agreed a rolling programme of training with the Adult Protection team in Islington. Standards 27 29 and 30 were assessed at this inspection and met the requirements standard 28 was not assessed. The Highgate Nursing Home G58 s10326 Highgate v169582 140405 Stage 4.doc Version 1.20 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 33 36 38 The Highgate Nursing home is well run with a competent and knowledgeable managed in control. The needs and best interests of the service users are considered by experienced staff at all times throughout the day and night. Members of staff have access to managers on a daily basis and can discuss issues at all times. Recorded supervision does not at present take place on a regular basis. The welfare of staff and service users are promoted by the homes policies and procedures at all times. EVIDENCE: The manager has a relevant first level nursing qualification and has just completed the NVQ level 4 award in management. The manager is registered with the Social Care Commission and has many years experience of working in a senior role with adults and older people. The quality of the services provided at the Highgate is monitored through the relatives association, through service user questionnaire which are reviewed by an independent company and through regulation 26 visits which are carried
The Highgate Nursing Home G58 s10326 Highgate v169582 140405 Stage 4.doc Version 1.20 Page 19 out monthly by the registered provider. Copies of the reports of regulation 26 visits are sent to the commission regularly each month. The home has an annual development plan, which is based on information available from the above monitoring systems. Service user care plans were seen during the inspection these are monitored reviewed and updated regularly. All service users have a handbook in their rooms, which contain information about the home and services provided. The inspector saw three staff files and spoke with two members of staff. Supervision is recorded but on the files seen evidence showed that in the last year supervision has taken place on only 4 occasions. Issues regarding supervision must be addressed to ensure that it takes place regularly at least six times a year. The Highgate has introduced a Personal Best programme for all staff to ensure that service users receive the best quality services available. All files seen had a training section which included training identified in the yearly appraisal. The home has a Health and Safety Committee who take overall responsibility for ensuring relevant checks are carried out. It is clear from the records seen that all relevant legislation is complied with and reportable incidents are reported to the appropriate authorities. The home has a written policy regarding safe working practices. Fire signs and safety posters are evident throughout the home. All members of staff have health and safety training as part of the induction process. Standards 31, 33, 36 and 38 were assessed 3 standard were met 1 standard was partially met. The Highgate Nursing Home G58 s10326 Highgate v169582 140405 Stage 4.doc Version 1.20 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 4 3 4 3 4 4 3 4 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 x x 2 x 3 The Highgate Nursing Home G58 s10326 Highgate v169582 140405 Stage 4.doc Version 1.20 Page 21 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 6(a)(b) Requirement The Registered Person must ensure that the homes statement of purpose and the service user guide is reviewed and updated. The registered perosn must ensure that all staff have regular recorded supervision at least six times every year Timescale for action 31/5/05 2. 36 18(2) 30/4/05 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 22 Good Practice Recommendations The inspector recommends that all emergency call bell no longer in use be removed from service user rooms or be covered to avoid any confusion. The Highgate Nursing Home G58 s10326 Highgate v169582 140405 Stage 4.doc Version 1.20 Page 22 Commission for Social Care Inspection Centro 4 20-23 Mandela Street Camden Town London NW1 0DW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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