CARE HOMES FOR OLDER PEOPLE
Highgate Nursing Home (The) Northgate House 12 Hornsey Lane London N6 5LX Lead Inspector
Edi O`Farrell Unannounced Inspection 19th April 2007 09:40 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 Highgate Nursing Home (The) DS0000010326.V336539.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. Highgate Nursing Home (The) DS0000010326.V336539.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Highgate Nursing Home (The) Address Northgate House 12 Hornsey Lane London N6 5LX 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) 020 7281 3511 020 7281 8412 robertsu@bupa.com www.bupa.co.uk BUPA Care Homes (GL) Ltd Carol Quinn Care Home 55 Category(ies) of Old age, not falling within any other category registration, with number (34), Physical disability (17), Terminally ill (4) of places Highgate Nursing Home (The) DS0000010326.V336539.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. For the provision of general nursing care for 34 people aged 60 years and over, some of whom may have dementia 17 continuing care beds for people of all ages and 4 palliative care beds. The Staffing Notice 2. Date of last inspection 16/09/05 Brief Description of the Service: The Highgate Nursing Home provides accommodation, personal, social, and nursing care, for up to 55 people. It is registered to provide this care to both younger adults (18 to 64) and older people (aged 65 plus). The home is managed by BUPA, a Provident Society with many other similar homes across the UK. The home is situated just off Highgate Hill, in North London, and on several local bus routes. Archway tube station is a short bus ride away, as are the shops of Highgate Village. Access to local amenities by foot or wheelchair would be difficult for anyone with any mobility problems due to the steepness of the hill. There is parking to the front of the home. The accommodation is over four floors, fully wheelchair accessible, with a lift and stairs to all floors. Most bedrooms have ensuite showers, with all having toilets and hand basins. There are specialist communal bathrooms on each floor for those who prefer a bath. There are communal dinning and lounge areas on each floor, but people can also choose to eat in their rooms if they wish. Bedrooms are of varying shapes and sizes, and efforts are made to match people, and their needs, to available rooms. There is a spacious, and well designed and stocked, garden to the rear of the home. People living in the home are a mix of short and longer stay, and funding themselves or funded by social services and health. In some cases a combination of funding is agreed, with the person, or their relatives, paying a ‘top up’ fee, where charges are above the level that health and social services will agree to fund. Charges are £1,210 per week and £220 per day for short stays. Additional charges are agreed with health where a higher level than usual of nursing care is needed. Extras charged are for hairdressing, chiropody, physiotherapy, phone, dry cleaning, newspapers, and private prescriptions.
Highgate Nursing Home (The) DS0000010326.V336539.R01.S.doc Version 5.2 Page 5 Highgate Nursing Home (The) DS0000010326.V336539.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The site visit for this key inspection was unannounced, and took place on a weekday from 09.40 to 15.00. One inspector carried it out. Prior to the site visit all information held at our office had been reviewed. This included reports that had been sent to us on a monthly basis, and about any incidents/changes that had occurred since our last visit. The manager had completed a pre-inspection form, which gave us information about the people living and working in the home. We then sent questionnaires to ten people living in the home, and received seven replies. Theses were a mix of younger adults and older people. Based on the above we developed an inspection plan. This concentrated on those key standards that we could not make a full judgement on without a site visit. During the visit we spoke to people living in the home, and examined four case files in depth. We talked to three of these people, and compared the planned care with the care they were actually receiving. In one case we spoke to their relative. We carried out a small sample audit of medication on the first floor, and discussed the findings with the nurse in charge and the manager and deputy manager. We went round the home with the manager, speaking to other people living in the home, and to some staff. We indirectly observed both nurses and care staff carrying out their duties. We have used the information collected from all sources to reach the judgments made in this report. At the end of the visit we discussed our findings with the manager and deputy manager, and left a form so they could let us know how they felt we had conducted the inspection. What the service does well:
“ I would highly recommend this home to anyone, lovely staff, and do a grand job”. “ Show a great deal of respect, more than respect”. “ If I ever want to talk I can ask anyone of them”. “ Very good carers and nurses”. “All complaints have always been responded to quickly”.
Highgate Nursing Home (The) DS0000010326.V336539.R01.S.doc Version 5.2 Page 7 Prior to the site visit our records showed that this was a well run home, where the best interests of the people living there were at the core of service provision. The evidence we found during this visit supported this, as did the views expressed above by some of the people living there and one relative. Individuality, dignity, respect, and personal choice were given a high priority. Staff were knowledgeable about the past lives of each person, and were able to carry that through into the care they provided. There were several very positive examples of this. It was particularly good to see this where the level of disability meant that the person was no longer able to verbally articulate their views. For example, where staff knew that someone supported a particular football club the wall opposite their bed had been developed as a notice board, with a considerable amount of memorabilia. There was a welcoming atmosphere, homely environment, and pleasant decoration, some of which had been chosen by the people living in the home. Assessment and care plans clearly set out how health and personal care tasks should be performed, with an emphasis on independence and, where possible, rehabilitation. There was a commitment to seeking the views of the people who lived at the home, and making improvements based on this. Staff training, supervision, and appraisal, was based on this and the identified needs of the residents. What has improved since the last inspection? What they could do better:
As stated above the home seeks the views of the people who live there on a regular basis, and is committed to continuous improvement. Because of this, where we found areas for improvement plans were already in place to address the issues.
Highgate Nursing Home (The) DS0000010326.V336539.R01.S.doc Version 5.2 Page 8 The manager and deputy manager recognised that some of the new assessment forms had not been fully completed. As the QUEST system was only introduced in February 2007, and any new system takes time to ‘bed in’, this was unsurprising. We discussed the more sensitive aspects of the assessment and care planning system with them. This included diversity, end of life wishes, and sexuality. We also discussed quality of life and well-being, as these were not well documented in the daily records. Whilst we have not set any requirements in relation to these aspects of care we do look forward to seeing the full impact of both the QUEST system and the ‘Personal Best’ staff training at future visits. Paintwork on doors, doorframes, and skirting boards was badly marked by wheelchairs in many parts of the building. As the manager informed us that a programme of redecoration was in place we have again not set any requirement. We will check on this at future visits. The, small, sample audit, of medication on the first floor showed discrepancies between medication recorded as administered, and that remaining in the containers. As the home has not had a CSCI pharmacist inspection we agreed with the manager that one would be carried out over the next few weeks. In the meantime we are satisfied that service users are not being placed at risk as the manager and deputy rechecked the findings immediately following our visit. This identified the problem as probably a lack of recording of stock brought forward, than any medication mistakes. 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. Highgate Nursing Home (The) DS0000010326.V336539.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 Highgate Nursing Home (The) DS0000010326.V336539.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples’ needs are assessed before they more into the home. EVIDENCE: Four people’s case files were examined, including those of the two most recent admissions. The home introduced a new assessment and care planning system, called QUEST, in February 2007. This system is being implemented across all BUPA homes over the coming year. The positive thing about this system is that it triggers the assessor to carry out more detailed assessments in key areas, such as nutrition, and tissue viability. This is important as many of the people being referred to this home have complex health needs. If identified at an early stage, and appropriate care plans set up, then health improvements may be gained. Highgate Nursing Home (The) DS0000010326.V336539.R01.S.doc Version 5.2 Page 11 The manager or deputy carries out the initial assessment prior to admission. This is then passed to the nurse in charge of the floor that the person is moving into. They then build on the initial assessment, supplementing it with specialist assessments, and further discussions with the person and their relatives. We found some gaps in information being completed, and some omissions, such as racial origin, from the form. However, the information gaps were in some cases due to the forms having been filled in for people who had lived at the home for some considerable time, or being well known, due to previous admissions. In other cases it was due to sensitive issues, such as wishes for end of life care. Once the system is fully implemented, and staff more experienced in using it, it will form the basis of an excellent service. In recognition of this we have not set any requirement, and look forward to seeing the full impact at future visits. Highgate Nursing Home (The) DS0000010326.V336539.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples’ health and personal care needs are met in a safe and respectful manner. Medication administration records need to be more robust in order to fully protect residents and staff. EVIDENCE: The files looked at, and the people spoken to, included both older people and younger adults. They included people with complex physical and psychological health needs, and both short stay, and people who had been living in the home for some considerable time. Staff were indirectly observed carrying out nursing and personal care tasks. People living in the home felt that staff supported them in the way they preferred. As one said, when asked about dignity and respect, “More than respect”. The care plans seen supported this view, having a clear emphasis on carers carrying out personal care, such as baths or showers, in ways that promoted these values. Promoting independence was also central to the care plans seen, with clear instructions to carers as to the level of support needed.
Highgate Nursing Home (The) DS0000010326.V336539.R01.S.doc Version 5.2 Page 13 Peoples’ preferences in terms of male or female carer for personal and intimate care were noted in the assessments seen. Where admission followed prolonged periods in hospital, and declining health, such as weight loss and pressure sores, initial assessment identified the need for specialist input. In many cases, the home provided this by having nurses who had post-qualifying certificates in specialist care. Where people with relatively rare health conditions had been admitted the relevant specialist organisation had been asked to hold a training seminar for staff. Where appropriate local specialist nurses, such as tissue viability and palliative care, had been fully involved in the care planning and delivery of care. The home employs physiotherapists, including one that specialises in motor neurone disorders. As the home takes people with a wide range of ages and health disorders this is an important service. A random medication audit was started on the first floor. The home uses a monitored dosage system wherever possible. The medication chosen for audit was not in this type of system, but individually dispensed. It was not possible to reconcile the amounts given with the amounts remaining in the containers in all four cases. We discussed this with the manager and agreed that one of our pharmacist inspectors would visit in the near future. Highgate Nursing Home (The) DS0000010326.V336539.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users follow the lifestyle of their choice and abilities. However, greater attention to such things as diversity, well-being, and quality of life, would enhance the service. EVIDENCE: The lifestyles of people living in the home are to some degree dictated by their health conditions and disabilities. For example, for two people spoken to admission had followed lengthy periods in hospital with very serious and complex medical conditions. As one put it “ It’s taken me all my time to get from the bed to this chair”. In the surveys one relative wrote “As far as is physically and mentally capable of doing”, in response to the question about activities. There was, however, ample evidence of a variety of individual and group activities being organised, geared towards the wide ranging needs of the people living in the home. On the day of the visit a Mad Hatters Tea Party was being held, and one of the people spoken to had made most of the decorations. They were, quite rightly, proud of these, and looking forward to the party. Tea parties are also held every third Saturday of each month. The activities chart supplied by the manager detailed one-to-one sessions, drama therapy, and art and craft
Highgate Nursing Home (The) DS0000010326.V336539.R01.S.doc Version 5.2 Page 15 relating to events such as Valentine’s Day. Also hairdressing and manicures, library for coffee and chat, shopping, flower arranging, music, gentle exercise, movie afternoon and external entertainers one or twice a month. The people spoken to confirmed that both group and one-to-one activities were available. “ If I ever need to talk to someone I just ask, and any of them come in and we have a one-to-one”. Lifestyle wishes and preferences were recorded in the QUEST assessments seen. However, activity records were kept separately from the health and personal care records. This detracts from the person centred approach that is at the core of QUEST, and is best practice in social care services for both younger adults and older people. The manager reported that there are plans for records to be integrated. Therefore no requirement has been set, but we will follow this up at future visits. We discussed the concepts of well-being and quality of life with the manager and deputy, and the need for these to be reflected in the daily records. In those seen there was little mention of how the person’s day had been, simply what personal or health care had been provided. Both managers were well aware of the need for recent staff training and the QUEST system to become fully integrated into the service. This is covered further in the staffing section of this report. Visitors are made welcome, and there were some good examples of thought having been given to how contact could be encouraged. For example, a particular bedroom for someone with children. The home is a member of the local Hornsey Lane Association (HLA) and are currently trying to develop ‘ The friends of Highgate’ with HLA members. The manager has discussed a befriending scheme with HLA members where they can buddy up with people living in the home. Several of the people living in the home previously lived in or around Highgate Village, and retain close contacts with the local community. The home encourages this, for example, at Christmas the trees at the front of the property are decorated with lights. Local residents, staff, relatives and people living in the home, sponsor each light, with the money being donated to a local cancer charity. The manager sent us a sample 4 week menu prior to our visit. This showed a very varied menu with lots of choice. Lunch was soup or alternative starter, then a meat or poultry dish with a fish alternative. Supper had a main option, such as salmon fishcakes, macaroni cheese, and ham, egg, and chips. There were them alternatives of omelettes, sandwiches, fruit, and yogurt. In surveys and discussions the people living in the home generally praised the food. Two people raised concerns but confirmed that staff had responded promptly and appropriately when they had raised them. In both cases they praised staff, including the head chef, for taking considerable time and effort to meet their individual tastes.
Highgate Nursing Home (The) DS0000010326.V336539.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are protected by the approach to complaints and poor practice. EVIDENCE: Six of the seven surveys stated that people were clear about who to speak to if they were not happy. One had some negative comments, but in discussion confirmed that these had been responded to, when raised with the manager, and improvements made. People confirmed that the complaint procedure was in the service user guide, and formed part of the admission process. No complaints, concerns or allegations had been raised with us since the last key inspection. The home had received five complaints in the past 12 months. Two were substantiated and three partially substantiated. Records showed that appropriate investigations had been carried out. For example, Where an incident of rudeness to a resident’s wife had occurred the manager reported it to us promptly. This was investigated by BUPA, and appropriate remedial action taken. They kept us fully informed during this process, including about the outcome, which included staff training. Staff have received training in Safeguarding Adults, though the policy and procedure is currently being discussed at a senior level between BUPA and CSCI. Comments from people living in the home, and observations of staff during the site visit demonstrated that during this process people remain safe, and protected from abuse.
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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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a pleasant, comfortable, environment. This will be enhanced when redecoration of paintwork is completed. EVIDENCE: We toured the building at the start of the visit. As it was morning cleaning was taking place, and appropriate safety signs were in place. All parts of the building were exceptionally clean, even where the cleaners had not yet reached. People living in the home confirmed that it was always clean, tidy, and free from offensive odours. The entrance to the home is spacious, with a small waiting room, and a reception area. As it is furnished and decorated to a high standard this gives a very positive impression to first time callers. Where redecoration of communal areas, such as dinning rooms, had been carried out, the people living in the home had been involved in choosing colour schemes.
Highgate Nursing Home (The) DS0000010326.V336539.R01.S.doc Version 5.2 Page 18 Bedrooms were individualised, and many had character, due to differing shapes and sizes. Particularly important for people with severe disabilities, and degenerative illnesses, were photographs and mementoes of their lives before they came into the home. This is important for they and their families, and also for staff to be continually reminded of the person, rather than the illness or disability. Appropriate health and safety notices, such as use of oxygen in bedrooms, were displayed. Appropriate specialist equipment, such as hoists and mattresses were being used where necessary. The only thing that let this outcome area down was the amount of scuffing and scratches to the paintwork in the corridors. As the manager reported that this will be dealt with during this year no requirement has been set. As with other issues we will follow this up at a future visit. Highgate Nursing Home (The) DS0000010326.V336539.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A staff team that is trained and competent to do their job supports people who live in the home. The service will be enhanced once the personal best training and the QUEST system have been integrated into day-to-day practice. EVIDENCE: “A well run nursing home’ staff ‘know the clients well’. Comment from a visiting professional. “We have found the staff generally very helpful and cheerful – they do a difficult job very well”. Comment from a relative. “ Staff are excellent, they explain things”. Comment from a person living in the home. During the visit we observed care staff carrying out their duties. On each floor there was a calm, unhurried, approach, with staff having clearly defined tasks, via a written shift plan. The people living in the home knew which member of staff was providing their care, and when it was due to be provided. They said that staff always treated them with dignity and respect. This included asking them when and how they wanted personal care and support to be provided. Highgate Nursing Home (The) DS0000010326.V336539.R01.S.doc Version 5.2 Page 20 Nursing, cleaning, catering, activity, and maintenance staff equally had clear duties, carrying them out in an unobtrusive manner. Two recruitment files were examined and found to be in order, with all necessary documents recorded. Supervision and appraisal records were also up to date, and included plans to improve performance where necessary. Training in the past year had included fire prevention, manual handling, personal best/customer care, National Vocational Qualification at levels 2 & 3, introduction to activities, dementia, infection control, nutrition, diabetes, epilepsy, continence management, dysphasia, care of the dying person, care documentation, and challenging behaviour. Planned training for the coming year is on nutrition, safeguarding adults, Alzheimer’s, and the care of elderly people. Within the nursing team there are specialist-trained staff in palliative care, which is important as the home is registered for this group of people. As stated earlier in this report the introduction of QUEST, and the learning from the personal best training needs to be fully integrated into care and nursing practices. The manager has identified four ‘Champions’, one for each floor, as part of the strategy to achieving best practice. This an excellent way forward and we look forward to seeing the results at our next visit. Highgate Nursing Home (The) DS0000010326.V336539.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a well managed home, which is run in their best interests. EVIDENCE: Last year was a year of change for the home as the permanent manager was on long-term sick leave. We were kept fully informed of the temporary arrangements, where the deputy manager covered the post. Research shows that changes in managers can often result in sliding standards, but appropriate arrangements were put in place to ensure that this did not happen. The permanent manager has now been seconded for a year to help to implement the QUEST system across all BUPA homes. The deputy manager has been interviewed by our registration team, and is about to commence the Registered Managers Award. Highgate Nursing Home (The) DS0000010326.V336539.R01.S.doc Version 5.2 Page 22 During our visit both this manager, and the acting deputy demonstrated a sound knowledge of the running of the home. They, and the nurses in charge of the floors, also demonstrated a good level of knowledge of the needs of the people living there. Shifts were well planned in order to meet each person’s needs, including staff talking and listening to each person. “ Those two are doing a brilliant job”. Comment from a person living in the home. The manager gave us a copy of the 2006 resident customer satisfaction survey, which was carried out late last year. She also gave us a copy of the service action plan developed in response to the survey. The survey showed year on year improvement, apart from in the area of activities, which was addressed in the action plan, including the input of the people living in the home. During our visit when we raised potential areas for improvement, such as an increased emphasis on well-being and quality of life, the managers already had plans in place to achieve this. These plans were based on best practice, and national standards for the type of health care that the home provides. Investor in People status was re-awarded to BUPA last year, and the personal best training received a prestigious award. As stated earlier in this report the full implementation of both the training and the new QUEST system will continue to give year on year improvement. At a senior level BUPA continue to work with us on improvements to such things as the safeguarding adults policy and procedure. Ours comments from this inspection, such as racial origin being omitted from the QUEST form have been fed into this process. People living in the home told us that they felt protected by the financial accounting where their money was concerned. The manager was aware of the legal status and arrangements for each person, such as Court of Protection. Health and safety records were up-to-date. Prompt action had been taken in response to a small number of requirements made by fire safety and environmental health inspections. Highgate Nursing Home (The) DS0000010326.V336539.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Highgate Nursing Home (The) DS0000010326.V336539.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Highgate Nursing Home (The) DS0000010326.V336539.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU 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
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