Inspection on 27/06/07 for Highground Nursing Home

This inspection was carried out on 27th June 2007.

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

The inspector 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

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Highground Nursing Home 7 Waterford Road Oxton Birkenhead Wirral CH43 6US Lead Inspector Miss Julie King Key Unannounced Inspection 08:50 27th June 2007 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 Highground Nursing Home DS0000069679.V342315.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. Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highground Nursing Home Address 7 Waterford Road Oxton Birkenhead Wirral CH43 6US 0151 652 9448 0151 651 0015 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) Southern Cross Healthcare (Focus) Limited Jean Marjorie Redfern Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41), Physical disability (2) of places Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care (including nursing) and accommodation to service users of both sexes whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Category OP). No more than 41 places. Physical Disability (Category PD). No more than 2 places. The maximum number of service users who may be accommodated is 41. New service 2. Date of last inspection Brief Description of the Service: Highground is a 41-bed care home providing nursing and personal care to elderly people. The home is set in its own landscaped grounds, and offers a choice of accommodation over two floors (including the ground). 24 hour RGN cover is provided, along with care and support staff. The home provides various activities and actively encourages families to play a large part of the resident’s lives. Situated on a quiet road near Oxton Village, the home is a few minutes from a main bus route and local amenities. The fee rates are from local social service rates to privately arranged agreements, dependent upon care needs. Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit was completed in one day as part of Highground’s key inspection. During the visit some members of staff, residents, management and multidisciplinary healthcare team (MDT) members were spoken to. Most areas of the internal environment were also inspected. Documentation, especially staff files, resident’s care files and medication administration records were examined. What the service does well: What has improved since the last inspection? What they could do better: The accuracy of accident records and some daily reports needs to be improved, and the environment could be further improved with remaining areas being completed as soon as practicable. Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 Page 6 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. Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3,4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents assessed needs are being met, and the home is able to provide assurances to residents that assessments will be a continuous process throughout the resident’s stay. EVIDENCE: All residents have a pre admission nursing assessment before they are admitted to the home; the acting manager, or one of the qualified nurses in the home undertakes the assessment. The overall standard of these assessments is satisfactory, with the assessments being completed on the recently acquired documentation brought in by the new providers. Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 Page 9 The pre admission assessment tool is utilised in detail to ensure that all prospective resident’s needs are fully identified, therefore providing adequate information upon which to formulate a detailed care plan. Multidisciplinary healthcare team (MDT) input is evident in resident’s care files, and include reference to NHS out-patient’s appointments, opticians, dentistry, and tissue viability nurse specialist (TVNS) input at the home when needed. Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 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. 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. Resident’s individual health, personal and social care needs are being recorded, providing staff with most of the information they need to meet each resident’s care needs. Medication management is not compliant, therefore potentially putting residents at risk of harm. EVIDENCE: Most of the care plans seen evidenced the actual care delivered by staff to meet the needs of the residents, but the standard and quality of the recording and reviews varied depending upon which Registered Nurse (RN) had Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 Page 11 completed them. It is strongly recommended that the manager completes regular, documented audits of all care files and medication administration records (MARs) sheets to check accuracy and content of all relevant paperwork. Evidence was available to show that GPs, NHS services and visiting professionals were involved in resident’s care. Also available were monthly reviews, which had improved in detail and accuracy from the previous site visit. Examination of medications evidenced that both the storage and recording of administered medications were below the standard required, and again varied according to which member of staff had completed the record. The main findings were gaps in the MARs, some transcriptions not signed or dated, medication fridge and room temperatures being consistently above the maximum recommended levels, ‘key’ system not being used correctly on MARs, missing signatures (x 2) on the controlled drug register and one qualified staff member administering prescription only medications to a resident without a prescription. These findings clearly identify a training and supervision need for the qualified staff concerned, and the acting manager and operations manager (who were both present at the time of this site visit) are going to complete an investigation and take appropriate corrective action on these findings. Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 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. 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. Links with the local community are good, and support and enrich the resident’s lives. EVIDENCE: Residents in the home are asked on admission about their lifestyle, choice of foods, and choices and preferences of the social activities they would like to participate in, such as outings, bingo and manicure therapy. Since the previous inspection there has been an improvement on the level and documentation of activities - a welcome addition according to residents spoken to during the site visit. Visitors are allowed in the home at any reasonable time of day, residents may entertain their visitors in the communal lounges, or in their own bedroom. The gardens are accessible, and are an ideal setting for residents to sit with their relatives, especially in the summer months; and have a fully accessible Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 Page 13 seating and patio area, and one resident has planted some flowering tubs in the main courtyard area for the other residents to share and enjoy. Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 Page 14 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. A complaint and adult protection policy and procedure was in place that helps ensure the safety and welfare of residents. EVIDENCE: Highground has a complaint and adult protection policy and procedure in place to help ensure the safety and welfare of residents; and residents, relatives and staff can access these when necessary. The procedure includes information on ‘whistle-blowing’ (reporting concerns regarding poor practice), in accordance with the Department of Health ‘No Secrets’ guidelines. The CSCI has not received any complaints about this service since the previous inspection and site visit. Most of the staff have, or are in process of training in adult protection, with the remaining having training planned for the near future. However all staff do receive basic training in the protection of vulnerable adults during induction. Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 Page 15 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): 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most resident’s rooms are personalized, providing the residents with a homely, comfortable place to live. EVIDENCE: Highrgound has pleasant gardens to the rear of the property that are accessible to residents. A patio area with seating is also provided. Most communal areas were examined, and some evidenced ongoing decoration and / or refurbishment, to varying degrees; but all bathroom and en-suite floorings throughout the home require urgent replacement as soon as possible. Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 Page 16 Bedrooms were personalised, with some residents bringing in their own furniture, and a number of bedrooms had new carpets and had been redecorated to a comfortable standard. One of the residents spoken to told the inspector that she had chosen the colour scheme of her bedroom, including the carpet, and the entire room had been redecorated whilst she was away for a few days. Improvements were also seen on the ground floor and top floor main landing, with painting and decorating and the addition of pictures, furnishings, etc. A number of rooms still require new floor coverings and some other rooms require deep cleaning to get them up to the required standard in line with the other, improved rooms. Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 Page 17 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. There is a consistency within the home provided by permanent staff, which helps to offer safety and stability for the residents. EVIDENCE: A selection of staff personnel files was examined as part of the case-tracking process. Most files contained the required documents and records, but others are still in process of completion. CRB and POVA evidence was available, as were references, some training information, NVQ training, proof of identification and basic inductions. Records of staff training evidence the competence of staff to do their jobs. The specialist care training needs of staff could be reviewed to ensure the health, safety and well being of all residents, and should include recorded clinical training in areas such as administration of medications as appropriate. Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 Page 18 Supervision records in the current format have only recently commenced, and a recommendation was issued to ensure that all staff files contain all the required information and records as required. Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 Page 19 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 area is good. This judgement has been made using available evidence including a visit to this service. There is good leadership to staff from the home’s acting management, which helps provide stability for residents. EVIDENCE: The acting manager has been in charge of the home since last Christmas and has done a commendable job of running the home in sometimes difficult circumstances, and providing continuity to staff and residents. He now has the support of other managers, an area manager and an administrator for Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 Page 20 assistance with the day-to-day running of the home. Overall this home has improved considerably since the previous site visit. Records appeared accurate regarding resident’s monies, and all valuables are kept in a secure, limited access area. The recording of resident’s accidents and incidents, especially regarding any follow-up or actions taken is not fully compliant with requirements; and does not evidence what actions the qualified staff have taken following a resident’s fall. All record keeping must comply with the Care Standards Act 2000 and accompanying Regulations, and qualified staff must also comply with their professional codes of conduct issued by the Nursing & Midwifery Council. Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 Page 21 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 3 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 Page 22 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 The registered person must ensure that all medications received into the care home are managed in accordance with current good practice requirements at all times. The registered person must ensure that the premises to be used as the care home are kept in a good state of repair internally and externally at all times – refer to floor coverings throughout the home. Timescale for action 01/07/07 2 OP19 23(2) 01/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations It is strongly recommended that all daily reports evidence the actual care delivered rather than generic comments such as “care continued as plan”, which is not in line with current good practice guidelines. It is strongly recommended that no abbreviations are used DS0000069679.V342315.R01.S.doc Version 5.2 Page 23 2 OP7 Highground Nursing Home 3 4 5 OP7 OP7 OP8 6 OP31 7 OP38 on any legal documentation. It is strongly recommended that residents and their representatives (as appropriate) sign to acknowledge the resident’s care plans. It is strongly recommended that monthly reviews do not have non-specific comments such as “continue with care”, but evidence all changes in clinical condition. It is strongly recommended that all photographs of wounds are clearly identified with the name of the resident, their date of birth, the date of photograph, area and consent (if possible). It is strongly recommended that the manager completes regular, documented audits of all care files and MAR sheets to check accuracy and content of all relevant paperwork. It is strongly recommended that a designated member of staff completes suitable and sufficient training in the fitting and monitoring of bed rails. Highground Nursing Home DS0000069679.V342315.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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. 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