CARE HOMES FOR OLDER PEOPLE
Highgrove House Highfield Road North Chorley Lancashire PR7 1PH Lead Inspector
Pauline Randles Unannounced Inspection 28th February 2006 09:00 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 Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 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. Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Highgrove House Address Highfield Road North Chorley Lancashire PR7 1PH 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) 01257 270643 Park Lane Healthcare (Highgrove) Limited Care Home 40 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (40) of places Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The home is registered to accommodate a maximum of 40 service users to include: Up to 40 service users in the category of OP (Old age, not falling within any other category) needing personal care only. Up to 5 service users in the category DE(E) (Dementia, aged over 65 years) needing personal care only. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 8th June 2005 5. Date of last inspection Brief Description of the Service: Highgrove House is a 40 bedded purpose built care home for older people, a small number of whom have dementia, which is situated close to Chorley Town Centre and is easily accessible by public transport. The home is purpose built and provides all single room accommodation on two floors. One room is provided with en-suite toilet facilities, whilst the remainder are all fitted with vanity units. The home has a dining room and a lounge area on each floor, with a further communal area situated just within the reception area of the home. The homes gardens were easily accessible, secure and were furnished with a range of garden furniture. Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over a period of seven hours. Thirty-six residents were at home at the time of inspection. The manager, five staff members, a visitor, a District Nurse and eight residents were spoken to, of which four were case tracked. Documents and records were examined and the premises viewed. This was the first inspection since the new manager had taken up post. Information from a pre inspection questionnaire and pre inspection comments completed by residents contributed to the findings. What the service does well: What has improved since the last inspection? What they could do better:
All staff members must have a full and satisfactory Criminal Records Bureau checks in place to protect the safety and security of vulnerable residents. This matter must be addressed as an issue of serious concern in accordance with the Immediate Requirement Notice issued at the time of inspection. Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 Page 6 Medication policies and procedures must be reviewed in line with Royal Pharmaceutical Society guidelines to ensure procedures and practices are up to date. Adult Protection procedures must be consolidated, and underpinning training provided so that staff have the opportunity to further develop their skills and knowledge. A record of consultation, participation and satisfaction of residents in relation to activities provided must be maintained. Staff members must each be issued with a contract of employment outlining their personal terms and conditions and a signed copy be kept on the personnel file of the individual. To fully support residents with special needs it was required that training in care of people with dementia be provided as a priority. A supervision policy and procedure must be in place to ensure staff members receive formal guidance and support and supervision training be made available for senior care staff as appropriate. Improved continence management strategies should be introduced to create a healthier and pleasanter environment in which to live and work. The appointment of an activities organiser would enable dedicated activities time for the benefit of residents. Improvements to the method of recording, and attending to, repairs maintenance work would enhance accountability. Bedrooms should be kept clean, have a lockable facility and have good quality furniture for the benefit of the resident occupying the room. The control of infection and smoking policies should be reviewed to improve health and safety. Staffing rotas should clearly state the hours and in what capacity each staff member is working. 50 of care staff should hold NVQ2 and there should be a registered manager in post who holds qualifications equivalent to NVQ Level 4 in management and care. Individual training profiles and an annual training plan should be drawn up to demonstrate that staff members are receiving adequate training to undertake their task competently and safely. Residents and other stakeholders should be consulted about the care service provided to determine whether the home is meeting it’s stated objectives. Policies and procedures should continue to be reviewed and consolidated to ensure accurate staff guidance is in place. Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 Page 7 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. Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 Page 8 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 Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 Page 9 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 the following standard(s): 3 Pre-admission assessments were thorough and undertaken in a manner that was suitably informative for staff delivering care and the prospective resident. EVIDENCE: Discussion with residents, observation and examination of records evidenced that full pre admission assessments had been undertaken and that relevant care planning process had been introduced. Staff members demonstrated an understanding of the needs of residents and knowledge of individual likes and preferences. Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 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 the following standard(s): 7, 8 and 9 Care planning processes were thorough and used to guide daily practice. Strategies for the management of continence were in need of development. The policy and procedures for medication were not adequately written, however storage and administration practices had improved. EVIDENCE: The care planning processes had improved since the previous inspection. The booklet in use covered all aspects of care needs and was used by staff to guide daily practice. Where practicable residents had signed to agree the content of the plan. Reviews were undertaken monthly and risk was reassessed on a regular basis. A visitor commented that, “The atmosphere at the home is warm and friendly, the care is excellent.” A record was maintained of health care needs and residents confirmed that access to health care services was enabled. A district nurse spoken to, who was attending three patients said “Pressure sores have healed indicating good nutrition.”
Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 Page 11 Maintaining continence of residents did appear to be a problem with an unpleasant odour permeating the first floor. The manager explained that she considered this to be due to some of the furnishings being in need of replacement and she evidenced that this matter was in hand. On speaking to the district nurse she also expressed concern about the hygiene standards on the first floor and agreed that this was an area for improvement. Continence training had been commissioned to take place during March and new deep cleaning equipment was due to be introduced. It was recommended that following training some agreed continence management strategies should be introduced in order to establish effective continence practices and routines. The medication policy had not been reviewed in line with Royal Pharmaceutical society guidelines so this remains an outstanding requirement. Practices had improved to ensure health and safety of residents in accordance with recommendations from the previous inspection. For example, records were being effectively maintained of the temperature of storage areas, regular stock checks were being made, patient information leaflets were available and medication was administered and recorded correctly. Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 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 the following standard(s): 12 and 14 There were inadequate records of consultation in regard to activities. Residents were supported to make choices in daily living routines. EVIDENCE: There was evidence from discussion with residents and staff that social activities were taking place. These activities generally happened in the lounges during the afternoon. Staff members acknowledged that their time was limited and they were often called away to respond to other residents’ needs. As previously recommended the appointment of an activities organiser would ensure that dedicated activities time was available. It was recommended that a further recruitment drive take place in this regard. Also there were no formal records available of resident consultation or participation in activities. To meet standard requirements a log must be introduced that evidences residents have been consulted before, and following activities and includes the names of participants. Residents confirmed that they were involved in choice in relation to daily living routines, for example meal and bed times. Records showed that preferences of individuals in terms of personal care needs and diet were recorded and acted upon. Advocacy information was available for residents who wished to access independent support. A visitor spoken to confirmed, his satisfaction with the
Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 Page 13 quality of service his sister received, and that she was enabled to make decisions and exercise control within the limits of her abilities. Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The policy and procedure for dealing with complaints ensures that residents and their representatives are confident that their complaints will be listened to and acted upon. The policy and procedures for adult protection were in need of review and consolidation in order to provide effective guidance for staff and protection of residents. EVIDENCE: A complaints log had been introduced as required following the previous inspection. Details of a recent complaint, including dates, investigation and outcome had been recorded. Staff and residents showed an awareness of the complaints process. All residents had been issued with a revised copy of the Service User Guide that included reference to the complaints procedure. A number of procedures relating to adult protection were in place, for example whistle blowing and basic information about general aspects of what constitutes abusive behaviour. Also a copy of Department of Health guidance, No Secrets in Lancashire was available. An extensive review of all the policies and procedures of the home was being undertaken at the time of inspection. The manager agreed that the adult protection policy was not robust and therefore must be reviewed as a priority. Underpinning training for staff members should also be provided in order to adequately develop their knowledge and competence. Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Significant refurbishment taking place was beginning to improve the environment. Further work was required to ensure a good standard throughout the premises. Policies and procedures for control of infection were in need of updating to ensure relevance to current good practice guidelines. EVIDENCE: Extensive refurbishment work was continuing at the time of inspection. Since the previous inspection visit, six bedrooms had been decorated, new carpets had been fitted in lounges and dining rooms and new laundry and kitchen equipment had been installed. Examination of the home’s quality objectives indicated the priorities within the refurbishment plan for example, new shower rooms and bath hoists plus a redesign of the staff room. Residents were generally pleased with the improvements. Comments made included, “its’ unbelievable the change, it’s transformed, its lovely,” and “makes a difference to how you feel, very tastefully done.”
Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 Page 16 A bedroom viewed when speaking to a new resident was noted to include a damaged bedside cabinet and a carpet in need of vacuuming. It was requested that all bedrooms be kept clean, tidy and free of damaged furniture at all times. Lockable facilities had been ordered for bedrooms so that residents could retain their own items for safekeeping. In the interim small amounts of money were being held securely in the office with records kept. No valuable items were being held by the home on behalf of residents. Daily maintenance tasks were being attended to. However it was recommended that the system of recording be improved to include full details of task required and response. New washers and dryers installed since the previous inspection have full disinfectant and sluicing facilities. The laundry area is being redesigned and a dedicated laundry assistant had been employed to improve service to residents. Policy and procedures relating to control of infection were under review. The premises were not odour free at the time of inspection. As noted in relation to standard 8, continence management strategies need to be established following the continence training. Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29 and 30 Staff members were accessing appropriate training and were sufficient in numbers and skills to meet the needs of residents. Recruitment practices were inadequate and did not satisfactorily protect residents from the potential of abuse. EVIDENCE: There were adequate staff members on duty at the time of inspection. Discussion with staff and examination of staff rotas indicated that the requirements of the previous regulatory authority were being met taking into account the high dependency needs of some of the residents. It was recommended that the rota be redesigned to improve clarity in regard to position held, off duty hours and evidence of training in first aid. Approximately 36 of care staff held a minimum of NVQ Level 2. Six additional care staff had been registered to begin NVQ Level 2 training in April 2006. Senior care staff holding NVQ 3 had been appointed to improve supervision capability within the home. Personnel records had been extended as recommended following the previous inspection. For example, from examination of four files it was noted that evidence of identity and character references had been obtained. However a serious issue of concern was raised in regard to Criminal Records Bureau checks that had been accepted without full consideration of the disclosure
Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 Page 18 information provided. It was required as a matter of urgency that this matter be addressed and an action plan submitted to the Commission For Social Care Inspection by the date agreed. Records showed that training, in moving and handling had taken place in 2005, training in the use of hoists during February 2006, and continence training was planned to take place in March this year. In consideration of the needs of residents with dementia it was required that suitable training for staff be also sourced as a priority. It was, in addition, recommended that individual training profiles be drawn up for all members of staff and the resultant identified training needs be reflected in a training plan for the home. Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 36 and 38 Good progress was being made in establishing effective management of the home and there was evidence of commitment to continuous improvement of health and hygiene practices. Formal supervision procedures were inadequate and did not provide care staff with the periodic guidance and support required. EVIDENCE: The manager, who was new in post, had extensive experience in a senior role caring for older people. There was evidence of the manager undertaking training relevant to her role and of a current commitment to improve working practices and procedures. However the manager was also aware that in order to be approved as registered manager the intent to achieve qualifications that are equivalent to NVQ Level 4 in management and care should be evident.
Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 Page 20 Consultation with residents takes place informally on a daily basis as observed at the time of inspection and confirmed in discussion with residents. Comment cards had been completed pre inspection by residents and a survey of residents had been carried out some time ago with findings analysed and acted upon. The manager was aware of the need to do a further survey including other stakeholders but felt this would be more pertinent when the present refurbishment work had been completed. The home holds ISO 90012000 an award issued by an independent assessor of quality in services. The awarding company is presently working closely with the management of Highgrove to review policies and procedures customising them to the Highgrove context. Staff members when spoken to confirmed that they received suitable general supervision and support from their managers. One staff member when asked about support from management and colleagues said, “If I need help here, it’s excellent.” However there were no formal supervision processes in place and therefore no records to examine. It was required that formal processes be established as a priority with supervision training for senior care staff members where appropriate. Pre inspection information indicated that all safety testing was up to date, for example water, electricity and gas. Water temperature check records and food temperature checks were all in good order. Recommendations from the previous inspection, in relation to covering of food kept in refrigerators, and food hygiene training requirements, had been satisfactorily addressed. As already mentioned in this report continence management strategies and further replacement of furnishings and fabrics were needed to improve health and hygiene. In addition it was recommended that in the interest of all people living and working at the home, the smoking policy should be reviewed in order to provide a non- smoking staff room for staff that don’t smoke and a more suitable area for those residents who presently smoke within the entrance area of the home. Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 2 Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13 (2) Timescale for action Medication policies and 01/05/06 procedures must be reviewed in line with Royal Pharmaceutical Society guidelines. (Previous timescale of the 31/7/05 had not been met.) A record of consultation, 01/04/06 participation and satisfaction of residents in relation to activities must be maintained. (Previous timescale of the 31/08/05 had not been met) The provider must ensure that 01/05/06 the adult protection procedures are robust, and are underpinned by associated staff training. (Previous timescale of the 31/08/05 had not been met) All staff must have full and 10/03/06 satisfactory Criminal Records Bureau checks in place. A contract of employment must 01/05/06 be issued to each staff member with a signed copy retained on the personnel file. Training in care of residents with 01/06/05 dementia must be provided as a priority. Formal supervision policies and 01/05/06
DS0000065791.V285946.R01.S.doc Version 5.0 Page 23 Requirement 2 OP12 16 (2) (m) (n) 3 OP18 12 (1) (a) 13 (6) 4. 5. OP29 OP29 19 (b) Sch2 (7) 18(1)(a) Sch4(6) (f) 18 (1) (c) (i) 18 (2) 6. 7. OP30 OP36 Highgrove House procedures must be established and suitable training in supervision methods provided. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 8 9 10 11 12 13 Refer to Standard OP8 OP12 OP19 OP24 OP24 OP26 OP27 OP28 OP30 OP31 OP33 OP33 OP38 Good Practice Recommendations Strategies for the management of continence should be further developed. The appointment of an activities organiser is recommended The repairs maintenance log should be further developed as recommended. Bedrooms should be kept clean at all times and any damaged furniture removed. Lockable facilities should be provided in each bedroom. Control of infection procedures should be reviewed as agreed and the home kept odour free. The format of the staffing rota should be developed as discussed. 50 of care staff should hold NVQ Level 2 Individual training profiles and a training plan should be available for inspection. A registered manager should be in post who holds qualifications equivalent to NVQ level 4 in management and care. Policies and procedures should continue to be reviewed and adapted to the needs of Highgrove. Residents and other stakeholders should be consulted about the quality of care and whether the home is meeting it’s objectives. The smoking policy should be reviewed. Highgrove House DS0000065791.V285946.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Chorley Local Office Levens House Ackhurst Business Park Foxhole Road Chorley PR7 1NW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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