Inspection on 08/10/09 for Highlands Care Home

This inspection was carried out on 8th October 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Highlands Care Home 56 St. Leonard`s Road Exeter Devon EX2 4LS Lead Inspector Louise Delacroix Key Unannounced Inspection 8th October 2009 08:30 DS0000073257.V376879.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highlands Care Home Address 56 St. Leonard`s Road Exeter Devon EX2 4LS 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) 01392 499201 01392 499201 Highlands Care Home Limited Vacant Care Home 26 Category(ies) of Dementia (26), Mental disorder, excluding registration, with number learning disability or dementia (26) of places Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) 2. Mental disorder, excluding learning disability (Code MD) The maximum number of service users who can be accommodated is 26. Random inspection on 4th September 2009 Date of last inspection Brief Description of the Service: The home is located in the centre of Exeter and has a small car park at the front of the building. To the rear is a mature garden which is secluded and quiet. This can be accessed from the ground floor by a passenger lift. The home has two lounges on the ground floor, one with a television and the other combines with a dining area. The majority of the bedrooms are single occupancy and do not have an ensuite facility. Bedrooms are situated on three of the four floors of the home and vary in size and outlook. Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people using this service experience adequate quality outcomes. The inspection was unannounced and took place over eleven hours. There were three inspectors, Louise Delacroix and Rachel Fleet, and a pharmacy inspector Sue Fuller. During the inspection, we spent time talking with the people living at the home and people working at the home. For a period of two hours, we spent time in communal areas of the home to help us build a picture of what life is like for people living at Highlands as some people are unable to comment verbally on the care they receive. This is called a short observational framework for inspection (SOFI) and the outcomes of this observation have been included in the text of the report. However, we also spent time in the communal areas throughout the inspection to help us see how the home is run. Prior to the inspection, we asked the home to distribute surveys to people visiting the home, and we have included the six responses we received within the report. The home was registered with the Care Quality Commission (CQC) as a new service in April 2009. At that time there was a registered manager already working at the home but now that post is currently vacant. However, the provider has introduced us to their prospective manager who has told us that they will start working at the home on 2nd November 2009. As a result of concerns raised by visitors to the home regarding the quality of the care, a safeguarding referral was made by CQC following a random inspection on 5th August 2009. Subsequent safeguarding meetings have taken place, which have included health and social care professionals. People living at the home have had their care needs reviewed. The provider has been invited to these meetings and has demonstrated a commitment to improving the service, both through their discussions and their actions. CQC carried out two further random inspections on 27th August 2009 and 4th September 2009. These visits resulted in enforcement action being taken by CQC, with two statutory requirement notices being served on the home relating to care planning and health and welfare. The compliance date for these two notices is 20th October 2009 therefore although these areas of care were checked during this inspection, CQC acknowledge that the home still has time to make the necessary improvements. Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 6 A further inspection will take place after 20th October 2009 to check on compliance in respect of the statutory requirement notice. What the service does well: Staff practice during the inspection shows that the majority of staff know people’s individual likes and dislikes, and can adapt their approach to suit the individual. There have been improvements to care planning which have been updated, although further work is needed. People living at the home have access to health services, such as the dentist and optician, while the provider is encouraging GPs to visit and review treatment. Some of the medication practices within the home are well managed. People’s privacy and dignity is maintained by caring and well meaning staff, who ensure that people are well dressed and look cared for. Regular visits from the hairdresser also helps boost people’s self esteem and the current activities programme being developed to maintain people’s well-being. People visiting the home felt that they are kept up to date with important issues and told us that they appreciated the caring staff group. Choice is promoted within the home for day to day decisions, such as what to drink, where to sit and when to get up. The cook knows the likes and dislikes of people living at the home, and spends time with them discussing the choices available. Home made food is prepared at the home from fresh ingredients. People working at the home are aware of the complaints policy and some visitors feel confident that any concerns they raise will be dealt with appropriately. The outside of the home is being re-decorated, and there is an attractive and mature garden at the rear of the house, which can be accessed via a lift. Bedrooms are clean and odour free, with many of them personalised and homely. People’s clothes are well cared for and stored in a careful manner. Staff generally know how to maintain good infection control practices. Current staffing levels meet people’s care needs well and there are key staff who provide good role models and encourage improved practice by less experienced or skilled staff. In this role, they promote individualised care and a gentle approach. A number of staff at the home have a care qualification. Quality assurance is being developed in the home to measure the standard of care and a billing system is in place for additional items. There are measures around the home to maintain people’s safety i.e. covered radiators. Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: As a result of this inspection and previous random inspections, a number of requirements have been made to improve the standard of care and service at the home. These have timescales attached to them. In line with two statutory requirement notices, care planning must improve to provide up to date information and instructions for staff to meet the changing needs of people living at the home. Effective systems must be put in place so that each person living in the home receives the care they need, especially regarding their diet, drinks and personal care, which need to be kept up to date and reviewed. Medication management and storage must be improved to help keep people well and safe. Further work is needed to ensure that the activities available meet people’s differing needs and interests. Improvements are needed to make the complaints procedure, the recruitment process and safeguarding practice in the home more robust to help protect the well-being of people living at the home. We have advised that the home contacts the Health Protection Agency to ensure that the home’s hygiene practice keeps people well and safe. Staff training needs to be reviewed to ensure that all staff have been provided with the correct training to perform their work, while risks must be assessed and action recorded. The home requires management that provides strong leadership and direction to the staff team. Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 8 We also made eleven recommendations based on best practice. These do not have timescales attached to them. These recommend improving assessments, medication reviews, accompanying policies and the management of medication. We have recommended that rooms are audited to ensure they are suitably equipped and warm. Improvements to staffing levels at breakfast time are needed, and staff training and induction should be reviewed. The home should establish a robust quality assurance system to monitor the home’s performance. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Highlands Care Home DS0000073257.V376879.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 Highlands Care Home DS0000073257.V376879.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 3 and 6. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current assessment arrangements do not ensure that the home can meet the individual needs of people considering moving to the home. EVIDENCE: Mrs Zhang, the provider, confirmed that the needs assessments for someone living at the home on a trial basis had been completed subsequent to our previous inspection. Care needs information had been obtained from the person’s previous care setting. During the previous inspection, we found that an assessment had not been carried out before the person’s admission to the home, which is not good practice. We looked at the admission process for another person who has moved to the home since April 2009. There was a record of discussion of the person’s needs Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 11 with staff at the hospital, which was based on their physical needs but no mention of the person themselves i.e. how they had been included in the decision, whether they had visited the home and no reference to their interests, spirituality or social care needs. However, there was evidence that the home wrote to prospective residents to confirm the home could meet their assessed needs, which is good practice. Although no-one is being admitted to the home currently, the prospective manager said they would in future accept emergency admissions, on a trial basis, if sufficient information had been provided about the individual’s needs by another party, with the home carrying out their own assessments in the days after the person’s admission. They advised that one-to-one support would be provided during this assessment time. They were clear that there would be a structured approach to assessing prospective residents to ensure that they could meet their social and care needs, and to be sure that the home was right for the person. It was confirmed by the provider that the home does not provide intermediate care. Highlands Care Home DS0000073257.V376879.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 7, 8, 9 and 10. People using the service experience adequate. quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is making progress towards providing an improved approach to meeting people’s health and welfare needs but further improvement is still needed to help keep people well and safe. Improvements are also needed in the handling of medicines to make sure that people’s health is better protected. However, staff attitude towards people’s privacy and dignity has improved so that people living at the home are treated more as individuals. EVIDENCE: Staff generally appear to know individuals’ routines, preferences and dislikes as indicated by assessments found within care plans, and through our observations of their interactions with people throughout the day. We saw that people living at the home generally respond well to staff, and we saw that some staff were skilled at changing their approach depending on the needs and character of the person. Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 13 However, one staff member could provide us with little detail about the needs of a person who had lived at the home for approximately three months, despite confirming that they had cared for this person during this time. They acknowledged that they needed to look at the care plans in the home, and acknowledged that a recent meeting had confirmed that all staff must take time to read care plans. In six surveys from relatives and visitors to the home, they commented on the ‘caring service’ and that staff seem to have a real awareness of people’s emotional needs, including likes and dislikes. One of the people felt staff showed ‘care and patience’. The compliance date for improving the care plans in the home has not yet been reached but we looked at care plans to see the progress made so far. We looked at four care plans in total but we also saw that all people living at the home had a care plan in place. We looked at the care plans for people who had been recently reviewed by health and social care professionals and who had been assessed as having residential care needs. We saw signs of good practice. For example, one person had signed part of their care records – a written ‘personal profile’ relating to their life history, preferences, interests, usual routine, etc. There was evidence that their nextof-kin had been involved, in order to find out about the person as an individual. However, for two other people their personal profiles were poorly completed. Some more detail is needed in the care plans we read, to ensure people received consistent, person-centred care and support. For example, the views of people living at the home were not recorded regarding their preferences as to how personal care should be delivered. We looked to see how staff are supported to meet people’s mental health needs by looking at the information available in individuals’ care plans. We saw that one person repeatedly asked about their spouse, but their care plan contained conflicting information about how staff responded and some of the information was not based on current best practice, which a staff member confirmed in their discussion with us about their approach. Staff are beginning to record people’s behaviour in their care plans. Staff we spoke with had views on what affected individuals’ moods or behaviour, although these ideas were not reflected in individuals’ care plans, or differed from the information given there. A ‘behaviour assessment’ had been completed for each person’s file we looked at. In response to these behaviours, separate plans had been written, though in one case this was about another aspect of the person’s behaviour to that on the assessment. One person’s care plan suggested a cause or trigger for the change in their behaviour, although a Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 14 second person’s care plan did not. Therefore the care planning approach is still not always consistent. We looked to see how risk is managed in the home and how this is recorded in care plans. For example, we saw that the fire evacuation plan for two people indicated they would use the stairs to exit the building. Yet the risk assessments for one person indicated they were at high risk of falling, and we saw staff helping them to use the lift between floors, rather than the stairs. The second person used a walking frame, suggesting other means might have to be found to get them down any stairs in a timely way, should evacuation be necessary. Risk assessments therefore need to be reviewed to ensure they are practical and effective. The compliance date for the statutory requirement notice for meeting people’s health and welfare needs has not yet been reached but we looked at people’s care plans, observed care and spoke with staff to see if progress has been made. Due to the original safeguarding alert, social and health care professionals have been reviewing people’s care needs and advising the provider on best practice. Professionals who have been visiting the home in this capacity told us that the provider has been adopting their advice and has shown a commitment to improvement. We saw that separate records are kept of different aspects of care such as mouth care, application of prescribed skin creams, and helping people to the toilet. These included the help each individual needed. During this inspection, we saw that there had been improvements to supporting people with their continence. For example, our observations, plus a comment from laundry staff that they were sent less soiled washing, suggested care practices to promote people’s continence have improved in recent weeks. We saw some staff picking up throughout the day on people’s body language and offering discretely to help them to the toilet. Care plans regarding health and welfare issues do not always cross-reference information, which would alert staff to related matters in different parts of a person’s care records, and help to avoid inconsistencies in care. For example, one person’s ‘Feeding/Drinking’ form stated they were ‘independent’ and had no chewing or swallowing difficulties; their ‘Physical Health Assessment’ said they had their meat pureed, which we were told was their preference; a risk assessment about their mobility said they might put food on the floor (creating a slipping hazard). We saw that one person who we have been told has swallowing difficulties and requires a soft diet was eating toast in the morning and was not closely supervised. The provider told us that the speech and language team’s advice had been sought but that a full assessment had not yet taken place. The provider agreed as a matter of urgency to clarify with the specialist team appropriate foods for the person. Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 15 Care records showed that the people we case-tracked had been visited by opticians, dentists and district nurse. There was evidence in records that staff had followed advice given on such visits. For example, we saw from people’s records that they have access to the dentist, and that a number of people have been prescribed a mouthwash or been provided with more appropriate toothbrushes. Staff told us that some people were resistant to having their teeth cleaned using a brush, which was reflected in their care plans, and that was why mouthwash was being used. However, GP visits were more infrequent, with advice given over the phone instead. Mrs Zhang told us she had recently been asking GPs to visit to review people at least 6-monthly, because of this. We observed that most people looked alert. Two people who looked very frail on our previous visit looked well, appearing hydrated and having had their personal care needs attended to. One person was being moved and a staff member immediately picked up that they needed help with personal care and ensured they received help with this to maintain their dignity and personal hygiene. During our observation, we saw that for the majority of the time most people appeared to be in a positive state of well-being or spent time watching what went on around them. Someone, who in the past, has been seated at the back of the room, was this time sat in with the main group and seemed from their body language to enjoy watching the actions of others around them. Several people commented how lovely it was to sit in the warmth of the sun whilst listening to music. We saw throughout the day that people are encouraged to drink and staff responded well to request for extra drinks. For example, a carer said ‘you’ve had a cup of tea but you can have another’ and we saw this happen. However, we saw that some changes are not responded to according to the records. For example, someone had lost weight recently, but this was not reflected in their care plan despite reviews. A second person had also lost weight recently, although their weight was now at the same level as it was at the start of the year. Monthly reviews are needed to ensure that all changes are picked up on and responded to appropriately. Apart from one instance, we saw good moving and handling practice by staff when they assisted people to move. A number of people need equipment to help them move and staff explained what they were doing. They approach was calm and gentle, ensuring that the person was safe at all times i.e. brakes on, head protected and footplates in the correct position. One person has a swollen hand and staff tried to make them more comfortable with a cushion. People appeared to sit in chairs that were suitable for care needs, such as recliner chairs, although one person’s feet dangled off the end suggesting a review of equipment was needed for them. Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 16 We checked to see how medicines are handled in the home. Staff told us that none of the people living in the home are able to look after their own medicines so they are stored and given by care staff. Mrs Zhang told us that the senior carers give medicines. Training records showed that most had received training in 2007. Mrs Zhang said that she had already arranged for further training, through their pharmacy, at the end of October. We saw one member of staff giving some medicines at lunchtime. These were handled safely and the correct records made. Two people we spoke to told us they did not take many medicines but were happy with how they were given. People living in the home are registered with a number of different doctor’s practices. Staff order monthly repeat medicines via a local pharmacy, who supply them using a blister pack system. Staff order additional prescriptions from the doctor. Records are made of the medicines received into the home. The date they are received must be recorded to ensure there is a clear audit trail of medicines coming to the home. The pharmacy provides printed medicines administration record sheets with the monthly supplies. These have been completed by staff and records showed that generally medicines had been as prescribed. Codes are available to explain why medicines have not been given. We saw that one code (NT) used on several occasions meant “not taken” but did not give a reason for this. For example one person prescribed Paracetamol four times a day had the code NT regularly used for the night time dose. Another person had not been given their eye drops at night for five days during the month. The provider, Mrs Zhang, told us that this was because this person was asleep, but action had not been taken to ensure that this person received their treatment at a more appropriate time. If regular medicines are not given, the reason must be recorded. If they are frequently not given this should be discussed with the prescribing doctor so that people do not miss having important medicines. Records also showed that two liquid medicines had been out of stock for a number of days during the month. Action is needed to ensure that prescriptions are received before medicines run out. We checked the blister packs of medicines and saw that these reflected the records of medicines given. However we could not check the medicines supplied in standard packs because there is no record of when these have been started or how much has been carried over from the previous month. Action should be taken so that these medicines can be audited. Records are kept of the medicines disposed of from the home. Secure storage is available for medicines and a medicine trolley is used to safely transport medicines around the home. A medicine fridge is available and temperatures recorded were in the safe range. Some additional secure storage is available for medicines called controlled drugs that have special storage requirements. This does not meet the Misuse of Drugs Act 1973 (safe custody) Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 17 regulations. During the inspection Mrs Zhang contacted the pharmacy for advice about ordering a suitable cupboard. A register is used for recording these medicines to ensure they have been looked after safely. Improvements are needed to this record to make sure that it accurately reflects the medicine held in the home. In particular the disposal of medicines must be properly recorded in the register. The home has a medicine policy dated September 2005. This does not explain how the medicine system in the home works and needs to be updated. This is so that staff are aware of the correct procedures to ensure that medicines are looked after properly and people’s health is protected. A copy of the Royal Pharmaceutical Society of Great Britain guidance; The Handling of Medicines in Social Care, was available for information. We looked at six people’s care plans and saw that there was information about current medicines and that this was updated when medicines changed. However it was not clear from the records that medicines were regularly reviewed by the prescribing doctors. It is recommended that staff request that people’s medicines are reviewed by the doctor at suitable intervals and record the outcome. As part of inspection, we spent time in communal areas to observe if staff practice and the home’s environment maintained people’s privacy and dignity. We heard staff knock before entering people’s bedrooms and greet the person as they entered the room. People were given tables to put their drinks on when served a drink in the lounge, which is an improvement in staff practice. We saw people stroking staff faces saying that ‘you’re nice people’ and ‘I like you’ when staff spent time talking with them or reassuring them. One person takes comfort from a doll and staff were respectful in their interactions ensuring that the ‘baby’ was safe when they assisted the person. We saw that some staff recognise the need to try different approaches so that they avoid confrontation and maintain the person’s dignity by not openly challenging them. For example, in the way they encouraged people to drink or visit the toilet. When speaking with people who were seated, staff bent down to the person’s level promoting better communication as eye contact was made and facial expressions could be seen easily. We saw some staff time invest time and patience to ensure that people ate their meals in a dignified manner. For example, telling them what the meal was, responding to their body language and supporting them at the individual’s pace. One person went off whilst assisting someone with their meal to answer the front door but remembered to apologise when they returned for leaving without explanation. Changes to the dining room make the room a more dignified place to eat while good practice by some staff meant that people’s clothes were adjusted to Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 18 protect their modesty when being moved using equipment. We were told that staff had been reminded about the personal achievements of people living at the home, which appears to have improved staff approach by being more respectful. The hairdresser was visiting during the morning and we saw that people responded positively to her and their hairstyles, as well as the resulting compliments from staff. A person told us that it was important to have their hair done regularly to make them feel good and we saw records that they were a regular visitor to the hairdresser. One person we spoke with had glasses that needed cleaning but otherwise people looked well-dressed and cared for. We saw from people’s wardrobes that clothes were well cared for and this was confirmed by the response from relatives. A visitor told us their friend ‘is always dressed appropriately and care seems to be taken of their appearance and emotional well being’. Another person told us that their ‘mum is always clean and well cared for… she is bathed a lot and always got clean clothes on’. Another relative said that their spouse ‘is always dressed smartly’ and that their clothes are ‘very clean’. Staff we spoke with told us that one person we case-tracked preferred female staff to help them with any personal care. This was noted in the person’s care plan and the staff member said that as a result did not provide this form of care. Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 12,13,14 and 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People generally have access to activities within the home but further work would help ensure people’s individual social and spiritual needs and interests are met. People live in a home where visitors are welcomed, choice in day to day life is promoted and meals are provided to meet people’s differing needs. EVIDENCE: We looked to see how people’s personal interests are supported, as recorded in their care plans and in their activity records. We were told that this is an area that is being developed so that care staff also become involved in their area of care. Currently, records show that some people have one to one time, such as sensory work and aromatherapy sessions, and others participate in group sessions. An overview chart was kept for each person to show what recreation people had taken part in, in addition to notes made by the Activities coordinator about how the person participated in these activities, whether they enjoyed them, etc. People’s religious or spiritual preferences are not recorded. Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 20 People we spoke with responded positively when we asked them about their life at the home, their accommodation, the food and their care, although there were periods of the day that some people seemed at a loss of what to do. However, we could see that some more mobile people walked around the home and had particular areas where they liked to sit and watch the life of the home. One visitor said that the home had brought their relative ‘back to life again’. One person’s care plan said they mainly liked magazines by way of recreation, and staff indicated in daily care records that the person regularly enjoyed magazines – but without saying what type of magazine. A staff member told us the person liked magazines with short stories, although throughout our visit the person looked at a word puzzle book. The person told us staff got these books for them, which they looked like they were enjoying. Information on activities planned in October was written on a notice board in the entrance hall. Autumn harvest celebrations were to include food tasting and cooking with seasonal produce, as well as a seasonal art session; games and quizzes, one-to-one activities and group sessions, sensory and musical events were planned. Music was put on in the lounge without consulting those present as to what should be played. We asked someone sitting by the music player if it was to their liking, having seen in their care records that they preferred a different sort of music. The individual said they didn’t mind it, adding they had come to like various types of music. It was not always evident that people were supported in practice to enjoy their previous interests. Care notes for another person showed that twice when a donkey had visited the home, the person spoke about their love of horses rather than donkeys, but there was no indication that this had been followed up. One person we case-tracked had regular visitors, who sometimes took them out. The other person told us they had few visitors (as also indicated by their records); they said they didn’t want to go out. We saw they kept themselves occupied during our visit. Care records stated that two people liked to go to the pub but there was no record that this had been considered or offered. We saw one person being taken out in their wheelchair, after the appropriateness of their pressure cushion had been checked, and staff felt this was a positive outcome for them as they used to have an outdoor lifestyle. From the response that we received in the six surveys from relatives and friends, people indicated a good rapport with staff, and this has been confirmed by relatives in their discussion with relatives, some of whom have known the staff for many years. Five people felt that they were always kept up to date with important issues affecting the person they visit, and one person said this was usually the case. The visitors’ book shows that some people are Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 21 visited regularly and at different times during the day. We saw visitors who appeared to be at ease with staff and their surroundings. As part of the inspection, we looked at how choice is promoted in the home. Staff we spoke with were clear that people were assisted to get up early (i.e. by the night staff) only if they wished to or appeared to be wanting to be up. Care records show a range of times that people are assisted to get up. When we arrived at 8.30am some people were up and dressed and eating their breakfasts and other people joined them later. People were offered a choice of where to sit when they left the dining area. We noted these choices reflected information in the care plan of one person we case-tracked. We saw people making choices about what type of drink they had. This was assisted by staff offering a tray with an array of cold drinks, plus a trolley with hot drinks. From conversations between staff and people living at the home, it was clear that the staff members knew people’s preferences and serving the drinks was a time when staff joked and chatted with people. The full-time cook was on duty. She told us that two people had recently started having pureed food. A staff member gave us a practical example of how training on assisting people to eat, when they had swallowing difficulties, had helped them. Care records for those we case-tracked included particular dining arrangements or preferences that helped make their mealtimes a positive experience. We observed that people were seated with certain of their peers, for example, in line with this information. We heard the cook asking people later in the morning what they wanted for lunch. She told us she sometimes had difficulty communicating with individuals because of their dementia, but confirmed the home was beginning to put together photographs of the meals served at the home. This was to help people indicate their choice when saying what they would like was difficult. She had recently made an updated list of people’s preferences and dislikes, but told us she still offered people things they disliked if it was on the menu in case they had changed their mind. The written record made daily, of people’s choices, provided evidence of the varied diet individuals ate over time. During our visit, the main meal was lamb casserole, which was served with separate jugs of mint sauce. A choice of homemade cake was now offered midafternoon, with cherry cake being made during our visit. The cook made homemade soup when on duty, with mushroom soup on the menu for tea along with sandwiches and home-made cheese scones. She told us that people on pureed diets were offered the soup or the light meal if it could be liquidised, at teatime. The current week’s lunchtime menu included toad-in-the-hole, chicken chasseur, stew & dumplings, and fish pie. Teatime options included corned beef hash, home-made quiches, fish fingers & baked beans, as well as soup Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 22 and sandwiches. We were told that sandwiches were offered again later in the evening, with for example cake. We saw fresh produce, a variety of condiments, and whole fat milk (which is generally recommended in such a care setting) among the kitchen supplies. As described earlier in the report, the dining area is now a more attractive place to sit and looks less institutional. The atmosphere during the meal was calm and less rushed than in the past, with some people being supported in an appropriate one to one basis. However, two people had been assisted to sit at the table by staff but then had to wait longer than everyone else to be served, one person fell asleep at the table, which looked uncomfortable. People visiting the home commented in their surveys that there is ‘an excellent cook, so very good food’ and a visitor commented that their relative is ‘well fed’. Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 16 and 18. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Currently, the home’s complaints and safeguarding procedures are not robust enough to ensure that people can be confident that their complaints will be managed appropriately and their well-being safeguarded. EVIDENCE: We asked a staff member where the complaints policy was kept, and they confirmed it was displayed in the hall. Other staff we spoke with told us that if anyone made a complaint or seemed unhappy, they would report this to Mrs Zhang, who they felt would listen and try to address the matter. The five relatives/friends that responded to our survey told us that they knew how to make a complaint and said that the service responded appropriately if they raised concerns. The home’s AQAA states that there had been one complaint since the home has been registered. However, CQC are aware of three complaints that have been made to the home since this time, and that people had not been satisfied with how these were handled. Two visitors have approached CQC to express their concerns about the management of their complaints and this resulted in CQC carrying out a random inspection, which confirmed their concerns about the quality of the care. We asked to see how these three complaints had been Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 24 recorded and how they had been addressed but the paperwork was not available. During our visit, a file was put together with forms to record complaints and concerns. Mrs Zhang expressed concern that she had been let down by the poor recording of a former staff member. Since the inspection, we have spoken with the provider about their responsibility regarding appropriately worded references when staff have been dismissed from the home. The prospective manager has confirmed that this will be addressed to ensure that poor practice does not go unreported. As described in the report summary, the home is currently the subject of a safeguarding referral. This has led to intensive monitoring through reviews and unannounced visits by health and social care professionals resulting in some people being assessed as needing nursing care and moving to alternative homes. Before this key inspection, CQC carried out three random inspections, which has enabled us to focus on people’s health and welfare needs, and care planning in the home. Because of the level of our concerns, we served two statutory notices on the home to improve these areas of care as part of our enforcement methodology. At the time of this inspection, the compliance date had not passed. We will carry out another random inspection to measure the home’s compliance once the date has expired. We asked staff about their understanding in their role of safeguarding people in their care. One person recognised their responsibility to report concerns to a senior, could describe what they considered abusive practice and could name one outside agency that they could also contact but not the key external organisation i.e. Care Direct. Another person we spoke with was not confident about what might be considered abusive practice, or to what external agencies they could report any concerns, if necessary. They told us they hadn’t had recent training on safeguarding, as indicated by their training records. Recruitment procedures are not robust enough to fully ensure people will be looked after by suitable staff. While the policy relating to safeguarding in the home, the current policy is not robust i.e. it gives the option of a suspected member of staff working in a non care capacity without consulting professional advice. The policy does not provide local contact information. Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 19,20,21,22,24, 25 and 26. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean and generally odour free, although further work is needed to make it a more comfortable and safe place to live. EVIDENCE: The outside of the home is currently being re-decorated. The back garden is secure and has mature shrubs, including scented plants which can enhance the experience for people with dementia. There is space for people to walk around, although most people would need to be accompanied as there are no handrails. The garden cannot be accessed from the communal areas of the home because of the style of the building. Instead, the lift provides access from the ground floor to the basement where access is flat. Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 26 Internally, the majority of the décor is well maintained but there are areas where the paintwork is scuffed and tired looking. Most furniture is clean but the arms of some chairs need further cleaning due to stains. Some rooms have poor lighting either with low wattage bulbs/dark lampshades or in one case the light did not work in one area of the room. We saw that there was a call system in place but this was not always located near to a bed and call bell cords were not available. Since the last inspection, we have spoken to the Devon Fire and Rescue Service who confirmed that they visited the home in September 2009 and that there was no major work to be carried out. The home has two communal areas. One room is large and provides a lounge and dining room area, while the second room has a television, which is popular with some of the people living at the home. Both rooms look out onto the quiet road, and one has views of the garden although this view can only be seen by standing. During this visit, we saw more people walking around and making decisions as to where they sat. However, more could be done to orientate people to different areas of the home i.e. the nearest toilet and the lounge with the television. Since the last inspection, part of the dining area has been re-decorated making it a more attractive place to sit. Time has also been taken to look at the layout of the tables and how they are presented. Dining room tables now have tablecloths, place mats and individual vases of flower and there is more space for people to move around. The owner told us that new carpets had been ordered for some of the communal areas and that a plain style had been chosen, which is a good design for people with dementia. As part of the inspection, we spot checked eleven bedrooms. We found that they were all clean and odour free. We observed a staff member carefully cleaning people’s personal items. Many rooms on the first floor were bright and airy, although some rooms felt cold. Rooms in the basement were clean but one in particular smelt musty. The owner said that two of the bedrooms have also been decorated; we saw one and it looked clean and fresh. Many of the rooms have been personalised, including photos and pictures on the walls. Most areas of the home were free from odour, apart from a corridor and a nearby bathroom where a clinical waste bin had a poorly fitting lid. The home provides both adapted baths and a shower room. All of the bathrooms we saw were clean but one has poor lighting making the room gloomy. The bathroom that is most frequently used by people living at the home looks institutional and therefore does not support a pleasant experience for people using it. We spoke with one person in a lounge who told us they were cold despite having a cardigan on. We also felt it was cold when we visited bedrooms when we arrived, but there were no wall thermometers for monitoring temperatures. Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 27 The building has large windows that help provide a bright environment but which are not double glazed. We gave the person a blanket from a pile already available in the lounge (although we found it needed to be washed). Cool temperatures do not promote people’s welfare because they do not encourage people’s movement or general comfort. The home looked clean. There was alcohol gel by the visitors’ book, although a notice asking people to use it might encourage more use, with liquid soap and paper towels throughout the home. Staff described appropriate infection control practices for containing possible infection risks and preventing crossinfection. We also saw that staff are supplied with a stock of gloves in each room, which are discreetly stored. In the morning, we saw staff taking wellstocked linen trolleys, with plenty of clean towels and flannels, when attending to people’s bedrooms. Having foot-operated pedal bins in all areas would further help to reduce cross-infection risks. The laundry area was orderly, with washing machines that had programmes for proper cleaning of laundry. Soluble bags were available for transporting soiled washing straight into machines, to minimise cross-infection risks from handling such items and staff told us they used them. Wheeled laundry skips were also used. There are no hand washing facilities, with staff telling us they just used gloves. Staff appeared unaware of the sluice cycle on the washing machine, for rinsing soiled laundry before washing it at high temperatures. They also thought a sink was needed for rinsing items, rather than hand washing considerations, which would be the more appropriate use. Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 28 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 27, 28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further improvements to the staff mix of skills, the home’s recruitment process and the training available will make the home a safer and a more pleasant place to live for the people living there. EVIDENCE: On the day of the inspection, there were five care staff on duty in the morning, plus the cook and two domestics. We checked the rota and this showed the staff on duty. However, when we arrived there was only one staff member in the communal areas with approximately six people eating their breakfast in different areas of the large room i.e. some sitting in armchairs and some people sitting at tables. This meant when the staff member was providing one to one support at the end of the room, they also had to supervise the needs of people further away. One of these people included a person who has been identified as having swallowing difficulties and another person who appeared unhappy. Staff told us that there were two waking night staff, and this was recorded on the rota. We saw from daily notes that some people living at the home are restless at night and some are reluctant to stay in bed. Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 29 During this inspection, we saw some staff who can provide good role models for less skilled staff. We saw during our observations that these staff members responded to people in way which recognised each person’s individuality. For example, we saw some gentle exchanges where staff reassured people and comforted them, while later we saw them joking with other people who responded well to the humour. Some staff picked up on people’s body language and responded appropriately. For example, discreetly checking with people to see if they needed the toilet or checking if they were in pain or uncomfortable. Some staff were observant and recognised when to offer assistance and when to stand back and give people space to move around the home. All of these examples showed us that some staff are skilled at working with people with dementia and know the people they look after well. On this occasion, the staff in the morning and at lunchtime appeared to work more as a team in contrast to previous inspections. Staff seemed more aware of what support each other was providing and were quick to assist one another. This shows greater observation skills and improved communication. However, for some staff these skills were less apparent shown by a lack of individual approach and poorer observation of the non-verbal communication by some people living at the home. Despite, a person talking and gesticulating at them, a staff member ignored them and asked other staff who were busy caring for people ‘have you all had breaks?’. We looked at recruitment information for three staff employed since the service was registered. There were statements about each person’s health and an initial police check, obtained before each started their employment. However, recruitment processes were not robust overall. For example, two satisfactory references had not been obtained for each person; evidence of employment histories, experience and training was not sufficiently documented to show how suitable people were for the work they were employed to do. The written induction programme for new staff was of a nationally recognised standard. There was evidence that two of these new staff had begun this induction, both still being within recommended timescales for completion of the induction. There was no evidence for the third person, who should have completed it by the time of our visit. Out of fifteen staff, Mrs Zhang told us eight had a care qualification, including six who had qualified as nurses in their country of origin. However, 4 were undertaking NVQ3 to develop their skills for their current role. We were told that five other staff would be taking NVQ2, although one of these people seemed unaware of this training opportunity. We looked at the training records for three new members of staff but one recorded no appropriate training and the person’s induction was incomplete. Some staff had attended training on caring for older people with dementia Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 30 within the last year (including the cook, but not since the home was newly registered), or assisting people who have swallowing difficulties, in addition to training on safe working practices. One person told us that despite sometimes leading the shift they had never received training in caring for people with dementia. This was evidenced by their practice. Seven staff were due to attend medication training later in the month, and all staff were attending training on assisting people to eat when they have swallowing difficulties later in the year. Staff are also enabled to undertake the local authority’s learning modules online, on the Mental Capacity Act 2005 and safeguarding, whilst on duty as Mrs Zhang said she covered for them. Some staff we asked, who had had some training on caring for people who have dementia, were unaware of factors that can help or hinder such individuals when eating a meal. One said they would like more training on how to manage aggression, since they were hit by some individuals whilst trying to care for them. They were unaware of guidance in one person’s care plan on how to respond if the person became agitated in a certain circumstance. But they described how they would respond – by sitting to chat with the person, which was in a way that indirectly explored and acknowledged the emotions the person was feeling. Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 31 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 31, 33, 35 and 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living and working at the home do not currently benefit from strong and experienced leadership to maintain quality care and safe working practices. However, there is evidence that this will shortly be addressed by the appointment of an experienced manager. EVIDENCE: The home does not currently have a manager in place but events at the home, such as previous poor care practice, poor care planning and a lack of recognition of people’s changing needs indicates that the home needs strong leadership and that the management of the home has been very poor but we can see there have been enough improvements for the service to now be Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 32 adequate. However, we will continue to monitor the service because of the seriousness of the previous concerns. As part of the safeguarding process, Mrs Zhang responded positively and immediately to the suggestion that she needed to recruit a new manager as matter of urgency. She has recruited a new manager who is due to start on 2nd November 2009, and who has been involved in making improvements to the home prior to starting their official appointment. Mrs Zhang has been committed to improving standards at the home and since the resignation of the previous manager has overseen the running of the home but does not currently have the experience or skills to manage the home. Recruitment practice at the home is not currently robust. (see standard 29). One person living at the home has been assessed in line with the Deprivation of Liberty safeguards under the Mental Capacity Act 2005 as an action point from a safeguarding meeting. But the outcome was that action did not need to be taken; other people at the home have had their care needs recently reviewed by social and health care professionals and no one else has been found to currently need this specialist assessment. The provider and their staff team have been recommended by the safeguarding team to attend suitable training in this area as the provider was unclear about this legislation. We agreed with the home which areas of the Annual Quality Assurance Assessment (AQAA) that they must complete prior to our inspection. Our main priority was for the home to focus on improving care. Mrs Zhang told us that when she acquired the home, she sent letters of introduction to the families of people who lived at the home, and to visiting health professionals. We saw a notice which was an invitation for visitors to meet the new manager at a wine and cheese evening early in November 2009. Families told us that they are waiting to see what changes occur as the result of the change in ownership but some felt the atmosphere had changed but did not say whether this was a positive or negative change. Staff we spoke with confirmed that senior staff were more available to them for advice or practical assistance, with good team-working. Staff supervision and training records are kept, showing Mrs Zhang has begun to carry out annual appraisals with care and ancillary staff, as well holding staff meetings. We saw minutes are kept of staff meetings, which were made available to all staff so those who could not attend would be aware of matters arising. Surveys had been sent out by the home early in the summer to relatives or other advocates of people living at the home, with a few returned. They were yet to be analysed or used to create an action plan for further development of the home. There were plans for a newsletter, support networks for relatives, audits of various aspects of home life (such as activities, meals and the environment), and using care plan reviews in addition to surveys to get Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 33 people’s views about the service. More regular staff supervision (every 3 months as a minimum) was also to be part of the quality assurance process. We asked staff if there had been any changes at the home in recent weeks. One told us that folders (introduced by the prospective manager) were now kept for recording care and observations - on both positive and negative matters. Group discussions were encouraged regarding these records, to inform and develop care plans. One person felt there had been lots of changes such that staff were not always kept up-to-date with them - after a period of time away from work, for example. However, a ‘buddy’ system had just been started, which could address such issues. Staff we spoke with were positive about the newly introduced keyworker system, although one felt they needed more time for this to fulfil people’s social needs as indicated by the description of the role. We looked to see how people’s personal allowances are managed. Mrs Zhang told us that no money was kept on the premises; instead a billing system for relatives or advocates has been set up, which we saw evidence of for the people we case tracked. One person we case-tracked had no next-of-kin, so their financial affairs were managed on their behalf by the Court of Protection. Finally, we looked at whether the home is safe place to live and whether it is well maintained. Care staff told us that there was always sufficient hot water. We were shown servicing certificates for the bath thermostatic mixer valves which were dated 24th November 2007. Mrs Zhang told us there was no routine testing of tap water temperatures, to monitor it for risks of scalding, etc. We saw evidence that the fire alarm system and lifting hoists had been serviced in September 2009. The lift servicing certificate was also more than a year old. Mrs Zhang she would contact the company as she said that she had a service contract with them. Mrs Zhang told us that the maintenance person carried out safety testing of portable electrical equipment, using specific equipment for this. However, she said there were no records of when testing had been carried out, such as labelling of items or otherwise. However, when we looked around the home, we saw electrical items did have labels to confirm they had been tested. The maintenance person had no specific training or specialist experience for the role, and we noted he had not had an update of health and safety for over a year. There was no record to show a member of the laundry staff had had an infection control update in the last year/recently, though they had had updating on manual handling and fire safety. Apart from one instance where staff lifted someone in a wheelchair inappropriately by their arms and legs, we saw good handling and moving of people who needed such help from staff. One staff member said some of the hoists were difficult to use in certain situations where the width of furniture did Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 34 not match well with the width of the hoist legs. There was no record that this staff member had had recent manual handling training. A staff member who took people out into the local community in wheelchairs confirmed they used lap-belts for safety. We saw they had had recent first aid training. They suggested that more suitable wheelchairs were needed for such outings, for safety and comfort, which senior staff were going to look into. We discussed related risk assessment. The cook told us she had undertaken an Environmental Health department food handlers’ course in March 2008. The kitchen areas were clean and orderly, with cleaning schedules available and up-to-date. Other records had also been kept in line with the latest food safety guidance. We spot checked eleven bedrooms, and saw that radiators were covered to provide protection for people from burning and windows were restricted. Care staff told us that repairs were addressed quite quickly. Kitchen staff told us that equipment had been provided or replaced as necessary. Laundry staff said a tumble drier had been purchased recently. Servicing labels on fire fighting equipment in the kitchen showed it had been checked in the last month, and the cook told us that additional fire signage had been put in place recently in the kitchen. Mrs Zhang agreed to consider removing a locked gate from one of the main corridors as this gives an institutional look to the home, and staff advised us that it was not necessary for the people living at the home. Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 35 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 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 3 3 x x 3 2 2 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 1 Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 36 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 OP7 Regulation 15 (1) (2) (b) Requirement All service users’ care plans provide staff with the information required as to how service users’ needs in respect of health and welfare are to be met. In that all service users’ care plans provide clear instructions to staff to meet the health and welfare needs. Care Plans are reviewed regularly to take into account people’s changing needs. ( this requirement will be checked as part of a compliance visit ) 2 OP8 12 (1)(a)(b) There are effective systems in place so that each person living in the home receives the care they need, especially regarding their diet, drinks and personal care Systems are put in place to ensure all information relating to a person’s needs, health and Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 37 Timescale for action 20/10/09 20/10/09 welfare are reviewed on a regular basis and updated Systems are put in place to ensure care plans are used effectively to monitor peoples’ health and welfare needs. And updated on a regular basis to reflect change of need ( this requirement will be checked as part of a compliance visit ) 3 OP9 13 (2) The registered provider must ensure that suitable storage is available for controlled drugs in accordance with the Misuse of Drugs act 1973 (safe custody) regulations. The controlled drugs register must be completed fully and accurately. This is to make sure that controlled drugs are looked after safely. The registered provider must ensure that suitable arrangements are in place for the ordering, receipt, recording and safe administration of medicines. This refers to medicines running out of stock, recording the date medicines are received, the recording of medicines as “not taken” and auditing of medicines supplied in standard pack. 01/12/09 4 OP9 13 (2) 01/12/09 5 OP12 16 (2) (m) This is to make sure that medicines are looked after and given safely. People living at the home need 31/12/09 to be supported to maintain their faith/spiritual beliefs and existing interests, including external interests. DS0000073257.V376879.R01.S.doc Version 5.2 Page 38 Highlands Care Home 6 OP16 17 (2) Schedule 4 (11) 13 7 OP18 8 OP26 16 (2) (j) This is to ensure that people’s well-being and individuality is maintained. Complaints must be recorded accurately and in detail, including the action taken to ensure that people are protected in a robust manner. The responsible individual and staff must familiarise themselves with, and follow, the local authority’s multi agency guidance on safeguarding people to ensure that people living at the home are protected from abuse and harm. This includes updating the home’s policy. (This requirement has been repeated. The original compliance date was 22/09/09). The home must consult with the Health Protection Agency to ensure that current practices in the home maintain satisfactory standards of hygiene. To ensure that people are kept well and safe. Staff must receive training that is appropriate to the work they perform, including training on supporting people with dementia, and understanding behaviour that challenges the service, plus moving and handling and infection control. To ensure that people’s diverse needs are met safely and appropriately. (This requirement has been repeated. The original compliance date was 22/09/09). Recruitment must be more robust in the home, and include DS0000073257.V376879.R01.S.doc 02/11/09 01/12/09 01/12/09 9 OP27 18 01/12/09 10 OP29 19 (1) (b) 02/11/09 Page 39 Highlands Care Home Version 5.2 11 OP31 10 12 OP38 13 (4) (c) suitable written references and detailed employment histories to help safeguard people living at the home and ensure that staff are suitable to work at the home. You must carry on and manage 02/11/09 the care home with sufficient care, competence and skill to ensure that care staff receive the leadership and direction they need so that people’s needs can be met. (This requirement has been repeated. The original compliance date was 22/09/09). Unnecessary risks to the heath 01/12/09 and safety of service users must be identified and so far as possible eliminated, with records kept of action taken. This is to ensure that people live and work in a safe and well maintained environment. 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 Refer to Standard OP3 OP9 Good Practice Recommendations People’s assessments should be holistic i.e. not just focussing on their physical needs but also their mental health needs and their spiritual and social needs. Staff should request that people’s medicines are reviewed by the doctor at suitable intervals and record the outcome. This is to help ensure that medicines are given appropriately. The medication policy should be amended so that it informs staff about all aspects of how medicines are handled in the home. This is so that staff involved with medicines are clear about the correct procedures to ensure DS0000073257.V376879.R01.S.doc Version 5.2 Page 40 3 OP9 Highlands Care Home 4 5 6 7 OP15 OP18 OP19 OP25 8 9 10 11 OP27 OP30 OP30 OP33 that medicines are looked after and given safely. People should not be sat at dining room tables if they then have to wait to be assisted with meals when staff are busy assisting other people. All staff should receive training in safeguarding to help them recognise their responsibility to report abuse and poor practice. Rooms should be audited to ensure that they are lit appropriately, have a working call bell and clean furniture. Room temperature should be monitored with the heating settings reviewed, and immediate action taken if people look cold or rooms feel cold. Blankets should be checked to ensure they are routinely cleaned. Staffing levels at breakfast should be reviewed to ensure that people can be monitored and assisted by appropriate levels of staff. All staff should have written induction records which are completed within six weeks of being appointed. All staff should have their training records reviewed and their practice observed to help build a picture of their future training needs. A robust quality assurance system should be put in place to monitor the service’s performance and to help measure improvement. Highlands Care Home DS0000073257.V376879.R01.S.doc Version 5.2 Page 41 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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