CARE HOMES FOR OLDER PEOPLE
Highnam Hall Residential Home Park Avenue Hartlepool TS26 0DZ Lead Inspector
Belinda Parker Unannounced Inspection 22nd June 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 Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Highnam Hall Residential Home Address Park Avenue Hartlepool TS26 0DZ 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) 01429 869019 01429 233715 Mr Matt Matharu Mrs Christine Noble Care Home 45 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (17), Mental disorder, excluding learning of places disability or dementia (5), Old age, not falling within any other category (45), Physical disability (5) Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Five persons in the category DE above the age of 55 may be accommodated in accordance with the home’s Statement of Purpose Five persons in the category PD above the age of 55 may be accommodated in accordance with the home’s Statement of Purpose. Five persons in the category MD above the age of 55 may be accommodated in accordance with the home’s Statement of Purpose 3rd November 2005 Date of last inspection Brief Description of the Service: Highnam Hall is registered to accommodate up to 45 older people, including people with mental health needs. On the day of the inspection there were 17 people living in the home. Highnam Hall is a grade 2 listed building, which retains many of its original features. The home is situated in a quiet road overlooking a popular park and has lawned areas to the side and private car parking to the front. The home has recently been purchased by Mr. Matt Matharu from the previous owners Mr. Russell Hart & Mrs. Olwyn Hart. Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 22/06/06 over a period of 7 hours. During the visit time was spent talking to service users, staff and a relative. A tour of the building was conducted and a number of records examined. Two survey forms were returned to CSCI prior to the visit. What the service does well:
On entering the home we were welcomed by the manager. The atmosphere through out the visit was friendly and relaxed. During the day it was noted that staff and service users had a good relationship. Plenty of chat and laughter could be heard. The provider was present in the home on several occasions through out the day. Mr Matharu escorted us around the building explaining the work going on to improve the standards of comfort for the people who live there. Survey forms returned to CSCI prior to the visit and discussion with service users and a relative highlighted their satisfaction with the service provided. Many positive comments were made including, “ The staff are cheerful”, “ The owner Matt tells me all about the plans to make the home nice”, “ No problems, great place”, “ I’ve got my own room and stuff”, “ Nobody pushes me to do anything that I don’t want to”, “ The cook gives me what I want”, “ Had a nice lunch today, mince and yorkshire puddings, proper food”. Staff commented favourably on the professionalism of the manager and how changes within the home have been implemented slowly. Records were examined. The majority of records were up to date, some systems in place for the provision of information to prospective service users and their representatives require further development. This will ensure they have enough information on the service offered, to enable them to decide if they wish to move in to Highnam Hall. Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 (Standard 6 not applicable) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The home’s Statement of Purpose and Service User Guide is inadequate and does not provide sufficient information for prospective service users to be clear about the services the home provides to meet their needs. A clear pre-admission assessment process is in place. This ensures that the individual needs of the prospective service user can be met by the home. Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 9 EVIDENCE: The manager had evidence to show that development of the Statement of Purpose is ongoing. A Service User Guide is not available at this time. It is important that this information is available to prospective service users and their representatives to enable them to make a decision as to whether they wish to move into the home. Three care plans examined included evidence to show that a full pre-admission assessment had been carried out prior to admission. This process involved the service user and their relatives in deciding as to whether the home could meet the individual needs of the prospective service user. Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. There is a clear and consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet service users needs. The medication in this home is well managed promoting good health. Personal support in this home is offered in such a way as to promote and protect service users’ privacy, dignity and independence. Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 11 EVIDENCE: Continuity of staff means that they know the needs of the service users living in the home well. Since the last inspection new care planning documentation has been implemented. Three care plans examined included satisfactory information to enable staff to meet the changing needs of service users’ accommodated in the home. Information is recorded in service users’ individual care plans to show that other health care professionals are involved in meeting their health needs. Care plans are evaluated monthly, to ensure the changing needs of service users are met. An audit of medication was carried out. The home uses a monitored dosage system at present. The manager said this system is currently under review. There are adequate policies and procedures in place relating to the safe handling of medication. This ensures the health and protection of service users is promoted. During the visit staff were observed interacting with service users. It is evident that staff and service users have a good rapport and privacy and dignity are respected. A relative and service user spoken to was complimentary towards the general attitude and friendliness of the staff at Highnam Hall. Comments included, “ No problems, great place”, “ Nobody pushes me to do what I don’t want to”. Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The activity programme in the home is limited. The current programme does not provide a varied and fulfilling social life for service users to participate in if they wish to do so. Visiting is flexible and evidence is available to show that service users are encouraged to maintain contact with relative, friends and the community. Service users are encouraged to take control within their chosen lifestyle. And are supported to do so by the provider and staff. The dietary needs of the people living in the home are met. Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 13 EVIDENCE: Due to the low number of service users accommodated at present (Will increase following completion of refurbishment), activities available in the home are limited and organised by staff. The manager said consideration is being given to appointing an activities co-ordinator when the number of people accommodated in the home increases. Responses received from the two survey forms received prior to the inspection stated, “ Activities are available sometimes”. A relative responded of behalf of their family member saying, due to disability her relative finds it difficult to participate but support is provided from staff for appropriate activities. A service user spoken to said, “ I’ve been for tea at another home belonging to the owner”. Staff commented now the weather is better service users accompanied by staff, visit the adjacent park and make use of the café facilities in the park. Visiting in the home is flexible. A service user said, “ My friends from the church are made welcome”. Service users and a relative spoken to commented positively about the staff encouraging and supporting the service users to be independent, and to make their own decisions. A relative was observed talking to the provider. The relative addressed the provider by his first name, the conversation was friendly and relaxed. A service user said, “ The owner watches count down with me”, “ The owner Mat tells me all about the plans to make the home nice”. Service users spoke positively about the food served. One service user commented, “ Had a nice dinner today. Mince and Yorkshire puddings proper food”. Another service user said, “ The cook gives me what I like”. The manager had evidence available to show that the menus are currently being seasonally adjusted. Service users are asked by staff the day before about their choice of meals. The dining area in the home is traditional in style and comfortable. A meal sampled during the visit was home made, tasty and well presented. Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The home has a system in place to enable service users to make their views known if they are dissatisfied with the service offered. Clear processes and systems are in place to protect service users from harm or abuse. EVIDENCE: The home has a complaints policy and procedure in place. A copy of this procedure is available in service users rooms for their information. Service users and a relative spoken to were aware of whom they would speak to if they were unhappy with any aspect of the service. Comments included, “ I feel confident to speak to any member of staff”, “ I would see the manager or my social worker. If I had any problems”. There have been no recorded complaints since the last inspection. Staff spoken to during the visit was able to demonstrate an awareness of POVA (Protection of Vulnerable Adults) and the process to follow if an incident of abuse occurred in the home. Records examined for the protection of service users are up to date. Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. Recent investment in the home is significantly improving the appearance of this home creating a comfortable and safe environment for those living there and visiting. The home must remain free from offensive odours for the comfort of service users. Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 16 EVIDENCE: The provider accompanied us on a tour of the home. Discussion took place regarding the ongoing refurbishment within the home, time scales and disruption to service users being kept to a minimum. Health and safety is given a high precedence during this time. A service user commented positively about the changes. Saying, “ Definitely a change for the better”. Other areas of the home viewed where work had been completed are traditional in style, comfortable and accessible. Service users were observed moving freely around the home. Some bedrooms viewed had an offensive odour present. The manager must ensure the home is kept odour free for the comfort of the people who live there. Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. The home carries out a robust recruitment procedure to ensure service users are protected from harm or abuse. Staff are trained and employed in adequate numbers to meet the collective needs of the people who live there. EVIDENCE: On the day of the visit staff were on duty in adequate numbers to meet the needs of the people who lived there. Staff duty rotas examined showed that the home ensures staffing numbers meet the changing needs of service users. The manager said as refurbishment continues staffing numbers will increase as more service users are admitted to the home. Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 18 Existing staff are well qualified to either NVQ level 2 or 3 in Care. Two staff members spoken to said they would like the opportunity to progress to NVQ level 4. But funding remains an issue. Staff during discussion were able to demonstrate training attended. Staff personnel files included certificates of achievement by individual staff. Staff spoken to said it is important for them to update their skills and abilities to continue to provide a good service to the people who live there. Staff personnel files examined included all the required information to show that a thorough recruitment process had been followed for the protection of service users. Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 19 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The home is well run. Further development of the quality assurance process by the provider is required to meet Reg 26 of the Care Homes Regulations 2001. Service users financial rights are protected. The standard of the environment in this home is improving. That will provide service users and visitors with a high standard of comfort in attractive surroundings. Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 20 EVIDENCE: The registered manager is well qualified and is continuing on with the Registered Managers Award. Due to her current workload she is only able to make slow progress but this should improve as systems in the home are implemented. Staff spoken to said this has been a time of change which they feel is for the better and are more accepting of the need as to why new systems have been introduced. The manager is aware that it is important to provide service users and their representatives with an opportunity to make their views known. The manager said meetings have so far proved unsuccessful but has found regular 1-1 chats with service users and their relatives very productive. Service users and a relative spoken to confirmed this. A recent inspection has been carried out by the Local Authority and the findings were positive towards the service offered. As part of the quality assurance and monitoring system the provider is still failing to complete Reg 26 visit audit form. It is a requirement that this visit is carried out by the provider monthly and a copy of this document being available in the home office for inspection by CSCI. This ensures the home is being run in the best interests of the people who live there. Money held on behalf of service users by the home is accounted for appropriately. Records examined showed two signatures for all financial transactions. Due to the major works taking place internally and externally in the home health and safety is maintained ensuring service users, staff and visitors to the home are safe and disruption is kept to a minimum. Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 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 OP1 Regulation 4&5 Requirement Statement of Purpose and Service Users Guide documents must be developed to reflect the management of the home and service offered. The registered manager must ensure that personal accommodation is kept free from any offensive odours The registered provider shall review the care in the home at monthly intervals. And make available in the home a copy of the findings of this visit. Timescale for action 30/09/06 2. OP26 16 (k) 22/06/06 3. OP33 24 & 26 01/08/06 Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP31 Good Practice Recommendations The registered manager should continue to work towards achieving the Registered Managers Award. To provide the manager with a higher degree of skills and abilities to deliver a continued good standard of service in the management of the home. An activities coordinator should be employed or designated activities hours given to staff. The registered provider should continue to work to wards completing the refurbishment of the home. To increase the level of comfort for service users and visitors to the home. 2. 3. OP12 OP19 Highnam Hall Residential Home DS0000065270.V298203.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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