CARE HOMES FOR OLDER PEOPLE
Highstone Mews Care Home Highstone Road Worsbrough Common Barnsley South Yorkshire S70 4DX Lead Inspector
Mr Steven Vessey Unannounced Inspection 29th November 2005 10:05 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 Highstone Mews Care Home DS0000006484.V264002.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Highstone Mews Care Home DS0000006484.V264002.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Highstone Mews Care Home Address Highstone Road Worsbrough Common Barnsley South Yorkshire S70 4DX 01226 733966 01226 779427 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) Tamaris Healthcare (England) Ltd (wholly owned subsidiary of Four Seasons Health Care Limited) Debra Ann Owen Care Home 60 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (30), Old age, not falling within any other category (30) Highstone Mews Care Home DS0000006484.V264002.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. For the OP unit, staffing levels must be maintained as follows: one member of staff must be on duty when 1 to 10 service users live at the home; two staff for 11 to 20 service users; and three staff for 21 service users and above. The remaining 30 beds in a separate unit are registered for PC, Personal Care in the category OP, Older People. Two of these beds can be used instead as PD, Physical Disability for people aged 55 or over. For the DE/E, MD/E unit, minimum staffing levels and the manager supernumerary hours must be maintained as agreed with the previous registration authorities, see attached, Appendix 1. 30 beds in one unit are registered for N, Nursing Care or PC, Personal Care in the category DE/E, Dementia for people aged 65 or over OR MD/E, Mental Disorder for people aged 65 or over. Of the 30 beds above two can instead be used for the category DE or MD for people aged 55 or over and 28 for people aged 60 and over. 15th June 2005 2. 3. 4. 5. Date of last inspection Brief Description of the Service: Highstone Mews is a registered care home for 60 older people. The home is divided into two units, which comprise of a 30-bed unit providing residential care and a 30-bed unit providing dementia/mental disorder nursing care. The home was purpose built. Both units share the same facilities for kitchen, laundry and administrative support. The home is situated in the residential area of Worsbrough Common on the outskirts of Barnsley, close to the M1 motorway and local bus routes and shops. All 60 places are accommodated in single en-suite rooms. Resident’s rooms are located on the ground and first floors and the home is equipped with handrails, other adaptations and a lift to assist people in moving around the home. Similarly, aids for residents are provided in bathrooms and toilets. The home had a range of communal areas. An enclosed garden and car park are provided. Highstone Mews Care Home DS0000006484.V264002.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over approximately six hours from 10:05 am to 4:00 pm. The inspection process included a partial inspection of the premises, inspection of a sample of records and policies, discussions with staff, residents and relatives and observation of staff carrying out their duties. The majority of residents and staff were seen during the inspection and the inspector had the opportunity to speak to six staff, six residents and relatives in some detail. What the service does well: What has improved since the last inspection?
A written contract/statement of terms and conditions with the home had been issued to residents and there was a detailed assessment of residents needs included in care plans. Some work had been done on improving the environment for residents, the redecoration of the bathroom on Dillington unit had started and the bath had been replaced. The dining room carpets on Kingston Unit had been replaced with wooden flooring and some bedrooms had been redecorated and had replacement carpets. The home was clean and free from unpleasant odours. Highstone Mews Care Home DS0000006484.V264002.R01.S.doc Version 5.0 Page 6 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. Highstone Mews Care Home DS0000006484.V264002.R01.S.doc Version 5.0 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 Highstone Mews Care Home DS0000006484.V264002.R01.S.doc Version 5.0 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): 2, and 3. Standard 6 was not applicable at the home. Residents had a written contract/statement of terms and conditions with the home. Residents had a detailed assessment of their needs included in their care plan. EVIDENCE: Three residents files included a completed written contract/statement of terms and conditions with the home. Four care plans included a detailed assessment of residents needs and some included assessments from the placing authority. Highstone Mews Care Home DS0000006484.V264002.R01.S.doc Version 5.0 Page 9 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 Residents had a detailed up to date plan of care reflecting their identified assessed needs. Resident’s health care needs were in the main met, however this would be improved if all care plans included residents choices regarding care following their death and risk assessments for residents needing bed rails and other specialist equipment. Medication was stored securely and managed well. Residents were treated with respect and that they had adequate privacy. EVIDENCE: Five care plans checked included detailed information as to the actions required from staff to meet the needs of the individual residents and were reviewed regularly by staff. Risk assessments were in place for, development of pressure areas, moving and handling, falls and nutrition. However care plans did not include risk assessments for the use of bedrails or other specialist equipment and some care plans did not include information relating to resident wishes relating to their care after death.
Highstone Mews Care Home DS0000006484.V264002.R01.S.doc Version 5.0 Page 10 Residents seen were well cared for, they were clean, hair and nails had been attended to and male residents were shaved, relatives confirmed that residents were well cared for. Records were kept of medication being received into and leaving the home. There were medication administration records for residents, which were in the main completed appropriately. Staff administering medication on Kingston Unit confirmed that they had received training from other staff at the home and had recently completed a course on the safe administration of medication. Qualified nurses administer medication on Dillington Unit. All medication, including controlled drugs were stored appropriately and securely, maintaining the health safety and welfare of residents. The manager stated that the clinical waste contractor disposed of medication. Care plans included information for care staff on how to meet the needs of residents whilst promoting dignity. Care staff were able to describe how they promoted privacy and dignity when providing care for residents and nursing and senior care staff described how they monitored care delivery to ensure the privacy and dignity of residents was maintained. Relatives confirmed that residents were treated with respect. Highstone Mews Care Home DS0000006484.V264002.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 A variety of activities, outings and entertainment were provided for residents. Residents were given choice in many aspects of their lives, maintaining their independence. EVIDENCE: Two part time activities co-ordinators were employed and records showed that a wide range of activities, outings and entertainment were provided for residents. Staff and relatives confirmed that residents could choose when they get up and go to bed, what they wear, what they have to eat and where they spend their time. Residents were offered a choice of drinks throughout the day and were provided with a drink on request. Highstone Mews Care Home DS0000006484.V264002.R01.S.doc Version 5.0 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Relatives had been given information about complaints and thought that their complaints would be listened to and dealt with. Residents were protected by the policies and procedures in place relating to the recognising and reporting of abuse and adult protection training attended by staff. EVIDENCE: Relatives stated that they received information relating to making a complaint at the time their relative was admitted to the home. They stated that the staff were approachable and stated that they felt that any complaints would be listened to and sorted out. Relatives also stated that they had nothing to complain about. Staff spoken to were aware of the policies and procedures in place relating to the recognising and reporting of abuse, including whistleblowing. Training records showed that staff had attended adult protection training. Highstone Mews Care Home DS0000006484.V264002.R01.S.doc Version 5.0 Page 13 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, 21, 24 and 26 The environment was in the main well maintained and well decorated, however this would be further improved if the corridor carpets were replaced and the bathroom door was repaired or replaced. Resident’s rooms were clean, comfortable and personalised. The home was in the main clean and free from unpleasant odours. EVIDENCE: In the main the environment was well maintained and well decorated. The bathroom on Dillington Unit was in the process of being redecorated and the bath had been replaced, however the bathroom door had a hole in it. The dining room carpets on Kingston Unit had been replaced with wooden flooring and some bedrooms had been redecorated and had replacement carpets. The corridor carpets were showing signs of wear; the manager stated that she had made an application to the company for money to replace these. The home was clean and odour free, relatives stated that the home was always clean.
Highstone Mews Care Home DS0000006484.V264002.R01.S.doc Version 5.0 Page 14 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 Sufficient staff with an appropriate mix of skills was on duty to meet the needs of the residents, however staff on Kingston Unit felt that an additional member of care staff would enable them to spend more time with residents, enhancing the quality of care they receive. More than half of the care staff were trained to at least NVQ level 2 in care. Residents were not fully protected by the recruitment process, as files for staff that had recently commenced work at the home did not include all the required recruitment information. Some staff files contained completed induction training records and staff stated that they had many opportunities to attend other training. EVIDENCE: The manager was on duty on the morning of the inspection. On Kingston Unit there was one member of senior care staff and three care staff. On Dillington Unit there was two nurses and four care staff. In addition to this five domestic staff, a laundry assistant, a cook, a kitchen assistant, two activities coordinators, an administrator and the handyman were working around the home. Residents and relatives stated that there was sufficient staff on duty to meet the needs of the residents. Staff on Kingston Unit stated that more staff would be useful to meet all the needs of residents. They stated that the personal care needs of residents were being met to a good standard but they felt that they did not have sufficient
Highstone Mews Care Home DS0000006484.V264002.R01.S.doc Version 5.0 Page 15 time at present to spend time with residents on an individual basis. Staff spoken to on Dillington Unit felt that sufficient staff were on duty to meet the needs of the residents. The manager stated that more than fifty percent of care staff were trained to at least NVQ level 2 in care. Three out of five staff files for staff recently recruited staff did not include a CRB disclosure, POVA check or two written references. An application had been made for the CRB disclosure and POVA first check and references had been sent for. The manager stated that the staff had been in the home for their induction training but had been working under close supervision. Staff files did include a completed application form with any gaps in employment identified and the registration of recently employed nursing staff had been checked with the Nursing and Midwifery Council (NMC). Files of staff who had completed induction training included these records and staff stated that they had opportunities to attend additional training. Highstone Mews Care Home DS0000006484.V264002.R01.S.doc Version 5.0 Page 16 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, 35 and 38. The manager was experienced, qualified and competent to run the home. Residents’ financial interests were safeguarded. Residents and relatives felt that the home was safe, however the health safety and welfare of residents and staff would be better maintained if the weekly testing of the fire alarms was recommenced, the hot water temperatures were recorded and accidents were appropriately reported to the Commission for Social Care Inspection (CSCI). EVIDENCE: The manager had an appropriate nursing and management qualification, appropriate experience and was competent to manage the home. Systems in place for the management of residents’ personal allowance safeguarded residents’ financial interests. Money held at the home on behalf of residents was held securely and reconciled with records kept.
Highstone Mews Care Home DS0000006484.V264002.R01.S.doc Version 5.0 Page 17 Relatives stated that there were no problems with the management of residents’ personal allowance. Staff had received fire training and had attended fire drills maintaining the health safety and welfare of residents and staff. Fire equipment had been serviced and records stated that until recently the fire alarms had been tested weekly, however the last fire alarm test was on 7th October 2005. Staff had received moving and handling training and equipment was available to assist them in moving residents safely. The handyman stated that the hot water temperatures on baths and showers were tested monthly and this was recorded on a checklist, he stated that the temperatures were usually between 41 and 43 degrees centigrade, however there were no records available to show the actual temperature of the hot water. Accident records were fully completed and details of accidents were recorded in residents care plans, the manager stated that accidents that had resulted in residents receiving hospital treatment for their injuries had been reported to the CSCI, however this information had not been received at the local CSCI office. Highstone Mews Care Home DS0000006484.V264002.R01.S.doc Version 5.0 Page 18 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 2 Highstone Mews Care Home DS0000006484.V264002.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 15 Requirement Information relating to residents wishes for care following their death must be recorded in all care plans Risk assessments must be included in care plans for the use of bed rails and other specialist equipment. The plan to replace the corridor carpets must be implemented. The identified bathroom door must be repaired or replaced. Staff must not be employed without two written references, a CRB disclosure and POVA check. The fire alarm must be tested weekly. The temperature of the hot water on baths and showers must be recorded. Timescale for action 28/02/06 2. OP8 15 29/01/06 3. 4. 5. 6. 7. OP19 OP19 OP29 OP38 OP38 23 23 19, Sch 2 23 23 28/02/06 28/02/06 28/02/06 29/12/05 29/12/05 Highstone Mews Care Home DS0000006484.V264002.R01.S.doc Version 5.0 Page 20 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 OP38 Good Practice Recommendations A system for monitoring and recording the water temperatures throughout the building should be implemented. Highstone Mews Care Home DS0000006484.V264002.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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