Inspection on 01/05/07 for Highwell House

This inspection was carried out on 1st May 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Highwell House 20/04/06

Highwell House 07/02/06

Highwell House 05/12/05

Highwell House 11/07/05

Highwell House 05/10/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Highwell House Highwell House Highwell Lane Bromyard Herefordshire HR7 4DG Lead Inspector Wendy Barrett Key Unannounced Inspection 09:20 1st May 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Highwell House DS0000060412.V332822.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. Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highwell House Address Highwell House Highwell Lane Bromyard Herefordshire HR7 4DG 01885 488721 01885 482882 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) Ms Karen Anne Rogers Mrs Angela Susan May Staphnill Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28), Physical disability over 65 years of age of places (19) Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users assessed as being in the nursing category must be accommodated in the fifteen bedded nursing unit. Service users in the physical disability category must be accommodated in the nursing unit or on the ground floor of the residential unit. From time to time up to three (3) service users between the ages of 60 and 65 years of age can be admitted into the nursing unit as long as their needs can be appropriately met within an elderly setting. Service users who have mental health needs relating to confusion, mild dementia can be accommodated in the nursing unit as long as these needs are secondary to their general nursing needs. 20th April 2006 4. Date of last inspection Brief Description of the Service: Highwell House is owned by Ms Karen Rogers, who also owns two other registered care homes in Herefordshire. Highwell House is situated at the end of a narrow lane half a mile from Bromyard town centre. It provides excellent views across the Froome Valley to the Malvern hills. There are car-parking facilities in the grounds but the situation of the home does not offer easy access to public transport. The home provides nursing care for sixteen older people in a purpose built unit and personal care for twelve older people in an adjacent Georgian house. There is a rack of information literature in the main entrance to the nursing side of the home. This includes a Statement of Purpose in large print, a Service User Guide (updated in July 2006), and the last CSCI inspection report. Potential residents are all given a copy of the Service User Guide. The current scale of charges ranges from £400(personal care) to £550(nursing care) per week. Additional charges are made for hairdressing, personal newspapers and chiropody. Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report has been written with reference to information held on the Commission’s records about the service, details contained in a pre-inspection questionnaire completed by the Care Manager, completed feedback cards from 3 residents and a health care professional. Relatives’ feedback cards were sent to the home but no completed cards were returned to the Commission. What the service does well: What has improved since the last inspection? What they could do better: The way that care is planned should involve more attention to the individual lifestyle preferences and choices of the individual so that staff work in a way that is most likely to help each resident enjoy their daily life as much as possible. Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Highwell House DS0000060412.V332822.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 Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Before agreeing to an admission the Care Manager gets the information she needs to decide if the home will be able to meet the potential resident’s needs. There is written information describing the service and this helps potential residents and their relatives to decide if the home will suit them. They are welcome to visit the home to help them with this decision. EVIDENCE: Before admissions are agreed the Care Manager gets as much information as she can about the potential resident’s care needs. This helps her to make a good decision about the home’s ability to meet these needs. She also asks for reports from other care professionals e.g. hospital staff or social work staff who have previously cared for the person. Potential residents and their relatives are given written information about the service. They are also welcome to visit the home and look around before they decide if it would suit them. Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 9 The Care Manager makes written records when she meets potential residents. Three examples of this work were inspected at the home. They showed that there was good attention to all aspects of care e.g. what medication was being taken, whether there are any particular problems that will require careful attention by the home’s staff e.g. skin care, dietary needs of the individual. There was also reference to past life experiences e.g. details of family members, education, employment. One resident had previously worked as a forester. It is important for staff to have this information because new residents are often very frail and may be unable to help the staff see them as a unique human being. The pre-admission assessment work is used to give staff guidance about the way they should care for a new resident e.g. one record referred to the resident’s wish to have the door to their en-suite facility open at all times. Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9, and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each resident has a written plan of care and there are examples of significant improvement in physical wellbeing as a result of staff following and reviewing the plans that address this aspect of the residents’ welfare. The plans don’t tell staff enough about the other important areas of a resident’s life. They should address more clearly lifestyle choices and preferences and how staff take this into account in their work with the resident. EVIDENCE: Once a resident is admitted to the home the staff have a written plan of care so they know how to work in a way that will suit the individual. Three examples of the care plans were inspected and two of the involved residents were spoken to during the inspection visit. The third resident was seen as he rested in bed. There were examples of good attention to residents’ health care needs. This had resulted in significant improvements in the physical wellbeing of two of the Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 11 residents whose care plans were inspected e.g. one lady’s mobility had improved and she had been able to move from the nursing side of the home into the residential side. A gentleman was admitted with a number of pressure sores. With good care of his skin and diet the pressure sores had healed, he had put on weight and was now able to enjoy normal meals. The staff had also received additional training from a specialist nurse to help them understand how to care for a person with Huntington’s disease. The picture was less clear when looking for evidence of attention to individual emotional and social needs. The care plans were weighted towards physical needs, even for those residents who did not need nursing care. There was some reference in the care records to the residents’ participation in some social activities but these were brief and not up to date e.g. one record had no entries made since December 2006. When asked to comment on some observations made during the visit the Care Manager explained that the resident was a lady who did not like to have her hair set by the hairdresser, did not wish to bring in personal items from her home to put in her bedroom, and was reluctant to purchase new clothes. There was nothing in the care plan to reflect these lifestyle choices, or any record of ongoing consultation to find out how the lady prefers to live, although the initial assessment record described her as ‘very sociable’. Previous inspections have found that staff handle residents’ medication safely. This satisfactory situation is reflected in recent action taken by the Care Manager in investigating a problem that arose when medication was transferred with a resident from a hospital to the home. There was no fault with the home’s practice and the Care Manager’s work resulted in a commitment from the hospital to improve their practice. A sample of administration records was seen during the inspection visit. There were a few recording omissions. However, the Care Manager was already aware of this and was taking appropriate action to resolve the problem. Two resident comment cards indicated satisfaction with the attitude of the staff –‘very pleased with care received’. A resident who was met during the inspection was also happy with the way he was being treated. Staff were seen to approach residents in a calm, respectful manner when providing care. Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are social activities for the residents and relatives are welcomed into the home. However, there needs to be more attention to helping individual residents exercise choice and control over the way they spend their days, with staff support when needed, so they will be most likely to enjoy their life in a way that suits them. The meals are well planned to be sure the residents get the nutrition they need. EVIDENCE: Some time was spent observing the residents in the residential lounges. There was apparently a coffee morning planned but this didn’t happen and the Care Manager was unaware of the reason for this. Several residents were sitting in the lounges and a few people were doing jigsaws. A television was on in one lounge but none of the residents appeared to be watching it. There was little conversation between residents and the care staff were not seen sitting with residents chatting – although one care assistant was helping with the jigsaws at one stage. A visiting relative felt it was unusual to see so many residents in the lounge and she did not recall having see staff doing jigsaws previously. Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 13 She also commented that her stepfather had spoken more to the Inspector than she had ever seen him speak to staff. The Care Manager felt that the observations were not typical of life at the home. In May 2006 the Care Manager undertook a consultation exercise with residents and relatives. This resulted in 80 satisfaction with ‘Life in the Home’. However, there were no comments cards returned from relatives as part of this inspection process to add to the available evidence. The meals service was satisfactory at the last inspection. There was a current example of staff giving a new resident a lot of extra attention to help him gain weight and improve his overall physical wellbeing by providing 2 hourly meals throughout the day and night. He was now able to enjoy a normal diet. Residents were observed having lunch. Drinks of squash were provided with the meal. The Care Manager explained that staff often sit at the table with residents to help them enjoy their food and use it as a social event. This did not happen during the inspection visit and perhaps this was why residents did not seem to chat much together at the table. Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints about the service are listened to and acted upon appropriately. The staff are given guidance to help them recognise and report any concerns about the protection of the residents and their work with residents leads to considerable satisfaction. EVIDENCE: The Commission has received one complaint about the service since the last inspection. The Provider was contacted by the Commission regarding the issues raised and a satisfactory response was received although this was not received very promptly. There have been 4 complaints or concerns raised at the home since the last inspection. Records of the Care Manager’s attention to these were seen and they confirmed robust action to deal with any issues raised. There were also many complimentary letters and cards from satisfied residents and relatives. Two out of the three comment cards received from residents confirmed that the residents knew who to talk about their concerns. Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 15 During the past 12 months the staff have received training to help them understand how to recognise abusive practice and how to report any concerns they have. No allegations have been made about the service since the last inspection. Two staff who were interviewed during the inspection visit were very enthusiastic about their work and displayed a genuine commitment to protecting the interests of the residents. Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in a clean, well-maintained home that is equipped to make them as comfortable and safe as possible. Residents are protected from infections by good staff working practices and supply of appropriate equipment that they need to achieve this. EVIDENCE: Much of the residents’ accommodation has been refurbished to offer a comfortable environment that is equipped and arranged to take account of the residents’ disabilities. This work is ongoing e.g. there is more equipment to make the premises safe in the event of fire, new cleaning schedules have been implemented, linen skips and bins have been purchased. Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 17 At the time of the inspection visit the home was clean, tidy and odour free. Maintenance schedules are kept and routine servicing contracts are in place for things like compliance with legionella, aids and equipment checks. Recommendations arising from the most recent inspection by an Environmental Health Officer had been actioned. The residents can bring in personal items to make their bedrooms feel more homely although the space available for some residents will depend on the amount of space required by the staff providing high dependency care. Some of the bedrooms in the residential side are very spacious and provide good accommodation for those residents who may prefer to spend most of their time in their own room. The Care Manager addresses infection control measures very carefully. This work includes regular checks of staff practices e.g. cleaning routines, supply of equipment e.g. linen skips. The staff also have written guidance so they know how to go about their tasks in a hygienic manner. Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough staff to meet the residents’ needs and new staff are carefully selected to be sure they will be safe to work with vulnerable adults. The staff are encouraged to undertake the training they need to work well with the residents. They feel enthusiastic and well supported. When any staff are not performing well and the service for the residents is being adversely affected, action is taken to put things right. EVIDENCE: The staffing levels are organised to take into account the care needs of the residents. The Care Manager monitors the changing needs and adjusts the staffing arrangements to be sure there are always enough staff. The nursing staff are given the training they need to keep their professional knowledge up to date e.g. palliative care, nutrition. There are also plans to have training for them in computer studies so that they can keep good records. An interviewed nurse was very enthusiastic because she was being supported by her employer to develop her interest and knowledge in nutrition. She had also noted that care staff were becoming more committed to attending training sessions so they could work effectively with the residents. This enthusiasm was Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 19 reflected in a conversation with a care assistant who had achieved a National Vocational Qualification in care and had also completed health and safety training e.g. manual handling. The interviewed care assistant felt well supported by the nurses and the Care Manager –‘they are very good. They support you’. Staff records confirmed that the necessary checks had been made to be sure they would be safe to work with vulnerable adults e.g. criminal records bureau checks. This work was being done at the time of appointment so new staff would not be working alone with residents before the checks had been completed. All new staff complete a recognised induction programme at the start of their employment. Their performance is monitored through a supervision and appraisal programme. When there is a problem, the Care Manager protects the residents by providing extra support to the particular staff member. There is a disciplinary procedure and there is a recent example of the Care Manager’s willingness to resort to this if the worker’s performance is adversely affecting the service to the residents. Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An experienced and competent Care Manager runs the service in the best interests of the residents although there does need to be more emphasis on managing the care for residents who do not have significant physical care needs and are well enough to make choices about the way they spend their days at the home. Residents and their relatives are encouraged to contribute their ideas for developing the home and the Care Manager regularly checks progress. When shortfalls are identified the Care Manager takes action to put things right. The premises are maintained well so that residents will be safe and comfortable and the staff receive the guidance they need to work safely with the residents. Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 21 EVIDENCE: The Care Manager has been approved for registration with the Commission since the last inspection. She has considerable management experience in health care settings and has strengthened the way the home is run in a number of ways e.g. there are regular, recorded checks of all aspects of the service so that she can identify and rectify any shortfalls. As part of this monitoring, the Care Manager sent out questionnaires in 2006 so that residents and their relatives could comment on their experience of the service. This exercise was due to be repeated soon after this inspection and a relatives’ meeting was planned for May. There are policies and procedures at the home that are relevant to the service and guide staff in the way they go about their work. These need to be reviewed at regular intervals because sometimes there are changes in the law or recognised good practices that need to be taken into account. It was unclear from the pre-inspection information supplied by the Care Manager how often this is being done. The procedures for handling personal money held in the office for residents have been strengthened. There are records kept of all transactions and receipts for expenditure. Two staff sign the records when there is any movement of a resident’s money into or out of the office. The Provider has set up various service agreements so that water, heating, electrical and specialist equipment are working safely. Recommendations arising from an Environmental Health inspection have been addressed and fire safety arrangements have been reviewed to be sure they meet current legislative requirements. The staff are receiving health and safety training at the recommended intervals so they understand how to work safely with the residents. Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Care plans should more clearly reflect the wishes and feelings of the individual so that residents receive care that includes attention to all aspects of their life at the home and reflects their preferred lifestyle. Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Highwell House DS0000060412.V332822.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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