Inspection on 11/07/05 for Highwell House

This inspection was carried out on 11th July 2005.

CSCI 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 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 01/05/07

Highwell House 20/04/06

Highwell House 07/02/06

Highwell House 05/12/05

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 Lane Bromyard Herefordshire HR7 4DG Lead Inspector Sandra Bromige Unannounced Inspection 11 July 2005 at 09.55 hrs. 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 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 E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Highwell House Address Highwell Lane Bromyard Herefordshire HR7 4DG 01885 488721 01885 482882 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Karen Rogers Care Home 27 Category(ies) of Old Age (27) registration, with number Physical Disability over 65 (19) of places Highwell House E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 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. The provider must arrange for the nurse manager to receive formal supervision from someone suitably qualified and trained at least six times a year. These sessions must result in a report to the provider on the quality of the clinical nursing practices in the Home. 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. Date of last inspection 29 March 2005 Brief Description of the Service: Highwell House is owned by Mrs Karen Rogers, who also owns and manages another Care Home for older people in Bromyard. Highwell House is situated half a mile from Bromyard town centre and enjoys excellent views across the Froome Valley to the Malvern hills. The home provides nursing care for fifteen older people in a purpose built unit and personal care for twelve older people in an adjacent Georgian house. Some service users may have a physical disability. Highwell House E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspection was unannounced and took place over 8 hours. A site visit was made to the Home the week before as the Home is converting a ground floor room on the nursing unit into another bedroom with a proposal to increase the number of nursing beds from 15 to 16. The Inspector looked around some parts of the building and a number of records were inspected. Five residents, six staff and three visitors were spoken to. The Provider Ms. Karen Rogers was at the Home at intervals throughout the day and was available at the conclusion of the inspection to discuss the findings. There is currently no registered manager in position at the Home. The Commission has received information from the Provider that the post is being advertised nationally and in the interim she has appointed an experienced registered nurse on a temporary basis to support the staff team at the Home until a more permanent appointment is made. What the service does well: What has improved since the last inspection? What they could do better: Care plans must be improved to ensure that the staff know what to do for each resident. Assessments of residents ability to walk must be done to ensure that Highwell House E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 Page 6 staff know the residents abilities and are given clear instruction about which walking or lifting equipment needs to be used at all times. The management of the residents medicine needs improving to ensure that they do not run out of any tablets needed, they are stored at the correct temperature in the fridge, they are written up correctly on the medicine records, residents allergies are recorded and items are dated when opened. More screens are needed in two shared bedrooms to make sure that the resident’s privacy is maintained. The owner needs to make sure that the armchairs they provide are safe and suitable for all of the residents so that they can sit in the lounge during the daytime. Foul washing needs to be sluiced in the machine provided and not by hand. There were three serious concerns noted during the inspection. These were that staff had been employed without a valid Criminal Records Bureau check and they were working on their own with residents. Cleaning products when not in use by staff were being left accessible to residents who are confused. An official letter was given to the owner telling them that these issues must be put right immediately. More training is needed for staff in fire procedures, moving and handling, and Protection of Vulnerable Adults. More checks need to be made by the Home to ensure the water is stored at the right temperatures to stop the growth of any organisms, the bath/shower water is the right temperature before use, bed rails are used and fitted correctly to the right bed, and wheelchairs are safe to use and the tyres are inflated. The owner needs to make sure that she sends a monthly report into the Commission about the quality of the service and the premises. 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. Highwell House E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Highwell House E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 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 standard(s) 3 Assessments are done by the Home prior to admission to ensure that care needs can be met. EVIDENCE: The Provider prior to admission had visited a prospective resident at their own Home prior to making a decision about coming into Highwell House. Highwell House E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9 & 10 Limited progress has been made on improving arrangements to ensure that the health care needs of residents are identified in the individual care plans and are met. These shortfalls have the potential to place residents at risk. Systems for the management of medication are poor and potentially place residents at risk. Resident’s privacy and dignity is not being maintained at all times. EVIDENCE: Little progress has been made on the requirement to ensure that all aspects of health, personal and social care needs are identified and planned for. Information for care staff to show the mobility needs of residents and any equipment they may need is not clearly documented. One resident was observed being lifted out of a chair without the use of any aids. All residents seen were nicely dressed. Residents and relatives spoken with were happy with the care provided. Medication Administration Records are at times being handwritten and are not being checked by a second nurse to ensure that the medication has been written up properly. Information about resident’s allergies is not always being accurately completed on the Medication Administration Records. Medicines are Highwell House E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 Page 10 not always being ordered in sufficient time to ensure that there is always stock available for the resident. Creams and ointments are not being dated when opened. The temperature of the medicine fridge is not being checked every day. Discussion with relatives and residents highlighted that one resident had experienced a problem where they had been dressed in clothes not belonging to them and staff had tried to put a piece of clothing on the resident that did not belong to them. Two shared rooms on the residential side did not have sufficient screening around the beds to ensure that resident’s privacy is not compromised when personal care is being given. Highwell House E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 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 standard(s) 15 The meals in the Home are good offering variety and catering for special dietary needs. EVIDENCE: The week’s menus are on display in the Home. Lunch on the day of the inspection was roast gammon & parsley sauce with a dessert of apricot crumble & custard. Residents and relatives spoken with said that the food is good, it was described as “splendid” and there is “so much fresh fruit and vegetables”. “There is more than enough food”. The catering staff confirmed that all of the meat, fruit and vegetables are fresh and there is plenty of stock. Resident’s likes and dislikes are catered for. Residents ate at dining tables, at tables in their armchairs or in the privacy of their room. Staff were observed assisting residents to eat discreetly and individually. Highwell House E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 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 standard(s) 18 Robust procedures are not in place to ensure that the people living in the Home are protected from abuse. EVIDENCE: Not all staff have received training regarding Protection of Vulnerable Adults. All staff spoken with were aware of the need to report any suspected abuse. Staff are being employed prior to receipt of Protection of Vulnerable Adults first clearance. Highwell House E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 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 standard(s) 22 & 26 Recent investment has significantly improved the appearance of the Home creating a more comfortable environment for those living there and visiting. The Home is well maintained to ensure that the residents live in a pleasant and clean environment. The current practice for the handling of foul laundry is not in line with recommended practice for the control of infection. EVIDENCE: Aids and equipment to assist staff to move residents, prevent skin damage from sitting or lying and electrically operated beds are available. New furniture has been purchased including reclining armchairs. Further specialist armchairs are needed as a reclining chair in use is not functioning properly and a more specialised chair is needed for an identified resident to enable her to spend more time out of bed. An additional assisted bath has been installed, although it is not yet in use by the staff. All areas of the Home were clean and tidy and there were no unpleasant smells. Hand washing facilities are provided throughout the Home and plenty Highwell House E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 Page 14 of disposable aprons, gloves and incontinence pads are available. Resident’s clothes are nicely laundered. Special bags are provided for foul laundry that opens up in the washing machine to minimise the risk of cross infection through handling of foul washing. This procedure is not being followed at all times, as staff are hand sluicing foul laundry. Linen is being washed at the correct temperatures to thoroughly clean the linen and control the risk of infection. Highwell House E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 The deployment and number of staff available were sufficient to meet the residents care needs. The procedures for the recruitment of staff are not robust and do not offer protection to people living in the Home. EVIDENCE: There was a registered nurse and two care staff on duty in the nursing unit and two care staff on duty in the residential unit. In addition there was a cook, and a team of ancillary and administrative staff in the Home. The Provider was also available at the Home at intervals throughout the day. The administrator could not find a staff file requested by the Inspector. An identified member of staff had been employed prior to receipt of a valid Criminal Records Bureau clearance check. Highwell House E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 & 38 All systems are not in place to promote and protect the health & safety of residents and staff. EVIDENCE: Notification of any accidents or events that take place in the Home are being sent to the Commission. The monthly Provider visit report required through regulation was last submitted to CSCI in May 2005. Health & safety records contain information that the Home’s water supply has recently been checked for compliance with Legionella and water samples have gone off for testing. There are records indicating that the lift and hoists have been serviced. Portable Appliance Testing is due soon. Fire checks are recorded. Not all staff have received fire or moving and handling training in the last twelve months. Highwell House E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 Page 17 There was a first aider on duty at the time of the inspection. There were no records of the monitoring of hot and cold water storage temperatures by the maintenance person, and bath water temperatures are not being recorded by the care staff. Bedrails and risk assessments are in use. The risk assessment documentation needs reviewing, as it does not show that the Home has considered all of the potential risks to residents prior to use. There are no records of any monthly maintenance checks taking place. Wheelchairs are not being checked monthly by the Home. Cleaning products are being left unattended in toilets and bathrooms. The health & safety poster in the residential unit needs completing with the information required. Highwell House E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION x x x 2 x x x 2 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 x x x x x x 2 1 Highwell House E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 Page 19 NO Are there any outstanding requirements from the last inspection? 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 7 Regulation 15 Requirement Comprehensive care plans must be in place for all residents. Records showing evidence of the care provided must be kept up to date in both units. TIMESCALE OF 31/05/05 NOT MET Moving and handling risk assessments must be completed by a competent person. These must result in clear guidance to staff being included in the care plans. TIMESCALE OF 31/05/05 NOT MET. When residents need assistance to stand or transfer to another chair, staff must ensure that moving and handling equipment is used at all times to ensure that the resident and/or themselves do not get injured. The Home must ensure that there is sufficient stock of the prescribed medicines in the Home to ensure that it can always be given as directed. The temperature of the medicine fridge must be checked and recorded each day. Screening must be provided in shared bedrooms to ensure that the residents privacy is Timescale for action 30/09/05 2. 7, 38 12, 13 30/09/05 3. 7, 38 12, 13 Immediate & Ongoing 4. 9 13 Immediate & Ongoing 5. 6. 9 10 13 12, 16 Immediate & Ongoing 31/08/05 Highwell House E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 Page 20 7. 22 16 8. 9. 26 29 13 19 10. 29 19 11. 12. 38 38 13 13 13. 38 13 14. 38 13 15. 38 13 maintained . The screening must enclose the space around the bed and washing area. The Provider must ensure that there is an armchair provided for all residents that is suitable for their individual needs. Foul washing must not be sluiced by hand. Staff must not be employed until a minimum of Protection of Vulnerable Adults first clearance has been obtained in addition to all other elements of 19 & Schedule 2. Staff employed without Protection of Vulnerable Adults first clearance by the Home must be supervised at all times until a minimum of Protection of Vulnerable Adults first clearance is in place. All staff must receive moving and handling training updates annually. Hot and cold water storage temperatures must be checked and recorded monthly by the Home. Bed rail risk assessments must be reviewed in line with the guidance from the Medical Devices Agency called Advice on the Safe use of Bed rails. Monthly maintenance checks must be carried out and recorded. Wheelchairs must be checked each month to ensure that the tyres are inflated, the foot rests are in place and correctly fitted and that there are no defects. All cleaning products must be locked away securely when not in use by staff. 31/08/05 Immediate Ongoing Immediate & Ongoing (Notice Issued on day of the inspection) Immediate & Ongoing. (Notice issued on day of the inspection) 30/09/05 31/08/05 31/08/05 31/08/05 Immediate & Ongoing (Notice issued on day of inspection) Page 21 Highwell House E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 16. 38 13 17. 38 13 18. 19. 38 37 13 26 20. The green reclining chair in the nursing unit must be risk assessed to ensure that it is safe to use. The health & safety poster in the residential side must be completed to give clear local instructions for staff. All staff must receive fire training at regular intervals. The Provider must forward to the Commission monthly monitoring reports. TIMESCALE NOT MET OF 31/10/04 & 30/04/05. End of Requirements 14/08/05 14/08/05 30/09/05 31/08/05 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 9 Good Practice Recommendations It is strongly recommended that hand written entries on the Medicine Administration Records are signed by the designated person making the entry with a signed check by a second nurse. Residents allergies should be listed accurately on the Medicine Administration Records. All creams and ointments should be dated when first opened. A new medicine reference book (BNF) should be purchased. Provide staff with Adult Protection Training. BROUGHT FORWARD The bath and shower water temperature should be checked and recorded each time it is used. 2. 3. 4. 5. 6. 9 9 9 18 38 Highwell House E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 178 Widemarsh Street Hereford HR4 9HN National Enquiry Line: 0845 015 0120 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 E52 E02 S60412 Highwell House V238229 110705 Stage 4.doc Version 1.40 Page 23 - 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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