CARE HOMES FOR OLDER PEOPLE
Highwell House Highwell House Highwell Lane Bromyard Herefordshire HR7 4DG Lead Inspector
Sandra J Bromige Unannounced Inspection 7th February 2006 09:45 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.V282498.R01.S.doc Version 5.1 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.V282498.R01.S.doc Version 5.1 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 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.V282498.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 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. 5th December 2005 Date of last inspection Brief Description of the Service: Highwell House is owned by Ms 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 sixteen 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 DS0000060412.V282498.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place between 09.45 – 15.20 hrs on Tuesday 7th February 2006. The focus of the inspection was to follow up the requirements from the last inspection report dated 5th December 2005. The Inspector looked around parts of both units and a number of records were inspected. The manager (designate), residents and staff were spoken to. The Pharmacy Inspector will carry out a separate inspection shortly to look at the Home’s management of medicines. This will reported upon through separate correspondence, which will also be available to the public when the report is finalised. The Commission has received a complaint since the last inspection raising concern about the management of residents’ money. This issue has been referred by the Commission to the local adult protection team and is being investigation by the multi-agencies with the co-operation of the owner and manager (designate) of the Home. What the service does well: What has improved since the last inspection?
The manager (designate) has been in post at the Home for 3 weeks. Meetings have been held with the owner and staff to discuss how the Home is going to move forward in order that the service and outcomes can be improved for residents. The care documentation has been reviewed and work is underway to improve the standard of the information recorded. A named nurse and key worker
Highwell House DS0000060412.V282498.R01.S.doc Version 5.1 Page 6 system has been put into place, so that each resident has a trained nurse and/or carer who is responsible for identifying and meeting their physical, social and emotional care needs. The records of complaints were available for inspection. Some new commodes have been purchased and other furniture and equipment has been ordered. The manager’s office has been relocated into another room, the nurses station has been moved in the nursing unit to enable residents to be better supervised when they are sat in the lounge. The treatment room is being refurbished and the medicine cupboard is to be replaced. The management of foul laundry is much improved and now satisfactory. The underside of the bath seats were clean and the Parker bath in the nursing unit is to be resited in the bathroom to enable it to be used by residents who need a hoist to get in and out of the bath. The staffing levels for the residential unit have improved and are now satisfactory. A new structured induction and mentorship programme is in place for newly recruited staff. All new staff will be supernumery to the staff numbers for the first two weeks of employment. This is good practice. Monthly reports from the owner are being sent to the Commission. Cleaning products are now being securely stored. A reclining chair that was faulty has been removed and an identified rusty commode has been removed and replaced. The electric light has been repaired and the wires concealed. The health & safety posters in both units have been completed to give clear local instructions for staff. Fire training has taken place this month and further health & safety training is being organised for later this month. The radiator in the downstairs toilet in the residential unit has been repaired and repainted. Radiator covers are on order for two identified radiators in the residential unit. What they could do better:
Highwell House DS0000060412.V282498.R01.S.doc Version 5.1 Page 7 Care plans must be improved and reviewed each month or more often if the care needs change, to ensure that the staff know what to do for each resident. Risks to residents’ when moving, and for skin care, dietary needs and continence must be reviewed each month. Residents’ must be consulted about the content of their individual care plans and their agreement to the content obtained. Residents’ must be weighed each month to ensure that they are not losing or putting on too much weight, which may be a risk to their health. More screens are still needed in two shared bedrooms to make sure that the resident’s privacy is maintained at all times. A call system with an accessible alarm facility must be provided in the lounge on the residential unit to ensure that residents can call for assistance from staff and that staff can call for assistance in case of an emergency. Commode pots must not be washed in the bath, as there is a risk of cross infection. The laundry floor must be upgraded to provide a washable surface that is not impervious. More training is needed for staff in moving and handling, and Protection of Vulnerable adults. The system for recording complaints and concerns should be reviewed to enable the owner and manager (designate) to use this information to inform them of the quality of the service provided by the Home. The complaints records should be held in the manager (designates) office to ensure that they are accessible at all times. 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 manager (designate) needs to review the condition and quality of the commodes in use in the Home to ensure that they are suitable for moving by staff and that they have washable surfaces, which are not damaged to ensure that cross infection does not occur. The manager (designate) should carry out an audit of the infection control standards in the Home. Highwell House DS0000060412.V282498.R01.S.doc Version 5.1 Page 8 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 DS0000060412.V282498.R01.S.doc Version 5.1 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Highwell House DS0000060412.V282498.R01.S.doc Version 5.1 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed during this visit. EVIDENCE: Highwell House DS0000060412.V282498.R01.S.doc Version 5.1 Page 11 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 & 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. Resident’s privacy and dignity is not being maintained at all times. EVIDENCE: All residents seen during the inspection appeared to be comfortable. They were nicely dressed and well groomed. The shortfalls in meeting the health care standards are that the individual care plans do not provide supporting information and guidance for staff to ensure that the care given is consistent and that all risks to the resident have been identified and the action taken to reduce these risks. The format of the care planning documentation is being revised. Four care plans were seen on this occasion, two on each unit. The manager (designate) has introduced a named nurse and key worker for each resident. These staff will have the responsibility of ensuring that the residents’ needs are identified and a clear written plan of care is in place that can be followed by all staff. Some progress has been made, although overall the standard of the care plans remain poor and they are not being used as ‘live working’ documents.
Highwell House DS0000060412.V282498.R01.S.doc Version 5.1 Page 12 The manager (designate) is developing links with the local visiting professionals to ensure that the medical and nursing needs of the residents is being reviewed on a regular basis. Two shared rooms on the residential side remain without sufficient screening around the beds to ensure that resident’s privacy is not compromised when personal care is being given. Although one of the shared rooms is currently only occupied by one resident. Highwell House DS0000060412.V282498.R01.S.doc Version 5.1 Page 13 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): These standards were not assessed during this visit. EVIDENCE: Highwell House DS0000060412.V282498.R01.S.doc Version 5.1 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): 16 & 18 Complaints are being investigated and responded to by the Home. The management of complaints including the procedures for recording need to be reviewed now that there is a manager (designate) in post to ensure that all complaints/concerns are being recorded and audited as part of the Home’s quality assurance system. Staff training is needed about abuse to ensure this is recognised and acted upon by the staff in the Home. EVIDENCE: Records of complaints are being maintained by the Home. They are currently being held by the administrator and not by the manager (designate) within the Home. The Commission has received a complaint since the last inspection raising concern about the management of residents’ pocket money. This issue has been referred by the Commission to the local adult protection team and is being investigation by the multi-agencies with the co-operation of the owner and manager (designate) of the Home. Not all staff have received Protection of Vulnerable Adults training particularly regarding the Herefordshire local procedures for Protection of Vulnerable Adults. The contact details for the local Adult Protection Co-ordinator have been given to the manager (designate). Highwell House DS0000060412.V282498.R01.S.doc Version 5.1 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): 22 & 26 Some of the aids and equipment provided by the Home are in a poor condition which may be a potential hazard regarding cross infection to the people using them. A complete infection control audit of the Home is needed to establish current practice and the quality of the equipment provided. EVIDENCE: Two of the commodes have been replaced in the residential unit and two new wheelchairs are on order for the Home. There is no call system available in the lounge on the residential unit. There was an identified commode in one of the bathrooms on the residential unit and the plastic covering over the metal tubing had worn away. The manager (designate) was informed about this commode and she advised that it would be removed. The assisted bath on the ground floor of the nursing unit is to be re-sited within this room to enable it to be used by residents who need hoist facilities to get in and out of the bath.
Highwell House DS0000060412.V282498.R01.S.doc Version 5.1 Page 16 Foul laundry is now being managed correctly and is not being sluiced by hand. The laundry floor is still in need of refurbishment. The manager (designate) is currently seeking quotations for this work. Concerns were noted regarding some practice by staff on the residential side for cleaning commode pots and the condition and type of the bath mats in use. These practices may have an impact on the control of infection in the Home. Information was given to the manager (designate) from the local Health Protection Agency regarding the management of infection control in care homes. Highwell House DS0000060412.V282498.R01.S.doc Version 5.1 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 & 30 The deployment and numbers of staff provided are sufficient to meet the residents’ care needs. Staff are receiving structured induction training to ensure that they are familiar with the Home’s standards, policies and procedures. EVIDENCE: The manager (designate) and 3 care staff were on duty in the nursing unit for 16 residents. Two care staff were on duty in the residential unit for 9 residents. The manager (designate) and staff confirmed that 2 care staff are being provided throughout the daytime in the residential unit. In addition there was a cleaner in the nursing unit and in the residential unit, who was also responsible for doing the laundry. There was a cook and a part time administrator. The manager (designate) has developed a structured induction and mentorship programme for new staff. All new staff will be supernumery to the staff numbers for the first 2 weeks of employment. Highwell House DS0000060412.V282498.R01.S.doc Version 5.1 Page 18 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): 35 & 38 Satisfactory procedures are now in place for the safe management of residents’ money to prevent any potential financial abuse. Systems are improving in the Home for the promotion and protection of the health & safety of the people living and working at the Home. EVIDENCE: The manager (designate) has started work at the Home and has been in post for 3 weeks. A satisfactory action plan has been submitted to the Commission outlining how they will address the requirements and the recommendations from the last report. Meetings have been held with the entire staff team to discuss areas that need to be addressed in order that the Home can meet National Minimum Standards. These areas include care planning, management of medication, and supervision and appraisal of staff performance. The owner and manager (designate) are having weekly meetings and the owner as required through regulation has submitted a report to the Commission in January 2006.
Highwell House DS0000060412.V282498.R01.S.doc Version 5.1 Page 19 The procedures for the management of residents’ monies have recently been reviewed by the Home. A bound book has been set up to record money that is held in safe keeping and receipts are being given when money is received or returned to the resident or their representative. Signatures of staff are not being provided for each entry in the records and receipts are not being provided for all expenditure of residents’ money. Money had been taken by a staff member for shopping at the end of January 2006, but there was no receipt for any purchases on behalf of this resident to show how the money had been spent. This was discussed with the manager (designate) and the day after the inspection a new format for recording any expenditure for residents had been produced. The new format requires two staff to sign for each entry and a receipt number will be listed to correspond with the paper receipt that will be held with these records. The records will be on individual sheets to enable them to be archived as part of the residents record that are required to be held by the Home for 3 years from the last date of entry. Fire training has taken place since the last inspection Manual handling training is planned to take place before the end of this month. The Inspector observed 2 care staff using poor techniques for manual handling a resident. The manager (designate) was informed about this practice 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 still 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. The Commission has sent guidance produced by the Medical Devices Agency on the ‘Safe use of bedrails’ to the Home. Wheelchairs are not being checked monthly by the Home. Cleaning products are now being stored securely. Highwell House DS0000060412.V282498.R01.S.doc Version 5.1 Page 20 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X X X 2 X X X 2 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X 3 X X 2 Highwell House DS0000060412.V282498.R01.S.doc Version 5.1 Page 21 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 OP7 Regulation 15 Requirement Timescale for action 28/02/06 2. OP7 3. OP7 4. OP8 5. OP9 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. Brought forward. 13, 14, 15 Mobility, skin care, nutrition, & continence risk assessments must be in place for all residents’ and reviewed each month. Timescale of 31/12/05 not met 15 Care plans must be drawn up with the involvement of the resident and agreed and signed by the residents and/or their representatives. Brought forward. 14, 17 A record of residents weight gain or loss must be recorded on a regular basis. Timescale of 31/12/05 not met 13 The temperature of the medicine fridge must be checked and recorded each day. Timescale of Immediate & ongoing not met Brought forward to be assessed by pharmacy
DS0000060412.V282498.R01.S.doc 31/03/06 28/02/06 31/03/06 31/12/05 Highwell House Version 5.1 Page 22 6. OP10 12, 16 7 OP22 16 8. 9. OP26 OP26 13 13 inspector. Screening must be provided in shared bedrooms to ensure that the residents’ privacy is maintained. The screening must enclose the space around the bed and washing area. Timescale of 31/12/05 not met A call system with an accessible alarm facility must be provided in the lounge in the residential unit. Commode pots must not be washed in the bath. The laundry floor needs refurbishing to ensure that it is impervious and cleanable. All staff must receive moving and handling training updates annually. Timescale of 30/09/05 not met. Brought forward. All staff must receive moving and handling training upon commencing employment at the Home. Brought forward Hot and cold water storage temperatures must be checked and recorded monthly by the Home. Timescale of 31/12/05 not met. 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. Timescale of 31/12/05 not met. 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. Timescale of 31/12/05 not met.
DS0000060412.V282498.R01.S.doc 31/03/06 31/03/06 13/02/06 31/01/05 10 OP38 13 28/02/06 11. OP38 13 28/02/06 12. OP38 13 28/02/06 13 OP38 13 28/02/06 14 OP38 13 28/02/06 Highwell House Version 5.1 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 OP9 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. Brought forward to be assessed by pharmacy inspector. Residents’ allergies should be listed on the Medication Administration Records. Brought forward to be assessed by pharmacy inspector. All creams and ointments should be dated when first opened. Brought forward to be assessed by pharmacy inspector. The British National Formulary should be updated to the September 2005 edition. Brought forward to be assessed by pharmacy inspector. All staff should be provided with Adult Protection training particularly regarding the Herefordshire Local procedures for Protection of Vulnerable Adults. Brought forward The system for recording complaints/concerns should be reviewed to enable them to be audited as part of the quality assurance system for the Home. The complaints records should be held in the manager’s office to ensure that they are available at all times. The Provider should review the condition and quality of the commodes in use in the Home, with particular regard to their suitability for moving and handling by staff and that all of the surfaces are washable and impervious for the control of infection. Brought forward. The manager (designate) should carry out an infection control audit in both units. The bath and shower water temperature should be checked and recorded each time it is used. Brought forward. 2. 3. 4. 5. 6 OP9 OP9 OP9 OP18 OP18 7 OP22 8. 9. OP26 OP38 Highwell House DS0000060412.V282498.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire HR4 9HN National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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