Inspection on 12/09/05 for The Highgrove

This inspection was carried out on 12th September 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Highgrove 07/10/09

The Highgrove 08/08/07

The Highgrove 31/05/06

The Highgrove 23/05/05

The Highgrove 22/11/04

The Highgrove 01/06/04

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

CARE HOMES FOR OLDER PEOPLE The Highgrove 88/90 St Annes Road Blackpool Lancashire FY4 2AT Lead Inspector Christopher Bond Unannounced Inspection 12th September 2005 1.00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Highgrove DS0000009764.V250947.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. The Highgrove DS0000009764.V250947.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Highgrove Address 88/90 St Annes Road Blackpool Lancashire FY4 2AT 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) 01253 344555 Mr Anand Seedheeyan Mrs Savitree Seedheeyan, Mr Islamuddeen Duymun Ms Nicola Patricia Bryan Care Home 30 Category(ies) of Dementia (25), Mental disorder, excluding registration, with number learning disability or dementia (5) of places The Highgrove DS0000009764.V250947.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service is registered to accommodate a maximum of 30 service users to include up to 25 service users in the category DE (dementia) and up to 5 service users in the category MD (mental disorder). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 7th July 2005 2. Date of last inspection Brief Description of the Service: The Highgrove is a care home that specialises in the care of 25 people who have dementia and also 5 people who have a mental illness. The home is situated in the South Shore area of Blackpool opposite Palatine High School. Parking in the immediate area is quite limited. There are bus services that run from close by into the town centre and to other parts of the Fylde. There are a number of local shops within the immediate area. There is a doctor’s surgery close by and there are other resources such as a library and places of worship in the local area. There are several shared bedrooms but the majority of people have their own room. A lift is available to the first floor and there are paved areas at the front and rear of the building. The Highgrove DS0000009764.V250947.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over three hours. The registered manager gave the inspector a tour of the building. Staff and care records were examined and two residents were spoken to during the inspection. The inspector also spoke at length to both of the home- owners and to one of the senior care staff. What the service does well: What has improved since the last inspection? There have been several improvements to the home since it was last inspected. New carpets have been fitted in some rooms. New beds and other furniture have been purchased. New bedding and soft furnishings brighten up the home. Training for care staff had improved since the last inspection. There was evidence that a number of essential training events had taken place since the service was last inspected and more had been planned. This is important as it ensures that the care staff have the skills and ability to do their jobs correctly and provide a good service for the people who live within the home. This also helps to ensure that residents are safer and not put at risk. The new ‘Service User Guide’ has been handed to present residents and people now know much more about the home and the facilities that it has. This information also explains what specific needs that residents must have to live there. The Highgrove DS0000009764.V250947.R01.S.doc Version 5.0 Page 6 The way that the resident’s medication is handled and given has improved since the last inspection. Residents are no longer put at risk because of bad practices. There are new screens available in some of the shared rooms to help ensure that people were given privacy when the care staff were giving personal care. This helped to preserve their dignity. 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. The Highgrove DS0000009764.V250947.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 The Highgrove DS0000009764.V250947.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): 1, 2, 3 and 4. All new residents have a full assessment completed prior to moving into the home, ensuring that the home can meet their needs. Information about the home is given to residents and their families. EVIDENCE: Since the last announced inspection the information available to potential residents and their families has greatly improved. The new ‘Service User Guide’ has also been handed to present residents and people now know much more about the home and the facilities that it has. This information also explains what specific needs that residents must have to live there. The home is specifically for people who have Dementia or Mental Health issues, so this information is important. One resident had been admitted to the home since the last inspection. It was clear that the registered manager had tried to get as much information about this person as possible before he was admitted, and an assessment had been completed. This information is important because the home now knows how to care for this gentleman correctly and can plan his care whilst he’s at the home. The Highgrove DS0000009764.V250947.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 The home ensures that residents’ health and personal care is closely monitored and reviewed so that the staff team meets individual needs. Residents are treated in a respectful manner. Medication is now being handled safely and is regularly checked by the manager. EVIDENCE: Each person in the home had information kept on file that helped the care staff to attend to their needs properly and correctly. This care plan reviewed regularly and changes were noted so that the information was always current. The plans concentrated on current need rather than the ‘problems’ that residents presented. During the last inspection the handling of medication by the home was looked at in detail by the Pharmacy Inspector. Several problems were found and the residents were being put at risk by bad practices. Since that inspection the manager and the owners have reviewed their medication procedures and have made several changes. Medication is now checked by the manager on a regular basis. The Pharmacy inspector has since visited and has found the The Highgrove DS0000009764.V250947.R01.S.doc Version 5.0 Page 10 procedures to be acceptable. All of the care staff were now trained in the handling and care of medication, which helps to ensure the safety of residents. There were new screens available in some of the shared rooms to help ensure that people were given privacy when the care staff were giving personal care. This helped to preserve their dignity. There was lots of confirmation on file to show that peoples’ health needs were being correctly attended to. Health care professionals were being consulted about mental health issues and there was evidence to show that their needs were being addressed appropriately and that they were being cared for properly. There was also evidence that people were being taken to see their doctor when they needed to and that opticians and dentists were being consulted where appropriate. The Highgrove DS0000009764.V250947.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 15 Activities are generally poor and are not organised with the residents interests and needs at heart. EVIDENCE: The Highgrove is a home that is specifically for those with Dementia related illnesses and also those with mental health issues. The inspector found that many of the daily activities that were available within the home were essentially similar to those found in ordinary care homes, or those that do not specialise in this type of care. It is very important that new activities and pastimes are developed to help alleviate the symptoms of this condition. This may involve looking at the environment that people live in, whether there is enough space, colour, light and brightness. Some research has centred on the use of gardens to stimulate sensory activity (scent and colour). Gardening has been seen as a valuable activity for some. Other research has stressed that the correct nutrition can help alleviate the effects of the disease. There are activities that involve the use of sounds and music to stimulate people. Other research suggests that regular exercise is beneficial when linked with multi-sensory activity. The Highgrove DS0000009764.V250947.R01.S.doc Version 5.0 Page 12 There are also more formal ways of treating the illness, such as ‘Dementia Care Mapping’ or lifestyle improvement planning. The manager and care staff also need to receive regular formal training in the care of those who have dementia or are mentally ill. This home has to develop new ways of caring for those with dementia so that it can truly be identified as a service that specialises in dementia care. The menus confirmed that a balanced choice of meals was offered and there was information in the care plans about special diets that people had. All of the residents that were spoken to said that they found the food enjoyable. The Highgrove DS0000009764.V250947.R01.S.doc Version 5.0 Page 13 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 Arrangements for complaints are handled well and taken seriously ensuring people feel listened to. Procedures for dealing with and reporting abuse were satisfactory ensuring people are adequately protected. EVIDENCE: Since the last inspection the complaints procedure has been posted on the wall of the home so that residents or their relatives have the information they need should they wish to voice their concerns. This was easily accessed and easy to read. It explained that there was a timescale for the manager to respond to complaints. This procedure also explained what residents should do if they were dissatisfied with the homes response. This procedure was also part of the information given to residents and their relatives on admission to the home. Training had been arranged to ensure that all staff were aware of the effects of abuse and the procedures to follow should abuse be suspected. This was certificated training given by the local council. This is very important as it helps to ensure that residents are safe whilst living at the home. The manager was fully aware of the action she should take should abuse be suspected within the home. The Highgrove DS0000009764.V250947.R01.S.doc Version 5.0 Page 14 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, 20, 21, 23, 24, 25, and 26 Residents are benefiting from improving facilities, which help to make the home a better place to live. EVIDENCE: A tour of the home was undertaken. There had been a number of improvements to the home since the last inspection. New carpets had been fitted as well as non-slip flooring in one of the bedrooms. New beds and chairs had been purchased. Some of the rooms had new matching bedding and curtains. There were lots of personal possessions in the bedrooms and an effort had been made to make them look homely. The bathroom and toilet facilities were adequate and each of the bedrooms had their own wash- basin although the vanity units that surrounded these needed replacing due to water damage. The Highgrove DS0000009764.V250947.R01.S.doc Version 5.0 Page 15 The manager had clearly worked hard to improve the look of the home. It is important that this is continued a there are still areas of the home that need to be improved. It is also important that the process of buying new furniture continues rather than buying second hand items that look tired and damaged. This is essential to ensure that the residents live in a safe, well -maintained environment. The manager was now doing weekly checks on all of the bedrooms to ensure that they were maintained correctly. Garden furniture had been bought so that residents could sit out in good weather. The majority of residents within the home had specific needs regarding continence. There were inevitably areas of the home that had unpleasant odours. It is important that cleaning regimes are thorough and that masking these smells becomes a priority. Some of the care staff had received training in the management of incontinence and this would clearly help when tackling this problem. The Highgrove DS0000009764.V250947.R01.S.doc Version 5.0 Page 16 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 Better support and training for staff means that they are more able to do their jobs correctly, which benefits the residents of the home. EVIDENCE: The staffing rotas for the home were looked at and there were no concerns regarding the amount of care staff on duty. Observation of care practices throughout the day confirmed residents are treated with respect and dignity. Criminal Records Bureau and POVA checks were now being completed and care staff were not being employed without these checks taking place. Work still needs to be done to ensure that all of the care staff files have the right information on staff to ensure that the residents of the home are fully protected. This work should be ongoing and evidence of training courses attended should be put in each file. Training for care staff had improved since the last inspection. There was evidence that a number of essential training events had taken place since the service was last inspected and more had been planned. This is important as it ensures that the care staff have the skills and ability to do their jobs correctly and provide a good service for the people who live within the home. The Highgrove DS0000009764.V250947.R01.S.doc Version 5.0 Page 17 The manager should continue to ensure that sufficient numbers of staff are qualified up to NVQ level 2. Two of the staff had reached this level and a further two were in the process of achieving this qualification. This is a compulsory requirement for the home. The Highgrove DS0000009764.V250947.R01.S.doc Version 5.0 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): 31, 33, 36 and 38 The home does not regularly review aspects of its performance through self – review and consultation. The views of residents, relatives and visiting professionals were not sought, listened to and acted upon to improve the quality of the service. The registered provider does not have a clear development plan and vision for the home, which makes the future for its residents unclear. The manager has been registered which helps her to be more effective in her role. EVIDENCE: No quality assurance system was being used at the time of the inspection. This would involve seeking the views of residents, relatives, friends and visiting professionals to measure success in meeting the aims and objectives of the home. The Highgrove DS0000009764.V250947.R01.S.doc Version 5.0 Page 19 The registered provider had not introduced a business/ financial plan to show how he intends the service to develop in the forthcoming year. This would include how much he intends to spend on improvements to the home. Since the last inspection the manager has been registered by the Commission for Social Care Inspection. This is an important step and the home will benefit from having a permanent registered manager in charge. It is important that the manager now achieves her National Vocational Qualification level 4 in Management and Care. This is a compulsory qualification to help her manage the home effectively and to provide a safe, caring environment for residents. Records were seen that showed that the manager was supervising care staff regularly. This is important as it helps the staff to do their jobs correctly. It was apparent that care staff were now being instructed to ensure that the health, safety and welfare of all of the residents was guaranteed and the home becomes a safer place for people to live in. The Highgrove DS0000009764.V250947.R01.S.doc Version 5.0 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 3 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 X 3 3 2 2 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 2 X X 2 X 3 The Highgrove DS0000009764.V250947.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP33 Regulation 24(1)(2)( 3) Requirement Timescale for action 30/11/05 2 OP34 3 OP24 4 OP26 5 OP29 6 OP12 The home must have a system used to measure quality assurance. (Timescale of 30/07/05 not met.) 25(2)(3) The Registered Person must produce a financial/business plan. (Timescale of 30/07/05 not met.) 16 (2) c23 Furniture in service users’ (1)(a) bedrooms must be of good quality and suitable for its intended use. (Timescale of 30-07-05 not met) 13(3)16(2 The premises must be kept )(j)23(2)( clean, hygienic and free from d) offensive odour. (Timescale of 30-07-05 not met) 17(2)Sche All care staff personnel files must dule 4 (6) contain the information required in Schedule 2 of the Care Home Regulations and be available in the home for inspection at all times. (Timescale of 30-0705 not met) 14 (1) (a) The manager must provide all service users with activities based on current good practice in the field of Dementia and Mental Health. (Timescale of DS0000009764.V250947.R01.S.doc 30/11/05 30/11/05 30/11/05 30/11/05 30/11/05 The Highgrove Version 5.0 Page 22 30-07-05 not met) 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 2 3 4 5 6 7 Refer to Standard OP5 OP23 OP24 OP22 OP24 OP24 OP26 Good Practice Recommendations The home should have an emergency admittance policy. Service users should be seen to make a positive choice regarding sharing a room. All bedrooms should have sufficient bedside lighting. An assessment of the building should be completed by an Occupational Therapist to ensure that appropriate disability equipment is available for all service users. All bedrooms should have two double electrical sockets. Carpets throughout the building should be of reasonable quality. A wash hand basin should be provided in the laundry area for care staff to wash their hands after handling soiled washing. The Highgrove DS0000009764.V250947.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1 Tustin Court Port Way Preston PR2 2YQ 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. 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