Inspection on 31/05/06 for The Highgrove

This inspection was carried out on 31st May 2006.

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 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 12/09/05

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 31st May 2006 09:30 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.V289353.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. The Highgrove DS0000009764.V289353.R01.S.doc Version 5.1 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.V289353.R01.S.doc Version 5.1 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 12th September 2005 2. Date of last inspection Brief Description of the Service: The Highgrove Care Home is situated on St. Annes Road, Blackpool. It is registered for 30 people, and at the time of the inspection there were 30 people in residence. The Highgrove is registered to care for people who have Dementia and Mental Illness. The home is close to a variety of shops and amenities, and bus services run from close by to Blackpool town centre and other areas of the town. There are some double rooms, but the majority of service users are accommodated in single bedrooms. The home has a private garden to the front of the house; the rear of the house is paved. A lift is available that services both floors. At the time of this visit, (31/05/06) the information given to the Commission showed that the fees for care at the home are £278 per week, with added expenses for chiropody and hairdressing. The Highgrove DS0000009764.V289353.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, which took place over a total of five hours. A guided tour of the home was undertaken. The manager completed a pre-inspection questionnaire before this key inspection visit and comment cards were received from residents and relatives. Resident records and staff records were also examined. The manager and care staff were spoken to and their responses are to be found in the body of this report. Residents of the home were also spoken to. Everyone was very friendly, welcoming and co-operative throughout the visit. What the service does well: What has improved since the last inspection? There has been some new furniture and beds delivered. The registered provider is replacing the older furniture periodically and second hand furniture is no longer being purchased. This makes it a better place for people to live in. The cleaning regime within the home has been improved and the home smells fresher and looks cleaner. Some of the bedrooms look nice and some of the residents were clearly proud of their rooms. Some of the buildings to the rear of the premises had been purchased and there were plans to use some of this space for a visitors’ room and for training purposes. The manager of the home had completed Business and development plan for the service. This has helped her to look at the strengths and weaknesses of the The Highgrove DS0000009764.V289353.R01.S.doc Version 5.1 Page 6 service and to outline objectives for the home to reach in a given space of time. 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.V289353.R01.S.doc Version 5.1 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.V289353.R01.S.doc Version 5.1 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, 3, and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Thorough admission procedures and careful assessment ensures that the home can meet people’s needs. Written information provided to prospective residents is good, ensuring that an informed decision about admission to the home can be made. EVIDENCE: The home had a Statement of Purpose and a Service User Guide that told new residents what services they would expect if they came to live at the Highgrove. The residents’ files had assessments on them, which showed that peoples’ needs were being looked at before they came to live at the home. Three residents had been admitted recently and all had good assessments on their files. This meant that there was good information on which to base a plan of care whilst the person was living in the home. The Highgrove DS0000009764.V289353.R01.S.doc Version 5.1 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were put at risk by poor medication practices and care staff not following the correct procedures. Other health care matters were attended to correctly. This meant that the residents of the home were receiving the services and checks that they are entitled to and that the information was recorded properly by the home. EVIDENCE: There was lots of evidence to show that the health, personal and social care needs of the residents were being attended to. Everyone who lived in the home had a care plan where the care staff could write down changes and record daily life. The care plan helped the staff to care for someone by setting down their needs and wishes. There were records of visits by the District Nurse and the Doctor. No one within the home had pressure sores but special equipment was available should this happen. The Highgrove DS0000009764.V289353.R01.S.doc Version 5.1 Page 10 All of the plans were reviewed on a regular basis to make sure that the information was always current and that the care staff knew the latest condition of a resident. There was evidence of reviews on the care plan. Residents were spoken to and they all felt that they were treated with respect by the care staff, and that their dignity was maintained. The pharmacist inspector examined current medication administration records that covered a 31-day period and the medicines storage trolleys. Procedures were in place for the recording and handling of medicines. However errors were noted relating to staff who rarely handled medicines. Evidence was seen of medicines not being administered as prescribed and poor records of receipt and administration were noted. Handwritten records were poorly produced and variable dose medicines were not recorded accurately, advice was given for improvements. The disposal of medicines had not been recorded accurately for the previous several months. The manager was also advised to carry out regular documented medicines audits that identify medicines handling errors; these should be used for staff supervision and retained for inspection purposes. Medicines training and direct supervision is required for members of staff that persistently fail to follow the homes’ policies and procedures. The Highgrove DS0000009764.V289353.R01.S.doc Version 5.1 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, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities for residents were good which improved the delivery of their care. Meals were well managed and varied. Family and friend were encouraged to visit therefore ensuring personal relationships are maintained. EVIDENCE: During the inspection some of the residents of the home were going out on a coach trip around the Fylde Coast. There were lots of general activities and plenty of things for people to do, such as board games, dominoes, and reminiscence sessions. Some of the residents were able to go out on their own and everyone had a television in their room. There was a monthly party at the home which some of the residents said that they enjoyed. Specialist activities for those with Dementia were, however, infrequent. The manager was anxious to ensure that relatives and friends of the residents felt comfortable when they visited. Plans were being made for a special visitors room to be added so that people had privacy when they had visitors. The home tried hard to ensure that friends and relatives to visited on a regular basis. The Highgrove DS0000009764.V289353.R01.S.doc Version 5.1 Page 12 Records were available of residents’ meetings and several of the residents that were spoken to said that they were given plenty of choice in their daily lives. There were some good examples seen of people having the choice about when to get up, when to eat, and what they wanted to do during the day. Many of the residents had complex needs and the care staff struck a good balance between offering choice, and the necessity of routine. Lunch was being cooked during the inspection. Fresh vegetables and meat were being used. Three of the residents that were spoken to during the inspection said that they always looked forward to mealtimes and that the food was good. Menus showed that plenty of choice was being offered and special diets were being catered for. The Highgrove DS0000009764.V289353.R01.S.doc Version 5.1 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Abuse procedures and training were available to help ensure that people felt safeguarded. Procedures were in place to enable residents to express their dissatisfaction of the service if they wished to do so. EVIDENCE: The staff that were spoken to were aware of abuse issues and the importance of keeping people safe from harm. There had been training on abuse awareness for most of the care staff and some of them had been given instruction on this during their National Vocational Qualification level 2 training. Some staff had certificates for this on their files. It is important that this training is regularly updated to reinforce the importance of safeguarding people. The residents that were interviewed said that they knew how to complain if they felt that things were wrong for them. The complaints procedure was in the hallway of the home. This information was also in the Service User Guide and Statement of Purpose. The Highgrove DS0000009764.V289353.R01.S.doc Version 5.1 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, 23, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was cleaner and furnishings were improving in some areas. Longstanding problems regarding poor furniture were still evident in some of the rooms. This affected the quality of life of some of the residents. EVIDENCE: There had been a lot of work done around the home to make it look presentable. Some of the residents within the home challenged the service, which meant that maintenance of the home was ongoing and regular decoration was important. The nature of the building, with its narrow corridors and stairwells, did not help. There was still some old and tired furniture around the building. Many of the vanity units around the hand basins in peoples’ rooms had been damaged by water. There were drawer fronts hanging off. Very little of the furniture was matching. Some wardrobes had been removed in one of the rooms and the The Highgrove DS0000009764.V289353.R01.S.doc Version 5.1 Page 15 wall behind them had not been re-papered. Some of the rooms looked very sparse because the residents who lived in them severely challenged the service. It was hard for the care staff and domestic staff to keep these rooms looking nice but every effort should be made to ensure that rooms look clean and homely. On the positive side, some new furniture and beds had been delivered. The cleaning regimes within the home had been improved and the home smelled fresher and looked cleaner. Some of the bedrooms did look nice and some of the residents were clearly proud of their rooms. There were tables and seating areas to the front of the home where people could sit out in good weather. There was a conservatory area where people who smoked were encouraged to sit. The residents that were spoken to said that they liked their rooms and the facilities that the home offered. The Highgrove DS0000009764.V289353.R01.S.doc Version 5.1 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by good recruitment practices. Training in dementia care and mental health awareness is infrequent which affects the way that staff worked with the residents. EVIDENCE: The information held within the home regarding the care staff showed that employees were recruited properly and proper checks were completed before people started work. This included Criminal Records Bureau checks. This meant that the residents were less likely to be put at risk because of poor recruitment. There is a need for the home to ensure that it complies with the guidance of the working time directive and that care staff have signed an agreement to work over a set number of hours. Care staff files contained the correct information. All of the files held Criminal Records Bureau checks and Protection of Vulnerable Adult checks. There had been several training events since the last inspection to help ensure that skills were being improved and updated. This needs to continue. The care staff that were interviewed confirmed that there had been training events and their files confirmed this . Training included fire safety, first aid, moving and handling, and caring for people with diabetes. The manager needs to ensure that there is training available regarding caring for those who have Dementia. This is vital when providing a specialist service. The home also provides accommodation The Highgrove DS0000009764.V289353.R01.S.doc Version 5.1 Page 17 for residents with mental health issues and training in this area was also poor. The care staff that were interviewed said that they would really benefit from this type of training. There is a need to make sure that 50 of the care staff employed by the home are trained up to National Vocational Qualification level 2. This target had almost been achieved. Staffing rota’s showed that the home was staffed adequately and there were plenty of care staff working in the home on the day of the inspection which showed that the residents were having their needs attended to. The Highgrove DS0000009764.V289353.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): 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A lack of comprehensive risk assessment affected the safety of the residents. EVIDENCE: The home had recently had a fire service inspection and several requirements were made. Fire doors were shut during the inspection and large notices were placed on them telling residents and staff not to prop them open. On other visits to the home this had not been the case. Some of the residents insisted on smoking in their rooms and risk assessments had not been completed to minimise the risk of fire. This is vitally important for the safety of the home and these should be completed as soon as possible. The current situation affected the safety of all the residents within the home and control measures need to be put in place. The Highgrove DS0000009764.V289353.R01.S.doc Version 5.1 Page 19 The manager of the home was now registered and was looking to achieve a recognised qualification in management. She had completed a business plan for the home and had identified strengths and challenges that affect the homes running. She described how the financial affairs of the residents were safeguarded and recorded. Evidence was seen of this through record books. Current Gas and Electricity safety certificates were not available at the time of the inspection. These need to be seen by the commission and the registered manager will forward copies to the Commission for Social Care Inspection. The care staff that were interviewed said that they had regular individual support from the management team. The record of this support was held on the staff files. The registered provider was spoken to during the inspection. The Commission for Social Care Inspection no longer receive monthly reports or notification of significant events as outlined in the Care Home Regulations. This needs to be continued to ensure that there is external overview of the day- to- day running of the home. The Highgrove DS0000009764.V289353.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 3 X 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X X 2 2 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 3 X 2 The Highgrove DS0000009764.V289353.R01.S.doc Version 5.1 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 OP9 Regulation 13(2) Requirement The registered manager must ensure all medicines are accurately recorded on receipt, administration and disposal. The registered manager must ensure all staff that administer medicines are competent to do so. The registered manager must provide the Commission for Social Care Inspection with quality monitoring reports. The registered provider must provide the Commission for Social Care Inspection with regular notification of death, illness and other events. Furniture in service users bedrooms must be of good quality and suitable for its intended use. (Timescale of 30-04-05 not met) The registered manager must assess all areas of identified risk to reduce the danger to service users. Care staff must receive training in caring for those with dementia and other mental health issues. DS0000009764.V289353.R01.S.doc Timescale for action 14/06/06 2 OP9 18(1)(a) 14/06/06 3 OP33 26 31/07/06 4 OP33 37 31/07/06 5 OP24 16(2c) 23(1a) 31/07/06 6 OP38 13 31/07/06 7 OP30 12 (1) (a) (b) 31/08/06 The Highgrove Version 5.1 Page 22 8 OP31 9 (2) (b) The registered manager must complete National Vocational Qualification level 4 in Management and Care. 31/12/06 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 Refer to Standard OP9 OP38 OP30 Good Practice Recommendations Regular documented medication audits should be carried out and retained for inspection purposes. Copies of all safety certificates must be available for inspection at all times. Over 50 of the total staff team must be trained up to National Vocational Qualification level 2. The Highgrove DS0000009764.V289353.R01.S.doc Version 5.1 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. Extracts may not be used or reproduced without the express permission of CSCI The Highgrove DS0000009764.V289353.R01.S.doc Version 5.1 Page 24 - 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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