Inspection on 26/02/09 for Victoria Highgrove

This inspection was carried out on 26th February 2009.

CSCI found this care home to be providing an Adequate service.

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

Victoria Highgrove 29/09/08

Victoria Highgrove 04/03/08

Victoria Highgrove 11/12/06

Victoria Highgrove 07/12/05

Victoria Highgrove 23/06/05

Victoria Highgrove 04/02/05

Victoria Highgrove 03/08/04

Similar services:

Springfield House

The Shelley

Thorndene

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

CARE HOMES FOR OLDER PEOPLE Victoria Highgrove 59 Dyke Road Avenue Hove East Sussex BN3 6QD Lead Inspector Elizabeth Dudley Unannounced Inspection 09:30 26 February 2009 th 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 Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Victoria Highgrove Address 59 Dyke Road Avenue Hove East Sussex BN3 6QD 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) 01273-562739 01273-882818 sueknights.victorianursinghome@virgin.net Victoria Nursing Homes Ltd Manager post vacant Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (0), Physical disability (0) of places Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 2. Physical disability (PD). The maximum number of service users to be accommodated is 23. Date of last inspection 27th November 2008 Brief Description of the Service: Victoria Highgrove (the Service) is registered to provide nursing care and personal care for 23 older people. The premises are a detached four-storey property. All of the people in residence have their own bedroom. All of the bedrooms have a private wash hand basin and toilet. All but one also has a private bath or shower. There is a passenger lift that gives step-free access around the accommodation. There is a call bell system. This enables people to contact a member of staff if they need assistance. There are various items of equipment such as hoists to help people who experience reduced mobility. The property stands in its own gardens. It is set back from the main road. There are no shops within easy walking distance. Hove town centre is about one mile away. There is a bus stop just outside the Service and there is some off-street parking. The Registered Provider is a private limited company. It operates four other similar services in the area. People who might want to move in can get information from several sources. There is a Service Users’ Guide. This is a brochure that outlines the principal features of the facilities and services available in the Service. There is also a document called a Statement of Purpose. This gives a more detailed account of the provision in place than does the Guide. The Registered Provider ensures that a copy of the most recent Inspection Report from the Commission is Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 5 available for reference. The home currently has block contract beds with the Local Authority and Primary Care Trust to admit residents under the Intermediate care scheme. This means that they provide ongoing rehabilitative care for people that have been in hospital in order to enable them to return home. The range of fees charged currently for each person’s residence in Victoria Highgrove runs from £625 to £750 per week. Daily rates are available for short stays. The actual fee charged depends upon the source of funding, the bedroom occupied and the amount of assistance required. The fee includes the provision of accommodation, nursing care, personal care, catering and laundry. It does not include items such as the purchase of toiletries and other services such as consultations with the hairstylist. Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced key inspection took place on the 26th February 2009 over a period of eight hours, and was facilitated by the appointed manager, Ms T Lenton. The appointed manager is applying for registration with the CSCI and will be referred to as ‘ the manager’ throughout this report. Methods used to collect information about the home included examination of documentation in the home, observation of staff working with residents, the serving of lunches and supper and conversations with residents, and staff. Six residents were spoken with in depth during the day and gave their views on life in the home. Documentation examined included care plans, personnel files, staff training and supervision records, catering records and health and safety files. The Annual Quality Assurance Assessment, required by the CSCI, which gives an overview of what has been achieved in the home and issues to be addressed, was received by the CSCI prior to the inspection. This accurately reflected the current status of the home. This was used as part of the inspection process. Residents spoken with said: Food not bad, we have a choice and it tastes alright, staff are very nice and quite polite. I haven’t seen an activities co-ordinator Food OK, good choice of food. I haven’t been in the lounge, I didn’t even know they had a lounge. Whats an activities person? I did not have any information about the home, normally staff introduced themselves when they came in I think its quite nice living here, the staff are very good and I am comfortable. I am extremely well looked after, but the food is not really very good. The staff are lovely, they are very nice indeed Generally there are some considerable improvements that have taken place and are continuing to take place in the home. What the service does well: Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 7 The service provides nursing care for up to twenty-three older people, these include residents admitted under the Intermediate Care Service (ICS). The home provides a Statement of Purpose and Service User Guide, which complies with regulation, and is provided to each resident on admission to the home. Residents in the home currently benefit from the knowledge of the visiting ICS therapists and staff, and whilst this is primarily for the residents admitted under this scheme, knowledge gained by the staff in the home from these staff benefit the four permanent residents in the home. The home provides a pleasant, clean and reasonably well-maintained home for residents. All residents spoken with said that the staff were very good, very nice very nice but always busy. The staff at the service enjoy a good rapport with the ICS team and one member of this team confirmed that the staff follow instructions well and give her information over any concerns they may have. What has improved since the last inspection? Since the last inspection the standard of care planning is improving and thus ensuring a better delivery of care. Medication administration now safeguards the residents in the home. The home has appointed a member of staff to act as Infection Control Champion. This involves the member of staff receiving further training in infection control and liaising with the Health Protection Agency. Staff were noted to appear to be more aware of their actions in the control of infection. The provider has purchased new variable height nursing beds for all residents and is in the process of purchasing new equipment such as commodes. Staff are receiving ongoing training from sources outside the home and the manager has applied for adult safeguarding training from the local authority. The personal files of newly appointed staff were inspected and these showed that a more robust recruitment process is being followed. This includes the use of an application form, interviews, Criminal Records Bureau (CRB) checks and written references prior to employment commencing. The home is now kept secure by entrance only being available by a keypad and residents rooms are now provided by magnetic door closures, which activate in the event of the fire alarm sounding. However many of the improvements made are still in their infancy and there must now be a period of sustained good management and practices in order Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 8 for the home to be able to evidence an overall rating of good under the Commissions Key lines of Regulatory Assessment (KLORA). What they could do better: Nine requirements have been made at this inspection. None of the residents admitted under the ICS have been informed in writing over whether the home can meet their needs. Care plans still require more complex information in some cases to ensure that care delivery does meet the residents needs and expectations and require evidence of involvement with the residents or their representatives where possible. Concerns were raised with the manager regarding the serving of food. Some residents are not getting a choice at mealtimes and although food coming out of the kitchen is hot, the practice of putting several meals on one trolley to take around the home could mean that it they lose heat when they arrive at the resident. Whilst infection control practices have improved, the block soap in the bathrooms could negate any impact made. Staff are not currently receiving formal supervision, whilst it is appreciated that the manager said that this will be commenced, there was no evidence of supervision taking place since July 2008. More flexibility in the homes routines are required to ensure that residents have sufficient choice around the activities of daily living, and it was noted that for those residents who are unable to make their needs known, choices were not being made for them by a suitably qualified and accountable person. The home provides very few activities for residents and the provider needs to be aware that interesting leisure activities and the opportunity to take part in these are an important part of health and recovery. Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 10 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 Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6. People who use the service experience adequate quality outcomes in this area Whilst the home provides sufficient information to enable prospective residents to make a decision over whether they wish to be admitted to the home, current practices around assessment do not give them the opportunity to make this decision. The home is not currently undertaking preadmission assessments on those residents admitted under the Intermediate Care Scheme, and these have formed the total admissions to the home at the present time. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 12 The Statement of Purpose and Service user guide have been amended to reflect the current management status in the home and to explain the meaning of the ICS (Intermediate Care Scheme) and how this is managed by the home. All residents have a copy of these documents on admission to the home. At the present time, there are only four permanent residents living at the home, the remainder of the residents being those admitted under the Intermediate care scheme. The permanent residents have lived at the home for a considerable time. Currently the manager is not assessing ICS residents prior to their admission in spite of considerable discussion taking place over this at the last inspection. The Intermediate Care Service Nurse Assessors carry out assessments of need and include this in their referral to Victoria Highgrove. The manager uses this as the homes pre-admission assessment. It is essential that the manager makes a judgment as to whether this assessment from the Nurse Assessor includes all the necessary information about the needs of the person in order for the service to confirm that they can meet the persons care needs. Should this not be the case, the care home will need to obtain further information, which may include carrying out their own assessment of need and meeting the person in hospital. A requirement was made at the last inspection for the manager to inform prospective residents in writing over whether the home can meet their needs and therefore admit them. This has not been done. During a discussion with the manager regarding the care planning of residents, which should use the preadmission assessment as a plan for initial care, the manager stated Under no circumstances would I form a care plan on someone elses assessment. This is correct as registered nurses are accountable for their own assessment of the resident and subsequent care planning and care delivery. Under the current system of placement, neither residents nor their representatives can visit the home prior to admission. Under the current system of placement for the Intermediate Care Service, potential residents cannot visit the home prior to admission. They also receive minimal information about the care home to make an informed decision as to whether they want to move in. The home needs to have systems in place to ensure that all potential residents, and their relatives and supporters, have Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 13 access to the homes statement of purpose and service user guide, in order for them to make a judgment about the placement. . The home now provides contracts and Terms and conditions of Residence to all residents admitted to the home. This document complies with both the National Minimum Standards and the associated regulations. The Victoria Nursing Home does not provide specific care staff for intermediate care residents, as required by the National Minimum Standards, but the contracting authority provides Occupational and Physiotherapists and other health care professionals. There are no facilities available for residents to be able to make their own meals or beverages as part of their rehabilitation, but the manager states that this is done as part of the assessed visits with the resident to their own homes. Residents spoken with said that they had received no information about the home prior to their admission. This needs to be addressed. Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 14 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11. People who use the service experience adequate quality outcomes in this area The standard of care planning is much improved and whilst some care plans require expanding as to detail and inclusion of other information to ensure that care staff have sufficient instruction for delivery of care, there is evidence that the home has the knowledge and capability to ensure that residents receive care to meet their needs. The standard of medication administration safeguards the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 15 During the course of the inspection four care plans were examined (17 ), of these three belonged to residents admitted under the Intermediate Care Scheme (ICS) and one to a long term permanent resident. The home receives the ICS assessment but then undertakes a further assessment to enable a care plan to be formed. The provider stated that a new model of care planning had been introduced into the home, but this is not currently being used. Care plans detailed the physical, psychological health care needs of the residents, and to a lesser extent their social care needs. Care plans had been reviewed regularly. There was no evidence of consultation with residents or relatives in the forming or review of care plans. More detail is required in some care plans. In one particular care plan described the resident as requiring To improve mobility- physio assessment. Remind to use her call bell and wait for assistance and supervise when mobilising. - To increase current levels of independence- to assist with personal care while encouraging her to be more independent. The manager said that the resident concerned was not sufficiently cognitively able to give information at the initial assessment, so it is unlikely that they would be unable to make their care needs known to the person delivering the care. More specific information is required in care planning to assist care staff with care delivery and to evidence the level of care required. Daily records require more detail and to be more specific regarding the care given and should include details of how external medications were used. Care plans also require hoist sizes, continence aid sizes, electric bed pressures and resuscitation status to be included. Nutritional and wound care plans were in place and there was evidence of the home contacting the wound care nurse specialist as required. The manager must ensure that evidence of weight loss is followed up by an action plan. Risk assessments for bedrails are in place, but require clarity around all the risks involved and how these are addressed. Discussions were held with the manager around this. There has been considerable improvement in care planning and care delivery in recent months. However some improvements are needed to ensure that the home has sufficient documentary evidence to back up the standard of care that they are delivering. All residents receive the attention of General Practitioners, Occupational and Physiotherapists and Speech and language therapists. Whilst the PCT provides Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 16 these for those residents admitted under the Intermediate Care Scheme, the manager accesses these for the permanent residents as required. Two residents admitted under the ICS were concerned that they had not been asked whether they wished to keep their own General Practitioner for the duration of their stay, but permanent residents said that they had the choice over whether they were visited by their own General Practitioner or one of the homes choosing. Residents spoken with said that I feel safe in here, they come very quickly if I ring the bell and need anything, and the staff are nice ladies. They look after me alright, they do take good care of me. I think its very nice here, very good for this sort of establishment, and I am very comfortable. I am extremely well looked after. It was seen that care staff have received training on looking after residents with post operative and rehabilitation needs and a member of the Intermediate Care Service Team said We all work very well together, the staff inform me if there are any concerns with the residents and the care assistants follow any instructions I give them regarding helping residents with their independence. Postoperative needs were detailed in care plans and equipment provided to help residents rehabilitate were being used correctly and was available to those that required it. All residents are provided with variable height nursing beds. It was not ascertained at this inspection whether the home is now purchasing specific wipes for continence care or is using appropriate cloths for this purpose, to ensure residents dignity and comfort. Medications are now administered from a medication trolley. A medication round observed safeguarded the residents, and recording and storage of controlled drugs was satisfactory. The home does not administer homily remedies without permission from a General Practitioner, currently this is verbal permission and the home must ensure that the General practitioner signs the drug order when they visit the home, or obtain written permission from the General Practitioner to administer homily (over the counter) medications. Whilst all residents now have a risk assessment for self medication, which will comply with the Deprivation of Liberty Safeguarding, it was not clear how the home will proceed if the risk assessment shows that the staff do not consider the resident safe to self administer their medication, but the resident refuses to relinquish control of this to the home. The manager should give some thought to the management of this and a policy regarding this put in place. Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 17 Discussions were held with the manager regarding the timing of the early morning medication round, which currently awakens residents, and whether or not routines in the home could be more flexible to accommodate residents preferences and sleep patterns. The home admits residents for end of life care and whilst some staff have attended End of Life Care training, the home does not currently practice the Liverpool Care Pathway or the Gold Standards Framework. It was noted that no resident admitted under the ICS had any instructions regarding resuscitation in the hospital assessment sent to the home. General Practitioners have not yet had this discussion with the permanent residents in the home, and there was no information regarding preferred place of death in the care plans. There was evidence in the home that relatives of deceased residents were pleased, both with the care received by the resident, and the way the staff interacted with the residents family. Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 18 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. People who use the service experience adequate quality outcomes in this area There is scope for the variety and frequency of activities provided to residents to be increased to ensure that holistic care needs are met. Some routines around the home lack flexibility and impact on residents preferences. There is a varied and nutritious menu, which offers choice at all meals to most of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is one activities person at present for the whole of the Victoria Homes; she spends approximately 3 hours a week at Victoria Highgrove. There is currently no formal activities programme in place although the activities coVictoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 19 ordinator provides some group activities including quizzes, bingo and one to one conversation with residents. The residents living in the home under the Intermediate care service, spoken with on the day of inspection were not aware of the activities co-ordinator although all permanent residents had either spent time with her or taken part in group activities. Whilst it is appreciated that the provider has been trying to employ further activities coordinators to increase the frequency and variety of activities since the requirement was made at the last inspection, it must be stressed that this is an important area which has a high impact on the social and emotional wellbeing of residents, and thus on their health care, and must be addressed. Records of interaction between the coordinator and residents and any activities held are kept in a folder separate to the care plans. Although there are no formal group outings, care staff accompany one of the permanent residents out for walks on a daily basis. Some outside entertainers such as musical entertainers are brought in two or three times a year, and all residents are encouraged to participate. The Provider stated in the self-assessment that a very popular keyboard player visits the home. The majority of residents socialise by having lunch together and meeting in the lounge. Residents said that their choices of rising and retiring were upheld, although those spoken with said that they got woken up before their preferred time for medication. Consideration should be given to ensuring flexibility in the homes routines to ensure that, as much as possible, routines are person centred rather than task centred. Residents also said that they were happy that their choices around the activities of daily living were usually met and staff were very cooperative very helpful in making sure you have everything you want. Visitors are welcome at any time and previous discussions with visitors showed that they are made welcome and staff are communicative about their relatives. There are no formal religious services, but arrangements are made for residents to see ministers of religion on request. The home provides a varied menu, which takes into account the dietary needs of residents. All of the catering takes place at one home in the Victoria group and is transported around to the various homes, with homes having their individual servers. The majority of residents are able to have a choice of menu at all mealtimes, but evidence from residents suggested that in some cases staff may not be making the residents aware of the options available at all meals. Discussion with staff showed that they were not aware that the extra options available on the menu in the kitchen were available on a daily basis. Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 20 On the day of the inspection, those residents receiving pureed meals were receiving a liquidised meal that had also been served at lunchtime. There was no evidence of these residents having a choice of meal. Whilst the manager and provider stated that this does not usually happen, it is important to ensure that all residents are enabled to make a choice of their meal, whatever their level of ability or communication. Where the service user is unable to make this decision, a senior member of staff should make the decision and ensure that the resident receives a nutritious and varied diet. One resident spoken with was not aware of the options of having snacks or being able to specify the size of her meals although the Service User Guide clearly states that snacks are available at any time. The manager stated that cultural and dietary preferences such as vegetarian can be catered for, with efforts being made to source other foods such as Halal or Kosher as required, although the home cannot provide a Kosher kitchen. Whilst the residents spoken with on this day described the food as Not bad and Tastes alright, the provider stated that surveys sent out by the home to residents elicited very positive comments about the meals provided. Meals can be taken in the dining room or in residents rooms. Tables in the dining room were attractively set out, and food was well presented in a manner, which would stimulate the appetites of the residents in the home. Care staff were seen taking meals around the home on unheated trolleys with several meals on them at a time, which could lead to meals going cold, this was brought to the notice of the provider. Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16.18 People who use the service experience good quality outcomes in this area Residents feel comfortable with making a complaint if required and are aware of the complaints policy. They are confident that any concerns that they may have will be addressed in an open and transparent manner. Policies in the home address the safeguarding of the residents and staff have received some training to make them aware of their responsibilities towards those in their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed both in the main foyer and in the service user guide. Residents spoken with were aware of how to make a complaint, although all said they would go through a more informal route such as speaking to their carer first. There have been one complaint since the last key inspection and this was unsubstantiated. There was evidence of how this complaint had been addressed. There have been four adult safeguarding issues in the home, all of which were either unsubstantiated or inconclusive. The evidence showed that these had Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 22 been correctly reported and addressed, and any recommendations made by the Safeguarding Team had been carried out. An in house training course on adult safeguarding is made available to staff, and the Victoria homes group are waiting for this course to be accredited by the Brighton and Hove Safeguarding training. A requirement at the last inspection was made to ensure that senior staff attend safeguarding training with Brighton and Hove, however the manager was unable to attend this due to no places being available but is due to undertake this training in the next couple of months. The provider gave assurances that all senior staff throughout the group are in the process of attending, or have attended this training. The manager is also awaiting a place on the Deprivation of Liberty Safeguarding Course. The home has a copy of the Multi agency Safeguarding protocols. The policy in the home produced by the provider does include the protocols as identified in the manual but lacks clarity in instructions for staff. He gave his assurances that this will be reviewed. Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,25,26. People who use the service experience adequate quality outcomes in this area. The home is clean and generally well maintained. Whilst infection control procedures within the home are greatly improved, not all areas in the home are sufficiently monitored to ensure that residents are completely protected from cross infection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is generally well maintained and communal facilities include a large lounge and a garden, which is accessible to residents. Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 24 Resident’s accommodation is in single rooms, the majority of which have an ensuite bathroom, which comprise a shower or private bath and wc. All rooms are within easy reach of a shaft lift. Resident’s rooms are pleasant, with some of the upper rooms having views over the sea. All have a lockable drawer. All rooms have variable height nursing beds, these have been purchased over the past six months and staff stated that they had made the job easier. Several new mobile commode chairs have been purchased, these preserve residents dignity as they permit the resident to be wheeled to the toilet, however there are some of the older type of commode chair in the home and one of these is corroded, this is an infection control risk. Some of the commode pans in these commodes require replacing as they are stained. Chair raisers and other equipment were in place for those residents who require this. Other equipment, including full body hoists and a ‘Stand aid’ hoist, are provided in the home, and there was evidence of other moving and handling equipment. There was a minor incident involving a hoist and it was inconclusive as to whether this involved moving and handling techniques or the residents degree of mobilisation, the provider has ensured that all hoists were serviced again and that the staff involved had further moving and handling training. Window restrictors were in place and records showed that the temperature of the hot water in residents rooms and bathrooms is being monitored with temperatures being within recommended parameters. It is recommended that these are checked at more frequent intervals than is currently taking place. The majority of rooms provide an ensuite facility. The home also provides assisted bathing facilities. It was noted that block soap had been left in some communal bathrooms, and the staff and manager are aware that the use of this type of soap for communal use can introduce cross infection. One bathroom had shampoo provided and this could lead to restriction on resident’s choice or put residents at risk. Some cloth towels were also found in two bathrooms. The cleanliness of the home was to a good standard and there were no odours apparent in any area of the home. The deputy manager is the infection control champion for the home, and as such, liaises with the Health Protection Agency and ensures that infection control measures are in place. Although this has included the provision of alcohol gel throughout the home and use of aprons and gloves, these procedures are negated by the use of block soap and communal towels. The ground floor bathroom had some areas of mould around the tiles and was also difficult to keep clean due to the uneven flooring. Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People who use the service experience good quality outcomes in this area The numbers of registered nurses on duty during the day time hours, has been increased by one registered nurse, therefore enabling improved supervision of residents care and care planning. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has increased its staffing levels by an extra registered nurse on duty during the day in line with meeting the needs of the residents. The manager is working 8-5pm five days a week and this is usually in a management role. Staff said that the extra staffing had given them more time to spend on residents care and resulted in them being less hurried, but said that although there were now two registered nurses on duty, no extra carer had been employed for the daytimes, and that an increase of one in the mornings would have been helpful as sometimes they are very busy. However both the manager and the provider stated that they monitor the staffing according to the dependency and that extra staff were available as required. Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 26 A registered nurse said that having a second registered nurse on duty has taken the pressure off. It was noted that bells were being answered quickly and no resident had to wait long for attention, the residents confirmed this. The use of the Skills for Care Induction course has not yet been commenced although the provider stated that this was in hand. Staff still receive the majority of their training in house but additional training is now being provided by outside agencies, health care specialists and the Care Home Support team. Registered nurses are having some training in wound care and leg ulcer care but should be responsible for ensuring that their training and updating is to a high level in line with Nursing and Midwifery council requirements. Care staff are now more aware of the health care requirements of the residents admitted for postoperative care. Two members of staff now have the National Vocational Qualification level 2 in care and the provider must ensure that staff are encouraged to study for this qualification and to meet the criteria of having 50 of staff with this qualification. All personnel files of staff employed in the home had been examined on the random inspection of the 27th November 2008 and contained all information as required by regulation. Personnel files of the three recently employed members of staff were examined on this inspection and were satisfactory. No staff are now employed for work prior to robust recruitment practices being followed. All members of staff receive a copy of the General Social Care Code of Conduct on commencing work at the home. Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34,36,37,38 People who use the service experience adequate quality outcomes in this area. Some improvements have been made to ensure that the delivery of care and services meets with residents needs and expectations. Risk assessments and policies and procedures are not sufficiently robust to safeguard the residents. Some management systems in the home do not fully ensure that residents safety is upheld and that staff are appropriately supervised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 28 On the day of the inspection the current appointed manager, Ms T Lenton, had been in post for three weeks, and had spent the majority of this time continuing to improve systems within the home. Whilst she acknowledges there are still improvements to be made, there is evidence that the home has made considerable steps forward, however this has taken longer than was anticipated by both the CSCI and the provider. The manager is a registered nurse who was previously employed at another home in the Victoria Group as deputy manager. She has not yet attained registration with the CSCI or the Registered Managers Award but these are in the process of being undertaken. The Annual Quality Assurance Assessment was returned when we asked for it and identified the steps the provider was taking to ensure that the home meets residents needs and the improvements that were being made in the home. The home has sent out questionnaires to residents at the end of last year, and received positive comments about the services it provides. They also sent surveys to the General Practitioners that serve the home and received positive comments. The responses were not seen at the inspection but the provider stated that some negative comments were received which showed that residents and relatives still had some confusion regarding the Intermediate Care Service, and relatives and residents also said that there were insufficient activities taking place. Conversely, whilst the inspector received variable comments regarding the meals at this inspection, comments received by the homes own quality process, were positive. The home does not get involved in any of the residents finances and residents are required to have relatives or advocates dealing with their money if they are unable to do so. Staff are not currently receiving regular formal one to one supervision and there was no evidence of supervision being provided since July 2008. The manager gave assurances that this will be commenced but a requirement has been made. Regulation 26 visits (provider visits and reports required by regulation) are being undertaken at intervals as required by regulation, and copies of the reports were seen in the home. It was noted that the reports addressed various issues that had arisen in the past few months. Policies and procedures and risk assessments around the home are in urgent need of review. Certificates were in place for the servicing of utilities and equipment. As mentioned in the area of the report relating to environment, an incident had Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 29 occurred whilst a hoist was being used, this was unclear at the time whether this was due to the hoist or whether it was due to poor moving and handling techniques. The adult safeguarding investigation resulted in this being unproven but made recommendations regarding training. It was noted that hoists have been regularly serviced and staff received extra training. The electrical wiring certificate indicated that there is some work to be done; the provider gave assurances that this was taking place. The training matrix showed that staff are receiving mandatory training such as moving and handling and fire training. All residents doors, the kitchen and the laundry, now have automatic closures, which react in the event of the fire alarm being sounded. Concerns were raised with the manager regarding the practice of all staff being absent from the floors on their breaks at the same time. The manager has been asked to consider the flexibility of routines in the home to ensure that there are some staff around at all times to ensure that residents safety is upheld. Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 30 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 2 2 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 3 2 2 x 2 2 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 2 2 2 Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 31 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 OP3 Regulation Reg 14(d) Requirement The registered person must ensure that the assessment from the Nurse Assessor includes all the necessary information about the needs of the person in order for the service to confirm that they can meet the persons care needs and where it does not, ensures that further information and assessments of need are obtained and carried out. That prospective service users are informed in writing over whether the home can meet their needs and are able to admit the individual 2. OP7 Reg 15(1)(2) That care plans are formed in consultation with the service user where possible and contain sufficient information to inform a detailed plan of care regardless of the abilities of the service user. That staff provide ongoing written documentation in the care plans regarding type of external medications etc That care plans are reviewed to show DS0000014071.V374385.R02.S.doc Timescale for action 01/05/09 01/05/09 Victoria Highgrove Version 5.2 Page 32 actions when needs change i.e. weight changes and that all staff are aware of the necessity for daily recording that links with the care plans. That care plans record data specific to the individual such as hoist sling sizes, bed pressures and continence aid sizes to ensure that service users receive a standard of care that is personalised and applicable to their needs. 3 OP12 Reg 16 (m) (N) That all service users are consulted regarding the provision of leisure activities and that their preferences are recorded in the relevant social care section of the care plan and the home ensures that the provision of social and leisure interests is recognised as an important part of health care. That a reasonable amount of time is provided for the provision of leisure activities. 01/05/09 4 OP14 Reg 14(2)(3) 5 OP18 Reg 13(6) In instances where service users 01/05/09 are not able to make decisions or choices, the provider ensures that these choices are made by a suitably qualified and accountable staff member or by service users next of kin or advocate. That the routines of the home are sufficiently flexible to ensure that service users preferences are met. That the policy on adult 01/05/09 safeguarding is amended to reflect actions required by the staff to ensure that correct reporting protocols are followed That the ground floor shower room receives sufficient DS0000014071.V374385.R02.S.doc 6 OP21 Reg 23(2)(b) 05/07/09 Victoria Highgrove Version 5.2 Page 33 7. OP26 Reg (3) 8 OP36 Reg 18(2) 9 OP38 Reg 34 maintenance to ensure safety for service users and control of infection. That the manager monitors the 01/05/09 infection control practices in the home to ensure that service users are not put at risk That staff receive formal 01/06/09 supervision at intervals directed by the National Minimum Standards The manager ensures that the 01/06/09 practices and routines within the home are sufficiently flexible to ensure service user safety. That risk assessments throughout the home are reviewed and updated to adequately reflect the risk involved and the actions taken to minimise these. 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 OP37 Good Practice Recommendations That policies are reviewed at regular intervals Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Victoria Highgrove DS0000014071.V374385.R02.S.doc Version 5.2 Page 35 - 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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