Care Home: Highbarrow

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What the care home does well Residents confirmed that they were treated with respect and they were supported to maintain contact with family and friends. Highbarrow offers a genuine commitment to care with an open and personable approach, which reflects the homeliness of a confident relationship between carer and resident. The people who live at Highbarrow like the staff and feel safe living there, feeling they are well looked after. Relatives wrote in their survey forms "Looks after all my mother`s needs ....staff give her the attention she needs to be as happy as she can be at this time in her life. Gives family support.` "Visitors are made very welcome. The quality of decoration and furnishings makes the Home a pleasant and comfortable place to live". A well-balanced and nutritional diet was provided for the benefit of the service users. The home was safe, well maintained and very clean and hygienic. What has improved since the last inspection? What the care home could do better: The achievements have been recognised, areas of detail highlighted in recommendation will continue to play a part in the ongoing development and maintenance of an honest, solid, and yet a homely service. Continuing surveillance of medicines administration and continuing maintenance of the building fabric need reinforcement. Staff awareness for dementia and diabetic needs have been identified.There is a convention of informality in recording of important issues, i.e. complaints and accidents in notebooks, and daily reports of residents` events kept on loose-leaf lined notebook paper. Although they provide the required quality of record, they would be better maintained in a more formal method attuned to a system approach to essential record keeping. CARE HOMES FOR OLDER PEOPLE Highbarrow Toothill Road Uttoxeter Staffordshire ST14 8JT Lead Inspector Keith Jones Unannounced Inspection 3rd March 2008 09:00 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 Highbarrow DS0000004954.V360262.R01.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. Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highbarrow Address Toothill Road Uttoxeter Staffordshire ST14 8JT 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) 01889 566406 01889 569799 bobh123@tiscali.co.uk Mrs Regina Hayes Mr Robert Michael Hayes Mrs Regina Hayes Care Home 22 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (22), of places Physical disability (1), Physical disability over 65 years of age (15) Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1- PD over 54 years Date of last inspection 15th May 2006 Brief Description of the Service: Highbarrow is a large detached house that has been extended to provide residential accommodation for 22 older people, 16 of whom may have a physical disability, and five of whom may have dementia care needs, and one of whom may have a physical disability and be under the age of 65. The home is situated in rural areas but within a short drive of the town of Uttoxeter. Accommodation is provided in two double and 18 single bedrooms. There are two double and three single bedrooms on the first floor and 16 single bedrooms (10 with en-suite, three of those with showers) on the ground floor. The two double bedrooms on the first floor are being occupied as single, and it is the policy of the home as stated in the service users guide, that double rooms are only shared by partners or friends requesting to do so. Communal facilities consist of a large lounge, smaller quiet lounge, and a dining room. On the first floor there is an assisted bathroom with WC and two separate WCs, and on the ground floor there is an assisted bathroom with WC, a shower room with WC, and three separate WCs. These toilets are situated within close proximity of both lounges and of the dining room. The kitchen and laundry are situated on the ground floor as is the care office and proprietors offices. There is also a staff bathroom, bedrooms and kitchen. Externally there are large landscaped gardens all around the building, with lawns and patios that are fitted with garden furniture, and are accessible to all residents. At the front of the building there is space for car parking. Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. A quality rating is provided throughout the report based on each outcome area for the people who use the service. These ratings are described as excellent, good, adequate or poor based on findings of the inspection. We considered if the information given to us confirmed that customers were presented with the service they needed, and whether the service was of a satisfactory standard to ensure service users’ safety. The unannounced inspection was conducted with the Registered Provider and senior care staff. The last inspection report was discussed, and it was noted that there were no requirements or recommendations made from that visit. The Inspector acknowledged receipt of the prepared Annual Quality Assurance Assessment (AQAA) and 5 comment sheets, all complimentary, with some useful advice. “They are very good”, “I get good attention, staff are friendly, and the Home is fine”, “Highbarrow a nice place to walk in to, very clean. Mum very well looked after, very caring staff”. Surveys were also received with comments about the home’s services, especially the good meals and warm atmosphere. On the day of inspection there were 15 service users in residence, with five residents with dementia needs. Three residents were case tracked, which confirmed the establishment of a comfortable and well-run care home. A tour of the Home allowed free and open access to all areas for inspection. The opportunity was taken to speak with most of the residents, some relatives and members of staff. Residents and staff took an active role in the inspection process and contributed to the subsequent report. Throughout the entire inspection a sense of homeliness and familiar confidence pervaded into all aspects of daily activity expressed by those people met. A review of the administrative arrangements confirmed solid practice and effective management. A full verbal report was offered at the end of the inspection to the Provider. The inspector thanked all concerned for their contribution to a pleasing and constructive inspection. Information gained from the pre-inspection questionnaire identified that current fees are from £375 to £395 per week. This information was correct at the time of this inspection. The reader may wish to contact the service for current information Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 6 Potential residents and their representatives are able to gain information about the service from the Statement of Purpose and Service User Guide. Our inspection reports can be obtained directly from the provider or are available on our website at www.csci.org.uk What the service does well: What has improved since the last inspection? What they could do better: The achievements have been recognised, areas of detail highlighted in recommendation will continue to play a part in the ongoing development and maintenance of an honest, solid, and yet a homely service. Continuing surveillance of medicines administration and continuing maintenance of the building fabric need reinforcement. Staff awareness for dementia and diabetic needs have been identified. Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 7 There is a convention of informality in recording of important issues, i.e. complaints and accidents in notebooks, and daily reports of residents’ events kept on loose-leaf lined notebook paper. Although they provide the required quality of record, they would be better maintained in a more formal method attuned to a system approach to essential record keeping. 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. Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 8 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 Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 9 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,and 5 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The services that people receive are centred on the needs, wishes and views of those who use them. The Home ensures that prospective residents have the necessary information to enable an informed choice to be made. Aims and objectives, terms and conditions are clearly presented in a way to facilitate easy understanding of services and standards of care. The Home has demonstrated their commitment to promote a partnership of care, to meet the objectives of providing a home to meet individual needs. Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 10 EVIDENCE: The combined Statement of Purpose and Service User’s guide represent a satisfactory description of the Home’s aims and objectives, philosophy of care and terms and conditions, although needs an updating review. It offers residents, and their relatives the opportunity to make an informed choice about where to live. A separate, easily readable Guide, available in large print or audio presentation would be helpful. It is stated in the Statement of Purpose that independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of residents. The Statement of Purpose also indicates the terms and conditions, which are discussed with residents and relatives prior to admission. A pre-admission assessment, carried out by the Care Manager or designated deputy, appreciated any special needs of the individual, including cultural, social or personal needs, which are fully discussed and documented. This assessment initiates the process of care, each individual having a plan of care based on personal needs and a daily living process. The Home demonstrated through case tracking, that the assessor explained this information in respect of each individual to ensure a clear understanding is established. The care assessor also makes a judgement as to the suitability of each prospective resident, using the same criteria. There is evidence that the family is kept fully informed of the situation, offering prospective residents, and their relatives, the opportunity to make an informed choice about where to live. Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care assessment and planning system is a well-organised, yet personalised process offering meaningful and valid documentation of care administered. A broad vision of needs is addressed through the care planning process, meeting personal and health needs. It is recognised that this reflects an individual profile of needs, discussed fully with family. The care team manage the provision of a secure and safe medicines administration. EVIDENCE: There was evidence to show that a review of the care process has produced a satisfactory standard of meeting care needs. Each resident had a documented Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 12 care plan which provided details of all aspects of daily living. These were reviewed monthly and were meaningful, and well laid out. Risk assessments were in place and these were also reviewed monthly. Monitoring of events and care given were recorded with diligence. The daily report was informative and meaningful, but was distracted by being presented on loose-leaf lined paper, with no relative link to active care plans in a systematic way. Health care needs were met very well and records were well documented and evidenced that residents had access to a wide range of health professionals including: a GP, chiropodist, speech therapist, optician etc. District nursing services are also received, with which the Home has an established, and positive professional rapport. Discussions with residents confirmed their acceptance and confidence in the overall standard of care and service given. “ Everybody really kind”, ”I saw the doctor last week, it was really nice” were some of the comments offered by residents. There was evidence that suitable equipment was deployed effectively. The inspector observed the free, courteous interaction between residents and staff, based on a level of confidence of mutual trust and respect. Comments received by the assessor confirmed the warmth of the care atmosphere and daily interactions. Activities are a key element in the socialisation approach to care, with visitors encouraged to be involved in a partnership style with care staff. The Home has identified a need to have more imaginative and interesting activities to accompany recent new initiatives of weekly live music sessions. The facilities and bedrooms were presented to facilitate privacy for the individual, which included medical examinations and personal care procedures, being performed in private. Double bedrooms are presently used for single accommodation. The administration of medicines generally adhered to procedures to maximise protection to service users. The storage in a dilapidated wooden box frame is considered to be too insecure. It was noted that there were excess amounts of several items of medication, this should be reduced. Disused stock needs to be returned to the pharmacy. The practice of using stock bottles for administering common medicines will cease forthwith. The controlled drug management would be improved with the provision of a wall-bolted metal cabinet situated in the treatment room. A controlled drug register was examined and found to be inadequate for any potential recording. The MAR sheets were found to be administered effectively. There were no residents self-medicating at the time of inspection. A long established practice of giving ‘Homely remedies’ will cease due to no updated GP supported disclaimers. Relatives have freedom of visiting, emphasising on the importance of maintaining social contact. Adequate privacy policies exist for all Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 13 toilet/bathroom areas and bedrooms, although bedroom identifiers were considered poorly presented and of little value for people with dementia. Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 14 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 and 15 The quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There were discussions with residents, staff and examination of records in relation to social activities undertaken and general observations during to course of the inspection. The home had a relaxed atmosphere where people were encouraged to individualised lifestyles. Those who wish to bring in personal possessions are encouraged to do so. EVIDENCE: Discussions with residents and staff identified a relaxed atmosphere in which the residents’ needs were respected. A routine exists to establish a framework for managing the home, not as a regime for residents to comply with, but for a point of familiarity. Several residents exercised their freedom of movement, with the security that there are routine events to the day they could relate to. The Home has attempted to increase social activities with live music sessions, but recognises that more imaginative initiatives are needed. Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 15 Those residents’ rooms inspected showed a significant influence of personalisation in the inclusion of belongings, some furniture and general décor. During the course of the inspection staff were observed to interact with the residents in a positive and polite manner. Throughout the inspection, relatives and friends of the residents were seen welcomed into the home at various times. Residents confirmed that they were able to make their own choices, get up when they wished and go to bed at times to suit them. The standards of catering offered a satisfactory service, to which residents and a visitor spoken to were complimentary of all aspects of quality. A menu on a four weekly cycle offered a wholesome, varied and suitable choice. A very pleasant lunch was served during inspection, with choices available, served in dining rooms adjacent to the lounge areas. Three meals were provided daily, with hot and cold beverages and snacks available throughout the day. Residents that were interviewed confirmed that that the quantity and quality food provided was good. Individual preferences were recorded in assessment and conveyed to the catering staff, who met with, and discussed their requirements. It was confirmed that the cook knew each resident, and some of the relatives. Special diets were accommodated, with the staff making positive effort to engage with residents, and sometimes relatives, to discuss personal preferences. Residents were very complimentary about the food, one comment given was: ‘The food and its presentation are very good’. Relatives also made the following comments about the food as follows: “Mom is eating well now thanks to the lovely food and the staff” and “The food appears to be very good with an excellent selection”’. Staff were seen to offer discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of service users. Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 16 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, 17 and 18 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a Complaints Procedure in place and residents feel that their concerns will be listened to and acted upon. The homes’ Adult Protection procedure ensured that service users were protected from abuse. EVIDENCE: There is a Complaints Procedure in place, but this needs to set out the stages, timescales and process. The Acting Care Manager was advised to establish a single file to accommodate concerns, complaints and allegations separately, (a CCA record) each supported with the relevant procedure. The home and the Commission for Social Care Inspection had not received any complaints since the last inspection. Residents spoken to confirmed that they did not have any complaints, and any minor grumbles were dealt with promptly and effectively, “If there was anything wrong I’d tell them”, “Staff listen to you, you can go at any time to the matron.” Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 17 On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. The overall policy of openness and transparency was acknowledged. The complaints procedure was also available in the hall for visitors and relatives. No allegations of abuse had been received and procedures were in place for the protection of vulnerable adults. Staff induction and in-house training programmes clarified the responsibilities of all staff in their daily contact with residents, especially their privileged position in protecting residents from abuse, of all natures. Adult protection and recognising the signs of abuse and neglect is part of the Home’s training programme. Staff we spoke to said they would immediately report any concerns to Mr Hale, someone more senior in the organisation or to social services, the police or CSCI if necessary. People told us they feel safe and know who to speak to if they are concerned about something. A relative who sent us a survey form wrote –“Gives her security – saying she feels safe”. Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 18 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): 19,20,21,23,24,25,26 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The quality of décor and furnishings makes the Home a pleasant and comfortable place to live. The home is well appointed to meet the needs of an elderly population of residents in providing a safe and comfortable environment. All communal areas are of a good standard, offering social as well as private reflection, as the mood takes. The overall environment was found to be safe for residents’ comfort, within risk assessed limits. The Home was safe and well maintained and very clean and hygienic. EVIDENCE: Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 19 A tour of the Home verified that the premises were fit for purpose, clean warm and tidy, and being satisfactorily maintained. The surrounding garden areas and surrounding countryside, provide an outstanding vista for relaxation and recreation. Safety measures taken in the gardens render attractive, and safe areas for residents to take advantage of. A visual inspection of the exterior of the home was made during the course of this inspection, and nothing of note was seen by the inspector to alert him to any problem areas. Internal access was facilitated with suitable fittings of hand and grab rails, in adequate, well-lit and airy corridors. Wheelchair access was satisfactory throughout all areas of the home. On admission the Provider or Care Manager assesses each individual’s needs for equipment and necessary adaptations. Efforts had been made to provide a homely atmosphere and the décor in most areas of home was found to be of a high standard. Recent decoration of bedrooms, new carpets and the fitting of new glazed units were noted. Upgrades to bathrooms were very satisfactory. The home provided two lounge areas that were pleasantly decorated providing essential furnishings and items to provide a comfortable area where service users were able to interact with fellow residents, seek reflective peace, or to entertain their guests. There are active plans for the building of a conservatory attached to the lounge area. There was a spacious well appointed dining area where residents were able to dine in comfort. Menus were displayed and up to date. Toilets and bathrooms were located on both floors and were in close proximity to bedrooms and communal areas. Numerous floral displays greatly enhance the presentation. Bedrooms were well maintained to meet residents personal preferences. On inspection, most bedrooms were highly personalised, with some displaying their own furniture, and most with personal belongings. It is the policy that on bedrooms becoming vacant that each room is reappraised for redecoration, as confirmed during the Inspection. Residents spoken to expressed a sense of belonging, and satisfaction in the quality and presentation of their living areas. The Provider expressed a willingness to meet any reasonable demand for special needs. A locked facility and lockable bedroom doors are made available on request, following suitable risk assessment. The evidence seen on inspection of residents rooms, and on discussion with the individual resident and family, assured that this standard was well met. It was noted that with an increase of residents with dementia needs that the décor should provide memory triggers of recognition, with individual, named bedroom doors, themed wall décor, and visual effects to stimulate familiarisation. Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 20 The large domestic kitchen was inspected with the cook and found to present a well equipped and organised area. All fridges and freezers were well maintained and checked daily by the kitchen staff. A cleaning schedule was in place, up to date and accurately reflecting the observed standards. The laundry was well organised and equipped to a good standard. Notices regarding chemical handling in the areas that store chemicals are displayed. The process would benefit from COSHH poster displays in all areas dealing with chemicals. The external and internal environment was well maintained and secure. The Provider is to provide the Inspector with a development plan for 2008/09. Heating and ventilation were found to be satisfactory and lighting was domestic in style. Aids, adaptations and equipment were available throughout the Home. Fire equipment was inspected and seen to be serviced and up to date. The home presented a clean and pleasant, odour-free atmosphere, much to the credit of staff. Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 21 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 and 30 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service, and on the examination of staff files, working rotas and discussions with staff. The staffing levels in relation to the number of residents in residence, and their dependency level was suitable to meeting assessed needs. The procedures for recruiting and appointing staff were seen to be inconsistent with various stages of the process not completed, in studying several staff files. Staff training records complement the effort placed into staff training. EVIDENCE: There were 15 service users receiving care at the time of the inspection. Off-duties were provided and examined; staffing levels were seen to be satisfactory. The daily care staffing rota showed adequate balance between skills, experience and numbers to provide a good standard of care. Discussions Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 22 with staff also confirmed their commitment to providing a quality service and their awareness of the principles of good practice. The Registered Provider contributes a consistent presence, working closely with the Care Manager on a daily basis. At the time of inspection the duty rotas confirmed a staff coverage as thus: a.m – 1 Senior 2 carers p.m – 1 Senior 1 carer N.d - 1 Senior 1 carer Observations of staff on duty conveyed a very positive impression of their competence and care of the residents of Highbarrow. Three members of staff were interviewed, who confirmed the appropriate staffing levels, conduct and training of staff. It was noted that there are several overseas care staff, who have been appointed to their position after suitable screening, including their ability to communicate effectively. Those spoken with on the day of inspection showed satisfactory standards, and an infectious enthusiasm for their work. There are five members of staff qualified in first aid, which is due for renewal this Summer. Three staff files were examined which showed an inconsistency of general application of procedure in appointing staff. The procedures for recruiting and appointing staff were seen to be inconsistent with various stages of the process not completed. Several staff had insufficient evidence of clearance with references, letters of appointment, and contracts, although thorough checks are made of CRB and POVA records. The management is advised to review the procedures of appointing and maintaining staff. The Care Management remain committed to a learning environment. Staff induction programmes are well established and well designed, forming the base upon which in-service supervision and training are planned and achieved. Staff records displayed an account of training that includes the General Social Care Council’s code of conduct, obtained to compliment existing guides. Records were available to demonstrate an on-going process of supervised practice, showing training sessions and appraisals to be a routine feature of staff development. A training plan for 2008/09 is to be prepared for submission to CSCI. 50 of care staff are in receipt of NVQ level II or level III. There was evidence of regular NVQ assessor visits and numerous certificates on display, covering many relevant issues, to which the staff spoken to expressed pride and awareness in achievement. Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 23 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): 31,32,33,34,35,36,37 and 38 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Along with discussions with the Registered Provider, examination of the home policies and procedures, with regards to the effective management of the home, general observations during the process of the inspection, and discussions with residents, visitors and staff. There is a confidence apparent in the interaction of residents, staff and the Home’s management, that demonstrated a positive relationship that pervades throughout the Home. EVIDENCE: The Registered Provider, Mr Robert Hayes has demonstrated evident competence in establishing a solid professional policy portfolio, that has been implemented over the past 15 years, to achieve a good standard of set aims Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 24 and objectives. Mr Hayes the Provider has achieved a level IV NVQ Registered Managers Award. The inspector was impressed by the openness, professional and pleasing confidence in the observed interactions of staff, relatives and residents. The relationships were seen to be of mutual trust and respect. Appropriate risk assessments are in place for residents, thorough care planning and recording and general maintenance of the environment, are up to date and accurate. Health and safety notices can be seen throughout the home. The process would be enhanced with a room catalogue of risk assessment to update the present room based risk reports. The Home has an open door policy and a commitment to equal opportunities. An examination of administrative, monitoring, planning and care records showed an organised and professional attitude to effective record keeping. They were found to be well maintained, accurate and up to date, ensuring that the residents’ rights and best interests are safeguarded. Relevant legislation was discussed and is fully understood by the management, i.e. changes from CSCI, updates on Health and Safety issues, diversity, etc. Attention needs to be focussed on the implications of the Mental Capacity Act 2007 for all senior staff, who are to be expected to cascade the information to all staff. The Provider offered evidence of safe working practices including: - movement and Handling, abuse awareness, and challenging behaviour management. It was noted that there is a need to update these and other procedures to meet change in practice and organisation. Abuse policy should be reviewed in light of new Safeguarding arrangements with Social Services. Challenging behaviour is a theme that will present more as time goes by, and should be reviewed in conjunction with policies on restraint and abuse management. An index to the Procedures book would facilitate staff access and usage. It was advised that staff countersign that they are aware of the manual and its content. The health and safety of residents and staff are promoted with safe storage of hazardous substances, regular electrical PAT and servicing of electrical and gas appliances, and regulation of the water system, each record examined was found to be satisfactory. The accident book was seen and found to be in order for staff, residents and reporting arrangements to Riddor. A more formal approach to documenting events would enhance appraisal and action taken for analytical review of trends and occurrences. The administration and management of the home is efficient, and sensitive to the needs of residents. Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 25 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 2 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 4 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 3 3 3 3 3 2 3 Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP9 OP29 Regulation 13 (2) Schedule 2 Requirement That a review of storage space for security of medicines. You must demonstrate robust recruitment and selection procedures within the home, with regard to recording of interviews, letter of appointment and contracts. Timescale for action 01/05/08 01/04/08 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 OP1 Good Practice Recommendations Statement of Purpose and Service users Guide will need to be updated, to allow a clearer understanding of the aims of the Home in providing a suitable standard of care. A re-furbishment plan be drawn up to address improvements for 2008/09, to offer advance information on the level of development of the service. 2 OP24 Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 27 3 4 5 As a course of good practice COSHH laminate posters should be located in areas where chemicals are stored Update procedure manual to recognise change in practice and organisation, with attention called to safeguarding against abuse, and recognition of challenging behaviour. That a full unit risk assessment programme be updated, to enable the management to review safety, and appraise facilities on a regular basis. Provide CSCI with a staff training development plan for 2008/09, to identify needs and resources to effect a suitably trained workforce. To ensure adequate security of Controlled drugs at all times with the provision of a metal rag bolted storage cupboard, and a formal CDA register. • • • • • To cease administration of medicines from a single stock bottle. To maintain a list of approved carers to administer medicines with specimen signatures To maintain an effective Homely Remedy policy with formal GP signed agreement, or discontinue policy. Minimise stocks of re-prescribed medicines Replace medicines cabinet with a more secure store. 5 OP19 6 OP33 7 OP9 8 9 10 11 OP16 .4 A concerns, complaints and allegations book be established. Maintain consistency in the review of care plans process to ensure constant awareness of need. Cessation of poor daily record on loose-leaf paper, to replace with a more structured daily report system, to facilitate easier documentation and applying a systematic approach to care reporting and monitoring. Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Highbarrow DS0000004954.V360262.R01.S.doc Version 5.2 Page 29 - 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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