Care Home: Highborder Lodge

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What the care home does well It was evident through discussion with people living at the home, who were able to talk to the inspector that they felt their views were always taken into account and `nothing was too much trouble`. They found the Manager and staff approachable, helpful and friendly. People spoken with confirmed that they were very happy with the home and the care and they had no concerns. They felt they were kept well informed and that there was appropriate stimulation in the home. People felt that they had the ability `to do what they liked` and `they could go out if they wanted too`. There was confirmation that people were given choice in what they do and that independence was promoted as much as possible. All the comments made by people living at the home, relatives, in conversation and via questionnaires was very positive about the home, staff, care, activities and the food. There were a few minor grumbles but these had no impact on the outcomes for people living at the home. Interactions and communication between staff and people were observed during the inspection and it was noted that tasks were undertaken diligently, respectfully and compassionately. Staff were seen fully engaging with people living at the home throughout the day. Really positive interactions were witnessed. Carers spoke to people respectfully, provided explanations for why they were doing things and supported them throughout care, meals and activities. Whilst staff were busy there was a calm and unhurried atmosphere. A few people still are able to go out alone and some go out with friends or relatives. Lifestyle and hobbies are well recorded and social activity provision has improved immensely around individual interests. The activities are varied (group as well as individual) and are well attended by people who enjoy the activity and outing programme. The activity coordinator is well motivated and really enthusiastic about her role, which benefits the people living at the home. Management records relating to health and safety issues and regular checks were in place. There was evidence that if any action had been necessary that it had been completed. All incidents and accidents that require reporting under regulation 37 are completed and sent to the Commission. What has improved since the last inspection? The Homes` Manager has always been involved in the home on a `day-to-day` basis but a Senior Care coordinator who is an experienced Senior Carer now supports him. This has improved the communication with the Manager and the care team and assisted in supporting staff to take responsibility and be more accountable for their work. It has also allowed better coordination of care practice within the home and more consistency of care practice. It has also led to delegation of specific responsibilities to senior staff within the team, which assists in staff development. The recruitment of overseas staff has also improved the issues relating to staff shortages and has improved staffs working experience on a day-to-day basis. Staff report that there is resolution of issues and better communication than ever before and staff appear more diligent, motivated, happy and relaxed in their work. Documentation of care practice has improved although there are still some minor amendments to be made to make it fully compliant. The care practice is now supported by regular mandatory and skills training and this is assisting staff development. This results in the home being run safely and efficiently with people`s rights, independence and choice being safeguarded and protected. What the care home could do better: Documentation of care practice has improved but there are some minor amendments to be made to make it fully compliant with the required information necessary to underpin care practice. These must be addressed. Accident records must be kept in compliance with data protection within the home and a documented accident audit implemented. Some enhancement to the recruitment practice is still necessary such as interview records, documentation of the induction process and an interview/induction checklist for the administration staff. The Manager needs to further develop the Quality Assurance system to ensure a yearly documented `in-house` review is undertaken of all the processes and systems that are in place. From this the Manager needs to ensure that an annual quality assurance report with a development plan for the home is produced, which is then readily available for examination by the Commission and all interested stakeholders. CARE HOMES FOR OLDER PEOPLE Highborder Lodge Marsh Lane Leonard Stanley Stonehouse Glos GL10 3NJ Lead Inspector Mrs Helen James Key Unannounced Inspection 09:35 19th November 2007 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 Highborder Lodge DS0000016463.V342820.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. Highborder Lodge DS0000016463.V342820.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highborder Lodge Address Marsh Lane Leonard Stanley Stonehouse Glos GL10 3NJ 01453 823203 01453 822841 highborder@aol.com 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) Mr Roger Bruce Thorne Mrs Barbara Anne Thorne Mr Roger Bruce Thorne Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Highborder Lodge DS0000016463.V342820.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: NONE Date of last inspection 10th October 2006 Brief Description of the Service: Highborder Lodge is situated in the village of Leonard Stanley near Stonehouse. The home is an adapted early Victorian house with a large purpose built extension. There are 38 single rooms and 2 double rooms all with ensuite facilities. Two shaft lifts provide access throughout the home. There are two lounges and two dining areas and other areas where people can sit. Adaptations and hoists are provided throughout the home to enable staff to care for the needs of people living at the home. Most rooms have extensive views of the surrounding countryside. Level access is provided to the well-maintained grounds. The fees for personal care at Highborder Lodge range from £375 to £450 dependent on individuals assessed need.; The fee is determined by whether the needs for care are high, medium or low and whether the accommodation has en-suite facilities. The fees do not include the cost of items such as newspapers, toiletries, magazines, chiropody and sundry items and there may be charges for some outings/trips. Highborder Lodge DS0000016463.V342820.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key Unannounced inspection took place over nine and a half hours on one day in November 2007 and was completed by one inspector. Twenty-nine Standards for Older People including all twenty-two Key standards were assessed on this occasion. Of these six exceeded the standard and twenty met the standard, two almost met the standard and one was not applicable. Time during the inspection was spent speaking with the Registered Manager Mr Roger Thorne, Gen Stephens, administrator, staff and people living at the home. Eight people living at the home and two visitors were seen during the inspection, all were able to converse with the inspector fairly well. Information was also gained via observing other people living at the home. The Inspector observed care being provided to people and listened to the conversation and interactions between care staff, the manager and people living at the home. The inspector spent time cross-referencing information about the care and welfare gained from talking to and observing people with individual care records. A range of records were examined to include care plans, accidents, staff files, training records, quality assurance documentation and health and safety systems. A tour of the environment was also made. The pre-inspection Annual Quality Assurance Assessment (AQAA) record was provided to the Commission from the Provider prior to the inspection. Comment cards were sent to the service for distribution prior to the inspection and four relatives/representatives of people living at the home, one GP, who visits the home returned these, as did six people who live at the home. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: It was evident through discussion with people living at the home, who were able to talk to the inspector that they felt their views were always taken into account and ‘nothing was too much trouble’. They found the Manager and staff approachable, helpful and friendly. People spoken with confirmed that they were very happy with the home and the care and they had no concerns. They felt they were kept well informed and that there was appropriate stimulation in the home. People felt that they had the ability ‘to do what they liked’ and ‘they could go out if they wanted too’. There was confirmation that people were given choice in what they do Highborder Lodge DS0000016463.V342820.R01.S.doc Version 5.2 Page 6 and that independence was promoted as much as possible. All the comments made by people living at the home, relatives, in conversation and via questionnaires was very positive about the home, staff, care, activities and the food. There were a few minor grumbles but these had no impact on the outcomes for people living at the home. Interactions and communication between staff and people were observed during the inspection and it was noted that tasks were undertaken diligently, respectfully and compassionately. Staff were seen fully engaging with people living at the home throughout the day. Really positive interactions were witnessed. Carers spoke to people respectfully, provided explanations for why they were doing things and supported them throughout care, meals and activities. Whilst staff were busy there was a calm and unhurried atmosphere. A few people still are able to go out alone and some go out with friends or relatives. Lifestyle and hobbies are well recorded and social activity provision has improved immensely around individual interests. The activities are varied (group as well as individual) and are well attended by people who enjoy the activity and outing programme. The activity coordinator is well motivated and really enthusiastic about her role, which benefits the people living at the home. Management records relating to health and safety issues and regular checks were in place. There was evidence that if any action had been necessary that it had been completed. All incidents and accidents that require reporting under regulation 37 are completed and sent to the Commission. What has improved since the last inspection? The Homes’ Manager has always been involved in the home on a ‘day-to-day’ basis but a Senior Care coordinator who is an experienced Senior Carer now supports him. This has improved the communication with the Manager and the care team and assisted in supporting staff to take responsibility and be more accountable for their work. It has also allowed better coordination of care practice within the home and more consistency of care practice. It has also led to delegation of specific responsibilities to senior staff within the team, which assists in staff development. The recruitment of overseas staff has also improved the issues relating to staff shortages and has improved staffs working experience on a day-to-day basis. Staff report that there is resolution of issues and better communication than ever before and staff appear more diligent, motivated, happy and relaxed in their work. Documentation of care practice has improved although there are still some minor amendments to be made to make it fully compliant. The care practice is now supported by regular mandatory and skills training and this is assisting staff development. This results in the home being run safely and efficiently Highborder Lodge DS0000016463.V342820.R01.S.doc Version 5.2 Page 7 with people’s rights, independence and choice being safeguarded and protected. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Highborder Lodge DS0000016463.V342820.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 Highborder Lodge DS0000016463.V342820.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, 5 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that each prospective person is fully assessed prior to admission and on admission, to ensure that all their specific care needs can be met by the Home. The statement of terms and conditions and contract provides people with information about the service they will receive from the home. Intermediate care is not provided EVIDENCE: The Home sends a comprehensive package of information to prospective people and ensures that all prospective residents are seen and assessed prior to admission. The home offers visits to the home at times to suit individuals and ensures that senior staff are available to answer any questions. Highborder Lodge DS0000016463.V342820.R01.S.doc Version 5.2 Page 10 The pre-admission assessment has been delegated to one senior carer who is responsible for documenting this to ensure that the needs of each person can be fully met. This is reassessed on admission. There have several new admissions to the home since the last inspection. Talking to a new resident and their relative/representatives they were well informed about the home prior to admission and were assessed prior to coming in. They knew what to expect when they came. Individual care information was available in the home and was reviewed and updated regularly. Care records seen included an assessment of the persons’ needs prior to admission and on admission. The assessment was based on general information and on the activities of daily living in order to ascertain that a persons needs could be met by the home. People may also receive an assessment from the community nursing service if they have a health care need. A care plan is drawn up with each person and their relative based on the assessed need. People have contracts (not seen on this occasion) but it tends to be relatives / representatives or Social Services who deal with this and not necessarily the person who is to live at the home. This is due to the fact that many are unable to deal with this themselves or do not want to. The contract must contain all the required details and must be compliant with the Office of Fair Trading Standards. The fees for personal care range from £375 to £ 450 dependent on individual assessed need and the fee is determined by whether the needs for care are high, medium or low and whether the accommodation has en-suite facilities. People spoken with confirmed that they were ‘happy at the home and they liked the carers and received the help and care they needed’. Respite care is provided but not intermediate care. Highborder Lodge DS0000016463.V342820.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are treated with respect and dignity and facilitated and supported by staff to live as fulfilling and independent a life as possible within their own limitations. The care planning system involves the individual and their families and ensures that all members of staff have a clear understanding of the person centred care each person requires. EVIDENCE: Seven care files were examined in detail and for specific detail of care. All had a full and informative assessment completed, based on the activities of daily living, which is reviewed regularly. The home has improved in including the people and their family in the care planning process and some demonstrate agreement through signatory evidence and the aim is to have them all done. Speaking and observing the people whose files were examined confirmed that the needs identified reflected their current care needs. Highborder Lodge DS0000016463.V342820.R01.S.doc Version 5.2 Page 12 All had care plans for the problems identified and this was reviewed on a monthly basis with the person and signed by them in some cases. Daily records were not completed for all people living at the home, it appeared that when there were problems or any day-to-day incidents an entry was made but several care records examined had not had entries for a week or more. It is essential for the audit trail of care and incidents that an entry is made daily. The following care record refinements are required: • A Daily entry must be made in the daily notes for all everybody. • Where a person has a diabetic need a record of how frequently the BM test is being done must be care planned as well as who is doing it. The result must be recorded in the evaluation. • Where Injections are being given for specific reasons this must be care planned and the frequency and who is doing this. The evaluation must record when it was last given. • All care documentation must be completed fully with nothing left blank. • Where a person is intermittently aggressive the care plan must state in detail how the care staff are to manage the person. Risk assessments were completed for ‘moving and handling’ and these are reviewed monthly. Where someone has been assessed as at risk of pressure sores, health professionals have been contacted and appropriate equipment provided. Records of doctors and other multi -disciplinary agency visits are kept. These, daily records and conversations with people at the home confirmed visits from other health care professionals such as the chiropodist, optician, dentist etc, are arranged as required. Accidents and incidents were recorded and indicated that they were followed up and appropriate action was taken. But it was noted that all accident reports were still in the accident book these must be filed elsewhere in an audit file or on the personal file relating to the individual to comply with Data protection. Staff spoken with confirmed that they were fully informed about the needs of the people living at the home and how to meet their needs. People spoken with confirmed that they were very happy with the care received. Medication was examined at this inspection, a monitored dose system is in place and the responsibility for medication is delegated to named senior carer. There are good records of medication in and out of the home and Medication charts are completed diligently and no issues were identified at the inspection. The pharmacy is very supportive and carries out medication audits regularly. Doctors also review people’s medication when necessary and with some prompting at a minimum yearly. Highborder Lodge DS0000016463.V342820.R01.S.doc Version 5.2 Page 13 Medications are listed in the assessment on admission. Some of the staff spoken with confirmed that they had attended both initial medication training from Boots and have more recently undertaken a distance leaning package with a local college. Highborder Lodge DS0000016463.V342820.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 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People experience a stimulating and varied life at the home with visitors and community links encouraged, a varied and full programme of activities is made available and gives opportunity for social interaction, mental stimulation and religious preferences. Dietary needs are well catered for with balanced and varied selection of food available to meet tastes and choice. EVIDENCE: The Home has employed an activities coordinator who has had specialist training in this field. She has implemented an activities profile form for all people living at the home. She keeps a record of activities and also keeps record of attendance so that she can target activities and monitor what works well and what doesn’t. The activity coordinator and care staff spend ‘one-toone’ time with people who do not like group activities and this was valued greatly by people spoken with. Records seen confirmed all this. A notice board in the home indicates the weekly programme of events. She does reminiscence, board games, decoration making, themed activities, Music ands movement, walking around the garden, art class, bus trips and anything people living at the home would like her to arrange. She sees residents when Highborder Lodge DS0000016463.V342820.R01.S.doc Version 5.2 Page 15 they come in and discusses with them what they like doing. There are also activities that are run in the local village that some people do attend. The AQAA states that the home is planning to incorporate more trips out into activity plans and include families and friends in this. The Highborder Newsletter has been started to inform people and relatives about what is going on. The hairdresser visits each week and communion is held at the home. Many people like sitting or walking in the garden when the weather is warm. On the day of inspection one person had gone out on their own for a walk. One person stated that ‘she joins in with everything, she really enjoys it’; whilst another said she doesn’t join in activities as ‘she just enjoys reading her books, reading the paper, doing the crossword and watching the sport on TV’. One relative spoken with feels satisfied that her relative is offered activities to participate in and that activities are appropriate. Visitors are always made to feel welcome and there were a number of people visiting throughout the day. One felt that visitors received good support and hospitality as well as the people at the home. All who were spoken with felt they were offered choice in how and where they spent their days. People and the relatives spoken with confirmed that everyone was satisfied with the food provided. The home manager has reviewed the catering provision at the home with the seniors and has made two new cook appointments to enhance the quality and choice at the home. All food safety checks are completed to include fridge and freezer temperatures, food probing and food labelling and dating. Environmental Health visited in 2007 and work surfaces are to be replaced with stainless steel units. Apart from Diabetic diets there are no other special diets to cater for at present. Highborder Lodge DS0000016463.V342820.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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. All concerns and dissatisfaction are dealt with by the staff and the manager. People are protected from abuse. EVIDENCE: The home reported that they had received no formal complaints since the last inspection and the Commission has also not received any formal complaints. All concerns/grumbles are dealt with as and when they occur. There are always staff available to listen to any concerns/complaints, and these are recorded and then dealt with as necessary. The complaint procedure is in the Service User Guide and a copy is given to people on admission. Records of complaints and the response are kept on file by the manager. Eight people living at the home were spoken with and they knew about the complaint procedure even if they could not remember the detail, but they were happy to discuss issues/concerns with any member of staff or the Manager. They knew who to speak to if they had a concern or complaint and found the Manager and senior staff easy to approach and found that things were dealt with when they were raised. Two relatives spoken with stated that ‘they had no concerns about the care or the home and always felt confident to discuss concerns/issues with the Highborder Lodge DS0000016463.V342820.R01.S.doc Version 5.2 Page 17 Manager, deputy and staff’. They were positive about the home, the care and the staff. This was also evidenced from the questionnaires received. The home has its own policy on abuse. The Manager needs to ensure that he and senior staff attend the Enhanced Adults at Risk training. All staff have had abuse awareness /adult protection training evidenced by training records and certificates, this will be updated regularly. Staff spoken with confirmed they had received this training and knew what they would do if they saw abusive practice or saw anything that bothered them. The Manager states that the home needs to update the whistleblowing policy - to ensure that all people, visitors and staff are aware of policy. All staff must attend training on the Mental Capacity Act (2007). Highborder Lodge DS0000016463.V342820.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, 25 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The standard of décor within this home is good and no maintenance issues were identified. People live in a safe well-maintained environment. The standard of cleanliness was good at the last inspection there were issues of infection control identified and these have been addressed ensuring that people are not at risk of cross contamination and have a hygienic home to live in. EVIDENCE: Most of the rooms in the home were visited. All areas seen were clean, tidy and in good decorative order. Each room seen was personalised with personal possessions and had the required aids and adaptations individuals’ needed. The home has provided a new wet room shower facility, ideal for people with mobility problems. Everybody now has their own labelled toiletries and no Highborder Lodge DS0000016463.V342820.R01.S.doc Version 5.2 Page 19 shared toiletries were seen in communal bathrooms. There were no infection control issues identified during this inspection all bathrooms were clear of toiletries and protective clothing for staff was available in all areas. The AQAA stated that staff have been reminded to change gloves inbetween clients and to remove them after attending to each client. The inspector no longer saw staff wearing plastic care gloves all the time during their shift. All staff have received an update in infection control this year evidenced through training records and certificates. The Manager reported that he does a regular audit monthly of the home to check whether any work needs to be completed and to look for any health and safety issues. There is ongoing maintenance and this year a programme to recarpet the public areas of the home, fit stainless steel kitchen units and to purchase a new Cooker are on the agenda. The laundry area was compliant with the required work practices and infection control standards. Highborder Lodge DS0000016463.V342820.R01.S.doc Version 5.2 Page 20 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team are sufficient in numbers and now have access to training programmes to ensure they have the knowledge and skills necessary to provide care for the diverse needs of people living at the home. People living at the home are protected through recruitment practice at the home but the Manager needs to ensure that there are no gaps in the employment history to fully comply with Regulation 19. EVIDENCE: The lack of leadership of the care practice in the home appears to have been addressed by the new staffing structure and there appears to be more consistency in the care approach and a greater sense of responsibility and accountability for care and other tasks. Staff enjoy working at the home and felt that communication with the Manager had improved since the appointment of the Senior Care Coordinator and they now felt listened too in respect of care issues and they found that things now were actioned. A handover is given at each shift change. Staff feedback any changes in a person’s condition to the Senior Carer on duty. But entries on the daily care sheet are not done daily and it is essential that this is implemented for each Highborder Lodge DS0000016463.V342820.R01.S.doc Version 5.2 Page 21 person. Staff have access to the records and know all about the people living at the home and how to meet their needs, this was confirmed in discussion with staff members. Seven staff spoken with said that there was a good supportive team and it was a happy place to work. All staff stated that now the staffing is stable, through employment of overseas staff, there is enough time to give people the care they need. The staff stated that there was a keyworker system in the home and a list was available for the inspector to see. Staff feel they have time to spend with people now, as there are only a few highly dependent people. They confirmed that the home had regular staff meetings, which were minuted, albeit they did not feel they were frequent enough. People living at the home spoken with confirmed that the staff were very caring and met their needs and that they could choose when they got up, went to bed and what they did each day etc. All staff have undertaken mandatory training in fire, health and safety, moving and handling, food hygiene and first aid. Other training including infection control, Abuse awareness and clinical issues have been undertaken and are ongoing as the needs are identified. It is imperative that all new staff have their mandatory training updated once they are employed by the home, as the training provided by other organisations may not be to the standard that the home insists upon. Training records for some staff were seen. Staff are gradually completing National Vocational Qualification (NVQ) training and appear to enjoy doing this. Nine staff have an NVQ and seven are currently studying for one. Two cooks who have been recruited recently did not have any certificates on file relating to food hygiene, although this was confirmed at interview. The Manager reported that they would both be going on training to update their knowledge with the possibility that they would do the advanced certificate, which would enable them to train all staff in basic food hygiene, as all care staff have access to the kitchen and handle food. Records of four newly appointed staff were seen and these had improved. All had completed application forms, CRB/POVA checks, health questionnaires and two written references that were appropriate; Although in one case references had not yet been received (they was starting the following week), one did not have a full employment history (gaps were clarified during the inspection) and none had copies of training certificates on file, although these were apparently seen at interview. These issues must be rectified. There were no interview records or induction-training records seen on files and these must be implemented and available for inspection. Highborder Lodge DS0000016463.V342820.R01.S.doc Version 5.2 Page 22 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, 35, 36 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Management of the home is good and there now appears to be leadership, guidance and direction of care on a ‘day to day’ basis from the Senior Care Coordinator and this system appears to be benefiting the staff team as well as people living at the home The Manager manages the home demonstrating that the home is beginning to review all aspects of its performance through self-review and consultations seeking the views of residents, relatives and stakeholders. The home demonstrates that systems are in place to ensure the health; safety and welfare of people living and working at the home are protected. EVIDENCE: Highborder Lodge DS0000016463.V342820.R01.S.doc Version 5.2 Page 23 The Manager/Provider ensures that managerial duties are fulfilled and he has completed the NVQ Managers Award. The Manager and his staff are very approachable according to comments from several people seen at the inspection and from questionnaires received prior to the site visit. It was also observed by the inspector from interactions with visitors and relatives during the inspection. The manager /admin staff deal with all financial transactions for people at the home with regard to personal monies. A direct debit system has been implemented in the home and whilst it makes it easier to manage for the home many relatives are unhappy about it. Records were not seen at this inspection. The Manager audits the accounts regularly. The home has commenced a quality assurance programme and has a variety of regular monthly Manager audits in place. A questionnaire survey continues to be sent out to residents/their families etc; the results of these are collated and an improvement plan will be devised from these to indicate that views have been acknowledged and/or acted upon. Other survey possibilities were discussed including one to visiting professionals to the home. The Manager has or is in the process of implementing other audits of medication, medication records, daily records, care plans etc that will all contribute towards the Quality Assurance system in the home, so that any shortfalls can be identified and drawn to the attention of the staff responsible to rectify and ensure continuous improvement in the home. The Management still need to put together its Quality Assurance report and the development plan for the home for the next year so that continuous improvement in the home is maintained for the service that is provided and the staff team. When Accident records were examined it was noted that the accident form is being kept in the book. It is essential that under data protection that all these are kept elsewhere. Accident records should be checked and audited to monitor patterns in the home and this should be documented. Staff confirmed they had received some supervision and the system is ongoing. The supervision records seen indicated that the staff member had been observed during care practice and then had had a formal one-to-one session with their supervisor where staff and supervisor both discussed training needs, development and areas for improvement. This is then discussed and arranged with the Manager/administrator of the home. Where feedback is given to the member of staff this should be recorded. The system should be developed so that all staff receive formal supervision sessions at least six times a year. Catering and domestic staff should be included in the supervision and appraisal cycle. Highborder Lodge DS0000016463.V342820.R01.S.doc Version 5.2 Page 24 Some mandatory training and updates are still lacking for some staff and this is in the process of being addressed with the Manager/administrative staff trying to arrange a variety of training for staff. Staff spoken with, including someone fairly recently appointed had not received fire training to date, they had been talked through ‘fire Awareness’ on induction. Failure to comply with fire safety training requirements endangers the lives of the people living at the home and staff and must be rectified. Records were seen of fire safety checks such as fire alarm and emergency lighting check these were being carried out as recommended. All the required Health and Safety checks are in place. Temperature of stored water is checked and recorded for prevention of Legionella and the Manager has advised that yearly sampling and testing is also in place. Highborder Lodge DS0000016463.V342820.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 4 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 4 3 X X X X 3 4 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Highborder Lodge DS0000016463.V342820.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. Standard OP7 Regulation 15 Requirement Care planning issues to be addressed: 1) Evidence that the resident / family have been involved in the assessment and review process via signatory evidence. 2) Record whether residents consent to being checked during the night. 3) Where injections/treatments are being given for specific reasons, these must be care planned with the frequency and who is doing it. The evaluation must record when it was last given. 4) Where a person has a diabetic need a record of how frequently the BM test is being done must be care planned as well as who is doing it. The result must be recorded in the evaluation. 5) Implement signed disclaimers when the people choose to do something that is defined as putting them ‘at risk’. Highborder Lodge DS0000016463.V342820.R01.S.doc Version 5.2 Page 27 Timescale for action 20/03/08 6) A Daily entry must be made in the daily notes for everybody 7) All care documentation must be completed fully with nothing left blank. 8) Where a person is intermittently aggressive the care plan must state in detail how the care staff are to manage the person. 2. OP38 18(1a & c) 1) All new staff to have their mandatory training updated when they are employed. 2) All staff to receive Fire Safety training. 3) Copies of training certificates must be on personal file. 4) Induction training records to be on files and signed. 3. OP18 13(6) All staff must attend training on the: (i) Mental Capacity Act. (ii) Updated Adult Protection procedures. 4. OP9 13 A documented record must be kept of the medication fridge temperature. 20/03/08 20/06/08 20/03/08 5. OP38 37(e & f) i) Individual Accident records 20/03/08 must be kept in compliance with data protection and be accessible for auditing purposes. ii) A documented accident auditing system must be implemented. 6. OP33 24 The Quality Assurance system DS0000016463.V342820.R01.S.doc 20/06/08 Page 28 Highborder Lodge Version 5.2 needs to be further developed in the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP29 OP29 OP36 Good Practice Recommendations Interview records to be implemented and placed on personal files An Interview/induction checklist for the administration team to be implemented. 1) Ensure supervision is implemented for all staff at least six times a year. 2) Where feedback is given to a member of staff during supervision the feedback must be recorded and signed by both parties. Highborder Lodge DS0000016463.V342820.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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