Care Home: Highcliffe

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What has improved since the last inspection? This is the first inspection of the service under new ownership. However in the last six months there has been a programme of refurbishment and redecoration which helps to ensure the comfort of those living at Highcliffe. The Registered Manager confirmed that a great deal of work has been done by the staff to improve the standard of care provided to those living at Highcliffe. Care documentation now provides clear information to staff about how care needs are to be met. We saw that the care plans in place are being adhered to, which means that residents are receiving an appropriate level of care. Staff are sensitive to changing needs and act accordingly. The home has adopted a much more person-centred approach to care. Activities are arranged around the preferences of people living in the home and they told us they enjoyed them. What the care home could do better: HighcliffeDS0000072874.V375488.R01.S.doc Version 5.2 Page 7The Registered Manager confirmed that the refurbishment programme will continue and the upgrading of some bathrooms is planned soon. To ensure that medication procedures are staff the home needs to make sure the controlled drugs cupboard complies with the Misuse of Drugs Regulations 2007. When staff administer medicines prescribed `as required` there must be an individual care plan in place. This will ensure that guidelines are available to all staff who give this medicine. Key inspection report CARE HOMES FOR OLDER PEOPLE Highcliffe 5 Stuart Road Highcliffe Christchurch Dorset BH23 5JS Lead Inspector Amanda Bell Key Unannounced Inspection 19th May 2009 09:00 DS0000072874.V375488.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Highcliffe DS0000072874.V375488.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Highcliffe DS0000072874.V375488.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highcliffe Address 5 Stuart Road Highcliffe Christchurch Dorset BH23 5JS 01425 272093 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) highcliffe@kingsleyhealthcare.com Althea Healthcare Properties Ltd Paul Joe Benjamin Suenfa Care Home 45 Category(ies) of Dementia (45), Old age, not falling within any registration, with number other category (45) of places Highcliffe DS0000072874.V375488.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Dementia (Code DE) The maximum number of service users who can be accommodated is 45 New service 2. Date of last inspection Brief Description of the Service: Highcliffe is a large detached property, which stands in well-maintained gardens with parking to the front of the home. The home benefits from being a short walk away from the sea and main high street of Highcliffe village with its various amenities. Highcliffe is registered to accommodate a maximum of forty-five residents, for nursing care and personal care related to dementia type illnesses. The home is owned by Althea Healthcare Properties Ltd. Mr Ben Suenfa is the Registered Nurse who manages the service. Accommodation is provided in both single and shared rooms, although some shared rooms are utilised as single room occupancy. Many of the areas of the home have been upgraded and refurbished and now present desirable accommodation to residents in well furnished, clean bright rooms. All areas of the home are accessible by ramps, stairways and a passenger lift. Other mobility aids provided include grab rails, bath hoists and individual mobility aids are in place as required. Current fees are: £650 to £1275. See the following website for further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choos.aspx Highcliffe DS0000072874.V375488.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. This unannounced inspection took place on the 19th May 2008 over a period of approximately five hours. The purpose of the inspection was to assess all of the key standards. This is the first inspection of Highcliffe under the ownership of Althea Healthcare Properties Ltd. The Registered Manager, Mr Ben Suenfa, was on hand throughout to aid the inspection process. Information gathered for this report came from several sources including: • Reports made to the Care Quality Commission by the home. • The annual quality assurance assessment completed by the home. • Discussion with people living, visiting and working at the home. • Tour of the premises. • Review of a variety of documentation including care records, staff records, maintenance records, policies and procedures. Because people with dementia and/or complex needs and ways of communicating are not always able to reliably tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand. We call this Short Observational Framework for Inspection (SOFI). This involved our observing up to five people who live at the home for two hours and recording their experiences at regular intervals. This included their state of well being, and how they interacted with staff members, other people who use services, and the environment. We observed five people with dementia and/or communication needs in the main lounge and dining room. The two-hour period included lunchtime. During the course of the inspection people were asked their views on the service provided at the home. The comments we received included: “I am very happy with the care. I can’t praise it highly enough.” “We are always made welcome.” “We are consulted about the care our relative receives.” “We receive good training. The team work is good.” Highcliffe DS0000072874.V375488.R01.S.doc Version 5.2 Page 6 What the service does well: No one moves into the home without having their needs assessed which means that the home and the person considering moving in can be clear that this is the right place to care for them. People living in Highcliffe are able to keep in touch with the people in their lives that are important to them. Friends and family are made very welcome. People using this service could be confident that they would be listened to if they were unhappy with any aspect of the care given. The environment people live in is a safe, clean and comfortable one. There is enough staff on duty each day to ensure that people’s needs are met. Good recruitment practices mean that people are in safe hands. A robust quality assurance process means that people living in the home can be assured that it is run in their best interests. What has improved since the last inspection? What they could do better: Highcliffe DS0000072874.V375488.R01.S.doc Version 5.2 Page 7 The Registered Manager confirmed that the refurbishment programme will continue and the upgrading of some bathrooms is planned soon. To ensure that medication procedures are staff the home needs to make sure the controlled drugs cupboard complies with the Misuse of Drugs Regulations 2007. When staff administer medicines prescribed ‘as required’ there must be an individual care plan in place. This will ensure that guidelines are available to all staff who give this medicine. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Highcliffe DS0000072874.V375488.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 Highcliffe DS0000072874.V375488.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3. Standard 6 is not applicable to this service. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New residents move into the home having had their needs assessed and been assured that these needs will be met fully. EVIDENCE: The care files for three residents were inspected. These showed that the home had a good procedure in place. Prior to anyone moving into the home a full assessment of needs was undertaken with the prospective resident. Sufficient information was obtained so that a care plan could be drawn up and made available to staff. We spoke with relatives who told us that the Registered Manager had encouraged them to visit Highcliffe before a decision had been made about admission. They said that Mr Suenfa had given them all the information they needed to make an informed choice. Highcliffe DS0000072874.V375488.R01.S.doc Version 5.2 Page 10 Highcliffe DS0000072874.V375488.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 & 10. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems are in place to provide staff with the information they need to meet the health and personal care needs of residents. The principles of respect, dignity and privacy are put into practice. People are protected by the home’s procedures for the safe handling of medicines. The use of medicines prescribed ‘as required’ must be supported by appropriate guidelines. EVIDENCE: We reviewed care files for four people living at the home. Each file contained detailed assessments, from which staff had used the information to formulate a detailed plan of care. Each file contained a life story of the resident if they were happy to share this information. This helped to inform staff about the Highcliffe DS0000072874.V375488.R01.S.doc Version 5.2 Page 12 personal preferences of each individual in their care and as a consequence we found that care plans were more person centred. During the inspection we observed that care was given in accordance to the written plans. Staff had good relationships with the people living at the home and were patient and encouraging. People with dementia freely approached staff and staff gave them appropriate reassurance when they seemed unsure, distressed or anxious. Staff supported people to spend their time how and where they choose, for example, two of the people observed like to walk and spent time with each other walking around the home. Staff were observed to be relaxed with people. They reassured people by talking quietly, touching and supporting them when they were unsettled. Staff and people laughed and chatted together and clearly enjoyed each other’s company. Where the need for specialist equipment was identified it was provided. This included pressure relieving mattresses and cushions and a variety of moving and handling equipment. It was clear from discussions with staff and visitors that people living at Highcliffe have access to the health services they need. There was evidence to show that residents got support from General Practitioners, district nursing services, mental health professionals, opticians and chiropodists. Our Pharmacist Inspector looked at arrangements for the handling of medicines. All medicines were stored securely, however the controlled drug cupboards must be updated to comply with current legislation. Medication administration records had been clearly completed with signatures for administration or codes to show why a medicine had not been given. The records had photographs with them to aid identification and details of allergies. We saw medicines being given and this was done in a safe manner with consideration for people’s particular needs. Staff keep appropriate records of all medicines received and returned for destruction and the management undertake a regular audit. All staff who give medicines have had suitable training and some people have been trained in extra techniques so that they can support people in the home with more complex health needs. Some people have medicines prescribed for use ‘when required’. The use of these medicines is clearly recorded along with the reasons that they have been given, but there was no individual care plan to support staff to make a decision about using them. We spoke with several visitors to the home who confirmed that staff treated their relatives with sensitivity and respect. They said, “Staff are extremely caring. I am always kept informed of what is happening.” “Staff are excellent.” Highcliffe DS0000072874.V375488.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Highcliffe are encouraged to maintain as much independence as possible. Social and leisure activities are varied and suited to the preference and ability of each resident. EVIDENCE: The two-hour observation session started towards the end of the morning and covered lunchtime. The staff interacted in a positive way with people and in return, people’s moods were relaxed and positive. During the observation time the people observed were engaged in activities, either with staff, visitors, and other residents or by themselves. An activities co-ordinator was employed and a programme of activities arranged around the preferences of the residents. Highcliffe DS0000072874.V375488.R01.S.doc Version 5.2 Page 14 Visitors we spoke with confirmed that they could meet their friend or relative in private if they wished. Menus showed that the people who live there have a choice of meals through the day. The menu was varied and meals appeared nutritious. Staff observed at lunchtime, supported people in a quiet and sensitive way, they sat down with people and described the food that they were helping them with. People told us that the enjoyed the food. Highcliffe DS0000072874.V375488.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure. Protection from abuse is promoted. EVIDENCE: To ensure residents and their representatives have access to the complaints procedure it is included in the information pack given to each resident. People told us that they knew how to complain and felt confident that if they had concerns or complaints they will be listened to and taken seriously. One complaint had been received in the last year and had been investigated following the home’s written policy. The home has developed and implemented written policies and procedures for the protection of residents from abuse or neglect and provides all staff with training in the understanding of abuse and their role in protecting residents from abuse in its many forms, including neglect. Care staff spoken with during the inspection confirmed that they had received such training. Highcliffe DS0000072874.V375488.R01.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is maintained and furnished so that people live or stay in a homely, clean, comfortable environment. EVIDENCE: A tour of the premises and review of maintenance documentation showed the home is well maintained inside and out. There was evidence that equipment is serviced regularly. However some of the bathrooms were in need of refurbishment. The Registered Manager confirmed that this was scheduled to take place in the near future. Residents have easy access to all communal areas. The well-tended garden is attractive and easily accessible. Highcliffe DS0000072874.V375488.R01.S.doc Version 5.2 Page 17 The home had recently purchased several new items of furniture, including armchairs. Bedrooms were personalised with a variety of mementos, pictures and small items of furniture. All areas of the home seen during the inspection were clean, bright and free from any unpleasant odours. The laundry was well managed. Adequate supplies of clean linen were seen to be available. Highcliffe DS0000072874.V375488.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient care staff are employed to meet the needs of residents. Robust recruitment procedures are in place to protect residents from the risk of unsuitable staff working at the home. Generally staff are given the training and support so that they can give a good standard of care to the residents living at the home. EVIDENCE: At the time of inspection staff rosters demonstrated that there were sufficient staff on duty at that time. During the inspection staff were on hand to meet the needs of the residents. Residents spoken with confirmed that staff were available when they needed them and they were not kept waiting. The home has an ongoing training programme, which includes NVQ level 2 in care and at the time of inspection 29 of care staff held this award and further candidates were working towards this achievement. We reviewed three staff recruitment files. The files were well ordered and contained all the information required by law. POVA first and enhanced Criminal Record Bureau checks had been obtained for all new staff. Highcliffe DS0000072874.V375488.R01.S.doc Version 5.2 Page 19 Training files demonstrated that staff were receiving induction training and staff we spoke with confirmed that they were encouraged to take up training opportunities provided. Recent training included dementia care, better food for health, fire safety, basic food hygiene, health and safety and infection control. However, for some new staff, there was a period of delay before some training was given, for example, moving and handling training. A requirement has been made that staff receive the training appropriate to the work they are expected to perform before they undertake such tasks. The home used distance learning packs for several types of training undertaken, for example, first aid. As this is such a hands on skill we have recommended that the training for it is more practical. This will help promote the health and safety of residents and staff alike. Highcliffe DS0000072874.V375488.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 & 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well organised and the daily management and running of the home centres round the care of residents. Good management practice, systems in place, and records kept, confirm the health and safety of all in the home. EVIDENCE: Through observation and discussion it was evident that those people living at, visiting and working enjoyed the way the home was being run and found the Registered Manager was approachable. Mr Suenfa demonstrated throughout Highcliffe DS0000072874.V375488.R01.S.doc Version 5.2 Page 21 the inspection that he ran the home well. People told us, “Ben is very good.” “The home is interested in what we have to say.” Mr Suenfa followed robust procedures to ensure that he had a well-trained and competent staff to care for those people living at the home. There were quality assurance and quality monitoring systems in place. The home took steps to review its performance regularly and residents’/relatives’ views were sought and suggestions put forward were acted upon. Recent feedback from visitors to the home was very positive and highlighted the improvements made to the service. The Registered Manager confirmed that the home held a small amount of money for residents if they so wished. Records showed that all such monies were accounted for. Records showed us that most staff had received recent training in fire safety and manual handling updates. Substances hazardous to health were seen to be stored securely. Records showed that equipment had been serviced regularly. Highcliffe DS0000072874.V375488.R01.S.doc Version 5.2 Page 22 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 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 3 X 3 X 3 X X 3 Highcliffe DS0000072874.V375488.R01.S.doc Version 5.2 Page 23 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. OP9 Standard Regulation 13(2) Requirement Controlled drugs must be stored in a cupboard that complies with The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007. This will ensure that the medication is stored securely. The use of medicines prescribed ‘as required’ must be supported by an individual care plan. This will ensure that guidelines are available to all staff who give this medicine. The Registered Manager must ensure that staff receive training appropriate to the work they are to perform. This includes moving and handling training. Timescale for action 24/08/09 2. OP9 13(2) 06/07/09 3. OP30 18 24/08/09 Highcliffe DS0000072874.V375488.R01.S.doc Version 5.2 Page 24 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. Refer to Standard OP28 OP30 Good Practice Recommendations The ratio of 50 of care staff should hold the NVQ level 2 award in care. Staff should have robust first aid training. Highcliffe DS0000072874.V375488.R01.S.doc Version 5.2 Page 25 Care Quality Commission South West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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