Care Home: Highcliffe House Nursing Home

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What the care home does well The home is providing many good quality outcomes for people. When we asked people surveyed living at Highcliffe house what they feel the home does well, people`s comments included `meals are good, care is good, home is clean, they look after me`, `everything I have ever needed, I just would need to ask and it would be achieved`, `look after us, make sure we are comfortable, food is lovely`, staff` friendly`, and `always someone here to talk too/look after you`. Relatives survey comments on what they felt the home does well included `activities` and entertainment - especially at Christmas`, `food is freshly cooked and well presented.`, `complaints are dealt with swiftly, staff are polite and courteous`, `cleanliness - linen is spotless and rooms well kept`, friendly and welcoming to visitors`, `carers are cheerful`. and `I feel my (person`s name) is well-cared for, safe and content`. Staff tell us that they are receiving the training and support to be able to undertake their role. One relative in summing up the home told us `on the whole a friendly, cheerful, well run nursing home`. What has improved since the last inspection? Requirements made at our last inspection has been addressed. New safety bed rails have been purchased to replace the ones we identified `were not fit for purpose`. Staff have received further training in the fitting and monitoring of the bed rails to ensure they are kept in safe working order. There are systems now in place to follow up on any accidents or incidents, to see why the situation happen, and if any action can be taken to prevent it happening again. A nurse is being given dedicated time each month to oversee the ordering, checking in of medication and undertaking `audit` checks. This is to check nurses are completing resident`s medication records correctly, and residents are receiving their prescribed medication. The home now has a dedicated member of staff responsible for ensuring staff receive a range of training to support them in having the skills and knowledge to meet the ranged of resident`s needs. What the care home could do better: Although the manager has audit systems in place to check that nursing staff are completing medication records, and giving people their medication as prescribed, shortfalls are still being identified. Further systems need to be in place to ensure prior to going off shift, nurses are double checking that paperwork has been completed properly, and all medication has been given. The home needs to continue developing their care plan, to ensure it fully reflects resident`s preferences, like and dislikes, and gives information on how staff are monitoring residents well-being and emotional needs. The home needs to improve their recruitment administration procedures, to ensure new staff do not start work at the home until the required references have been received. Although the manager had stopped the carer working as soon as they spotted the missing paperwork, there should have been checks in place, to prevent this situation from happening in the first place. Key inspection report Care homes for older people Name: Address: Highcliffe House Nursing Home 10 Cobbold Road Felixstowe Suffolk IP11 7HQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jill Clarke     Date: 0 7 0 4 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Highcliffe House Nursing Home 10 Cobbold Road Felixstowe Suffolk IP11 7HQ 01394671114 01394671298 alison@highcliffehouse.com www.highcliffehouse.com Highcliffe House Limited Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Bridget Bone Type of registration: Number of places registered: care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Highcliffe House is registered as a care home with nursing, providing care for a maximum of 32 older people. The home is privately owned by Highcliffe House Limited and is managed by Mrs Bridget Bone. Highcliffe House is a large Edwardian building situated in a residential area of Felixstowe within walking distance of the sea front and local amenities. It is a detached building with gardens to the front of the property and parking at the rear. Accommodation is over three floors with communal rooms located on the ground floor. Access to the upper floors is by stairs or passenger lift. Fees (as given in their Service users Guide April 2010) range from £650.00 to £700 per week depending on the level of care needed and the accommodation occupied. The Care Homes for Older People Page 4 of 34 0 1 0 5 2 0 0 9 0 Over 65 32 Brief description of the care home fees do not include the cost of toiletries, hairdressing, chiropody or newspapers. Fees for Respite/Convalescent care are from £100 per day, and weekend breaks can also be arranged (from Friday afternoon to Monday morning) at a cost of £285 per person. The home also provides Day Care, although this is not regulated by ourselves. Please contact the home direct for a copy of their Statement of Purpose, which gives further details on fees, and what the home is able to offer. Care Homes for Older People Page 5 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We (The Commission) visited the home unannounced, to carry out a key inspection where we focused on assessing the outcomes for the people living at the home, against the key Lines of Regulatory Assessment (KLORA). In undertaking this, it helps us get an idea, from a residents view point, of what it is like living at the home, and feedback on the level of service they receive. The report has been written using accumulated evidence gathered since their last key Inspection (30th April 2009), and during this inspection. Earlier in the year we sent surveys to the home to give out. This gave an opportunity for people using, working in, and associated with the service, to give their views on how they thought the home is run. At the time of writing this report we had received completed surveys back from fifteen residents, six relatives, one Health Care Professional (General Practitioner), and nine staff. Comments from which have been included in this report. Care Homes for Older People Page 6 of 34 We also looked at the homes Annual Quality Assurance Assessment (AQAA) sent to us in February 2010. This provides the Care Quality Commission with information on how the home is meeting or exceeding the National Minimum Standards (Care Homes For Older People), and any planned work for the next twelve months. Comments from which have also been included in this report. The Registered Manager Mrs Bridget Bone was available during the inspection, to answer any questions and provide records to support work undertaken at the home. During our visit, we spent time talking to eleven residents, and a visiting relative, to gain peoples views on the home. We also spent time with the duty nurse, activities organiser, and person responsible for training. This supports us in identifying how well the home is being managed, and if staff are being supported, and receiving the training to be able to fulfill their role. Records viewed included, care plans, staff recruitment and training records, menus, staff rotas, Analysis of Patients Quality of Care Survey for 2009 and 2010, Incident reports, Statement of Purpose, Service Users Guide, and medication records. This further evidenced the on-going work being undertaken at the home. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: Although the manager has audit systems in place to check that nursing staff are completing medication records, and giving people their medication as prescribed, shortfalls are still being identified. Further systems need to be in place to ensure prior to going off shift, nurses are double checking that paperwork has been completed properly, and all medication has been given. The home needs to continue developing their care plan, to ensure it fully reflects residents preferences, like and dislikes, and gives information on how staff are monitoring residents well-being and emotional needs. Care Homes for Older People Page 8 of 34 The home needs to improve their recruitment administration procedures, to ensure new staff do not start work at the home until the required references have been received. Although the manager had stopped the carer working as soon as they spotted the missing paperwork, there should have been checks in place, to prevent this situation from happening in the first place. 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. Care Homes for Older People Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents can expect to be given sufficient information on the home before they move in. This supports people in being able to identify if the home will be able to offer the level of service, and environment they are looking for. Evidence: When we asked the residents we surveyed, if they felt they had received enough information to help them decide if the home was the right place for them, before they moved in, nine people replied yes, one person answered no, and five people said that they didnt know. Relatives surveyed told us that they felt they had been given enough information to support them, and their next-of-kin in deciding if to move into the home or not. When we then asked if the relatives felt the home was able to meet the needs of their next-of-kin, four people answered always, and two usually. The homes registration certificate is displayed on the wall in the entrance hall, so people can see who the home are registered to provide care for (Frail Older People). Care Homes for Older People Page 11 of 34 Evidence: There is also a copy of the homes Statement of Purpose near the signing in book for people to look at, last updated 30th March 2010, and provides information about the home, and the facilities and services on offer. There was also a copy of the homes Service Users Guide available for people to read. Discussions with the manager identified that at the present time, residents are not being given their individual copy of the guide, and therefore would be reliant on reading the copy kept in the front hall. However, to ensure residents can use the service users guide as a reference booklet, the manager is going to arange for everyone to be given their own copy which they can keep in their bedroom if they wish. The AQAA tells us that we welcome informal visits from relatives, friends and prospective clients. Feedback from residents and relatives surveyed, showed that any contact people have with the home has been met by the very friendly and helpful staff, who are happy to answer any questions they may have. The AQAA also tells us that the staff will identify if there are any special needs or requirements prior to admission, to make the process as straightforward as possible. The pre-assessment is undertaken by a trained, experienced member of staff who arranges to visit the prospective resident at their own home or care setting. By undertaking their own preadmission assessment, it supplements the information, where applicable, obtained from the persons social worker. It also enables the member of staff to meet the prospective resident in person, answer any questions the person has and identifiy if they will be able to provide the level of care and enviroment the person is looking for. A General Practitioner completing our survey when we asked them if the care homes assessments arrangements ensures accurate information is gathered, so the right services can be planned for the new resident, they answered usually. When asked what they felt the service does well they replied all aspects of medical and social care. During the inspection we spoke to two new residents, whose care plans held a copy of a pre-assessment which had been undertaken by the manager, before the people moved into the home. The assessments gave a good level of initial information to support the staff to identify if they will be able to meet the peoples needs, and used as the basis to start developing the peoples individual care plans. Discussions with the two residents identified that although they did not visit the home before hand, their relatives had undertaken this on their behalf. People can also have a taster of what the home is like, through booking a weekend Care Homes for Older People Page 12 of 34 Evidence: break, or staying for a longer period as respite/convalescent care. New residents we spent time talking with, confirmed that they felt the home was able to meet their needs, with one resident telling us that they didnt like it at first as they did not want to leave their home. However, they went on to say that they now felt more settled, and they think it is very good here. When we asked relatives do they feel the home meets the needs of their next-of-kin, four poeple replied always and two usually. Care Homes for Older People Page 13 of 34 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect staff to treat them with respect, and for their physical and nursing needs to be monitored, and where needed, appropriate action taken to address any health issues. Evidence: Residents completing our survey when we asked do you receive the care and support you need, fourteen people answered with either always or usually, with one person telling us sometimes. Their comments under what the home does well included care is good - they look after me, general care, I am looked after and they look after me properly. Each resident has their own care plan file, which staff start to put together once the residents pre-assessment has been completed. The care plan contains information and guidance for staff on how to support residents with their individual nursing, mental and physical care needs. This includes any support a resident requires with their mobility, including any aids such as a hoist, monitoring the condition of their skin, and taking appropriate action to prevent pressure sores occurring. Files seen Care Homes for Older People Page 14 of 34 Evidence: held information from other health and social care professionals who have been, or are currently involved with their care. Nutritional assessments are being undertaken to check for any malnourishment on admission, and on-going monitoring to check that residents nutritional needs are being met. Where staff have identified that a resident requires extra nutritional support, they had sought the guidance from a dietitian. Care plans held information on how residents personal hygiene needs are being met, and risk assessments to ensure their safety. At the front of the care plan there is a quick reference list which gives staff sufficient information to be able to provide assistance if they have not met the resident before. This is backed up by more detailed information later in the care plan, which is being regularly updated. During our inspection we met a Chiropodist who visits regularly, and a relative told us that a Physiotherapist also visits weekly, giving advice on gentle exercise, and any mobility problems. When we asked residents completing our survey if they get the medical care they need, fourteen people replied always, and one answered sometimes. Relatives surveyed told us that they felt staff always or usually responded to the different needs of the residents. Comments from relatives included the home looks after my sister well, and routine medical attention never fails. A visiting General Practitioner told us in their survey, a patient, 18 months bedridden, had no pressure sores or even impaired pressure areas. No secondary chest problems, and no concerns regarding feeding and hydration. This they felt was put down to the multiple daily nursing care intervention, the resident received throughout the time of their illness. During the inspection we tracked two residents care. This involves, meeting the people and gaining their views on their care, discussing their care needs with staff, where applicable their relative, and looking at the residents care records, to see if it reflects the level of care they say they are receiving. Both residents were of smart appearance, and required differing levels of nursing care and support, which was reflected in the information given in their care plans. They told us they are happy with the care being provided which is pretty good. Discussions with the residents confirmed that the support they required with their physical, and nursing needs, reflected the information given in the care plans. The AQAA under how we have improved in the last twelve months, informs us that they have devoted more attention to care planning and person centred care. We could see the improvement since our last inspection. However, to be person centred, we fed back to the manager further work needs to be undertaken to show how peoples emotional and well-being needs are being met. We also gave the manager examples where information obtained during the pre-assessment, about their likes Care Homes for Older People Page 15 of 34 Evidence: and preferences had not been incorporated in their main care plan. The daily records staff complete, generally focused on nursing and care tasks undertaken, rather than the state of the persons well-being. We noted that the words had a settled day or settled morning was often used by staff to describe the quality of the persons day. The care plan information tended to focus on what a person could not do, rather than what a person is able to do for themselves, and which areas they require support with. For example for one of the residents whose care we tracked, their care plan stated assist with a daily wash with aid of one person, there was no further information on the level of assistance the resident required and what the resident was able to do for themself. In knowing this it will prevent staff from taking over, and doing tasks that the resident is able to, therefore supporting people to maintain their independence. However, time spent talking to staff identified that although it was not written in the care plan, they told us if staff passed them the flannel that the resident could wash themselves. The AQAA informs us that the homes management of medication within the home has improved during the last year, and that they have easily checked audit trails of their medication. We looked at the medication systems they have in place which includes a nurse, being given dedicated time to order and check medication in, to ensure the right amount of drugs is ordered and received. They also audit residents previous months Medication Administration Records (MAR), to ensure that staff have completed them properly, and follow up any identified shortfalls such as staff not initialing to confirm that medication has been given. Looking at the MAR we found for the resident whose care we were tracking, that although the medication they had brought in on admission had been written on the sheet, they had not written how many tablets they had brought in. The home has set procedures and guidance for staff to follow to ensure safe practice are followed. The audit systems the manager has put in place was to address the shortfalls we identified during our last inspection. We noted that there has been improvements, however, even with the checks in place, we identified staff are not always following correct procedures. Therefore further work needs to be undertaken. We spent time with the manager going through the MAR sheets together, so they could see our findings. This included three incidents where staff had not signed the MAR chart, however a check of the amount of medication left confirmed that it had been given. For another resident we found more tablets in the container than had been prescribed, when the manager looked further at the additional three tablets contained, they felt that staff had removed it from the residents previous medication Care Homes for Older People Page 16 of 34 Evidence: packet, and put it with the new ones. As the foil, containing the three tablets had been cut, it did not clearly give the name of the medication, so the manager destroyed them straight away. A check of how many tablets for another resident also identified that one that had been signed for, was still sitting in the container, indicating that it had not been given. The manager confirmed that they would be discussing the shortfalls with the nurses involved, and taking action to prevent the situation happening again, and putting in further audit checks. We also identified good medication practices, with staff writing the date on containers which have a limited shelf life, to show when they were first open. The use of residents photographs on the front of their individual MAR sheet, to support new and agency staff in identifying they have the right person. When a resident is being written up for one or two tablets, staff are entering on the MAR chart the amount given. Residents controlled medication is being recorded in a bound register which gives details of the medication held and when it is being given out or received. We did a sample check of two residents medication to check that the amount held in the lockable cupboard, was the same as given in the register. We found the level of medication held, correct to the totals given in the drug register. The manager also confirmed how they are safely disposing of any unused medication including controlled drugs using specialist waste bins. A resident confirmed that they are receiving their medication at the right time. When we asked relatives what they feel the home does well, five out of the six relatives commented on how courteous, polite, friendly, and helpful staff are, which we also noted during the inspection. Staff never walked past a resident or visitor without acknowledging them, and many times we saw staff instigate a conversation, as part of acknowledging the resident as they entered the communal rooms. Staff were seen to close bedroom and bathroom doors, before providing personal care. In the upstairs bathroom we noted a modesty blind which can be moved across to protect residents dignity and privacy when they are in the bath, or using the toilet, to ensure if staff need to leave the room, they would not be seen when the door is opened. Care Homes for Older People Page 17 of 34 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to be offered nutritious home cooked meals, and have a range of activities going on in the home, to take part in if they wish. Evidence: We received a positive response when we asked residents if the home arranges activities that they can take part in, with fourteen people saying always, and one usually. The homes own quality care survey, in response to being asked the same question, seventeen residents replied yes and two residents said sometimes. During the inspection residents told us something was always going on. A relative praised the work of the motivated young person who arranges the activities. Part of the activitiy organisers role is to meet with new residents and gain an insight into their life, and what kind of social hobbies and interests they have, and would like to take part in. This is undertaken by completing an Therapeutic activities assessment form. The two we looked at we found to be very informative, and written in a more person centred way. The completed Therapeutic activities sheet filled in on the days the resident had joined in with either group of one to one activities, also contained information on the residents emotional well-being, an area we had found missing in the care plan daily write ups, which were more task orientated. Care Homes for Older People Page 18 of 34 Evidence: In the entrance hall there is a list of the weeks activities going on in the morning and afternoon, and on a white board in larger letters it sets out the morning and afternoon activities for the day we inspected. This included a Quiz, and classical music in the morning, Bingo and show tunes in the afternoon. The hairdresser was also visiting for the day, and had a constant stream of customers. When asked what the home does well, a relative surveyed told us activities entertainment, especially at Christmas. Another relative when asked what they felt the home could do better, asked if it would be possible to hire the local community transport bus occasionally, to get people out of the home, as currently there is one trip a year to a beach house. The location of the home is ideally located for walks along the beach front, or visiting the local shops, and cafes, and we met a resident and their next-of-kin who had just come back from one of their daily trips out. When we asked residents surveyed if they like the meals at the home, eleven residents answered always, two usually and two sometimes. Four residents when asked what they felt the home does well had commented on the good food. One resident when asked what the home could do better replied be a bit quicker on breakfast. The residents information board, gave details of the days lunch time menu, which was sausage meat pie, mashed potatoes, vegetables, followed by lemon layer pudding. We did not observe the lunchtime routines, however after lunch we asked the resident who we were tracking, their view on the meals. They told us that it is good, saying that although they always viewed themselves as being a faddy eater, they had found since moving in, that they are very happy with the meals. They also enjoyed their pre-lunch sherry. During the inspection, when visiting residents in their bedrooms, or when walking around the communal lounges we noted that residents had cold drinks close at hand, and staff regularly came round serving hot drinks. Feedback from residents, and relatives through surveys, and in person during the inspection was very positive over the friendly staff, who are welcoming to visitors. Time spent talking to residents in small groups and one to one, identified that they are able to make decisions on what they do, get up when I want, and what they wish to join in with at the home. Care Homes for Older People Page 19 of 34 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 can expect staff to listen and act on their concerns, and where applicable take appropriate action to safeguard their welfare. Evidence: When we asked residents surveyed if there is somebody informally they can speak to if they are not happy, thirteen residents answered yes, and two people said no. When asked if they know how to make a formal complaint, the numbers were lower, with eight residents saying they did, and seven people saying they were unaware how to do it formally. At the current time, residents are not being given their own copy of the homes Service Users Guide which contains information on how to complain. Therefore residents are reliant on looking at the information given in the reception area. However, as discussed in the information section of this report, the manager is going to ensure that each resident is to be given a copy of the service users guide, which will give them easy access to the information, if they ever needed it. The relatives we surveyed were all aware of the homes formal complaints procedure. When we asked if the home had responded appropriately if they, or the person using the service had raised any concerns, out of the five people answering this question four answered with an always, and one said usually. One relative commented that complaints are dealt with swiftly. Time spent talking with residents identified that if they have any concerns they would Care Homes for Older People Page 20 of 34 Evidence: be comfortable to discuss the matter with staff, with one resident telling us I have no complaints at all. Staff surveyed, all confirmed they know what action to take if a person raises concerns about the home. The homes Statement of Purpose contains information on the homes arrangements for dealing with any complaints, saying it welcomes comments, concerns or complaints about the services delivered or how to improve the running of the home. It goes on to say that any complaints or concerns about the service provided by the home will be treated seriously. The home has a comments, concerns and complaints book which is situated on the reception desk which informs people how they can make a formal complaint. Any person making a complaint are told that they will received a verbal response within 24 hours from the management. It also informs the complainant that every effort will be made to resolve the complaint within 28 days. Once investigated if the person making the complaint feels that it has not been suitably resolved information is given on how to contact The Commission, to enable them to seek further advice. We noticed that although the home has some residents whose care is fully or partially funded by a County Council, there is is not information, concerning their right to make a complaint direct to their funding body, including address and contact numbers. That AQAA informs us that during the last 12 months they have received one complaint. We spent time looking at the complaint made by a relative, which concerned the interaction of another resident living at the home, which had been dealt with appropriately. The ongoing safeguarding investigation which we mentioned in our last key inspection report has been investigated and resolve during the last year. The home has taken appropriate action by introducing a policy on the use of mobile phones whilst at work for staff, to reduce the chance of any allegations being made that mobile phones had been inappropriately used whilst in the work setting. The AQAA informs us staff supervisions and staff meetings provide an opportunity for people to be able to voice concerns and raise awareness of any safeguarding issues. Their plan for the next 12 months are to continue to improve staff training to increase knowledge of safeguarding issues that staff can come across in the line of their work, and also the implementation of deprivation of liberty safeguards as part of their care planning. Care Homes for Older People Page 21 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can expect to live in a homely, comfortable, clean and well maintained, safe environment. Evidence: The home is situated in a residential area of Felixstowe and is within walking distance of the sea front, promenade, cliffs and all the local amenities. All the communal rooms are located on the ground floor. Accommodation for the residents is distributed over three floors, ground, first and second, accessed by stairs or lift. The majority of the rooms on the first and second floors benefit from sea views. Residents also have access to well maintained gardens which provide a pleasant seating area. During the inspection we found residents making full use of all the communal areas including the conservatory. Residents commented on the lovely gardens, and told us that they are able to personalise their rooms. One new resident we spoke to confirmed that they were able to bring some of their furniture in with them, which they said helped it feel more like home. Another resident we spoke with, who was on bed rest, confirmed that they were comfortable in their room, which was decorated and furnished to a good standard. During our last inspection we raised concerns that the bed rails used on some of the beds, to prevent a resident rolling out of bed, were not fit for purpose. This was evidenced by incident reports showing where residents had lent against them, and the rail had given way, resulting in them falling out of bed. The Care Homes for Older People Page 22 of 34 Evidence: manager confirmed that following our last inspection they had purchased at least twelve new sets of bed rails. They also told us that all the beds used in the home are now hospital beds, which can be adjusted to support individual residents needs. Where bed rails cannot be used, as there is a risk of a resident trying to climb over them, but there is a risk of the resident falling out of bed, low rise beds are used which are a specialist bed that can be pumped down very low to the floor. This enables another mattress to be put on the floor, to prevent injury, if there is a chance of a resident rolling out of bed. When we asked residents surveyed is the home being kept fresh and clean thirteen people answered always, and two usually. When asked what the home does well, two residents told us keeping the home clean. One resident told us that although they felt the home is kept clean, they did feel the windows could be kept cleaner. A member of staff told us that the housekeeping staff are responsible for the internal windows, and the outside windows are cleaned by an external contractor. The three bedrooms we visited we found the windows to be clean, however we did feed the persons comments back about windows to the manager, so they could monitor the situation. All the communal areas we visited and residents bedrooms were found to be clean and odour free. When we visited an upstairs bathroom, we did note that there were three bars of soap in use sitting on a paper towel in the room. We raised our concerns with the manager, as there were no labels to indicate whose soaps they were, which could lead to cross infection. The manager confirmed that normal practice was the residents to bring their toiletries with them into the bathroom and their return to their bedroom after. As the manager couldnt identify who the soap belonged to, the manager put them in the bin, to prevent any chances of passing on any possible infections. Otherwise we found staff observing infection control procedures, by ensuring they were wearing plastic aprons and disposable gloves when handling bodily fluids. When staff had left their cleaning trolleys unattended in the corridors, we noted that any cleaning chemicals which could be hazardous to health had been securely locked away. The AQAA tells us that they replace worn or contaminated carpets and soft furnishings as necessary. They also tell us that they provide suitable bathing and toilet facilities and they are all kept clean and well lit, which was our findings during the inspection. The AQAA also tells us that the home provides a safe, and well maintained homely environment to residents to live in, which was also our findings during the inspection. When we noted in one of the bedrooms a sign on the window informing people not to Care Homes for Older People Page 23 of 34 Evidence: open the window as the latch was broken, the manager confirmed, as the windows are under warranty that they have contacted the supplier to replace the broken latch. The use of residents photographs, hanging on the walls around the home supports the homely atmosphere. Care Homes for Older People Page 24 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are receiving training and being supported in their role. However, people cannot be assured that the home is always following safe recruitment procedures, which could put people potentially at risk. Evidence: We asked residents surveyed if staff are available when they need them, seven residents answered always, six usually and two residents said sometimes. When asked what the home could do better, three residents had commented on getting more staff. Six out of the eight staff completing our survey felt that they usually have enough staff on duty to meet the individual needs of all the people who use the service. With two staff feeling they sometimes do. During our last key inspection, we raised concerns that staffing levels were being arranged around occupancy, rather than resident dependency levels, which can vary from day to day. The AQAA informs us that the home is increasing staffing levels as necessary, dictated by resident needs and dependency, not by occupancy levels. During the inspection we asked a nurse if the staffing is being done around dependency levels and they replied no. They showed us the guidance sheet staff use to identify how many staff are required for each shift, which is based on occupancy levels. For example for up to twenty-seven residents the staffing level for the morning is set at one Nurse and five carers. When the occupancy levels go above twenty-seven, the Care Homes for Older People Page 25 of 34 Evidence: staffing levels for the morning go up by one carer. We asked the nurse if they felt there are sufficient staff on duty to cover the residents assessed needs, and they replied at the moment it seems okay. We asked what action the nurse would take if they found they are struggling to meet residents needs, and they told us they would go to see the Matron. Discussions with the manager confirmed they are using the occupancy levels as a guideline to how many staff they need. However, if it is identified that extra staff are required, as residents dependency levels have changed, they would put additional staff on. During the inspection we observed a relaxed atmosphere where staff appeared busy, but not unduly rushed, as they answered call bells, and check on residents who were on bed rest. We looked at two new member of staffs recruitment paper work, to check that the home is following safe recruitment procedures. This identified that checks had been undertaken to check that the staff are not on a list preventing them working with vulnerable people, one member of staff had started work. However, we identified one of the staff had started work, shadowing staff, prior to the home being in receipt of their last employers reference. When we fed this back to the manager, they confirmed a mistake had been made, and as soon as they realised that the person had started work without the required references in place, they had stopped them working, until it was received. Information held on file, following an interview with the person, and staffing rotas, showed that this had happened. The manager apologised and said systems would be put in place to ensure that the situation does not happen again. On looking at the person completed application form, we also noted they had not given a full employment history. When we pointed this out to the manager, as the member of staff, they were asked to write the missing information directly onto their application form. We also noted that where the person had worked with vulnerable people before, no action had been taken to validate their employment with that company. This is part of safeguarding procedures, to confirm the person had worked for them, and the reason why they left. The health professional completing our survey when asked do they feel the manager and staff have the right skills and experience to support peoples social and health care needs, they replied always. When we asked staff different aspects about the training they received, all felt that the training they are given is relevant to the work they do. Eight out of the nine staff surveyed, felt the training they received helps them understand the residents needs, and keeps their skills and knowledge updated. When Care Homes for Older People Page 26 of 34 Evidence: asked what the home does well, two comments included provides training for staff relevant to their roles, and the home helps with NVQs and has begun to have more training sessions, i.e. Parkinsons, stoma care, wound care, and health and hygiene. Information provided in the AQAA confirms that all care staff have completed induction training as described and recommended by Skills for Care. The AQAA informs us staff induction and training has improved greatly now we have a person employed to only do training, whom we met during the inspection. Staff surveyed confirmed that their induction covered very well or mostly what they needed to know, to get them started in their role. Discussions with the person responsible for training staff, identified that they see their role as being more in-line with a clinical tutor, by going around asking and talking to staff whilst on duty, to see if they can help at all with their individual training needs. When we asked about induction training, they told us they have purchased induction DVDs and Videos from a recognised training company, and add more localised information which relates to the home. Information supplied in the AQAA shows with seven out of their twenty-six care staff having completed a National Vocational Qualification (NVQ) at level two or above, they are under having fifty percent of their staff trained to this level. The AQAA gave us no further information what action they are taking to address this. However, when we arrived we observed an NVQ assessor talking to two members of staff, which the manager confirmed during feedback that the staff had just completed their training, which will go towards increasing the number of staff who have an NVQ. Care Homes for Older People Page 27 of 34 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 management and staff are committed to working in the best interest of the people they care for, and for ensuing they provide a safe environment for people to live and work in. Evidence: Statement of Purpose gives information on the qualifications, and experience of their Registered Manager Mrs Bridget Bone, who was appointed as Matron at the home in June 2007. The organisational chart contained in the Statement of Purpose, shows the Manager is supported by the Deputy Matron. The AQAA informs us that the manager is developing their management skills by undertaking a Diploma in Management studies with Oxford College on-line learning, and so far has attained A grades in the work they have undertaken. During the next twelve months the AQAA also informs us that the manager and owner will attend courses, to further increase their knowledge in nutrition and Deprivation of Liberty Safeguards. Mrs Bone was available throughout the inspection, and was very helpful in answering Care Homes for Older People Page 28 of 34 Evidence: any questions and supplying extra information as required. Discussions with Mrs Bone identified that she is committed to working in the best interest of the residents living at the home. Mrs Bones eagerness to address any shortfalls identified during the inspection, further evidenced this. Where we identified that a member of staff had started employment at the home prior to the required paperwork being in place, we also noted that as soon as the manager had identified the mistake, they took action to address it straight away. Staff surveyed when asked does your manager give you enough support, and meet with you to discuss your work, seven staff answered regularly, and one said often. Comments from staff included they look after us very well, and that the management supports the staff. However, another member of staff when asked what the home could do better told us sharing of information, staff support. Discussions with the manager, and a notice on the staff information board identified that following on from informal discussions with members of staff it has been decided to reintroduce the Highcliffe House staff support group with the first session due on the day of our inspection. A relative completing their survey in response to being asked if there anything they feel the home could do better commented that perhaps the home could appoint a care leader to ensure that carers routines are maintained, as the nurses are very busy nursing and recording actions. Discussions with the manager and information given in the organisational chart shows that they do have two Healthcare team leaders who undertake this role. Another relative commented that they found Highcliffe house to be a friendly, cheerful, well run nursing home. In the AQAA, under what the home has identified they could do better, it tells us provide a job description for the responsible person in order to clarify the job role in contrast to that of the registered manager. This is to ensure that each person is aware of their responsibility, and overall accountability of any tasks being undertaken. We noted when reading the Statement of Purpose following the inspection that the nominated Responsible Individual for Highcliffe house Ltd, is undertaking the monthly visits under regulation 26. However, it also informs us that the responsible individual works in the home on a daily basis, working closely with the matron to ensure the smooth running of the home and that the standards of care and quality are maintained. Regulation 26 visits are part of the homes quality monitoring system, which needs to be undertaken by one of the directors who is not directly concerned with the conduct of the care home. During our last inspection we identified that where an incident had occurred, which involved a resident, that the home was not always Care Homes for Older People Page 29 of 34 Evidence: following up what had happened, and taking action to prevent it happening again. The AQAA informed us they have now started analysing accidents and incident forms. The manager showed us some completed incident forms, which attached to the back was a form which outlined what action had been taken to investigate the incident or accident, and any work undertaken to prevent it happening again. The work undertaken showed that they had addressed the requirement that we had made following the last inspection. The AQAA informs us documentary evidence of administration and accounts is stored securely in the front office. However, we noted that although this information, and staff records were being held securely, residents care plans are being stored in full view of people walking past. Although the care plan folders do not have the residents names showing, they can be read by passers by, as there are not always staff around to keep an eye on them. The manager gave assurances that they would look into the security of the information being held, discussing different ways to address the situation, including enclosing the shelved area to make into a lockable cupboard. The induction training the new staff includes health and safety training such as Fire awareness, and how to move residents safely using the appropriate mobility aids. During the inspection we observed two staff transferring a resident using a hoist, and several residents being assisted in their wheelchairs, which was undertaken safely. Where we found some records were being reviewed and kept up to date, we did find a shortfall in a persons employment history which was addressed during the visit, and completing of medication records (see health and personal care section of this report. Records we looked at were legible, signed and dated. The home has a system in place for the booking in, and recording of monies held for safekeeping on behalf of residents; however the manager confirmed that they are not often asked to look after any money. We undertook a check of the three residents money they were holding. The first residents money checked against their receipts, showed a deficit of one pound, fifty-five pence. The second residents money checked was ten pence over, and the third residents money agreed to what the home said they had.The manager said they would check to ensure all the receipts had been put through, and if not replace the missing money, and tighten up their procedures. The AQAA provides us with a list of policies and procedures that the home has in place to provide staff with guidance on safe ways of working in the home. We noted that the home had said they did not have policies and procedures in place some of the work being undertaken, for example individual planning and review, and annual Care Homes for Older People Page 30 of 34 Evidence: development plan to quality assurance, although we saw evidence that this is happening. Further information provided in the AQAA shows that equipment used within the home such as hoists, Fire detection and safety equipment is being regularly tested and serviced, to ensure they are kept in good, safe, working order. The home undertakes their own Patients Quality of Care Survey to gain feedback from the residents living at the home. The February 2010 analysis showed when asked Do you like living at Highcliffe, sixteen people replied Yes, two sometimes and one person declined to answer. When asked Do you feel safe, all nineteen people completing the survey answered Yes. Care Homes for Older People Page 31 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 29 The home needs to have systems in place to ensure that all required recruitment paperwork is in place, before staff start work at the home. Care Homes for Older People Page 33 of 34 Helpline: 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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