Care Home: Highcroft Rest Home

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What the care home does well One relative told us, "(We) are very satisfied with the care and attention my uncle gets at Highcroft". Another relative told us, "My mother is cared for very well at Highcroft. I am so grateful to all the staff and management for the care they give her". A resident told us, "I don`t think they could look after us any better". The home continues to work hard to meet the needs of residents, the majority of whom are suffering from dementia. The home is comfortable, well decorated and maintained and meets people`s needs. What has improved since the last inspection? Following a serious complaint earlier in 2009 the home has made a number of improvements, which are referred to in the relevant areas of this report, and is continuing to reinforce these. Improvements have included improving recording practises generally, reviewing the home`s menu and strengthening the home`s management team. It is essential that these improvements continue to be consolidated and maintained in the future. At the last key inspection six requirements were made and we were pleased to see these had been complied with. The six requirements that had been met were in the following areas: improving the recording of health care appointments to better monitor people`s health and well being; improvements to the home`s laundry room to maximise infection control; an improvement to moving and handling training to ensure staff are fully competent in this area; for written reports of the registered provider`s visits to the home to be available at the home in a timely manner to further improve quality monitoring and two requirements regarding health and safety to maximise protection to people that live in, work in or visit the home. What the care home could do better: At this inspection two requirement are made in the following areas: for the boiler to be replaced as is required by the environmental health officer and for the home to have a current gas safety certificate to maximise protection to people that live in, work in or visit the home. Four good practice recommendations are also made in the following areas: for care plans to provide more information on how people would prefer their needs and preferences to be met regarding their race, culture, gender and religion, to assist staff in meeting these; to provide a comments/ feedback book to obtain more informal feedback on the service; for staff to wear name badges to assist people remember staff`s names and to introduce a summary of staff training matrix to assist the registered manager in planning future training. Key inspection report Care homes for older people Name: Address: Highcroft Rest Home 13-17 Rectory Road Walthamstow London E17 3BG     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: Peter Illes     Date: 0 4 0 9 2 0 0 9 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 31 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) 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 Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Highcroft Rest Home 13-17 Rectory Road Walthamstow London E17 3BG 02085210427 02085210427 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Diwan Suresh Chand care home 23 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 23 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care need on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Highcroft Rest Home is a privately run care home registered to care for 23 older people. In November 2006 the homes registration was varied to allow it to care for up to 7 of the 23 people whose main need for care is a diagnosis of dementia. The home is situated in a quiet residential area of Walthamstow within the London Borough of Waltham Forest. The home has easy access to a range of public transport, Walthamstow Market and other multi-cultural local amenities. The premises consists of three converted adjoining residential houses. Accommodation is provided on two floors that are connected by both stairs and a lift. There are two double and nineteen single Care Homes for Older People Page 4 of 31 23 0 Over 65 0 23 Brief description of the care home bedrooms, four of the bedrooms have en-suite facilities and all have washbasins. The home has suitably equipped bathrooms and accessible toilets on both floors. The homes main communal areas are situated on the ground floor. The homes kitchen, laundry and staff facilities are also situated on the ground floor. The home has a pleasant landscaped rear garden and a front garden is paved and provides off street parking for the home. The stated objectives of the home include: to care for each person in the manner expected of a caring relative; and, to put maximum emphasis on enabling people to manage their own lives and affairs to the greatest attainable extent, respecting at all times their dignity and privacy whilst acknowledging their independence, previous lifestyles and idiosyncrasies. The provider organisation must make information about the service, including inspection reports by the Commission, available to people living at the home and other stakeholders. The current weekly charge starts from £544 depending on the assessed needs of the person. Care Homes for Older People Page 5 of 31 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: The last key inspection of this service took place on 8th October 2007. This key inspection took approximately nine hours and was undertaken by the lead inspector. However, terms such as we, our and us are used where appropriate within this report to indicate that the inspection activity was undertaken on behalf of the Commission. The registered manager was available to assist throughout this inspection. The inspection activity included: meeting and speaking to the majority of the residents present although conversation was limited due to their communication needs; detailed discussion with the registered manager; independent discussion with a number of care staff and the cook; independent discussion with a visiting district nurse; independent discussion with a number of relatives that visited on the day and a brief discussion with the registered provider who visited the home during the inspection and feedback from Care Homes for Older People Page 6 of 31 a Commissioning Manager from L.B. of Waltham Forest. Further information was obtained from a tour of the building, documentation kept in the home and from survey forms sent to us by residents, (most of whom were supported by relatives to fill these in), a healthcare professional and from staff working at the home. The registered manager sent us an Annual Quality Assurance Assessment (AQAA) when we asked for it. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Older People Page 8 of 31 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 31 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 31 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. The home has up to date information about the services it provides so that people can know what to expect from the home. The needs and preferences of people seeking to live at the home are properly assessed to help staff in meeting these needs. Once admitted people benefit from having information about the their own and the homes rights and responsibilities regarding the placement. Evidence: The homes annual quality assurance assessment, AQAA, states; All (prospective) service users are given a fully comprehensive assessment prior to admission and are invited to visit the home, have a meal and meet with the staff and service users. All service users are given a contract and statement of purpose. We were given a copy of the homes statement of purpose and service user guide, which were satisfactory and seen to have been updated in 2009 and included the latest contact details for the Commission. Relatives and residents spoken to confirmed Care Homes for Older People Page 11 of 31 Evidence: that they were satisfied with the information they were given about the home at the time of the persons admission. We inspected the files of five residents, two of whom had been admitted to the home since the last inspection. The files of the two people that had been admitted since the last inspection showed that the home had up to date assessment information about the persons needs and preferences at the time of the admission. This included a copy of a community care assessment of need from the placing authority and an in-depth hospital discharge assessment for one of the people. In addition the home had undertaken its own assessment of need prior to admission. A relative of one of these two people was spoken to independently during the inspection. They told us that they were satisfied with the admission process and that they visited the home most days. They went on to say that they were always made welcome, including by being offered refreshments and that to date they thought the home was 10 out of 10. The files of the other three people also showed that the home had sufficient assessment information at the time of their admission and that the home reviewed the persons needs and preferences, at least on a monthly basis, to enable staff to be aware of any changes. Following a serious complaint earlier in 2009 evidence was seen that the homes process for checking on peoples changing needs had been reviewed and strengthened. Following the serious complaint we also noted that the placing authorities for the majority of the residents had undertaken a review of their peoples needs. They were satisfied with the care their people were receiving following changes that had been put in place by the home following the complaint. We were also told that all residents had a contract containing the terms and conditions of living at the home and those sampled were satisfactory. The home does not provide intermediate care. Care Homes for Older People Page 12 of 31 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. People living in the home are benefiting from an improving system for recording their needs and preferences in their care plans. People are supported by improving recording practises regarding their health care needs and have access to a range of healthcare professionals. Satisfactory medication policies and procedures are in place to assist protect people living in the home. People are treated with respect and dignity, which they and their relatives appreciate. Evidence: The homes annual quality assurance assessment, AQAA, states; All service users health, personal and social care needs are set out in individual plans of care which are reviewed on a monthly basis with other professionals, staff and families involvement where needed. The AQAA goes on to say; We have improved by incorporating into (each persons) care plan the service users past and present medical and health needs, listing the signs and symptoms and the actions staff should take. This has given staff more awareness and information on service users past and present health needs and when to take appropriate action. Care Homes for Older People Page 13 of 31 Evidence: We looked at the care plans for five of the residents and these were generally satisfactory. The format of care plans included details of peoples needs regarding their general daily needs, personal care, mobility, food preferences and activities they enjoy. The care plans also had an assessment and review of care needs document that showed that care plans were now being reviewed systematically and changes made where appropriate to give clear guidance for staff on how to meet the persons needs. Each care plan seen had been informed by an up to date risk assessment, including a moving and handling risk assessment and a risk management plan. Evidence was seen that these were also being reviewed on a regular basis. The registered manager told us that the home was in the process of introducing a new and more person centred care plan format that included more details of peoples preferences and how the person would like these to be met. We were told that four of these had been completed to date and we saw two of these, which we judged were an improvement on the existing format. The new format plans seen contained some information about peoples preferences regarding their gender, culture, religion and race. However, a good practice recommendation is made that care plans should include more detail for any preference in how the person would like these met, to assist staff in meeting these. It was noted that the home is working hard to develop more detailed life histories of people to help staff be aware of what was important to the person before they needed residential care. We sampled one of these for a person whose ethnic origin is African Caribbean and this well put together. We saw evidence that the home has improved its arrangements for recording and monitoring peoples healthcare needs following a serious complaint earlier in 2009. The peoples files inspected included a Health Needs Checklist that is used as a management tool to help ensure that peoples healthcare needs are being properly reviewed and dealt with. In addition, up to date monitoring charts were seen including nutritional risk assessments and continence monitoring sheets. Each person is registered with a GP and we were told that the home has recently agreed with the GP that most people are registered with to undertake monthly blood pressure checks and send these to the GP for information. At the last inspection a requirement had been made that the home clearly records peoples health care appointments to enable staff to more effectively monitor the persons health and well being. We saw evidence, including that mentioned above, that this requirement was being complied with at the time of this inspection. Evidence was seen of a range of appointments with healthcare professionals including: GP, chiropodist, optician, mobile dentist, speech and language therapist and a range of general hospital outpatient appointments. Records of these were up to date and gave Care Homes for Older People Page 14 of 31 Evidence: the outcomes of these appointments. It is important that the home keeps up the improvements made to help staff be aware of each persons healthcare needs and how these can be promoted. We spoke independently to a district nurse who visited during the inspection. The district nurse told us that she was happy with the care provided by the home and that staff are making her aware of any issues of concern and follow her advice. The district nurse gave an example of the home had implemented advice on the importance of ensuring additional drinks and fluids were available in a recent spell of hot weather. The home had a satisfactory medication policy and procedure that was seen. Records of medication received and disposed of by the home were seen and were up to date. The medication and medication administration record (MAR) charts for two residents were inspected and indicated that medication was being safely administered. It was noted that two residents had recently been prescribed controlled medication and that the home had ordered a controlled drug cabinet from its dispensing pharmacist to store this. The registered manager contacted us soon after this inspection to say that this had now been received and was in use. Residents and visitors spoken to independently gave a range of positive feedback about the care provided at the home, including how staff provided personal care to them in a sensitive way. Residents were well presented throughout the inspection. Care Homes for Older People Page 15 of 31 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. People living at the home benefit from a range of leisure and recreational activities, which they enjoy. Relatives and other visitors are made welcome at the home, which they and people living there appreciate. People are encouraged to exercise as much choice and control over their lives as they can to maximise their independence. They are also provided with a range of good quality meals that they enjoy. Evidence: The homes annual quality assurance assessment, AQAA, states; The home has developed a person centred activity programme based on the individual needs of each service user. We now have an additional room used as a sensory room and where staff can have one to one interaction with service users. We saw evidence that the home has an activity programme that covers seven days a week. Activities included arts and crafts, gentle exercise, hand massage and activities to help people with dementia enhance their feeling of well being, such as reminiscence work, word games and naming parts of the body. We saw the latter being run during the inspection and residents that participated appeared to be enjoying the activity. In addition the home organises one off activities including; birthday parties for residents; visits to Vestry Road museum, which is situated in the local community; Care Homes for Older People Page 16 of 31 Evidence: BBQs in the summer and going to a pantomime at Christmas. The home has made a record of many of these activities, both inside the home and in the community, on photographs and video recordings. We sampled some of the photographs and residents participating appeared to be enjoying themselves. We observed that some residents did not want to participate in organised group activities and were offered one to one time with staff to just chat, which again those residents seemed to appreciate. We were also told that recently a staff member has bought their dog to the home for agreed and controlled sessions and that has been enjoyed by many of the residents. Residents come from a variety of ethnic minority communities and staff are trying hard to meet these peoples needs and preferences regarding this (a good practice recommendation is made in the Health and Personal Care section of this report to reinforce the importance of this). We were also told how the home is sensitively supporting one resident to maintain their sexual identity. Evidence was seen that the home makes relatives and visitors welcome to the home. One relative told us that they visit the home at least twice a week and other relatives, including grand children visit and are made welcome. The person went on to say that another relative, who lives outside London, visits and is offered a meal by the home. We were also told by one relative that they were always made welcome and went on to say; We visited a number of homes but this one is the best. The registered manager told us that the home is not an appointee for any of the residents finances and holds no money for residents either, which is either dealt with by relatives or another stakeholder, independent from the home. She went on to say that if a resident needs something then the home will purchase this and then invoice the person dealing with the residents finances. Residents are able to bring personal possessions to the home and residents bedrooms that were seen had been personalised to that persons taste. We were told that following the serious complaint earlier in 2009 the home had reviewed and revised the menu. The home operates a four week menu that includes: the choice of a cooked breakfast or cereal, toast etc; a choice of main meal at lunch time; afternoon tea and cakes; supper and a bed time snack.The menu included choices for people from different ethnic backgrounds including lamb with rice. The cook was spoken to independently and told us that he had been in post for approximately three weeks following the previous cook leaving on health grounds. The cook presented as being enthusiastic and competent and was able to tell us of the meal preferences of some of the residents. We were offered lunch on the day of the Care Homes for Older People Page 17 of 31 Evidence: inspection and chose the fish dish, which was well cooked and presented. We also noted that one resident changed their mind when their meal was presented and and staff prepared an alternative for them. Staff were noted to be assisting those residents that needed assistance with their meal in a friendly and unhurried manner. We noted during the inspection that some of the residents knew the name of the registered manager and greeted her by name. However, residents were not so familiar with other staff members names. A good practice recommendation is made that staff should wear name badges when on duty to assist residents, especially those with a degree of dementia, to interact more easily and comfortably with staff. Care Homes for Older People Page 18 of 31 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. The home has reinforced its safeguarding adults procedures with staff and reviewed a number of its working practises, to improve protection to residents. The home has satisfactory procedures for dealing with concerns and complaints and people living at the home felt confident that any issues raised would be properly dealt with by the home. Evidence: The homes annual quality assurance assessment, AQAA, states; We have had one serious complaint in the past six months which was addressed within 28 days and a meeting held with Waltham Forest Safeguarding Adults Team to address the issues concerned. Although improvements are ongoing, we feel we are doing well as service users and their families are aware of our complaints procedure and should there have been anything they were not happy about then they would have complained. As stated above and in other sections of this report there was a serious complaint made about the home earlier in 2009, which was dealt with under L.B. of Waltham Forests safeguarding adults procedures. This was about the care of a resident and was substantiated by the investigation. Evidence was seen that the home continues to work hard to implement the recommendations made from that investigation. This includes improvements to the homes recording practises, healthcare practises and the size of the homes management team and how it is deployed. The AQAA goes on to state; Complaints and incidents seemed to happen when manager was off duty or Care Homes for Older People Page 19 of 31 Evidence: sick. Training was given to staff in the act of role playing, which gave them more understanding and awareness. We have now employed two more senior staff who are responsible when the manager is off duty. There had been two other safeguarding allegations made about the home since the last inspection which were properly investigated under L.B. of Waltham Forests safeguarding adults procedures; one of these was substantiated and one was not substantiated. The home has an in-house safeguarding adults procedure and a copy of the L.B. of Waltham Forests safeguarding adults procedure. Both of these were seen and also evidence that staff have undertaken training/ refresher training in safeguarding adults. Staff spoken to were able to explain the actions they need to take if an allegation or disclosure of abuse is made to them. The home also has a satisfactory complaints procedure that was seen, including a summary in the service user guide. Apart from the complaint described above there have been no other complaints recorded by the home since the last inspection. Residents and relatives spoken to indicated they were confident that any concerns they raised would be taken seriously by the home and acted on properly. However, a good practice recommendation is made that the home makes a comments/ feedback book available in an accessible place in the home to allow people living at, and visiting the home, to give feedback about the service and raise any issues they may wish to. Care Homes for Older People Page 20 of 31 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. People live in a home that is well decorated, well furnished, well maintained and that meets their needs. However, specified work is needed to the homes central heating system to maximise the health, safety and comfort of residents. The home was clean and tidy throughout creating a pleasant environment for people accommodated, staff and visitors. Evidence: The homes annual quality assurance assessment, AQAA, states; We constantly maintain the environment to ensure that it meets with the National Minimum Standards. A programme of ongoing maintenance is in place and all equipment and furnishings are repaired and replaced where required. The home is kept clean, hygienic and free from offensive odours. We undertook a tour of the home. The accommodation is provided on two floors that are connected by both stairs and a lift. There are two double and nineteen single bedrooms, four of the bedrooms have en-suite facilities and all have washbasins. The bedrooms rooms seen were well equipped and decorated, had personal call bells and had been personalised according to the wishes of the people living in them. One double bedroom was being used by a couple and had been personalised to their taste. People spoken to during the inspection stated that they were happy with their bedrooms. The home has suitably equipped bathrooms and a number of accessible Care Homes for Older People Page 21 of 31 Evidence: toilets on both floors. The homes main communal areas are situated on the ground floor and consists of a television lounge, two quiet lounges, dining room and a conservatory. The homes kitchen, laundry and staff facilities are also situated on the ground floor. The home has a pleasant landscaped rear garden and a front garden is paved and provides off street parking for the home. The home is well furnished, well decorated and well maintained. There are suitable signs and pictures on doors to bedrooms and to other communal areas to assist people to find where they want to go and overall the building meets the needs of people living in it. The home has a planned maintenance programme and a handy person is employed to deal with smaller repairs on the spot. The home had received a recent visit from an environmental health officer and the report of that visit was seen. This was generally satisfactory although the report stated that the home must fit a new central heating boiler. The registered manager stated that this work was in the process of being undertaken and confirmed that the existing boiler was still functioning so that residents needs were still being met. However, a requirement is made for the completion of this work within an agreed timescale. At the last inspection a requirement was made that the damaged laundry floor and the damaged counter in the laundry were repaired or replaced to ensure they are nonporous to maximise infection control in this area. It was noted that this requirement had been complied with. The laundry equipment was satisfactory and the home was clean, tidy and free from unpleasant smells during the inspection. Care Homes for Older People Page 22 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive appropriate training, have a range of competencies and are appropriately deployed to support people living at the home. The homes recruitment procedure assists protect people living at the home. Evidence: The homes annual quality assurance assessment, AQAA, states; The home has a robust recruitment policy, there is sufficient staff on duty to meet the needs of service users. Staff are supported to undertake any training that they feel is relevant to their working requirements. Staff are competent in meeting the needs of our service users. An up to date staffing rota was seen. The rota indicated that three care staff were on duty throughout the day and two waking care staff at night. The registered managers hours are in addition to this. The home also employs a full time cook, domestic staff and a handyperson. We were pleased to see that the provider organisation had reviewed and strengthened the management arrangements at the home following a serious complaint earlier in 2009. Two new senior care staff have been appointed to assist the registered manager and deputy manager and this means that a senior member of staff is on duty on each day shift to coordinate and manage the care and support provided. The registered managers hours are in addition to this. The AQAA states that the home does not employ agency staff with permanent staff being prepared to cover any temporary shortages on the staff rota. Given the needs of the Care Homes for Older People Page 23 of 31 Evidence: residents living in the home at the time the staffing levels are considered satisfactory. The registered manager told us that the home was employing ten care staff and of these three had achieved the national vocational qualification (NVQ) level 3 in care; two care staff had achieved NVQ level 2 and were working toward level 3 and five care staff were working toward NVQ level 2. Staff records sampled supported this. The files of three care staff that had started work in the home in 2009 were inspected. All three files contained: evidence of a protection of vulnerable adults (POVA First) check obtained by the provider organisation prior to the staff member starting work, an enhanced criminal records bureau (CRB) clearance and protection of vulnerable adults (POVA) check, a clear application form, two references, proof of identity with a photograph and evidence of entitlement to work where appropriate. From the staff files seen and from discussion with the registered manager it is our judgement that the home works hard to implement a robust recruitment procedure to help keep residents safe. Evidence was seen that the home is part of the (Skills for Care) L.B. Waltham Forest Partnership and benefits from staff being able to participate in the rolling staff training programme that the Partnership offers. Evidence was seen of recent staff training including in: dementia care, deprivation of liberty safeguards (part of the Mental Capacity Act 2005), infection control, safeguarding adults, first aid and food hygiene. Staff also benefited from a recent training session in the care of people with diabetes from a specialist nurse from Whipps Cross hospital. At the last inspection a requirement was made that staff must receive an element of practical training when receiving training in moving and handling, which at that time was undertaken by distance learning. Evidence was seen that this requirement was being complied with by staff undertaking that training through the Waltham Forest Partnership. Feedback from staff was that the home is committed to training and that the training they received was beneficial to them. However, it was not particularly easy to be able to check the training each staff member had undertaken and when refresher training was due without looking at each staff members file. A good practice recommendation is made that the home develops a training matrix to show a summary of staff training to assist the registered manager monitor this. Care Homes for Older People Page 24 of 31 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. People living at the home benefit from it being managed by a qualified and experienced registered manager and from a strengthened management team. People accommodated and other stakeholders are consulted to monitor and improve the quality of the service the home provides. Peoples financial interests are appropriately safeguarded. Staff receive regular supervision to assist them meet the needs of people accommodated and to assist in their own development. People living at the home are generally protected by the homes health and safety procedures although further work is needed regarding gas safety to maximise this protection. Evidence: The homes annual quality assurance assessment, AQAA, states; Service users reside in a home which is managed by a manager with over 18 years experience in care of the elderly, eight of which is based at management level and has the ability to manage the home in the best interests of the service users. The registered manager has completed her Registered Managers Award and the Care Homes for Older People Page 25 of 31 Evidence: Dementia Care Trainers Training. She presented as being knowledgeable about the needs of older people and in managing a residential care home. As stated in the Staffing section of this report the provider organisation has enhanced the management team at the home with an additional two senior care workers, following a serious complaint about the home earlier in 2009. This is intended to strengthen day to day management control, especially when the registered manager is not on duty. Feedback about the registered manager from residents, relatives and staff at this inspection was generally positive. One relative told us in a survey form, My mother is cared for very well at Highcroft. I am so grateful to all the staff and management for the care they give her. Another resident told us, You can always talk to Marie, she is very good. We were told that the home monitors the quality of care in the home in various ways and we saw documentary evidence to support this. This includes satisfaction surveys given to residents or their representatives, generally on a three monthly basis; residents meetings, generally every two months with minutes seen having agenda items including activities, environment, staffing and choices; relatives meetings annually; regular staff meetings and senior staff meetings and management tools such as a care plan review matrix. Evidence was seen that the registered manager reviews and acts on this information regularly. At the last inspection a requirement was made that the registered provider must prepare a written report of his monthly unannounced visits to the home and ensure that these reports are made available to the registered manager and are available at the home for inspection. This requirement was being complied with. The registered manager confirmed that the home was not the appointee for any of the residents finances and does not hold money for them, she went on to say that residents money is managed by relatives or other nominated persons/ agencies. The registered manager also confirmed that if residents needed something personal to bought for them the home would make the purchase and then issue an invoice to the person responsible for the residents finances. Evidence was seen from staff files, from a supervision record matrix and from staff spoken to independently that staff regularly receive formal recorded supervision and staff confirmed that they felt that this was useful. At the last inspection requirements were made that the a current electrical installation certificate was available for inspection and that the homes water system is checked annually to minimise the risk of legionella. We saw documentary evidence that both of these requirements were being complied with. We saw a range of other satisfactory Care Homes for Older People Page 26 of 31 Evidence: health and safety documentation including for portable electrical appliances, servicing of the call bell system in the home and a fire log that showed that fire fighting appliances were being serviced, fire drills were being held and that the home had a fire risk assessment. However, the homes gas safety certificate had expired. We were told by the registered manager that this was work in hand but that the home was waiting on a new central heating boiler being installed and the gas safety certificate would be renewed at that stage (see requirement about the boiler in the Environment section of this report). However, given the importance of gas safety a requirement is made regarding the gas safety certificate with a more stringent timescale. Care Homes for Older People Page 27 of 31 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 28 of 31 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 1 25 13 The registered persons must 30/11/2009 ensure that unnecessary risks to the health or safety of service users are identified and eliminated. This is to include undertaking the environmental health officers requirements including replacing the homes central heating boiler. This requirement is made to maximise the health, safety and comfort of residents. 2 38 13 The registered persons must 30/09/2009 ensure that unnecessary risks to the health and safety of service users are identified and as far as possible eliminated. This is to include ensuring that the gas supply to the home has been checked as being safe by a person competent to do so. Page 29 of 31 Care Homes for Older People 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 This requirement is made to maximise the safety of all that use the home. 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 7 The home should include more comprehensive information on peoples care plans regarding how they would prefer their needs and preferences to be met regarding their race, culture, gender and religion; to assist staff in meeting these. Staff should wear name badges when on duty to assist residents, especially those with a degree of dementia, to interact more easily and comfortably with staff. The home should make a comments/ feedback book available in an accessible place in the home to allow people living at, and visiting the home, to give feedback about the service and raise any issues they may wish to. The home should introduce a staff training matrix to assist in identifying what training each staff member has undertaken and when refresher training is due in core subjects. 2 15 3 16 4 30 Care Homes for Older People Page 30 of 31 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). 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. 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