Care Home: Highfield

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What the care home does well The manager ensured that she was aware of the needs of a prospective resident before offering them a place at the home. This ensured that the home had the equipment, and the staff had the experience, to provide the necessary care. Care plans were clearly written for all areas of care and were supported by the appropriate risk assessments. Where appropriate residents had agreed their care plans. Residents` likes and dislikes were recoded in their care plans. Staff supported residents, in a respectful manner that recognised the resident`s skills to be as independent as possible. The complaints procedure was supplied to everyone living at the home and was on display. There was a comprehensive training plan and recruitment procedures were fully adhered to so that residents were cared for by suitable staff The manager had a clear understanding of the key principles and focus of the service. She worked closely with the staff team to continuously improve the service. What has improved since the last inspection? This service has not had a key inspection since June 2007 when it was under a different manager. What the care home could do better: The service needed to look at the activities provided in the home and how these met the expectations of the people using the service. Any activities needed to be documented along with details of the residents involvement and enjoyment. Key inspection report Care homes for older people Name: Address: Highfield Avon Drive Bedford Bedfordshire MK41 7AH     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: Sally Snelson     Date: 2 2 0 3 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 24 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 24 Information about the care home Name of care home: Address: Highfield Avon Drive Bedford Bedfordshire MK41 7AH 01234267196 01234353046 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): BUPA Care Homes (Bedfordshire) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 34 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Highfield is a purpose built residential home operated and managed by BUPA Partnership Homes (Care First Bedfordshire Limited), part of BUPA Care Services. The home provides permanent, and some respite care, for service users over the age of 65 years. The accommodation consists of 34 single bedrooms over two floors with a passenger lift. There is a secure courtyard garden, and various communal areas. The home is located in Brickhill, a residential suburb of Bedford with a small shopping Care Homes for Older People Page 4 of 24 Over 65 34 34 34 0 0 0 Brief description of the care home centre nearby and Bedford towns amenities accessible via a local bus route. There is ample parking available to the side of the home. The home offers accommodation in 34 single bedrooms, divided into 3 units for operational purposes. Fees for the home vary from £418.00-£700.00 according to circumstances. Care Homes for Older People Page 5 of 24 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: This inspection was carried out in accordance with the Care Quality Commissions (CQC) policy and methodologies, which require review of the key standards for the provision of a care home for older people that takes account of service users views and information received about the service since the last inspection in the form of the Annual Quality Assurance Assessment (AQAA). This inspection of Highfields was the first inspection since 2007. It was unannounced and started at 10.20hrs on the 22nd March 2010. The manager Natalie Koutsou was present throughout to assist with the inspection and receive feedback. During the inspection the care of three people who used the service was case tracked. Case tracking involved reading residents records and comparing what was documented Care Homes for Older People Page 6 of 24 to what was provided. In addition to sampling files, people who lived at the home and staff were spoken to and their opinions sought. Any comments received from staff or service users about their views of the home plus all the information gathered on the day was used to form a judgement about the service. We have also used information from a random inspection undertaken 12/01/10. Prior to the inspection we received three completed questionnaires from residents. The inspector would like to thank all those involved in the inspection for their input and support. Care Homes for Older People Page 7 of 24 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. 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 8 of 24 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 9 of 24 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 manager ensured that she was aware of the needs of a prospective resident before offering them a place at Highfields. This ensured that the home had the equipment, and the staff had the experience, to provide the necessary care. Evidence: The service had a statement of purpose that covered all the areas required by the National Minimum Standards and residents were provided with copies of a Service Users Guide. These documents outlined what the home provided and information about any additional costs, such as hairdressing and chiropody costs. The documents were updated and information altered as necessary. The manager informed us that all new residents were being provided with a contract that detailed what the home provided, the bedroom that was being occupied, and the cost. In the past contracts, or statement of terms and conditions, had only been given to those people who were self funding. Care Homes for Older People Page 10 of 24 Evidence: As part of the inspection we looked in detail at the records of a person who had been recently admitted to the home. This admission had been an emergency admission and assessments had been made as soon as possible after the admission. Other files indicated that pre-admission assessments were undertaken in advance of an admission and information about the resident was used to formulate care plans. The AQAA told us that there were plans for a key worker to attend any pre-admission meetings, and for the key worker to be on duty when the resident was first admitted to help with settling-in period. Residents spoken with confirmed that they, or someone on their behalf, had visited the home prior to moving in. One resident told us that she was close to her family which was important to her. At the time of the inspection the home did not offer intermediate care. Care Homes for Older People Page 11 of 24 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. Staff ensured that residents records included all their care needs to ensure continuity of care. Medication records were in order, and had been signed appropriately by staff in line with the homes medication policy. Evidence: We looked at three care files of residents who we had randomly chosen to case track; one was a new admission. All the files were neat and tidy and the information was easy to find. Each file had a photograph of the resident and clear information about the next of kin and who to contact in the event of sudden illness. Plans of care had been written for all aspects of the care provided. They had been reviewed at least monthly. One person was being seen daily by the community nursing team for the regular dressing of a wound. The community nurses recorded their activity in their own records and the care plan listed the community nurses visits Care Homes for Older People Page 12 of 24 Evidence: and any treatment changes. Community nurses and GPs were frequent visitors to the home and the staff had a good relationship with them. At the time of the inspection 15 different GPs were supporting the residents. The home was part of a trial for the Primary Care Trust (PCT) which provided a nurse, a GP and pharmacist to visit the home weekly in order to carry out any reviews. The manager felt that this was very beneficial. Risk assessments were also reviewed monthly and care needs were informed by the results. Staff must ensure that they write in the care notes all decisions about care that they make. For example a resident who had had a weight loss was being monitored more frequently and staff knew that they would make a referral to a dietitian if the weight did not increase. However the notes did not clearly indicate the plan of action. Documentation outside of the care files showed that the resident had immediately started to regain some of the lost weight. Specialist equipment such as hospital beds, moving and handling equipment and alarm mats had been provided as necessary and were being used correctly. Any restrictions, such as bed rails, considered necessary for the safety of the individual, or others, was recorded within the care plans and consent to the restriction obtained. We checked the Medication Administration Record (MAR) sheets for the three residents we case tracked, plus three more. Medications were appropriately stored in a locked trolley that was secured to the wall in a locked room. Monthly deliveries had been appropriately signed in and carried forward . MAR charts had been accurately completed with signatures and omission codes where appropriate. The back of the MAR sheet had also been completed when an omission code had been used. Controlled drugs (CDs) were stored appropriately and all administrations had been recorded accurately with two signatures in the CD register. If at all possible residents were supported to self administer their medication. The manager had a process to audit medication. which could be improved upon to include reconciliation of stock medication. Staff supported residents in a respectful manner that recognised the residents skills to be as independent as possible. There was a homely atmosphere within the home, the residents were relaxed and friendly with each other and the staff. Care Homes for Older People Page 13 of 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There was insufficient evidence that residents were involved in meaningful daytime activities of their own choice that reflected their individual interests, diverse needs and capabilities. Meals appeared to be balanced and nutritious. Evidence: The manager told us that there was no specific member of staff responsible for activities in the home, but all staff were expected to spend time with groups or individuals. During the inspection we were not aware that this was happening and there was nothing documented to provide the evidence that it was. We saw that a number of activities were advertised weekly such as a knitting club, a coffee morning and bingo. These activities were weekdays only and were suitable for those who were mobile and had mental capacity. Activities were not included as part of the care planning process. One residents told us, it can be a long day, while another told us that they would not want to join in activities with others. We were unsure if they would accept one to one time. The manager told us that she hoped people could go outside once the weather improved and that visits to the nearby shops and parks could be arranged. Care Homes for Older People Page 14 of 24 Evidence: We noted that visitors were welcomed into the home at anytime and staff had a good relationship with them. One visitor told us that she or a member of her family visited daily and were always made welcome. It was apparent that people using the service were making choices about when they got and up and went to bed and what they did. One resident told us he liked to have a nap early evening so he could watch the late films. This inspection spanned lunchtime. It was a sociable occasion as all but one of the residents was able to have their meal in the dining room. Staff were attentive to needs and supported people appropriately. Earlier in the year we had carried out a random inspection to look at how residents nutritional needs were met. We reported The file of one resident who had difficulty eating documented that the manager had sat and had a meal with this person as he/she had complained the meal didnt have enough taste. As a result the GP, dietitian and the cook had been consulted and some changes made as it was established that the persons condition, pain relief and smoking habit could be affecting their taste buds. At the same inspection, another resident told us about a five year history of swallowing problems. She said that the new manager Natalie, had been vigilant about finding a cause for her weight loss and that her weight was now increasing. She said when talking about the manager, she was interested in me and found out what I liked. We established that this resident continued to be happy. Care Homes for Older People Page 15 of 24 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 service had a complaints procedure that was clearly written and easy to understand. Staff residents and visitors were encouraged to make their views known to the manager. Evidence: In addition to being part of the Service Users Guide this homes complaints policy was displayed and was easily accessible to residents and visitors to the home. It confirmed the expected timescales for responses, and advised people of the process if they were dissatisfied with the outcome. The home had not received any complaints over the last year. The manager advised us that she was available for residents or relatives if they had a concern, which she believed prevented concerns becoming complaints. Safeguarding issues had been clearly recorded and reported appropriately to the Local Authority. We had been made aware of the referrals made since the previous inspection, and all had been managed correctly. Documentation indicated that the manager liaised with the safeguarding (SOVA) team as and when necessary. All staff underwent SOVA, Mental Capacity Act and Deprivation of Liberty training as part of their induction, and it was updated as necessary. Care Homes for Older People Page 16 of 24 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. The home was clean and tidy and provided a homely atmosphere for the residents. Evidence: The home was divided into three areas. Each area had their own lounge but all the residents used one dining room. There was no restrictions on residents moving around the home and there was communal space at the entrance which one resident told us she liked to use as she could see who was coming into and leaving the building. The home was clean and tidy and appropriately decorated. Throughout the home we noted a number of areas that needed some redecoration and carpets that were not appropriate for the client group. This refers to the carpets in the entrance hall which as well as being heavily stained were patterned, which is known to be confusing for people with dementia. We were aware that people using the service could personalise their bedrooms as they wished. One resident told us, I have many of my own things in my room. Care Homes for Older People Page 17 of 24 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. A variety of training was offered to the staff to ensure that collectively, they had the skills and experience, to meet the needs of the people living at the home. Evidence: At the time of the inspection 32 beds were occupied. Earlier in the year we had carried out a random inspection as a result of being told that a number of staff had left the service. Following the random inspection we reported that when the previous manager, who had been at the home for a number of years, left, some of the staff had also left. Staff told us it had been a difficult time because as new, less experienced, staff were employed there was a training issue. This had now settled as the team were more established. At that inspection we also reported The duty rota and the manager confirmed that five care staff worked with a team leader to provide care during the day. The deputy and the manager were supernumerary but often worked on the floor as extras. During the day there were also additional staff to clean, do the laundry and cook. However during the night there were only two staff on duty to care for a maximum of 34 residents accommodated over two floors. We therefore discussed the night cover at this inspection. The manager told us that she constantly reviewed the needs of the residents and would put extra staff on duty if needs altered. Care Homes for Older People Page 18 of 24 Evidence: There was a clear record of training and a training matrix which could be used to easily identify the staff that needed additional or specialist training. The matrix indicated that over the past year most of the staff had undertaken most of the mandatory training which included moving and handling, fire safety, infection control, food hygiene and SOVA. The manager was a train the trainer which meant she had additional recognised skills to train the staff team in-house. Staff told us that they discussed training with their supervisor and that they were encouraged and supported to attend training. The AQAA informed us that 13 of the 27 permanent staff had an NVQ to level 2 or above. Two staff files were picked at random during the inspection and examined. One of these had been recently recruited. All files contained the appropriate recruitment documentation, which included; fully completed application forms, two appropriate references, a Criminal Records Bureau (CRB) check, photograph identification, passport and home office documentation where appropriate. Contracts and terms and conditions of employment were clearly signed and dated. Observations of staff and residents interactions indicated that there was a happy atmosphere, and generally the staff were confident and competent in their roles. Care Homes for Older People Page 19 of 24 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 manager understood the importance of continually auditing and evaluating care practises in order to ensure that the best possible care was provided. Evidence: The manager had worked at the home for approximately nine moths. Prior to becoming the manager she had been a deputy at another BUPA home. She told us that she was being well supported by the operational manager and managers from other homes. She has started the process to become the registered manager of Highfields. She was supported by a deputy. At the time of the inspection the manager did not have administrative support. A visitor told us that she had a good relationship with the manager and could go to her or any of the staff team about the care they were providing for her loved one. BUPA carried out six monthly audits of the service and managers were expected to produce action plans from these audits. The operational manager also visited regularly Care Homes for Older People Page 20 of 24 Evidence: and reported on the service. The AQAA confirmed that the manager was aware of where improvements were needed and had implemented plans to ensure that the service continually improved. The manager carried out a number of internal audits to ensure good practise and continuity of care. Monies held on behalf of people were held in accordance with BUPAs corporate systems. These system paid monies received on behalf of people living in the home into private savings accounts and billed people or their representatives for purchases not included in costs for the accommodation, such as hairdressing and chiropody treatment. Small amounts of cash were held on site for those who wished to pay for these items directly. Staff were divided into small teams for supervising and the manager ensured that other senior staff prioritised supervision. As part of the random inspection we made a requirements that records needed to be reviewed. This had been met. We looked at health and safety documentation, including the fire log and maintenance book. There was evidence to indicate that fire call points and the emergency lighting were being tested on a regular basis, and that fire drills were carried out periodically. The fire service visited and carried out an inspection 20/01/10. Care Homes for Older People Page 21 of 24 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 22 of 24 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 12 12 The service must be able show that people are provided with activities that reflect their interests and capabilities. This is ensure that residents are kept stimulated and interested. 01/05/2010 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 8 Staff should ensure that where care decisions have been made and are bing carried through there is clear documentation to support the decision process. Consideration should be given to redecoration of the home and the replacement of some carpets. The manager should ensure that the whole staff team have all their mandatory training updated. 2 3 19 30 Care Homes for Older People Page 23 of 24 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. 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. 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