Care Home: Highfield Care Home

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What the care home does well We found that the home was very welcoming warm and well maintained. Staff interaction with the residents showed care and patience and that residents were encouraged to be as independent as possible. Comments received include "care and nursing staff are excellent" "care and understanding given" "staff are kind and courteous" The activity coordinator is very committed to the role and is always looking for new things for the residents to take part in to and to make sure they are offered choices that suit them.. Equality and diversity issues are understood by the organisation and addressed for individuals through their care plans, which describe how individual needs, and preferences are to be met. Staff are also provided with training to ensure they are clear on equality and diversity. Policies and procedures are adjusted in response to changing legislation and guidance to ensure they keep up to date with current practice and comply with legislation. What has improved since the last inspection? Since the last inspection the manager has ensured that all doors have been fitted with door guards which has increased the safety of the people living, working an dvisiting the home in regards to fire safety. Changes have been made to the process for residents monies which protects and safeguards them from possible financial abuse. The external decoration of the home has now been completed which has improved its appearance and makes it welcoming. What the care home could do better: The programme of activities could be put into a pictorial format which would allow all residents to see with ease what is being held and when. The manager may want to consider that if a form or assessment is not required for a residents that it is removed from the file, which would help staff in only providing information that is relevant for that person is contained within the file. Key inspection report Care homes for older people Name: Address: Highfield Care Home 34-36 Hoe Lane Ware Hertfordshire SG12 9NZ     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: Alison Butler     Date: 1 9 1 1 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 22 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 22 Information about the care home Name of care home: Address: Highfield Care Home 34-36 Hoe Lane Ware Hertfordshire SG12 9NZ 01920468976/467508 01920485728 highfield@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Tamhealth Limited (wholly owned subsidiary of Four Seasons Health Care Limited) care home 54 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: This home may accommodate 54 older people who require general nursing care. This home may accommodate up to 10 older people who require personal care. Date of last inspection Brief description of the care home Highfield Care Home is a residential care home for older people who require nursing care. It is owned and managed by Tamhealth Limited, which is a member of the Four Seasons Health Care group. The home is located on the outskirts of Ware, about a mile from the main shopping centre and local amenities. The building is a two-storey building served by a small lift. The administrative offices, dining room, kitchen and laundry room are all on the ground floor. There are ample community spaces including a main lounge and smaller sitting areas. There are bedrooms on two floors and most of the bedrooms are for single occupancy but there are some double rooms. Some bedrooms have en suite facilities. There is a large back garden overlooking the countryside. The garden is well Care Homes for Older People Page 4 of 22 Over 65 54 0 0 7 0 1 2 0 0 9 Brief description of the care home maintained with garden furniture and is accessible to wheelchairs. For information on up to date fees for the home, contact should be made with the manager. Information about the home and the service it offers is contained in the Statement of Purpose and the Service User Guide. A copy of these and the most recent inspection report are available in the home. Care Homes for Older People Page 5 of 22 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 unannounced inspection was carried out with the administrator on duty as the manager was away from the home on a training course. We conducted a tour of the home. Time was spent observing care practise, examining care records and talking with residents, relatives and care staff on duty. Information received by us was reviewed and this included the Annual Quality Assurance assessment (AQAA) this information focuses on how the home meet outcomes for the residents and also provides some statistical data. Surveys were sent to residents, professionals who visit the home and staff and these responses were reviewed and are reported throughout this report. Comments received from relatives are also taken into consideration and again reported on within this report. Care Homes for Older People Page 6 of 22 Care Homes for Older People Page 7 of 22 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 22 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 22 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. People who live at Highfield can be assured that their needs are assessed prior to admission Evidence: The manager carries out a comprehensive assessment prior to offering a place at Highfield to ensure that they have adequate resources and they are able to meet the persons needs. Where possible a day visit is offered to the prospective resident and their family. Over the past year they have created new forms for the pre-admission assessment which provides a detailed dependency rating. These assessments help form the individuals care plan. Care Homes for Older People Page 10 of 22 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 who use the service can be assured that there are care plans in place to ensure that staff are clear on peoples needs and how these are met, ensuring people are treated with dignity and respect. Evidence: From the care plans examined they were clear and gave details to staff how the residents needs are to be met although there is no record maintained of what the resident is able to do for themselves which would be more person centred and encourage peoples independence. There were various risk assessments in place including moving & handling, nutritional assessment, falls, wound care although some of these records had not been completed on all plans looked at. We discussed during the inspection that if a resident did not need them it would be better not to have them on the plan or at least state that they were not required. Those that had been completed had been reviewed during the month of October 2009. Each residents has their own doctor and can access them when required. Comments received from visiting health professional included the staff provide good care and support staff follow advice given. Comments received from the residents and their Care Homes for Older People Page 11 of 22 Evidence: families regarding health care included medical care is prompt Staff show care and understanding. Examination of the medication storage and administration showed that records were well kept and no errors were seen. Controlled drugs were well managed and recorded appropriately. A discussion took place with a nurse on duty and it was suggested that they need to decide if given as required medication (PRN) is to be positively recorded as each floor were using different recording systems. As some medication such as paracetamol can be given at any time but there must be four hour gap between doses it would be difficult if they signed at 8am (usual time for morning medication) stating it had not been given, then if at 9.30am the resident requested it, there would not easily be space on the recording chart. Care Homes for Older People Page 12 of 22 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 Highfield are given the opportunity to participate in a variety of activities of their choice. They are offered a varied and wholesome menu which meets their needs. Evidence: The residents at Highfield are offered a varied and full programme of activities and all staff are encouraged to take part in assisting the residents. They also have outings into the local community and use a local minibus which provides wheelchair access. Families are encouraged and are happy to support the residents in going out into the local community on arranged outings. The daily activities co-ordinator provides a not for profit shopping trolley which she takes round the home for the residents to purchase sweets and toiletries. Examination took place of the records for the trolley and these are audited monthly during a visit which is carried out by a member of the head office staff, the records were well kept, although it was recommended to get residents where possible to sign for the purchase to provide additional safety in the audit trail as rexcord show that money had been received for purchased goods. The daily activity co-ordinator organises raffles, fetes etc to provide some additional funds for the benefit of the residents. Families are very supportive of these and a comment received stated an excellent activities team. The records seen in respect of Care Homes for Older People Page 13 of 22 Evidence: activities only stated what activity they had taken part in and it was suggested that it would be beneficial if when recording the activity some information on how the residents felt about it and whether they enjoyed it or not as this could then be fed into the monthly review process and could help in looking at other choices of activity and provide an holistic approach to the well being of the resident. Whilst the activity programme is available in the home it may be worth looking into providing it in a pictorial format to aid some residents to access the information more easily. The daily menu is displayed in the dining room and alternatives are offered if the choices are not to the residents liking. We saw that the lunchtime was a very relaxed and unhurried experience, and the residents spoken to were complimentary about the food they had eaten. Although the comments received on surveys stated that meals could be improved and individual tastes catered for. The chef and her team regularly talk with residents to find out their views and any comments are taken on board and changes are made to the menus. After lunch those residents wishing to went to the conservatory to decorate cakes. Those residents spoken to had thoroughly enjoyed this activity and obviously enjoyed the cake tasting. Care Homes for Older People Page 14 of 22 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 who live at Highfield can be assured that their views and any concerns will be listened to and acted upon. They can also be assured that they are protected from abuse through the homes policies and procedures. Evidence: Following the safeguarding referral made after the last inspection the company have changed the system for managing the residents personal allowances to ensure that all parties are safeguarded and protected from possible abuse. The manager has an open door policy to ensure that any concerns are listened to and dealt with at an early stage. An examination of the complaints folder showed they had received a complaint from a neighbour and this had been recorded and dealt with appropriately. A copy of the Hertfordshire County Council safeguarding procedure is held in the home. All staff have received training in safeguarding policies and procedures and are clear on the process to following if an allegation of abuse became known to them. Care Homes for Older People Page 15 of 22 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 who live at Highfield can be assured that the live in a homely, well decorated and well maintained environment. Evidence: A tour of the home was conducted and it was found to be warm welcoming and well maintained. They have a maintenance person who is able to deal with most things on a day to day basis or to arrange contractors if required. Following the last inspection all rooms have now been fitted with door guards which allows residents to have their room door open if required but should the fire alarm be activated they will automatically close providing a safe environment. The passenger lift in the home remains an issue as it has limited space especially for residents who use wheelchairs, the company continue to review this but have found that it has a high cost implication to improve the size and re-site it on the external side of the home. The external decoration of the property was completed in September of this year. There is a rolling programme for the in house decoration to replace carpets and furnishings as required. Care Homes for Older People Page 16 of 22 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. People who live at Highfield can be assured that staff have been recruited following robust procedures and have all the relevant checks carried out prior to employment which helps keep the residnets safe Evidence: An examination of four newly recruited staff files showed that all the required checks had been carried out prior to them commencing employment. Comments received from residents and relatives stated that the care and nursing staff do an excellent job a first class service is provided. Training information showed that over the last year staff have attended training in the following, medication administration, moving & handling, Fire safety, First Aid, COSSH, Food Hygiene & infection control. There were 10 out of 28 care workers who hold an NVQ 2 qualification and there is 3 staff working towards NVQ 2. The nurses ensure that they keep there skills up to date and have attended training in Mental Capacity and Deprivation of Liberty and these two training course will be extended to include all levels of staff. Care Homes for Older People Page 17 of 22 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 who use the service can be assured that the health safety and welfare of all who live and visit the home are protected through a series of checks and regular maintenance. Evidence: The administration and care records were well kept and appropriately stored. A check on residents money showed that the recording system had improved and residents can be assured that there monies are handled appropriately and safely. Staff told us that they felt well supported by the home manager and that she has an open door and they are able to speak to her at any time. Equality and diversity issues are understood by the organisation and staff and addressed for individuals through their care plans, which describe how residents needs, and preferences are to be met. Policies and procedures are adjusted in response to changing legislation and guidance to ensure that they keep up to date and work with current practise guidance . There is an annual quality assurance and monitoring system in place however the Care Homes for Older People Page 18 of 22 Evidence: results have yet to be fully analysed and a report produced. Care Homes for Older People Page 19 of 22 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 20 of 22 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 Care Homes for Older People Page 21 of 22 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. 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