Care Home: Highfield House

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What the care home does well Potential service users` needs are assessed before a decision is made that the home can meet their needs. People`s health needs are met by maintaining good professional relationships with medical staff in the community. Visitors are made to feel welcome by the staff team. People who live in the home are confident that any complaints they have are listened to by the staff. The provision of food is good, with a menu offering choice, and ample servings. The building is well maintained. Staff have access to training and are provided in sufficient numbers to meet the needs of the service users. Staff came across as enthusiastic about their work and seemed to work well as a team. Service users and visitors who we spoke to were positive about their experience of the care provided at Highfield House. Comments included : "whatever I need I get", "the girls are all smashing" "[staff are] very helpful". When asked what the best thing about the home was, replies included "[being] well looked after" and "the friendliness, ambience and atmosphere". What has improved since the last inspection? New furniture and carpets have been provided as well as a `hydrotherapy` bath, and improvements to the inner courtyard. The manager is now registered with the commission and has established and strengthened her position in the home. People spoke positively about her attitude. Social activities include outings both of a regular nature, such as to a day centre, as well as to local shows or events. What the care home could do better: Staff recruitment should be undertaken more thoroughly and include a full employment history. This is so that the manager can make an informed decision as to the suitability of potential staff to work with vulnerable adults. Medication administration records must be accurately completed on all occasions to ensure that staff can demonstrate that correct doses of medication are being administered. A report of the outcome of quality assurance activities should be produced to demonstrate that the manager is seeking to improve the service. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Highfield House 70 Manchester Road Heywood Lancs OL10 2AN     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Steve Chick     Date: 1 7 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Highfield House 70 Manchester Road Heywood Lancs OL10 2AN 01706624120 01706623388 highfieldhouse@eaglecarehomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Donna O`Hanlon Type of registration: Number of places registered: Eagle Care Homes Ltd care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 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 needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 25 Date of last inspection Brief description of the care home Highfield House is registered to provide personal care and support for 25 people aged 65 years and over, nursing care is not provided. Eagle Care Homes Ltd became the registered owners of Highfield House in March 2006. Highfield House is situated close to the centre of Heywood and provides easy access to all local amenities. Transport between Heywood and Rochdale is also easily accessible. The home provides 2 lounges and 2 dining rooms. There are 23 single bedrooms and 1 double suite; all have the provision of a private toilet with the double suite having a full bathroom. The home is set in its own grounds and has ample parking space. Externally there is an enclosed Care Homes for Older People Page 4 of 28 Over 65 25 0 Brief description of the care home patio area, with access for wheelchairs and a large rear garden. The home welcomes visitors and as such operates no formal visiting hours. At the time of this inspection fees were from pounds 333. 70p to pounds 350 per week. Additional charges were for usual personal effects, including hairdressing, chiropody, toiletries and newspapers. Care Homes for Older People Page 5 of 28 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: three star excellent 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 quality rating for this service is three star. This means the people who use this service experience excellent quality outcomes. We (the Commission for Social Care Inspection) undertook a key inspection, which included an unannounced visit to the home. This meant that no one at Highfield House knew that the visit was going to take place. To help with this inspection three service users were interviewed in private, as were three relatives of service users and three staff members. Additionally discussions took place with the manager. Care Homes for Older People Page 6 of 28 We also looked at information we have about how the service has managed any complaints, what the service has told us about things that have happened in the service, these are called notifications, and any relevant information from other organisations. Before the site visit, we asked for surveys to be sent out to staff, asking what they thought about the care at the home. At the time of writing this report no completed surveys had been received by us. We also asked the management of the home to fill in a questionnaire, called an Annual Quality Assurance Assessment (AQAA). This is a legal requirement. The AQAA told us what they thought they did well, what they need to do better and what they have improved upon. Where appropriate, some of these comments have been included in the report. We undertook a tour of the building and looked at a selection of service user and staff records as well as other documentation, including staff rotas, medication records and the complaints log. Since the last key inspection we have received no complaints or allegations in connection with Highfield House. 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 Care Homes for Older People Page 8 of 28 following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 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 28 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. Service users needs are appropriately assessed and they, or their representatives, are able to visit before a decision is made that the home is appropriate for them. Evidence: The manager told us in the AQAA that all service users moving into Highfield House are assessed prior to admission to ensure that their individual needs can be met. It was also reported that potential service users can visit and are given a brochure which offers information about the services. They are offered the opportunity to spend one night or a day at the home, free of charge before making a decision to move in. A selection of service users files was looked at. All had a copy of an assessment, undertaken to establish the needs of the service user and to ensure the staff at the home could meet those needs. The assessments were completed before the service user moved to the home. Care Homes for Older People Page 11 of 28 Evidence: Highfield House does not offer intermediate care. Care Homes for Older People Page 12 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users health, personal and social care needs are met by the implementation of policies and procedures. Staff practices also serve to promote the dignity of the service users. Evidence: The manager told us in the AQAA, that each service user had a care plan containing detailed information on their needs, health and well-being. They also said that care plans were reviewed and evaluated regularly. This would help to ensure that staff had access to up to date information about the needs of each service user. At the site visit a selection of service users files was looked at. All had a copy of a written care plan. The manager reported that service users were involved in the formulation of their care plans. There was evidence that some service users, or their representatives, signed to confirm their agreement with the care plan. The documentary evidence of care plans being regularly reviewed was not up to date Care Homes for Older People Page 13 of 28 Evidence: in one file looked at. Management audit of the files had identified this oversight and the manager reported that this was being addressed. All staff who were asked, described a system of verbal handover at each shift as well as written records to ensure carers had up to date information about each individual service users needs. Staff expressed the view that the communication system worked well. Service users who were spoken to during the visit were positive about the care they received. One service user, when asked what the best thing about the home was, said [being] well looked after this person also said whatever I need I get. Other service users said they were happy and described the staff as very nice. Visitors who were spoken to were also positive about the care provided for their relatives. One commented that their relatives health had improved since being at Highfield House. Another visitor described, as being among the best things, getting X to eat and walking again. A comments book was available in the foyer which contained 14 positive comments from this year. Comments from relatives and a visiting professional all commended the staff on looking after X very well, with several saying how much X had improved since moving into the home. All service users and visitors who were asked expressed confidence that appropriate medical support would be obtained when necessary. There was documentary evidence on service users files that they had access to the full range of medical support available in the community. The manager reported that good working relationships were maintained with local doctors and district nurses. Staff who were asked were also confident that medical support was obtained for service users when necessary. Medication was looked at and presented as being appropriately and securely stored. A sample of the medication administration records was looked at. These records should provide evidence that service users are receiving the correct dose of the correct medication at the correct time. One example was seen where the record had been signed for to indicate that the medication had been taken by the service user, when in fact, it was still in the blister pack provided by the pharmacist. While there was no specific evidence that this had caused problems for the service user, the nature of the error called into question the validity of the other medication records. There was evidence that the manager periodically audits these records, and that she took appropriate action where necessary to ensure staff followed the written procedure for dealing with medication. All service users and visitors who were spoken to expressed the view that service Care Homes for Older People Page 14 of 28 Evidence: users were treated with respect and that their dignity was maintained. The manager reported that there was an expectation that staff ensure that the privacy and dignity of service users are respected at all times. Staff who were spoken to reported that this was done both by themselves and their colleagues. Care Homes for Older People Page 15 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An appropriate range of activities is available for service users, and visitors are welcome in the home, which enhances service users fulfilment and social stimulation. The provision of food to maintain service users health and well-being is good and service users are able to maximise their autonomy within the context of communal living. Evidence: The manager told us that daily routines were flexible to meet choices made by the service users. The manager also told us that family and friends are encouraged to visit and that service users could choose how to spend their time and join in activities provided. Visitors spoken to confirmed that they could visit at any reasonable time and that they were made to feel welcome. For example one visitor appreciated the fact that he was offered a cup of tea when visiting. One visitor, when asked what the best thing about the home was, said [the] friendliness, ambience and atmosphere. Social activities in the home were publicised on the notice board in the foyer. There Care Homes for Older People Page 16 of 28 Evidence: was also information in connection with a trip out to the theatre later in the month. Visitors who were spoken to confirmed the availability of activities, including Holy Communion. One service user expressed the view that there was not much entertainment, while others who were asked, confirmed that activities took place although they did not always wish to participate. Staff who were spoken to also reported that a range of activities were available for service users to take part in if they wish. One staff member said that when they had some spare time they were able to simply sit and talk with service users. Service users and staff members who were asked, confirmed that people were free to get up and go to bed when they chose and, within the limits of communal living, could spend their time how they wished. One staff member cited as an example of choice, that if a service user wanted a lie in they could its not a regime its free and easy. The manager reported that people could have a key to their bedroom if they wished. One meal was sampled during the visit which was pleasantly presented and tasty. Part of a mealtime was observed. It presented as being a relaxed occasion with staff asking people if they wanted any assistance, for example to put sugar in their tea. Service users who were asked expressed satisfaction with the food, confirmed that a choice was available and, as one service user said, if you ask for more you get more. Care Homes for Older People Page 17 of 28 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. Service users are protected from abuse or exploitation by the homes policies and practices and are confident that any complaint they may have would be dealt with appropriately. Evidence: The manager told us, before the visit, that they had very few complaints but that any complaint would be taken seriously. There is a written complaints procedure which has been found to be appropriate in the past and was not looked at again on this visit. The complaints record was looked at and presented as being appropriately maintained. All visitors and service users who were spoken to said they were confident that if they had a complaint it would be dealt with appropriately by the staff and manager. Similarly all staff who were asked, said they believed that any complaint would be listened to and taken seriously both by themselves and by the manager. The manager told us that staff received training to recognise and report abuse should they come across an incident or an allegation. Staff who were spoken to were confident that they would report any suspicions or allegations of abuse and that they were aware of the companys whistleblowing policy. All service users spoken to expressed the view that they were safe at Highfield House. One service user, when asked what the best thing about living at Highfield House was, Care Homes for Older People Page 18 of 28 Evidence: said being happy. Visitors who were asked, were also confident that their relatives were safe. We had not been made aware of any complaints or allegations in connection with Highfield house since the previous key inspection. Care Homes for Older People Page 19 of 28 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 is appropriately maintained, decorated and cleaned to enable service users to live in a pleasant, safe and hygienic environment. Evidence: During this unannounced inspection visit a tour of the building was undertaken. This included the communal areas and a selection of service users bedrooms. The manager reported that service users were able to personalise their own rooms with, for example, ornaments and pieces of their own furniture (subject to health and safety considerations). Service users who were asked, confirmed that they had brought in their own possessions and observation during the tour, demonstrated that a range of personal effects was present in peoples bedrooms. The manager reported that the torn covering on a seat seen in one service users bedroom had been noted earlier and a new chair was on order. At the time of this visit one service users bedroom was being redecorated and the manager reported that this was to the colour scheme decided on by the service user. Also at the time of the visit new carpet was being laid in one of the corridor areas. The manager reported that many improvements had been made since the previous inspection. This included replacing several items of furniture and the installation of a hydrotherapy bath. Care Homes for Older People Page 20 of 28 Evidence: The home presented as clean and tidy with no unpleasant smells. Service users, visitors and staff who were spoken to all said that this was the normal state of the building. No issues in connection with the building, were identified during this visit, as needing any remedial action. Staff who were asked, confirmed that they were encouraged to report any damage and that repaires were undertaken in a timely manner by the maintenance man. Care Homes for Older People Page 21 of 28 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. The numbers and skills mix of staff on duty promote the independence and well-being of service users. Recruitment and vetting procedures are predominantly effectively applied to minimise the risk to service users of inappropriate staff being employed. Evidence: The manager reported that staff cover is usually provided on the basis of two carers between 08:00 -- 15:00 (with an additional carer between 08:00 -- 13:00); two carers between 15:00 -- 22:00 and two night care assistants between 22:00 -- 08:00. In addition to the carers there is a line manager on duty between 08:00 and 22:00. In addition to these hours are the manager, domestic and cooking staff. The manager provided a copy of the staff Rota for the week beginning 13/10/08 as evidence of these staffing levels. The manager reported that these staffing levels were sufficient to meet the needs of the service users who were resident at Highfield House. The manager told us in the AQAA that care staff either had, or were working towards an appropriate NVQ. Similarly it was reported by the manager that all staff undertook an induction course. The manager reported that there had been some difficulty securing places on the training courses provided by Rochdale Metropolitan Borough Council although this Care Homes for Older People Page 22 of 28 Evidence: appeared to have improved recently. There was documentary evidence of applications to courses. Staff who were spoken to reported that the organisation encouraged and supported staff to undertake training. This included refresher courses and staff spoken to were able to confirm that they were booked on to some courses including moving and handling and protection of vulnerable adults. A selection of files relating to the vetting procedures for new staff was looked at. There was evidence that most of the legally required checks had been undertaken. However two examples were seen where the persons full employment history was not recorded, either on the application form nor in subsequent notes. Discussion with the manager indicated that she had more information about the applicants employment history but that it was not written down. Evidence of an applicants full employment history is important to demonstrate that all reasonable steps have been taken to protect the interests of service users, by making an informed decision as to the suitability of that person to work with vulnerable adults. Service users and visitors spoken to were positive in their description of the care staff. Comments included [staff are] friendly and welcoming - the girls are all smashing -all great -- very helpful. One service user said, when asked what the best thing about the home was, [you are] well looked after. Care Homes for Older People Page 23 of 28 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 is competent to run the home and implement the health and safety procedures the benefit of service users and staff. Service users financial interests are protected by the implementation of the Homes policies and procedures. Evidence: The current manager has been registered with the commission since the previous inspection. She told us that she had completed her NVQ level 4 and was now studying towards the leadership and management award (the current recognised qualification for managers of care homes). All visitors, service users and staff who expressed a view about the manager, were positive about her approachability and support. The manager was able to describe a range of methods to review the quality of the service. These included internal audits which were recorded and monthly meetings with service users which were not. The manager reported that quality audits via questionnaires were done although at the time of the visit no written report of an Care Homes for Older People Page 24 of 28 Evidence: analysis or outcome of these processes was available. A selection of records relating to money held on behalf of service users by Highfield House was looked at. These presented as being appropriately maintained to protect the interests of service users, including receipts for money spent on service users behalf. These records were regularly audited by the manager. The manager reported that all routine health and safety checks were undertaken regularly. A small selection of documentation was looked at in connection with the fire detection and alarm system, and the lift and hoist maintenance records to verify this. These presented as being in order. There was evidence that a number of staff had been booked on to a moving and handling course to take place shortly after this visit. For some people this would be a refresher course. The manager reported that all staff received training in safe moving and handling techniques at a very early stage of working at Highfield House however this was not always from a qualified moving and handling instructor. Care Homes for Older People Page 25 of 28 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 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 29 The manager should ensure that records are maintained which clarify any member of staffs full employment history, together with a satisfactory explanation of any gaps. This would assist the manager to demonstrate that a reasonable decision had been made to appoint each individual while protecting the interests of vulnerable service users. The manager should ensure that a report is produced, based on the findings of the quality assurance processes. This should include the views of the service users and their representatives. The report should identify how the service can be improved. 2 33 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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