Care Home: Highfield House Nursing Home

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What the care home does well The manager or deputy manager visits people wherever possible to carry out an assessment of their care needs before they move in to the home to ensure that their needs can be met there. Individualised care and attention is provided and there is a welcoming cheerful environment so that people who are cared for feel comfortable and at home. People`s plans of care were well documented and reflected each person`s individual needs. The home has an established staff team who were keen for standards to be maintained. We found people receive care and support that matches their expectations. Staff are quick to respond to changes in people`s health care needs and have an excellent understanding of the importance of treating people as individuals and promoting their privacy and dignity. Meals were varied and offered choice and variety. A survey form included the comment that, "the meals are fantastic". People who live at Highfield House have choices about how and where they spend their time and the home provides a varied range of activities so that people have enough to do. A good standard of hygiene was seen throughout the home and the standard of decor was good. Comments we received from relatives were, "Highfield House is warm, welcoming and spotless", "the home has wonderful staff", "all the staff are fantastic", "all homes should be like this one", "care is focused on the individual" and "I do not live locally and I can go home knowing my mother will be well cared for". Staff were seen to treat people they cared for with respect and had an easy friendly manner. Staff were seen to provide support in a sensitive and caring way. The home is very well managed by a well qualified and experienced management team. Staff, residents, and their visitors are given opportunities to express their views about the home. This helps to make sure the home is run in a way that suits residents` needs and preferences. Good recruitment procedures are followed to make sure new staff are suitable to work with vulnerable older people. All new staff complete a thorough induction programme to make sure they know how they should provide care for the people who live at the home. Most of the care staff have an national vocational qualification (NVQ) in care so they have the knowledge and skills to provide care for the people who live there. These are nationally recognised qualifications for people working in care and show they have been assessed as competent to provide good quality care. Staff have regular one to one meetings with their manager to ensure that they have the opportunity to discuss any concerns they have and are given the support they need. Regular auditing shows where staff are not achieving the required standard so that the managers can address this with them to make sure that residents receive good quality care. What has improved since the last inspection? Work is continuing in the home to improve the decor so that people living there do so in comfortable, well maintained surroundings that suit their needs. Staff training is continuous and keeps up to date with current legislation. The AQAA stated that the management continuously listens to the residents and relatives and acts accordingly to improve the lives of the people living in the home. What the care home could do better: No requirements or recommendations have been made as a result of this inspection. We saw evidence that the management are always looking at ways to improve the service they provide. Key inspection report Care homes for older people Name: Address: Highfield House Nursing Home 298 Park Lane Macclesfield Cheshire SK11 8AE     The quality rating for this care home is:   three star excellent 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: Joan Adam     Date: 0 9 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 House Nursing Home 298 Park Lane Macclesfield Cheshire SK11 8AE 01625511519 01625511519 markmmoss@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Denise Moss Name of registered manager (if applicable) Mrs Denise Moss Type of registration: Number of places registered: care home 13 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 with nursing - Code N, 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: 13 Date of last inspection Brief description of the care home Highfield House is a detached stone built property enclosed privately behind a high stone wall in 1/3 acre of mature gardens. It is situated within a conservation area, ? mile from Macclesfield town centre and is on a main bus route. It is a small, family run business and the proprietors live on site. The accommodation comprises one lounge and one dining room, one single and six double bedrooms. One double bedroom is on the ground floor and the other bedrooms are on the second floor, accessed by a passenger lift or stairs. The home is staffed with Registered Nurses, carers, and Care Homes for Older People Page 4 of 24 Over 65 13 0 Brief description of the care home domestic staff. 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: 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: This unannounced visit took place on 9 March 2010 and lasted five hours. One inspector carried out the visit. References in the report to we, our or us represent the Care Quality Commission. This visit was just one part of the inspection. Other information we had received about this service was also looked at. Some weeks before the visit the manager was asked to complete a questionnaire called an Annual Quality Assurance Assessment (AQAA) telling us what they thought they did well, what they needed to do better and what they had improved upon since the last visit, to provide us with up to date information about the services provided. This helped us to determine if the management of the home see the service they provide in the same way we do and if our judgements are consistent with home owners or managers. During the visit various records and the premises were looked at. We spoke with Care Homes for Older People Page 6 of 24 people living at the home, relatives, staff and manager who all gave us their views about the service. We also provided questionnaires for people using the service and the staff who work there so they could tell us their views about the service the home provides. In April 2009 we did an annual service review of the home, which told us the home was still providing an excellent service. An annual service review is a summary of our knowledge about how a service that has not had a visit in the last year is still performing. It is also how we decide if a service is still as good as we thought it was since our last visit or annual service review. Care Homes for Older People Page 7 of 24 What the care home does well: The manager or deputy manager visits people wherever possible to carry out an assessment of their care needs before they move in to the home to ensure that their needs can be met there. Individualised care and attention is provided and there is a welcoming cheerful environment so that people who are cared for feel comfortable and at home. Peoples plans of care were well documented and reflected each persons individual needs. The home has an established staff team who were keen for standards to be maintained. We found people receive care and support that matches their expectations. Staff are quick to respond to changes in peoples health care needs and have an excellent understanding of the importance of treating people as individuals and promoting their privacy and dignity. Meals were varied and offered choice and variety. A survey form included the comment that, the meals are fantastic. People who live at Highfield House have choices about how and where they spend their time and the home provides a varied range of activities so that people have enough to do. A good standard of hygiene was seen throughout the home and the standard of decor was good. Comments we received from relatives were, Highfield House is warm, welcoming and spotless, the home has wonderful staff, all the staff are fantastic, all homes should be like this one, care is focused on the individual and I do not live locally and I can go home knowing my mother will be well cared for. Staff were seen to treat people they cared for with respect and had an easy friendly manner. Staff were seen to provide support in a sensitive and caring way. The home is very well managed by a well qualified and experienced management team. Staff, residents, and their visitors are given opportunities to express their views about the home. This helps to make sure the home is run in a way that suits residents needs and preferences. Good recruitment procedures are followed to make sure new staff are suitable to work with vulnerable older people. All new staff complete a thorough induction programme to make sure they know how they should provide care for the people who live at the home. Most of the care staff have an national vocational qualification (NVQ) in care so they have the knowledge and skills to provide care for the people who live there. These are nationally recognised qualifications for people working in care and show they have been assessed as competent to provide good quality care. Staff have regular one to one meetings with their manager to ensure that they have the opportunity to discuss any concerns they have and are given the support they need. Regular auditing shows where staff are not achieving the required standard so Care Homes for Older People Page 8 of 24 that the managers can address this with them to make sure that residents receive good quality care. 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 9 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 10 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given good information and their needs are fully assessed before they live at Highfield House so they know their needs can be met there. Evidence: We looked at the AQAA and this told us that each person and their family are given good information about the home before they move in. A brochure and the information about who the home is for (the statement of purpose) is given to people in the form of a welcome pack which also contains an activities programme , menus, complaints procedure and gives the name of a senior person to contact if they wish to discuss any aspects of the home. Advice is also given about advocacy services to help people to understand the finances when living in a care home. We were able to confirm this during out visit to the home. We looked at the care plans of one person who had recently moved into Highfield House. These contained detailed checks that had been completed before the person moved in by senior staff from the Care Homes for Older People Page 11 of 24 Evidence: home. Details from the hospital were also included. This information showed that the persons needs could be met at the home. The information was then used to write a plan of care to let staff know what the persons needs were and how they could meet them in the way the person preferred. Care Homes for Older People Page 12 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are well kept records that show people who live at Highfield House have their health, personal and social needs met in a way that respects their dignity and individuality. Evidence: The AQAA showed us the the people who live at Highfield House should expect to receive care in a way that they choose. We saw that each person had a plan of care, which gave staff clear instructions on how to provide care in a way which people preferred. These were core care plans which were individually adapted to the individuals needs. All plans of care were reviewed each month so that any changes were up dated and all staff would know what changes if any had been made. A moving and handling assessment had been completed on each resident so that staff would know how to move them safely. A nutritional assessment had been filled in so that staff would know if the residents were at risk of losing weight. Weights were recorded on a weekly or monthly basis to make sure that people were staying at an appropriate weight for them. Care Homes for Older People Page 13 of 24 Evidence: Peoples choices about their daily routines were recorded in their care files, including when they liked to get up, where they spent their day and how their spiritual needs were met. This helped staff to make sure that people were able to follow the daily routines of their own choice. Visits from other health care professionals such as GPs, nursing home co-ordinators and district nurses were recorded so staff would know when these visits had taken place and why. The daily records were detailed so that all staff would know what had taken place during the shift. Care plans had evidence that the person living at the home or their family had been involved in drawing up the care plan. The manager audited the care plans on a monthly basis so that areas of concern could be acted upon. We saw staff that had the skills to care for people properly by providing them with specialised equipment to reduce the risk of their health deteriorating and by consulting with doctors and other health care professionals when their condition deteriorated. The atmosphere in the home was warm and welcoming and all staff were seen to be friendly and appeared to have good relationships with the people in their care. When spoken with staff were aware of peoples needs and their likes and dislikes. Residents we spoke with told us, it is a lovely place to live and the staff are really good. Completed survey forms we received had comments such as the staff are helpful and friendly helpful staff. The home cares for people who are at the end of their life and had achieved a gold standard framework for end of life care. Medicines were managed well. Policies and procedures were in place for the safe management of medications and staff training had taken place so that staff were aware of their responsibilities regarding the safety of medicines in the home. Medication that was in the home had been accounted for. All medication administration sheets had been completed properly. We looked at the management of controlled drugs and found these had been checked and recorded properly. Items with a short shelf life in the drug fridge had been dated and signed so that staff would know when these had been opened. The medication management was audited every three months so that any errors were identified and dealt with quickly. All this helped to make sure that the medicines were properly managed in the home so that people received them as their doctors had prescribed, safely and without errors. Care Homes for Older People Page 14 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 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 House were able to take part in a range of activities so they can stay active and staff help people so they could stay in touch with their family and friends. Evidence: People who live at Highfield House were offered choices in various ways, such as in the time they get up or go to bed, where they spend the day, which clothes to wear, whether or not to join in activities and by deciding how they wished to be addressed. This enables them to keep some control over what they do each day and to stay as independent as possible. The people who live at Highfield House are spoken with on an individual basis so that the staff know what kind of activities they would like to do and this information is recorded in the care plan. One to one sessions are most popular and some residents knit, complete crosswords and suduko puzzles. Staff sit with people and read papers or magazines with them. Church services are held at the home on a regular basis for all denominations. The menus are varied and the food looked wholesome. If any resident does not want what is on the menu then an alternative will be prepared. Survey forms received from the people living at the home said, the food is always good, the cook goes out of Care Homes for Older People Page 15 of 24 Evidence: his way to give us what we want. Care Homes for Older People Page 16 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. People who live at Highfield House are confident that their complaints are listened to and staff have received training so that they know what to do to protect people. Evidence: The information in the AQAA showed us that no complaints had been made to the home. It also told us that staff have received training in how to protect people rights and the complaints procedure. People spoken with said that they knew how to make a complaint. I would speak to the manager, but I have no complaints. People could be confident that their complaints would be listened to. The home had policies and procedures on the prevention of abuse and whistle blowing. The safeguarding procedure is how the local council and other agencies respond to allegations of abuse against vulnerable people. Staff have received training about safeguarding people from abuse so that they know how to deal with any incident or suspicion of abuse. Care Homes for Older People Page 17 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. Highfield House is well maintained so that if provides a clean and comfortable place to live, visit and work. Evidence: The environment in the home is warm, welcoming and the decor is of a good standard. The home has six double bedrooms and one single room; prospective residents are made aware of this when they make enquiries about the home. Residents wishes are taken into account about who they share a room with. If a bed became vacant in a shared room, the remaining occupant could pay extra to keep it as a single room. A programme of routine maintenance works is kept within the home. The home has adaptations to assist people with mobility problems and was clean and free from odours at the time of our visit. Equipment such as gloves, wipes and aprons used for the control of infection was plentiful so that staff had good access to these items to help them maintain good infection control. Care Homes for Older People Page 18 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are recruited using thorough procedures to check them out and receive training so people living at Highfield House receive care and support from skilled staff that they like. Evidence: The information we received in the AQAA showed us that a variety of staff are employed to provide care and support for the people who live in the home and that the staff were recruited correctly. The records we saw at the home confirmed this. We found that there are enough staff on duty to meet peoples needs and people who live in the home said they thought that there was enough staff on duty on each shift. People said that if they needed help this was supplied quickly. The told us, All the staff are very helpful. We saw that most of the staff working in the home had achieved a national vocational qualification in care. This is a nationally recognised qualification for people working in care and shows they have been assessed as competent to provide good quality care. We saw staff training is on-going and that all staff have received mandatory training in key subjects. This means that staff have been given the skills to promote peoples health and welfare. The home has achieved a gold standard framework for end of life care. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is very well managed to ensure that the health, safety and well-being of the people who live at Highfield House are promoted and protected. Evidence: The home has strong and stable management from the owner/ manager who has owned the home for a number of years, lives on the premises and has over twenty years of experience. She has achieved NVQ level 4 in management. She is supported by the deputy manager who has also achieved NVQ level 4 and has a wide range of experience over many years. The procedures within the home are thorough so the health, safety and welfare of the people who live there are protected. Staff are well supervised and there are processes in place to make sure the home is run in the best interests of the people who live there. The AQAA that the manager was asked to complete before our visit to provide us with up to date information about the home was detailed and showed that the management team of the home are always considering how the service they provide Care Homes for Older People Page 20 of 24 Evidence: can be improved. Monthly care plan audits are done by the manager and the deputy manager. The audits identify any errors or omissions so these can be rectified quickly. There are also regular checks done of medicines to make sure these are being managed well and safely so that residents receive their medicines as prescribed. There is a system for residents to be able to keep some personal spending money in a safe at the home. Detailed individual records are kept to make sure that this can all be properly accounted for. Accidents were recorded appropriately and analysed to see whether any preventative action could be taken. Staff have attended falls risk assessment training so they understand the importance of taking effective action to prevent people who live in the home from falling. We checked the fire log book and this showed that the fire precaution systems were tested and serviced at the required intervals. Staff training in fire safety had taken place and was recorded. Carers confirmed that fire safety, moving and handling, infection control and food hygiene training was carried out and they had easy access to the homes policies and procedures in these areas. Staff were seen to maintain safe working practices while going about their duties. 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 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 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). 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