Care Home: Highfield Manor

What the care home does well People`s social and healthcare needs are assessed prior to their being offered a placement at the home, to ensure that the home can meet these. The home provides full details about its facilities and services within the Service User Guide to assist people in choosing the home as a suitable placement. The home has care planning systems in place that ensures that residents` health and social needs are met. Care plans were person centred and linked to risk assessments to minimise risk of harm to residents. Medication administration is managed safely in line with best practice. Residents are treated with respect and dignity. The home provides activities and stimulation to meet social and recreational needs of people who live at the home. The home provides a balanced and wholesome diet to residents and specialist dietary requirements are also provided. The home has well-publicised complaints procedures and the staff at the home have been trained in adult protection. The physical environment meets standards. Staff at the home are recruited in line with best practice and are provided with training to ensure that they are competent to do their jobs. The home is well managed and run in the interests of the residents. What has improved since the last inspection? Written references are now taken up for all new staff recruited to work at the home. The home now has over 50 percent of staff trained to NVQ level 2 or above. Accident reports are now auditable. What the care home could do better: The home could improve in the way that prescribed creams are recorded as being administered. Key inspection report Care homes for older people Name: Address: Highfield Manor 44 Branksome Wood Road Bournemouth Dorset BH4 9LA     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: Martin Bayne     Date: 2 8 0 4 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 26 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 26 Information about the care home Name of care home: Address: Highfield Manor 44 Branksome Wood Road Bournemouth Dorset BH4 9LA 01202769429 F/P01202769429 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): RYSA Ltd Name of registered manager (if applicable) Mrs Yasmin Koussa Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Highfield Manor is registered to provide care for up to 27 older people with dementia and mental disorders. The home is owned by Mr and Mrs R. Koussa, trading as RYSA Ltd. Mr and Mrs Koussa also own another care home which is in Poole. Mrs Koussa is registered as manager and is responsible for the day-to-day running of Highfield Manor. Highfield Manor is a large detached property, set back from the road and situated in a quiet residential area. It is within easy travelling distance of all the amenities to be found in the centre of Bournemouth and also Westbourne. Attractive walks are available to the nearby Coy Pond and Upper Gardens. The area at the front of the home offers car parking for visitors and further parking is always available on the road outside. To the rear of the property, the garden is laid mainly to lawn and is Care Homes for Older People Page 4 of 26 Over 65 27 27 0 0 Brief description of the care home sheltered by shrubs and mature trees. The patio provides an enclosed sitting area. The grounds are well maintained and accessible to service users. Accommodation is provided on the ground and first floors in 19 single bedrooms (11 en-suite) and 4 doubles (2 en-suite). Communal areas, comprising a lounge, separate dining room and a large conservatory, are all situated together on the ground floor. A five persons passenger lift is available to assist residents between floors. Care Homes for Older People Page 5 of 26 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: We, the Commission, carried out a key inspection of Highfield Manor Care Home between 9:30am and 4pm on April 20th 2010. The inspection was carried out by one inspector, but throughout the report the term we is used, to show that the report is the view of the Care Quality Commission. The aim of the inspection was to evaluate the home against the key National Minimum Standards for older persons, and to follow up on the one requirement and three recommendations made at the last key inspection of the home in April 2007. We were assisted throughout the inspection by Mrs Koussa, the Registered Provider and Manager. Throughout the inspection, we tracked the personal care files of three people living at the home to evidence how record keeping and support of residents was managed within the home. At the time of this inspection there were 27 residents accommodated. During the inspection we were able to speak with four different groups of relatives who were visiting people living at the home and two members of staff. We Care Homes for Older People Page 6 of 26 also spoke with a number of the residents, however due to their mental frailty they were only able to provide limited information about what it was like to live at the home. Additional information that helped form the judgements contained within this report was obtained from the Annual Quality Assurance Assessment document (AQAA) completed by the home. Care Homes for Older People Page 7 of 26 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 Care Homes for Older People Page 8 of 26 order line 0870 240 7535. Care Homes for Older People Page 9 of 26 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 26 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. Residents benefit from having their needs assessed before being offered a placement at the home, to make sure that the home only admits people whose needs can be met at Highfield Manor. Evidence: Two of the residents we tracked through the inspection had been admitted to the home since the time of the last key inspection in April 2007. We were told by Mrs Koussa that she or the deputy manager would visit a person referred for a placement at Highfield Manor in order to assess their health and social care needs. They would also be invited to visit the home as part of this assessment process. We looked at the personal files for these two residents and found a record of their assessment of need. The assessments were comprehensive, covering all of the topics within the National Minimum Standards and were signed and dated. We were able to speak to relatives of both these residents, who told us that needs Care Homes for Older People Page 11 of 26 Evidence: were being met and that they were very pleased with the standards of care provided in the home. We saw that once a decision had been made to accommodate a person following their assessment of need, this was confirmed in writing. The returned AQAA informed us that the Statement of Purpose had been updated and that this document and the homes Service User Guide were available to residents and relatives to fully inform of the services provided at Highfield Manor. The home does not provide an intermediate care service. Care Homes for Older People Page 12 of 26 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. Residents benefit from their health care needs being met through the homes care planning arrangements, by medication being administered safely and through being treated with respect and dignity. Evidence: Once a person has been admitted into the home, further assessments are completed as well as gaining information about a residents life history so that a care plan can be tailored to the persons individual needs. We looked at the care plans and related documentation for each of the three residents we tracked through the inspection. A photograph of the resident concerned was attached to the front of their records, so that they could be identified by new members of staff. Care plans were typed and were sufficiently detailed to allow care staff to meet the identified needs of each resident. They were also signed by relatives, indicating that they had been involved in development of care plans. We saw good evidence of person centred care, such as information about what type of clothes a person liked to wear and how they should be approached individually. We saw that care plans were being reviewed each month to make sure that they were up-to-date. Care Homes for Older People Page 13 of 26 Evidence: Within each persons personal file we also saw that risk assessments had been completed to inform staff on how to minimise the risk of harm to residents when following through care plans. These included moving and handling assessments and nutritional assessments. Within the care planning documentation we found evidence of how the the health and social care needs were being met. In the case of one person we tracked through the inspection who lacked mental capacity, ongoing support was been provided through the community mental health team. This person had also been referred and made subject to a deprivation of liberty order appropriately. In the case of a second person we tracked, a referral had been made for district nursing intervention the treatment of leg ulceration. We saw within peoples records, that other health needs relating to chiropody, dental care and eye care needs were also being met. The relatives we spoke with all told us that the home maintained high standards of care and that when they visited, their relatives were dressed in clean clothes with attention paid to the personal grooming. We were also told that staff treated residents with respect and dignity. Owing to the mental frailty of the residents living at the home, all residents have their medication administered by the staff. We looked at the medication administration records for all of the residents and found that these were being completed with no gaps in the recording. We saw good recording practice of hand written entries being checked and signed by a second member of staff, any known allergies recorded at the top of the medication administration records and a photograph of the person concerned at the front of their medication recording sheets. We recommend changes to the current procedure adopted by the home for recording administration of creams prescribed to residents by doctors. We found the staff were recording in the daily notes when prescribed creams were administered, but this practice was not being consistently applied. We recommend that a recording sheet is kept in a residents room for the application of prescribed creams. This can then be completed when staff assist people with personal care. We found that the home had appropriate storage facilities of a locked medication trolley in the dining room and a controlled drugs cabinet that met new Regulations. Care Homes for Older People Page 14 of 26 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. Residents benefit from activites being provided in the home, by being able to maintain contact with friends and relatives and through being provided with a good standard of food. Evidence: We were able to observe throughout the inspection how residents were supported in their daily living. Staff were seen to be available throughout the day supporting residents and in the morning they were enjoying singing along to music of their era. The relatives we spoke with told us that there was always something going on in the home. We were shown photographs of various activities that had been arranged in the home. These included celebration of birthdays, Valentines Day, Christmas Easter and Halloween. Other activities include movement and music and crafts as well as staff spending time to speak individually with residents. We were told that some residents who choose are taken out of the home for walks or a visit to pubs or other local amenities. On the day or our visit some residents were enjoying the good weather and were seated outside. One resident was supported by staff in practicing putting, being a keen golfer. We saw that audio books had been arranged for another resident. By seeking information about residents life histories, the home is able to arrange activities that meet individuals interests. Care Homes for Older People Page 15 of 26 Evidence: All the relatives we spoke with told us that they could visit unannounced at any time and that they will always made welcome at the home. One relative described the home as, marvellous. We saw that a persons religious and cultural needs are assed when a person moves to the home. We were told that the home has contact with three different churches who support residents with spiritual needs. All of the relatives we spoke with told us that the food provided at the home was of a good standard and that residents were supported to eat food suited to their taste. On the day of the inspection we were able to observe staff assisting residents appropriately at lunchtime and there was a choice of main meal on offer to residents, with their meals looking wholesome and adequate in portion. We saw within peoples assessments information about their dietary needs. We saw that specialist diets were catered for such as a pureed diet or assistance from staff with feeding. We also saw that residents weight was reglarly monitored and that action was taken in cases where residents were loosing weight through nutritional assessments. Care Homes for Older People Page 16 of 26 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. Residents benefit from a well-publicised complaints procedure and through staff being trained in adult protection. Evidence: The complaints procedure for the home is detailed within the Service User Guide for the home and the terms and conditions of residence. Residents and their relatives are therefore informed of how to make complaints. We saw that the complaints procedure provided details of contact information of the Commission. The home maintains a complaints log for the recording of complaints. Since the last key inspection there have been no complaints made about the home and none have been brought to the attention of the Commission. As reported earlier in the report, the home had made an appropriate referral concerning one resident under the Deprivation of Liberties Standards. We saw within training records that all of the staff had been provided with adult protection training. The AQAA informed us that the home has copies of all the relevant policies and procedures for reporting suspected abuse. Care Homes for Older People Page 17 of 26 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 Manor provides a suitable environment for its residents. Evidence: Relatives with whom we spoke told us that when they visited the home was always clean and well presented. On the day of our visit, the home clean and free from unpleasant odours, as well as being in good decorative order. Furniture and fittings were also in good repair. The home has a small garden to the rear of the home that residents can access as well as the area to the front of the home as there are gates that restrict residents from being in danger from the road. Window restrictors have been fitted on the windows above ground floor and radiators have been covered to protect people living at the home from the risk of receiving burns from hot surfaces. Thermostatic mixer valves have been fitted to hot water outlets to protect residents from scalding water. On the day of our visit, we found one window restrictor that had broken. During the inspection this was repaired making the window safe. During the inspection we had the opportunity to view some of the residents bedrooms. Rooms were adequately furnished and we saw evidence that residents Care Homes for Older People Page 18 of 26 Evidence: were able to bring their own furniture and possessions to personalise their rooms. We also saw within residents personal files that an inventory was kept of possessions and things of value that residents brought with them into the home. We saw that wardrobes that could be pulled over were attached to the walls to make them safe from this hazard. The laundry area is set aside from food preparation areas and it was reported that the facilities were adequate in meeting the laundry needs of the home. Care Homes for Older People Page 19 of 26 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. Residents benefit from sufficient staffing levels, the staff being well-trained and recruited in line with Regulations. Evidence: We looked at staff duty rosters. Between 7 a.m. and 1 p.m. there are three carers on duty, between 1 p.m. and 2 p.m. there is an additional member of staff on duty to assist with mealtimes and between 2 p.m. and 8 p.m. three carers.The manager is rostered to be on duty between 9 a.m. and 5 p.m.. During the night-time period from 7 p.m. to 7 a.m. there are two members of staff who are on an awake duty. The home employs cooks and kitchen staff seven days a week, cleaning staff and a handyperson to carry out small maintenance needs of the home. We were told that the home does not use agency staff and that there is a stable long-standing staff team. The duty rosters we saw reflected the above staffng levels. The relatives we spoke with told us that the staff were king and courteous and that staffing levels met the needs of the residents. We looked at the employment and recruitment records for two members of staff employed since the last key inspection. We found that all the necessary checks and records required to be in place under Schedule 2 of the Care Homes Regulations 2001 had been complied with. Care Homes for Older People Page 20 of 26 Evidence: During the inspection we spoke with two members of staff who told us that they were supported by the management though supervision and that they received training to develop their skills and knowledge. We looked at the training records for the two staff files that we tracked through the inspection. We saw that new members of staff had been given induction training compliant with the Skills for Care. Staff had been provided with core training in such areas as moving and handling, fire safety, first aid, basic food hygiene, safe administration of medication, infection control and prevention of abuse. We also saw that some specialist training had been provided in caring for people with dementia. We were told that the Deputy Manager was currently undertaking a specialist training course with Bradford University in dementia care. We found that the home had achieved a level of above 50 of staff trained to NVQ level 2 or above. Care Homes for Older People Page 21 of 26 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. Residents benefit from a well-managed home. Evidence: Mrs Koussa has managed the home for many years and has completed an NVQ level 4 in management and is supported by a Deputy Manager. The home carries out regular surveys with relatives and people involved with the home as part of a quality assurance programme. We were shown some of the returned surveys, which reflected a high degree of satisfaction with the home and how they cared for residents. From the results of surveys and from the comments made by relatives we spoke with there was evidence that the home was being run in the interests of residents living at the home. We were told that the home does not manage or safe keep any money on behalf of residents, with relatives taking on this responsibility. Care Homes for Older People Page 22 of 26 Evidence: We saw that the homes certificate of registration was displayed, so too the homes public liability insurance certificate. The AQAA informed of data servicing of equipment within the home. We looked at the fire logbook and saw that tests and inspections of the fire safety system were taking place to the required timescales. No hazards were identified during the inspection, other than the broken window restrictor, which was repaired on the day. Care Homes for Older People Page 23 of 26 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 24 of 26 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 9 We recommend that a recording sheet is kept in residents rooms to record the application of prescribed creams. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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