Care Home: Highfield Nursing and Residential Home

What the care home does well The staff recruitment process is thorough; this means that people living at Highfield are protected by the safe recruitment of professional and friendly staff. Relatives told us they were happy with the service and care provided, they particularly expressed they could approach the manager at any time with any concerns they may have and be confident they would be dealt with appropriately. What has improved since the last inspection? Since the previous inspection visit the management of the home has undergone a period of change and has now stabilised with the recruitment of a permanent manager who has 10 years experience of managing nursing homes. There is now a staff induction programme based on Skills for Care standards. This ensures that staff will have skills to carry out their duties well and safely from the start of their employment at the home. What the care home could do better: The Statement of Purpose needs to accurately reflect the layout and designation of the communal areas of the home. This document is where people considering using the service will look and expect to find accurate information. Care plans need to contain more detail for care staff to follow to be sure they are meeting peoples` needs appropriately and consistently and in the manner that people wish their care and support to be delivered. Daily records did not consistently provide information to reflect how peoples` support was provided or how they spent their day. Entries such as `all care given` do not describe the well being of the individual. Good daily records should incorporate what has worked for the individual that day, where there has been progress, achievements or any concerns about their health and welfare. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Highfield Nursing and Residential Home Mandeville Road Saffron Walden Essex CB11 4AQ     The quality rating for this care home is:   one star adequate 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: Jane Greaves     Date: 1 8 0 5 2 0 0 9 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. 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. 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 © (2009) Commission for Social Care Inspection (CSCI). 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The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Highfield Nursing and Residential Home Mandeville Road Saffron Walden Essex CB11 4AQ 01799524936 01799526116 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Tronicgold Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 60 Number of places (if applicable): Under 65 Over 65 11 60 25 dementia old age, not falling within any other category physical disability Additional conditions: 0 0 3 Persons of either sex, aged 50 years and over, who require nursing care by reason of a physical disability (not to exceed 3 persons) Persons of either sex, aged 65 years and over, who only fall within the category of old age (not to exceed 60 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 11 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 25 persons) The total number of service users accommodated must not exceed 60 persons Date of last inspection Care Homes for Older People Page 4 of 28 Brief description of the care home Highfield Nursing & Residential Home was opened in 1990 and consists of a two-storey building with newer purpose built single storey accommodation. It is located in a quiet cul-de-sac within walking distance of the centre of the North Essex town of Saffron Walden. Highfield is accessible by road and rail and the nearest station is in Saffron Walden. Parking is available in the visitors car park and in the adjacent road. There are 42 single en-suite bedrooms and 9 double bedrooms. 8 of the double rooms are en-suite. There are two passenger lifts. The home has several small courtyard gardens that are attractive and accessible to wheelchair users. All ground floor rooms that face onto the courtyard garden have French windows to give the residents access to the gardens. Highfield Nursing & Residential Home provides nursing and personal care with accommodation for up to 60 residents. Tronicgold Ltd privately owns Highfield NH, which is part of Carebase Ltd. At 20th May 2008 the range of fees paid for care and accommodation at Highfields Nursing Home ranged from £541.77 in shared accommodation to £1038.20 dependant upon level of need. 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: one star adequate 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 was an unannounced key site visit that took place over 8 1/2 hours. At this visit we considered how well the home meets the needs of the people living there and how staff and management support people. A tour of the premises was undertaken, care records, staff records, medication records and other documents were assessed. Time was spent talking to, observing and interacting with people living at the home, visitors and staff. Prior to the site visit the manager had completed and sent into the Commission for Social Care Inspection the homes Annual Quality Assurance Assessment (AQAA). This Care Homes for Older People Page 6 of 28 is a self assessment document required by law and tells us how the service feels they are meeting the needs of the people living at the home and how they can evidence this. Before the site visit a selection of surveys with addressed return labels had been sent to the home for distribution to residents, relatives and staff. Views expressed by visitors to the home during the site visit and in surveys responses have been incorporated into this report. Feedback on findings was provided to the manager throughout the inspection and the opportunity for discussion and clarification was given. We would like to thank the residents, the manager, the staff team and visitors for the help and co-operation throughout this inspection process. The previous key inspection of this service took place on 20th May 2008. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 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 9 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. People considering moving into Highfields Nursing Home have sufficient written information available to help them make decisions. Assessments undertaken will give people confidence that the home will be suitable to meet their needs. Evidence: There was Statement of Purpose available at the home that detailed the aims, objectives and philosophy of care at the home. We noted this included information about a secure dementia wing with a dedicated lounge and dining area with a key pad door in and out of the unit. This facility did exist at this visit, however people living with dementia were using the saffron lounge for their day to day living and there was now a satellite kitchen with a dining table providing a homely atmosphere. This means that the Statement of Purpose did not accurately reflect the facilities that people with a diagnosis of dementia moving into the home may expect. The managers AQAA stated: Our Statement of Purpose needs to be reviewed to ensure that it explains the service Care Homes for Older People Page 10 of 28 Evidence: we provide. The service User Guide was informative and provided a clear picture of what people may expect from the facilities available at the home and the daily routines. The manager reported that when a person enquired about moving into Highfield they, and their families, were invited to look around the home and speak with staff, residents and visitors. The manager then visited the person in their own home or hospital to undertaken an assessment of their individual needs to ensure the services and facilities provided at the home were appropriate to meet peoples needs. The views of other professionals were included in the admission process including district nursing teams and social workers. We looked at three care plans as part of this inspection. All contained pre-admission assessments covering various aspects of peoples daily lives and care needs such as maintaining a safe environment, falls, communication, breathing, eating, drinking, continence, personal hygiene and dressing, mobility and sleeping. Families told us We went to have a look at it and liked it, we spoke to other visiting relatives and they said there were no negatives at all. Two relatives visited the home; we had a tour round and spoke with various people. It was agreed that our relative would try it for a week and they settled straight away thanks to the caring staff. Care Homes for Older People Page 11 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive a generally person led approach to their care however some shortfalls in care planning may mean that their independence is not always promoted and that their health needs are not always addressed. Evidence: There was a care planning system in place. We looked at three care plans; they were not very detailed and gave an outline of peoples preferences and needs. It was not always possible to get a clear picture of the support people needed to maintain their personal care due to lack of detail. One care plan we looked at stated in the personal hygiene section that x requires the support of one carer for all activities of daily living. Neither the care plan nor the daily recording gave any indication of what level of support the person had been provided with nor did it provide the level of detail necessary for person centred care delivery. Daily records in a further care plan stated No problems all care given. This persons care plan indicated that they had very complex personal care needs and needed considerable support to wash, dress, clean teeth, do their hair and shave. Another care plan we looked at included a good quality Care Homes for Older People Page 12 of 28 Evidence: of daily recording providing a real sense of how the person had felt and how their day had been spent. Daily records, when detailed, are a good source of evidence to show that care is being provided as detailed in the care plan and help to provide the information necessary to base regular reviews. Where possible, people had signed their care plans to indicate that they had seen/agreed with the content. Peoples weight was regularly monitored and recorded and there were records of medical visits from GPs, District Nurses and Occupational Therapists and the outcomes of these. The manager was aware the current care plans were not effective working documents and reported that a new system was being developed and the intention was that it will be implemented throughout the home by spring of 2010. One health professional we spoke with as part of this inspection process told us It has been a bit rocky over the past eighteen months or so and The staff dont necessarily have the skills to meet the needs of X, there is a lack of enablement and A major frustration is about lack of communication and us being kept in the loop and More recently the primary nurse has been much more proactive. Another health professional told us An ongoing issue is that nursing staff are not necessarily skilled to undertake male catheterisations, or take bloods or use syringe drivers for example and Not always sure which residents are nursing or residential, the staff dont always seem to know either and Have made some improvements over the past couple of years but the constantly changing management has made it hard to embed changes and I feel the service is satisfactory but there is room for improvement. We observed the medication being undertaken by nursing staff during the lunch service, this was done with courtesy and sensitivity. The medication was kept in a trolley that was locked and secured in the clinical room when not in use. We looked at the Medication Administration Records (MAR), there were no gaps in recording and there were photographs of the residents included in the MAR folder to aid with confirming peoples identity and the safer administration of medicines. The MARs showed us that some people were prescribed a high number of medications. The ordering of medicines was undertaken by one dedicated member of staff. Staff told us there had been difficulties in committing the GPs to undertake regular reviews of peoples medications. The manager reported the intention to organise a system of regular reviews of 6 or 7 people each week when the GP visited the home routinely. Care Homes for Older People Page 13 of 28 Evidence: This way there would be a regular revolving check on the medication each person was being prescribed ensuring that no person took any medications for periods longer than was necessary. Despite 10 care staff being on duty on the day of this visit there were frequent occasions when the resident call bell buzzer sounded and escalated to a frequent pulsing pitch because it was not answered in a timely manner. Family members we spoke with during this inspection process were very positive about the care and support provided for their relatives at Highfield. Comments we received were as follows: The care is fantastic, They keep good contact with us, if our relative is unwell or has a fall they phone us and let us know, The girls are fantastic, they look after X, they really are good girls and X has good care, they really look after X well. Care Homes for Older People Page 14 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will have have some opportunities to enjoy a fulfilling lifestyle, and will enjoy good food. Evidence: There was a steady flow of visitors to the home on this day, all people we spoke with said they were always made very welcome whenever they visited their relatives. There was a menu of activities available in the reception area and in each persons bedroom so that the people could choose what activities they took part in. The menu included crosswords, craft work, flower arranging, films, 1:1 time with individuals and music and movement. Evidence in recording showed us that people enjoy guided walks around the grounds. There was a womens group where the ladies could enjoy hand massages with lotions and relaxing music and a chance to talk in a safe space with other ladies. A mens group included dominoes and cards games, this was facilitated by a male staff member. The manager reported that the activity co-ordinator and a senior carer from the dementia unit were due to attend a day centre in order to increase their experience of activities specifically designed for people with dementia. The activities co-ordinator was a member of the National Association for Providers of Activities for older people Care Homes for Older People Page 15 of 28 Evidence: (NAPA). NAPA is an organisation dedicated to increasing the profile and understanding of the activity needs for older people, and equipping staff with the skills to enable older people to enjoy a range of activity whilst living in care settings. Some people regularly went out with friends or family, the manager reported there were plans for seaside trips and gave examples of planned outings to Newmarket to see the new born foals. People benefited from the home having a pleasantly appointed hairdressing salon, the Hairdresser visited the home Monday, Wednesday and Friday, a Beautician visited each Tuesday. There was a daily Breakfast Club in the Saffron lounge. At this visit we saw people happily breakfasting here in a domestic family manner. In surveys, people were generally complimentary about the activities provided, the only issue raised was that there may not be enough stimulation provided that was appropriate to meet the needs of people with impaired vision or lack of mobility. We were invited to eat lunch with the residents. They told us Its always a long time waiting at the table for dinner to arrive. We noted that it took a long time to usher people into the dining room for lunch. Some people were falling asleep at the dining table whilst waiting for service to start, others were just fed up. The activities co-ordinator joined care staff in providing residents in the dementia unit with sensitive assistance during the lunch service. We looked at four weeks menu, it was noted that the Autumn/Winter menu was in use with some amendments made. There were 2 choices daily for the main meal. This day there was homemade cauliflower and broccoli soup followed by toad in the hole or mixed bean and vegetable casserole. Staff asked people their preferences at the dinner table. The atmosphere was very subdued in the dining room, there was very little conversation amongst the residents. The tables were nicely laid with cloths and napkins, some placemats had dried on food. People were asked if they wanted plate guards to make it easier for them to eat their meals instead of assumptions being made that they needed them. There was a system in place to monitor peoples appetites to identify if individuals were off their food for any reason. An example the manager gave us was where an individual was noted regularly not to be eating their lunchtime meal. The decision was made to offer a light lunch and provide a cooked meal in the evening, this had proved to be very successful and is a good example of person centred care. During the lunch service in the main dining room we saw someone chewing their napkin and trying to take a bite from it when they became confused about what they were eating. This person had received some assistance with their meal however the carer had been called away at this time. Surveys from people living at the home were generally positive about the food telling us that The food is good and Its lovely, we really cant complain. The feedback from relatives was less positive with comments such as Food is Care Homes for Older People Page 16 of 28 Evidence: wholesome if a bit unimaginative. Does not reflect the fees charged and People in the Dementia unit being fed too speedily. 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. People were confident that any concerns would be listened to and dealt with properly and that, as far as possible, they would be protected in the home. Evidence: There was a complaints policy and procedure in place, and included within the service User Guide, that clearly outlined the timescales and where to address the complaint, including to the Commission, if a person was not satisfied that the management had dealt with it appropriately. Complaints records showed us there had been issues raised with the management of the home and they had been dealt with in a satisfactory manner within timescales identified in the policies and procedures. Relatives told us The manager is very responsive to any concerns raised. The staff are very friendly. There are sometimes issues with laundry but they do their best to sort these out. Another person said No complaints at all they are wonderful. There was up to date information available in the staff room for staff to access that told them who to contact if they had any adult safeguarding concerns. The manager was very disappointed that recent contact made with ECC safeguarding team to request current guidance and training information had not been responded to. Care Homes for Older People Page 18 of 28 Evidence: Staff spoken to confirmed a good understanding of adult protection procedures and attendance at training. They could also locate the current guidance on the subject. Training records showed that 51 staff members working at the home were up to date with their adult protection training with 6 people needing to attend refresher training. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that was generally pleasant and well kept. Evidence: We took a physical tour of the home as part of this inspection process. Overall the home was in good decorative order and provided a pleasant environment for people to live. It was noted at the previous inspection visit that the pattern of the carpets in the communal areas of the home caused some people to think there were biscuits on the floor and was therefore a potential risk to peoples safety when bending to try and pick them up. The carpet remained in situ at this visit. The kitchen had been completely refurbished since our last visit to this service. It had been tiled from floor to ceiling and appeared fresh, clean and bright. New equipment had been installed such as fridges and freezers. We saw that peoples bedrooms were personalised with their own belongings and nicely furnished. One double room was in the process of being upgraded to a single facility with en suite shower room, the manager reported this was the start of a planned upgrade of existing double rooms. In the corridor outside rooms 10 to 13 we saw a trolley with soiled laundry on our initial tour of the home in the morning. This trolley remained in the corridor after lunch; this is an area for residents to sit and enjoy the sunshine or to entertain visitors. The laundry trolley situated there was an eyesore and did not contribute to making this a pleasant place to sit. We saw a cleaning trolley left unattended in the doorway of an unoccupied room and a vacuum Care Homes for Older People Page 20 of 28 Evidence: cleaner left in a communal hallway. This was in a hallway close to where residents living with dementia spent their day in the Saffron lounge. Chemicals and equipment left unattended in this way could pose a risk to peoples health, safety and well being. Since our previous visit to this home there had been a satellite kitchen installed in the Saffron lounge to promote independence for those residents that were able and so that visitors could access refreshments readily. There was a dining table and a toaster and microwave etc, people were able have their breakfast here if they wished. 10 people were having their breakfast in this space at the time of our tour of the home. As at the previous inspection visit, storage facilities remained an issue at Highfield, we saw sit on scales in the corner of the Saffron lounge and hoists, privacy screens and wheelchairs in the main lounge. The bathroom on the ground floor on the corridor outside rooms 1 to 8 was untidy with gloves and aprons strewn around. This facility was cold and soulless with no blinds at the window, there was nothing warm and homely about this room. The bathroom on the ground floor in the established part of the building was nicely tiled but was cluttered with various pieces of equipment such as unused pressure pads and bins, it too was soulless and smelt musty. Living areas were arranged around pleasant secure courtyards that were easily accessible to people living at the home. These were pleasant outdoor spaces with some seating, hanging baskets and raised planters created a colourful display. We noted that the home was overall clean and tidy at this visit. Residents told us: Its like a stately home and The domestic staff show a very responsible attitude to their responsibilities and Cooking smells sometimes linger in the lounge. 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. People benefit from having a stable, well recruited and generally well trained staff team. Evidence: People living at the home were complimentary about the care and support they received. Residents told us: The staff are very caring and kind and Very supportive and helpful, staff seem very knowledgeable about the care needed and Despite being very busy they always try to help when needed. Relatives told us: All the staff are fantastic and friendly, we are so lucky! We looked at staff rotas; these showed us that the home was staffed with 10 care staff in the mornings, 8 in the afternoon and 4 at night. There were also 2 qualified nursing staff on duty during the day and 1 at night. A deputy manager had been appointed and was due in post imminently. Domestic, laundry and catering staff, an administrator and full time handyman were also employed to work at the home. The managers AQAA stated We have clear recruitment procedures in place to safeguard residents which ensure we recruit the right calibre of staff. We looked at recruitment documentation for 3 staff members, one of whom had been recently recruited to work at the home. These contained evidence to show that all pre employment checks had been made prior to people starting to work at the home in Care Homes for Older People Page 22 of 28 Evidence: order to safeguard the well being of the people living there. Photographs of the individuals were not available on the staff files, the manager reported that the photos had been taken but had not yet been printed. Records of staff training showed us that 15 care staff had achieved a minimum of NVQ level 2 in care and that 7 more were working towards this qualification. 21 staff had attended training to provide them with skills to manage challenging behaviours and 44 staff had attended training in looking after people with dementia. 55 staff had attended Fire Safety training and 32 had received Health and Safety training. 64 staff had received training in safer moving and handling, 56 had attended safeguarding vulnerable adults training and 2 had received infection control training. These records showed us that, whilst there were still some gaps in the basic core training necessary for staff to be able to care for people safely, there was a commitment to deliver training in these areas to the whole staff team. The manager provided us with detail of further training courses arranged for the staff team and dates when this was scheduled to take place. 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. People benefit from a generally well run home where the new management team are committed to improving the service provided. Evidence: The manager of the home had been in post since March 2009 and was a qualified nurse who had achieved the registered managers award, was an NVQ assessor and had 10 years experience managing nursing homes. Residents and family members shared their concerns with us about the unstable management over the past year. Staff indicated to us they had felt unsupported through this very unsettling period with each new manager implementing changes. Staff members spoken with were positive about the current management arrangements in the home and they felt the changes made to date were positive. The service had an established annual quality assurance process in place involving Care Homes for Older People Page 24 of 28 Evidence: questionnaires being distributed to residents, relatives and other stakeholders. Responses to these questionnaires were collated and put into a report with an action plan to address any identified shortfalls in the service provision. The operations manager reported to us that this process was to be amended with effect from this year to be a half yearly process to ensure continuous evaluation of the services and facilities provided at Highfield. Evidence was available to confirm that regular residents, relatives and staff meetings took place at Highfield. These were all minuted and showed us the management ethos was open and transparent. A family member told us We had a meeting 2 weeks ago where we had the opportunity to meet with the new manager. The manager had a staff supervision programme in place. Meeting minutes of 21/04/09 included reference to supervision and appraisals needing to improve. Accident records were reviewed and were found to be completed well and provided sufficient information. 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 1 7 15 Ensure that detailed care plans are in place for all identified needs and that staff use the plans to direct the care they provide. So that peoples needs are met in a way that they would prefer. 31/08/2009 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 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or 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) 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. 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