Care Home: Highfield Nursing Home

What the care home does well People are provided with a comfortable and homely environment. They benefit from a well run home, where the registered manager has been in post for a significant number of years. People are well settled in the home and believe they are well cared for. They are positive about the staff who work at the home. One person said, "All of the staff are really nice". Another said, "It is very nice here, all of the people are very nice, they speak to you respectfully. If I need help they give me help, but I like to be independent. Food is very nice as far as I am concerned and I have a choice". Relatives spoken to were also very positive about Highfield Nursing Home. They said, "I have nothing but praise, mum is happy, please with how she is being looked after. She couldn`t walk when she came here but she has had exercises and physiotherapy and she now walks on her own"."Staff are really kind, helpful and pleasant, there are things going on for people and a good atmosphere. She was unwell, they got the GP and she is much better now". What the care home could do better: A number of the management systems need to be developed further, including staff training, staff training records and staff supervision. An induction system is also needed for qualified nurses. First aid training is also needed and it would be beneficial to develop client specific training. Care is needed with the weekly fire checks and water temperatures as there needs to be a system in place when the maintenance person is not available. The work that has commenced on peoples` assessments and care plans in respect of developing more person centred plans should continue. There is the need to ensure that the assessment of needs are reviewed and updated. Random inspection report Care homes for older people Name: Address: Highfield Nursing Home The Meadowings Yarm Stockton On Tees TS15 9XH two star good service The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jacqueline Herring Date: 2 7 0 5 2 0 1 0 Information about the care home Name of care home: Address: Highfield Nursing Home The Meadowings Yarm Stockton On Tees TS15 9XH 01642781309 01642780253 Highfield@schealthcare.co.uk www.schealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Southern Cross Care Homes Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 40 Number of places (if applicable): Under 65 Over 65 Conditions of registration: Date of last inspection Brief description of the care home Highfield care home can provide care of up to 39 older people. This includes providing both nursing and personal care. The home is purpose built and of single story. None of the rooms have en-suite facilities however WC s and bathrooms are close to bedrooms and the lounges. There are 3 wings to the home with bedrooms and bathrooms; there is a quiet lounge diner at the end of the east wing and a lounge dining area at the south end of the home. A small lounge is in the middle of the home and has access to the enclosed patio. The patio has sturdy furniture for residents use when the weather permits it. Easy access to the home is from Yarm High street and is on a bus route situated on the edge of a housing estate. Shops are plentiful in the High St where residents can visit with family and friends. Care Homes for Older People Page 2 of 10 What we found: This inspection was a random unannounced inspection. It took place on27 May 2010 and was completed in one day by one compliance inspector. The purpose of the inspection was to look at a range of matters that effect the care, welfare and wellbeing of people living at Highfield Nursing Home. During the visit we looked at a number of care records of people living at Highfield, their associated medication administration records, menus and information about activities. We also looked at staff recruitment records, staff training records and staff supervision records. We also looked at some maintenance and servicing information. We had a look around the home, spoke with people living there and relatives who were visiting, we also spoke to staff and the manager. We found that the care records in the main were well written, they were in the process of being developed into much more person centred records. Two care files of people living at Highfield were looked at, one was a recent admission to the home and the other was someone with more complex nursing needs. All of the standard information had been completed regarding the individual, significant people to them, GP and Social Worker. There was a brief medical history completed. Peoples assessment of need had additional comments added making them more personal. Baseline observations had been completed for the new admission. The social profile had not been completed. A range of risk assessment were in place. Bed rail risk assessment only had a single staff signature. A range of appropriate care plans are in place, such as nutrition, weight loss, washing/dressing, continence, all of which matched up with the assessment of need. Interventions were well written and were specific to the individual. A number of them were however not dated. As this was a new admission, there were no evaluations of care as yet. The second care file also had a range of information in place as detailed above. The physical and social assessment was dated 7/7/08 and really needed to show evidence of review and updating. The manager did acknowledge this. The risk assessments were generally being completed monthly. Moving and handling was very detailed. Sample of care plans were looked at. Well described interventions, very good evaluations of care which had been cross referenced to the monthly risk assessment tools. There was clear involvement from the GP and diabetic nurse. Care plans were very specific to the individual, for example specific type of pad and size detailed for urinary incontinence. In terms of mobility, these care plans were extremely explicit and detailed moving and handling for a range of different situations. Social care plan was in place. Daily report were well written and informative. The weekly carers report could be more detailed and informative. It was confirmed through discussion with staff that there are no pressure sores at present. Community matron visits as does the GPs. Where necessary have fluid and nutritional charts, some people on hourly fluid, is totaled at end of day. Food is very good, weight is monitored, usually monthly but will do weekly if there are concerns Care Homes for Older People Page 3 of 10 would involve GP, dietitian. Everyones weight is stable at the moment, would monitor if there was an issue. Medication Administration Records (MAR) sheets for the two people we looked at, there wee no gaps, handwritten entries had two signatures and directions were good. North Tees Primary Care Trust pharmacy audit was looked at. One of the comments was about staff who are administering medication to wear a red tabbard, this was observed during the inspection. Menus were looked at, which were the standard Southern Cross menus. People were spoken to about the meal provision, which they were satisfied with. Later breakfasts were observed being served in peoples rooms. Lunch-time was observed and meals were well presented and people looked like they were enjoying them. An activities plan is in place which included, armchair exercises, gardening club, quiz, photography club, cookery club, bingo, games - dominoes, cards, crosswords and Sunday evening Karaoke. One member of staff spoken to said about activities, great activities coordinator - night time activities, glass of wine on the patio, ice lollies. The AQAA detailed there had been three complaints in the last 12 months. The environment is bright and homely. There was a slight malodour in one of the corridors. There was evidence of personalised bedrooms, matching towels and flannels, throws and light shades. Window openings are restricted. Nurse call leads available and able to be attached to people. Bedroom doors have hold open devises. Classical music playing in the background. A member of staff spoken to said they had three hoists, all suitable for peoples needs. One person said they could do with more straps, some people have their individual ones, there are also moving and handling belts and slide sheets. A number of staff files were looked at and it was demonstrated that effective, safe recruitment practice is in place. In one of the files looked at there was no training file available and no evidence of supervision. In another file for a qualified nurse there was no induction and no supervision. It was noted that individual training records are not up to date and one person had not had fire training since 2007. Supervision records again were not up to date, some people had not had supervision and other supervisions were not of an individual nature a number were about policies, procedure and care practice. Supervision forms dated 12/1/10 and 11/1/10 for six staff were all photocopied forms and were about administration of medicines, no individual comments or actions were detailed. Staff supervision planner with staff names and who is to supervise, nine separate sheets, all were blank. A Training matrix detailing 47 staff was looked at. Approximately twenty staff have not completed POVA training. There was evidence that the majority of staff have had up to date fire training and evacuation and drills. A good proportion of staff with moving and handling which were up to date. No staff who had completed any nutrition training. In regard to infection control a number have enrolled and 17 staff had completed this. There was no evidence of up to date first aid training and no actual training plan in place. It was also confirmed that qualified nurses are to commence clinical updating, with advanced Care Homes for Older People Page 4 of 10 medication management, venapuncture and catherterisation. Work is also to commence on the Gold Standard Framework for end of life care. No actual client specific training currently takes place. Staffing levels were discussed and one member of staff said, they had enough staff on the books, sometimes a little short due to sickness but usually enough to meet peoples needs. The manager had been diverted on occasions from the day to day management at Highfield Nursing Home to provide some input into other Southern Cross Homes. We were not notified of this. She is no longer involved in this. She is also involved in conducting regulation 26 visits in other services. A new deputy manager is in the process of being recruited. Health and safety manual contained an audit 20/3/10, minutes from the health and safety meeting, does identify some action points. Weekly fire checks generally taking place, arrangements need to be in place when maintenance person on annual leave as they get missed. Water temperatures are being tested and recorded confirmed weekly. There has been a problem with water temperatures in one of the wings, with the water running too cold, this needs to be attended to as soon as possible. An internal inspection, Key outcome tool was completed on 22/3/10. There is an action plan to go along with the audit for which there are timescales. Regulation 26 visits, 24/5/10 includes a review of the existing action plan and highlights areas that have been addressed or not. These have been taking place monthly, often by other home managers. What is good about the service, one member of staff said, it is friendly, talk to residents, sit with them, staff have a voice, listened to, can express an opinion, residents are appreciative, they are happy, it is a good place. Sue is supportive, approachable, can go to her with anything, confidential and helpful. What the care home does well: What they could do better: Care Homes for Older People Page 5 of 10 A number of the management systems need to be developed further, including staff training, staff training records and staff supervision. An induction system is also needed for qualified nurses. First aid training is also needed and it would be beneficial to develop client specific training. Care is needed with the weekly fire checks and water temperatures as there needs to be a system in place when the maintenance person is not available. The work that has commenced on peoples assessments and care plans in respect of developing more person centred plans should continue. There is the need to ensure that the assessment of needs are reviewed and updated. 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 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 33 24 (2) The results of quality surveys 30/09/2008 should be published and made available to people who use the service, relatives and other interested parties including CSCI. Care Homes for Older People Page 7 of 10 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, 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 18 12 All staff must be provided with protection of vulnrable adults training. This will ensure the protection, welfare and wellbeing of people living at 01/08/2010 2 30 18 All staff must be provided 01/08/2010 with the training that is appropriate to the work they are to perform and that will equip them to met peoples assessed needs. To ensure people living at the home are cared for by suitably skilled and trained staff. 3 36 18 All nursing and care staff 01/08/2010 must be provided with formal supervision at least six times a year. To ensure that staff are appropriately assessed and supported. 4 38 18 All staff must receive 01/08/2010 Page 8 of 10 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 training that is appropriate to the work they are to perform. There must be sufficient staff employed at the home that are trained in first aid. This will ensure that peoples needs are being met by staff who have the appropriate knowledge, skill and experience. 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 7 The work that has commenced in updating the care records should continue and should include the assessment of need being reviewed and updated. The malodour in one of the corridors should be addressed. There should be a system in place to ensure that the weekly water temperatures and fire checks are carried out when the maintenance person is on annual leave. 2 3 19 38 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial 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. 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