Care Home: Highfield Nursing Home

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What the care home does well This home provides a safe and comfortable environment for the people who live there although the building would not meet the standards expected of a newer facility. People told us that they chose the home because it had such a warm and cheerful atmosphere, they were very complimentary about the staff team, telling us that they were kind and friendly, and they liked the large communal area because they could see what was happening everywhere. Everyone we spoke with told us that they were always welcomed warmly in to the home. There is a comprehensive admission procedure in place which is designed to ensure that placements will meet the residents needs. Everyone would be visited by the homes manager or a senior staff member in addition to having a care manager assessment. This assessment then forms the basis of their care planning and they are encouraged to participate in this process. Medication processes in the home are generally well organised so that residents receive their medication as it has been prescribed by their doctor and their are regular audits to minimise the risk of any errors. There is a range of activities available for those who wish to join in and relatives are also invited to some of these. Of particular note was the recent "cultural day" when staff dressed in their national costumes and cooked traditional dishes for people to try. Photographs are around the home of various events that have been enjoyed. People told us that they enjoy the meals that are served. The chef has worked in the home for some time and meets with them regularly to make sure that they are happy with everything. There is a stable workforce within the home which helps people to feel safe and agency staff are not used. Staff training is given a high priority and we were able to see that staff are able to attend training sessions which are relevant to the client group that they are caring for. There are robust recruitment procedures place to help ensure that no one is employed who has been judged as being unsuitable to work with vulnerable people. Quality assurance monitoring is in place to make sure that standards are maintained. There are yearly satisfaction surveys, and residents and relatives meetings so that people can contribute their views and the regional director visits the home at least monthly. What has improved since the last inspection? Since our last visit the home no longer has any shared rooms. The Home tells us that the new single rooms help to support residents rights to privacy, dignity and choice. Some people have chosen to keep their doors locked when they are out of their rooms, everyone has been offered this choice. There has been some redecoration and a new carpet has been fitted in the lounge area.A new activities coordinator has been employed. This has helped to increase the range of activities that are available for people to join in with if they wish. What the care home could do better: This service is providing good quality care however, the home is looking tired and shabby. We understand that there are plans for redevelopment in the future but this is not for another four years or so. If the home is going to be able to compete in the current market the providers may have to consider how they can improve the environment in the meantime. We noted that one residents door was wedged open, and we have asked the service to fit automatic door closers to the bedroom doors of any resident who prefers their door to be left open. This would work in conjunction with the alarm in the event of a fire and help to ensure residents safety. We have also asked them to ensure that topical preparations and creams are only being used for the residents that they were prescribed for although the manager was addressing this at the time of the inspection. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Highfield Nursing Home 36-38 Bromley Road Catford London SE6 2TP     The quality rating for this care home is:   two star good 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: Alison Ford     Date: 2 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 27 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Highfield Nursing Home 36-38 Bromley Road Catford London SE6 2TP 02084883970 F/P02084883970 lorna.lang@excelcareholdings.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Highfield Healthcare Ltd care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 45 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 (maximum number of places: 45) Physical disability - Code PD (maximum number of places: 45) Date of last inspection Brief description of the care home Highfield is a home registered to provide nursing care for up to 45 elderly people however, rooms have now been changed to become single occupancy and the home only ever has a maximum of 24 people living there. It is a converted Victorian residence on the main road close to Catford, with shops etc. nearby and good public Care Homes for Older People Page 4 of 27 Over 65 45 0 0 45 Brief description of the care home transport links. There is limited parking available to the front of the property. Accomodation is provided over three floors and there is a passenger lift. On the ground floor there is a very large communal area which has been divided in to smaller seating areas and a dining room. The nurses station and managers office are also there. Toilets and bathrooms are on each floor and there is an attractive garden to the rear of the home which residents enjoy in the warm weather. At the time of the inspection weekly fees ranged from £547 - £646. Some extra charges would be payable for services such as hairdressing and these would be discussed prior to admission. Care Homes for Older People Page 5 of 27 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: This report follows an unannounced visit to the home as part of the planned inspection process. The service was last inspected in June 2007 at which time it was considered that it was providing good quality outcomes for the people who were living there. When writing the report we have also taken note of information that we have received since that time such as complaints, notifications and comments from the people who use or visit the service. During our inspection we undertook a tour of the home and we spoke with a number of residents, people who were visiting, staff and the homes manager. We looked at a sample of care plans, medication storage and administration and various records that the home is required to keep as evidence of its commitment to the health and safety of the people who live and work there. Care Homes for Older People Page 6 of 27 In addition the home has sent us their Annual Quality Assurance Assessment. This gave us information about how well the home is meeting its stated aims and objectives and also about their plans for the future. We have not received any complaints about the service since their last inspection. What the care home does well: What has improved since the last inspection? Since our last visit the home no longer has any shared rooms. The Home tells us that the new single rooms help to support residents rights to privacy, dignity and choice. Some people have chosen to keep their doors locked when they are out of their rooms, everyone has been offered this choice. There has been some redecoration and a new carpet has been fitted in the lounge area. Care Homes for Older People Page 8 of 27 A new activities coordinator has been employed. This has helped to increase the range of activities that are available for people to join in with if they wish. 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 9 of 27 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 27 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. No one is admitted in to the home without having a full needs assessment to make sure that the placement will be suitable for them. Evidence: We looked at five care plans during the course of the inspection, two were from residents admitted to the home fairly recently. We were able to see that an assessment was in place from the residents care managers and also that the manager of the home had visited the person and conducted their own assessment. Having satisfied herself that the home would be able meet the residents needs,she would ensure that a letter of confirmation of the placement was sent either to them or to their representative.Written information about the home was also given to them at the time. We were able to talk with the residents who confirmed that they had been visited and that they had been able to ask questions about the home. They had not been able to visit themselves but their relatives had come and had a look round on their behalf and Care Homes for Older People Page 11 of 27 Evidence: one said they had been able to choose the room. Care Homes for Older People Page 12 of 27 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 all have a comprehensive individual care plan which identifies any areas where they may need support. Medication procedures generally ensure that residents are receiving their medication as it has been prescribed. People are treated with respect and dignity Evidence: All of the residents have an individual care plan which sets out the care and support that they need and gives staff guidelines as to how they like to be supported. We looked at five of them and found them to be well organised and they are reviewed regularly so that any changes are identified. Residents and their representatives are encouraged to participate in the care planning process and sign the care plans to show that they have been involved. All aspects of residents lives are considered including end of life care and advance directives. Other health care professionals visit the home regularly such as the dentist and optician and the designated GP for the home visits weekly and as required. Relatives Care Homes for Older People Page 13 of 27 Evidence: told us that they are always given feedback if the resident had been visited by the doctor. We did recommend that moving and handling assessments could be a little more detailed with regard to the type of hoist and size of sling that should be used. The home has a robust medication policy in place and when we looked at administration records and storage we could see that residents were receiving their medication as it had been prescribed. We did raise one concern about creams and other topical preparations that were left in residents rooms. Some of these were unlabelled and in one room they belonged to someone else. A requirement has been issued to ensure that this issue is addressed although the Registered Manager was starting to do this on the day of the inspection. On the day of the inspection we saw that residents were clean, well dressed and all of them seemed to be happy. The feedback that we got from them was that staff in the home are very friendly and they do not have to wait long if they need anything. We noticed that they seem to have a good relationship with them and the atmosphere in the home is very relaxed and cheerful. Care Homes for Older People Page 14 of 27 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 find that the lifestyle in this home suits them. Activities are available for them to join in with if they wish, they enjoy the meals and their families are always encouraged to visit and be involved in events that take place. Evidence: Residents in this home are encouraged to make choices in their daily lives including what they wear, when they get up and go to bed, when they have a bath and what they eat. One lady explained that when she first arrived she didnt know that she was able to choose when to get up and wanted it to be earlier. After discussion with the staff she told us that now she is able to get up earlier and comes down to the sitting room to have a cup of tea and listen to the news. An activities coordinator is employed by the home and residents and their families told us that there is a range of activities available for them to join in with if they wish to. This includes trips out of the home and visiting entertainers. A reminiscence corner is also being developed. One lady told us that they particularly enjoy bingo and would enjoy more of that. The home is lucky to have a large well laid out garden and this provides a venue for Care Homes for Older People Page 15 of 27 Evidence: garden parties. People told us that they had particularly enjoyed a recent cultural day when staff had dressed in their national costumes and brought in traditional dishes for people to sample. We were able to see photographs of this and of other events that had taken place. Spiritual needs are met and church representatives visit the home regularly. The daily menu is displayed on a board in the dining room and all the people that we spoke with said the food that they are served is very good. We saw lunch being served in the day of the inspection and it was well presented and appetising. Drinks and condiments were on the table and there was help available for anyone who might need it.The chef has worked in the home for many years, knows residents well and often goes out to talk with them to see if they enjoyed their meals or if they would prefer other dishes to be included on the menu. Care Homes for Older People Page 16 of 27 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. Those who use or visit this service have been made aware of how to raise a concern and are confident that it would be acted upon promptly. Evidence: There is a robust complaints policy in place although all of the people that were spoken with agreed that they would raise any concerns with the registered manager and they would be sorted out. We also noted that there are posters around the home with a helpline number on so that people could ring someone within the company if they had any complaints. Since the last inspection the home has received one complaint which was unsubstantiated and The Commission has not received any. The manager tells us that the home actively encourages people to comment about any concerns in order to improve the service. Staff all displayed an understanding of how they would recognise and report any allegations of abuse and they have all received training in safeguarding issues. The home operates a robust recruitment procedure to ensure that people, judged as being unsuitable to work with vulnerable adults, are not employed in the home. Care Homes for Older People Page 17 of 27 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. Resident say that the home suits their needs and it is clean and warm however it is looking very tired and worn and would benefit from a significant amount of investment. Evidence: This home is a large converted Victorian residence on a busy main road, close to a town. There is some off street parking available. Most rooms were originally intended to be used for double occupancy however, this has gradually been changed so that each resident now has their own room. Even so some of them would not meet the standards expected of a newer facility, being awkwardly shaped which would limit the use of a hoist or other equipment. The home is warm and clean however, it looks tired and run down and would benefit from a significant amount of investment. The bathrooms that are in use are functional but would not be very relaxing. There is a real lack of storage space which means that some equipment is being stored in residents bedrooms. We understand that there are plans to redevelop the home in the future but not for at least four years. All areas of the home are accessible to residents there is a passenger lift and ramps to doors. Residents are able to personalise their rooms with items from home and they are given an option to lock their doors if they wish. Care Homes for Older People Page 18 of 27 Evidence: Some people said that they had chosen the home because of the open plan feel and being able to see everyone. This is due to the large communal space on the ground floor which has been divided into smaller seating areas and a dining room. The nurses station and managers office are also situated here. There is a very pleasant garden to the rear of the home which is enjoyed by residents and is used for the summer BBQ. As we walked around the home we saw that one resident has her bedroom door held open. We were told that a risk assessment has been completed for this however, to ensure the residents safety an automatic door closer must be fitted if she wishes to continue this practice. Care Homes for Older People Page 19 of 27 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. There are sufficient numbers of appropriately trained staff on duty to meet the needs of the people who live in the home. Recruitment procedures help to ensure that they are protected from those who have been judged as being unsuitable to be working with vulnerable adults. Evidence: On the day of the inspection there were three care staff on duty with one trained nurse. This was in addition to the registered manager, cook. laundry person and housekeeper. This seemed to be enough to met the needs of the twenty people currently living in the home. There is no use of agency staff, there is a bank of staff who could fill in if there are any absences. Staff training is given a high priority in the home, staff were able to tell us about the training they had attended and a matrix is in place to show exactly what has taken place. The majority of the staff have either achieved an NVQ qualification to at least level 2 or are working toward it. They are also able to access e-learning courses. This has included Health and Safety,First Aid, Basic Food Hygiene and Customer Care Standards. Other recent training has been concerned with Deprivation of Liberty Safeguards and the Mental Capacity Act. A robust recruitment process is in place and we were able to see staff file of people Care Homes for Older People Page 20 of 27 Evidence: who have been employed since the last inspection. These provided us with evidence that, in order to protect residents, all of the appropriate checks are completed before staff are employed. People that we spoke with all told us that staff are very kind and caring and that made up for the fact that the home could be improved in relation to the decoration and facilities. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run and well managed in the best interests of the people who live there. Their health, safety and welfare are protected and their financial interests are safeguarded. Evidence: The registered manager of the home is a trained nurse and has previously worked in a unit for people with dementia. She has additional qualifications both in management and in training and displayed an understanding of the client group in this home. People that we spoke with told us that she was very approachable and they could always raise any concerns that they might have with her. We were able to see that all staff have supervision and appraisals to make sure that their performance is being monitored and that any training needs are identified. Quality assurance systems are in place to ensure that people remain happy with the service and we saw that the results of annual customer satisfaction surveys are Care Homes for Older People Page 22 of 27 Evidence: collated and displayed in the entrance hall.The regional manager visits the home regularly and there are monthly audits of medication practices, health and safety, cleanliness and housekeeping. We were sent the homes Annual Quality Assurance Assessment when we asked for it and this shows that the home knows what needs to be done in order to maintain and improve the service. There are also regular meetings for residents and relatives to allow them the opportunity to contribute their opinions. Some money is kept for residents, mainly for hairdressing and personal items and we were able to see that accurate records are being kept. Equipment and services are being properly maintained and the home has provided the dates of the last checks. The environmental health visit to the kitchen resulted in a four star rating for the second year running. Care Homes for Older People Page 23 of 27 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 27 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 9 13 External preparations must only be used for the people for whom they have been prescribed. To ensure that residents do not have any adverse reactions from preparations that might not be suitable for them. 10/06/2009 2 19 13 An automatic door closer 30/09/2009 which operates when the fire alarm is activated must be fitted where any resident wishes to keep their door open. In order to maintain their safety in the event of a fire. 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 It is recommend that moving and handling assessments Page 25 of 27 Care Homes for Older People 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 should be more detailed with regard to the type of hoist and size of sling that should be used. Care Homes for Older People Page 26 of 27 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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