Care Home: Highfield Residential Care Home

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What the care home does well As at the last inspection people spoken with during this inspection and the feedback we received in the surveys indicated that people are happy with the care they receive at this home. The home exceeds the recommended 50 per cent of care staff with or undertaking an NVQ 2 or above in Health and Social Care, which is excellent. What has improved since the last inspection? A new experienced manager has been appointed and she has made some improvements to the home in the short time she has been running it. A new pre admission assessment format has been devised and the new manager is assessing prospective people. A new care planning format is being introduced to provide staff with clear direction on how to meet peoples` needs and care plans will be person centred and risk assessments will be in place. Improvements have taken place with the medication system used by the home. The activities coordinator is now in post for 15 hours per week and we saw the posters informing people of what was taking place for this month. Improvements have taken place in the food provision, once the numbers of people living in the home increases people will be offered two choices at lunchtime. At the present time they are always offered alternatives. The home has now appointed an evening cook so that people can now have the option of hot meal at tea time. Snacks are now available at all times in the lounge area along with a selection of cold drinks. A redecoration programme has started in the home and a number of carpets have been renewed. The home has reviewed the communal space and made a new dining area that has redecorated and new flooring provided. Some bedrooms have undergone redecoration. This is greatly improving the environment for people who use the service. An additional domestic has been appointed and new cleaning schedules put in place and this has improved the cleanliness of the home. Plans are in place to refurbish the kitchen area. Staff have been provided with more training and ongoing support from external health and social care professionals. Staff told us that they are much happier working at the home now they have a new manager in post and morale has greatly improved. The new manager is introducing a quality assurance system to make sure that the home is moving forward in their improvements. As part of this staff supervision sessions are underway so that the new manager can assess the skills and competency of the staff. Changes have been made to the care staff duty times and the new manager feels these now meet peoples` needs better. Additional ancillary staff have been appointed to assist the care staff and to reduce the amount of non care tasks they were undertaking. What the care home could do better: The care staff need to continue with the introduction of the new care planning system and to make sure all people have person centred plans in place and risk assessments. The home needs to look at ways of demonstrating that people who choose not to take part in the communal activities are receiving some social input from staff. To continue with the ongoing training and supervision of staff. To review their recruitment procedure to make sure all the required pre employment checks are undertaken prior to a new member of staff starting work at the home. The new manager also needs to look at making sure that all staff who start working at the home prior to their Criminal Records Bureau Disclosure (CRB) being received are supervised and records in place to demonstrate this. To continue with the redecoration and refurbishment of the home so that people live in a comfortable and safe environment. Key inspection report Care homes for older people Name: Address: Highfield Residential Care Home Culver Street Newent Gloucetsershire GL18 1JA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sharon Hayward-Wright     Date: 0 8 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Highfield Residential Care Home Culver Street Newent Gloucetsershire GL18 1JA 01531821007 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Accommodating Care (Newent) Limited Name of registered manager (if applicable) Manager Post Vacant Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 27 The registered person may provide the following category of service only: Care Home only - Code OP to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Highfield House is a converted and extended Victorian property located approximately half a mile from Newent town centre. The Care Home provides accommodation and personal care for up to 27 older people on three floors. A shaft lift is available to assist those unable to manage the stairs. In addition, a variety of aids and adaptations that include hoists and hand rails are provided throughout the property to assist those Care Homes for Older People Page 4 of 34 Over 65 27 0 2 6 0 1 2 0 1 0 Brief description of the care home living in the Home. The communal facilities comprise of a large lounge and dining area, plus a conservatory overlooking the garden. There is an additional smaller sitting room provided on the first floor. The majority of the bedrooms have en-suite facilities. The fees for this home are from 340.85 pounds to 477.75 pounds per week. Additional services not included in the fees are chiropody, newspapers and hairdressing. The home makes available to people a copy of our reports and their Statement of Purpose and Service Users Guide. Care Homes for Older People Page 5 of 34 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 inspection was carried out over 1 day by 3 inspectors in June 2010. One of the inspectors was a Pharmacist who examined the system the home has in place for the managment of medications. Prior to this inspection we sent the home an Annual Quality Assurance Assessment (AQAA). This was returned to us on time and contained information about what the service feels they do well and any areas they are looking to improve on. The AQAA also contained numerical data called Dataset. We also sent to the service some questionnaires for people who use the service and for their relatives/carers/advocates. We received 4 from people who use the service and 5 from relatives/carers/advocates. The results of these have been used in the report. We also looked at other information we have received from or about this service from other stakeholders. This includes notifications from the home regarding incidents that effect the well being of those who use the service. We also examined the homes improvement plan that was sent to us following the inspection in January 2010. Care Homes for Older People Page 6 of 34 As this home was rated as 0 stars at the inspection in January 2010 we followed up on the 32 requirements that were issued and of these 4 were outstanding from the inspection in May 2009. This included looking at a number of systems the service has in place to include care records, activities, complaints, food provision, ongoing maintenance of the home and staff training, supervision and recruitment. Since the inspection in January 2010 a new manager has been appointed and she has been in post since March. We found some improvements in the quality of service this home provides and for those areas where shortfalls still exist an action plan has been devised by the home to address these. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? A new experienced manager has been appointed and she has made some improvements to the home in the short time she has been running it. A new pre admission assessment format has been devised and the new manager is assessing prospective people. A new care planning format is being introduced to provide staff with clear direction on how to meet peoples needs and care plans will be person centred and risk assessments will be in place. Improvements have taken place with the medication system used by the home. The activities coordinator is now in post for 15 hours per week and we saw the posters informing people of what was taking place for this month. Improvements have taken place in the food provision, once the numbers of people living in the home increases people will be offered two choices at lunchtime. At the present time they are always offered alternatives. The home has now appointed an evening cook so that people can now have the option of hot meal at tea time. Snacks are now available at all times in the lounge area along with a selection of cold drinks. A redecoration programme has started in the home and a number of carpets have been renewed. The home has reviewed the communal space and made a new dining area that has redecorated and new flooring provided. Some bedrooms have undergone redecoration. This is greatly improving the environment for people who use the service. An additional domestic has been appointed and new cleaning schedules put in place and this has improved the cleanliness of the home. Plans are in place to refurbish the kitchen area. Staff have been provided with more training and ongoing support from external health and social care professionals. Staff told us that they are much happier working at the home now they have a new manager in post and morale has greatly improved. The new manager is introducing a quality assurance system to make sure that the home is moving forward in their improvements. As part of this staff supervision sessions are underway so that the new manager can assess the skills and competency of the staff. Changes have been made to the care staff duty times and the new manager feels these now meet peoples needs better. Additional ancillary staff have been appointed Care Homes for Older People Page 8 of 34 to assist the care staff and to reduce the amount of non care tasks they were undertaking. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 34 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 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has reviewed and updated their existing admission procedure to make sure they obtain detailed information about proposed people. Evidence: Following the last key inspection in January this year the home was rated as 0 stars. The Registered Provider worked with us in agreeing that no new admissions would take place so that the home could work on improving their standards. This remains in place at this key inspection. However we will be reviewing this with the Registered Provider as the home has started to make improvements. The new manager was able to show us a new pre admission assessment format that she is planning to use to assess potential people. The new manager informed us that she has plans to complete this document for people who are already living at the home, as it will provide them with valuable information about each person that can help the staff when caring for them. Care Homes for Older People Page 11 of 34 Evidence: This home does not provide intermediate care. Care Homes for Older People Page 12 of 34 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. Improvements have been made to the health and personal care people receive and in time the documentation will support this. Arrangements are in place for the safe handling of medicines. Evidence: We did not undertake a full case tracking exercise at this inspection as the new manager explained that she is working on peoples care records and looking to change to a new format. We did examine two peoples care records and we could see that the staff are looking to implement person centred care plans and to look at including peoples choices. One persons documentation was very detailed for example, a care plan for their challenging behaviour gave staff clear direction on how to manage this. This person had been seen by a Physiotherapist and the home had used photographs to show staff how to position this person when in bed as per their instructions, this is good practice. Hand written risk assessments were in place for the other person for their assessed risks. Risk assessment formats for pressure area care, moving and handling and nutrition need to be included in all peoples care records. A falls risk assessment was in place for both people. One member of care staff told us about the Care Homes for Older People Page 13 of 34 Evidence: recent training they have received about nutritional screening and they are looking to undertake these on all people. The new manager told us that care staff are receiving training and support from her in devising care plans. Daily records are in place and we saw records of any health and social care professionals visits. The new manager still needs to look at devising an ongoing assessment of peoples needs and to make sure that any entry in the care plans is signed and dated by the member of staff completing it. We observed staff assisting people in a calm and respectful manner. One person has difficulty in communicating but staff were very patient and allowed this person time to answer and they were always offered a choice for example, for drinks and meals. We examined the accident records of people who use the service and found that we should have been notified of several incidents. This was discussed with the new manager who said she would address this. We asked people in the surveys we sent them, do you receive the care and support you need? 2 people said always, 1 person said usually and 1 person said sometimes. One person had commented; they care for me very well. People spoken to were positive about the personal care they received and the approach of the staff. Comments made included;the staff are very good,very helpful and I always get help when I need it. On three occasions during the visit people were observed using their call bells and staff were responsive within a short period. We asked relatives/carers/advocates in the surveys we sent them, do you feel the care service meets the needs of your friend/relative? 2 had said always, 2 said usually and 1 said sometimes. Two relatives had commented that more care is needed with peoples personal care in relation to general appearance and nail care. The pharmacist inspector looked at the arrangements for handling of medicines in the home. We found that improvements had been made since the last inspection so that people can be more confident their medicines will be looked after safely. People living in the home are registered with a local doctors practice. Prescriptions for repeat medicines are sent to the home and checked before going to the pharmacy. This helps to ensure the correct medicines are available. The pharmacy supplies medicines using a monthly blister pack system. We saw that a review of peoples medicines had been carried out by the home care support team. Care Homes for Older People Page 14 of 34 Evidence: A policy is available for people looking after their own medicines but at present most medicines are given by staff. We spoke to one person who looked after some of their own medicines and was happy with this arrangement.There was no risk assessment in place but records in the persons care plan showed which medicines they looked after themselves. It is good practice to have a risk assessment in place to check that selfadministration is appropriate and remains safe. A medicine policy is available and we discussed with the manager the need to ensure that all parts of the policy apply to Highfield. This is to ensure that staff are able to follow the policy and handle medicines correctly. We saw staff giving some medicines at lunch time, using safe practice. Staff told us that all the staff involved in giving medicines had received appropriate training. A member of staff showed us the record of medicines training they were doing. We recommended that the manager should also include regular competency assessments to ensure that staff are able to give medicines safely. The pharmacy provides printed medicines administration sheets each month for staff to complete. A system is in place to allow staff to audit the medicines to check that they have been given correctly. We checked several blister packs, which confirmed the written records of administration. We checked five medicines in standard packs and saw that three agreed with the administration records but two Paracetamol records had small discrepancies and it was not clear why the record was not accurate. We noticed that one person was given one medicine that should be taken before food at the same time as two medicines that should be taken after food. Another person was given two medicines together which should be given some time apart. Action should be taken to ensure that all medicines are given at appropriate times. One person is prescribed a medicine which needs special monitoring. Some information has been obtained about this medicine but this is not specific to this persons medical condition. Further information should be obtained on the safe use of this medicine, this is available from the National Patient Safety Agency (NPSA). The medication administration record (mar) sheets have been filled in with no gaps in the record seen. Creams and ointments are recorded on separate sheets kept in peoples rooms. Three records we saw had been completed satisfactorily. When medicines are prescribed with a variable dose the amount given is usually recorded, it is important that this is always recorded so that it is clear how much medicine a person has been given. Care Homes for Older People Page 15 of 34 Evidence: Protocols have been put in place to give staff more guidance about when medicines prescribed to be given prn or as required should be given. More information needs to be included in these to ensure that medicines are given consistently and appropriately. For example one person had been prescribed two different medicines for pain relief but there was no information to help staff to decide which one they should give. Records are kept of the receipt and disposal of medicines in the home. Staff must ensure that the records of receipt are filed and kept so that there is an audit trail of medicines in the home to check that they have been used correctly. Suitable secure storage is available for medicines. The medicine cupboard has been moved as recommended at the last inspection. A medicine trolley is used to transport medicines securely around the home. A suitable cupboard is available for controlled drugs, which need additional security. We saw that the records for these medicines are checked regularly and showed that they have been looked after safely. Care Homes for Older People Page 16 of 34 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. Improvements have been made to the activities provision enabling people to have a more active lifestyle. People now have more choice in relation to the food and have access to snacks at times when they choose. Evidence: At the last inspection the home had appointed a new activities coordinator but at that point they were not actively in post. During this inspection the activities coordinator was on leave so we were unable to speak with them. We did see a monthly list of all planned activities on notice boards around the home. This has resulted in more organised activities in the communal areas, usually on a daily basis. The coordinator has also completed individual life histories for people living in the home. People spoken with were positive about the increase in activities and confirmed they were always given the option of joining in if they chose. We were unclear as to what activities are provided for people who choose to stay in their rooms as the records maintained by the activities coordinator did not go into detail about this. We did see that as part of the new care planning format that care plans are being produced for peoples hobbies and activities. The homes AQAA states we now have activities five times a week organised by our own activities coordinator and she also visits service users that prefer to stay in their rooms so they are able to enjoy social activities as Care Homes for Older People Page 17 of 34 Evidence: well. The AQAA tell us that their future plans include; we are looking to introduce trips out and also introduce a shopping list on a weekly basis so we can get small items such as toiletries, chocolates and small gifts to assist service users that are unable to shop themselves. We asked people in the surveys we sent them, does the home arrange activities that you can take part in if you want?, 2 people said always, 1 person said sometimes and 1 person did not answer the question. We were told that visiting to the home is not restricted and we observed some people receiving visitors during the inspection. During the tour of the environment we observed peoples belongings on display in their rooms. People we spoke with said they are able to make choices about their daily lives and we observed staff offering people choices for meals and drinks. We asked people in the surveys we sent to the home for them to complete, do the staff listen to you and act on what you say?, 2 people said always, 1 person said usually and 1 person said sometimes. We spoke to the cook about menus and choices for people. She told us that since the last inspection an evening cook has been appointed to enable people to have a hot choice of food and to reduce the workload on the care staff. We were shown the food records that clearly showed people are offered choices. We did notice that on the menu board only one option for the main meal was provided for lunchtime, however the cook said this is because of low numbers of people in the home but alternatives are always provided. She also explained that she is aware of peoples likes and dislikes. The cook told us she has recently undertaken training in nutrition and how to add additional calories and protein to peoples food who are assessed as being nutritionally at risk. She also said that she is due to undertake a food and hygiene course. The food was sampled by the Inspectors with lunch being provided by the home. The food was well cooked and there was evidence that choice is promoted and offered. Food and produce was correctly stored and labeled. Snacks, fresh fruit and cold drinks were available to the people living in the home. Several people spoken to said they enjoyed the food and that they could ask for different choices if they wished to. People can eat their meals in their rooms if they choose. We asked people in the surveys we sent them, do you like the meals in at the home?, 1 person said always, 2 people said usually and 1 person said sometimes. Care Homes for Older People Page 18 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have access to complaints procedure that will make sure their concerns are listened to and acted upon. A system is now in place to help safeguard people from possible risk of harm or abuse. However policies and procedures need to be updated to reflect latest legislation and provide staff with clear information. Evidence: The new manager said the home has not received any complaints since she started working at the home and we have also not received any complaints since the last key inspection in January this year. A complaints policy is on display in the home for people who use the service and their relatives/representatives to access if they feel necessary. We asked people in the surveys we sent them, is there someone you can speak to informally if you are not happy? all 4 people said yes. We also asked, do you know how to make a formal complaint? 3 people said yes and 1 person said no. We asked relatives/carers and advocates in the survey we sent them, do you know how to make a complaint about the care provided by the care service if you need to? all five had answered yes. We also asked, has the care service responded appropriately if you or the person using the service have raised any concerns?, 4 had answered always and 1 had not answered the question. Care Homes for Older People Page 19 of 34 Evidence: We were told by the new manager that 26 staff have undertaken abuse awareness training recently. Policies and procedures are in place for staff in relation to safeguarding, abuse and whistle blowing. However the new manager is aware that these need to be updated to meet current legislation and need to be pertinent to Gloucestershire County Council in relation to safeguarding procedures. At the last key inspection we were concerned that the conduct of some of the staff could have constituted abuse, the AQAA states that staff have had some training in reporting safeguarding issues and possible areas of abuse are discussed openly and support given as necessary. Further plans detailed in the AQAA for improvement are; 1) More training concentrating on induction to the Skills for Care Standards and then NVQ 2 training for all care staff will follow on. 2) Different approach to service users families now implemented, staff now being sensitive to their needs. We have more sharing of information and answering their concerns. 3) Staff moral has greatly improved over the last two months. 4) Clear guide lines and accountability of roles are now in place. One person has bed rails in use and we found a risk assessment in place and the home is trying another system so that bed rails will no longer need to be used, this is good practice. We did not observe at this inspection any conduct by staff that we felt could place people who use the service at risk. Care Homes for Older People Page 20 of 34 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. Improvements have been made to the environment and further refurbishment is planned and this will provide people with a clean, safe and comfortable home. Evidence: The homes AQAA told us we have replaced carpets in hall and stairways, laid new flooring in dining area and decorated. Provided new blinds around the home and have started a refurbishment programme. All areas of the home were inspected and the home was generally clean and hygienic throughout. The top floor is currently not in use, whilst there are vacancies in the home. Domestic staff explained how a new system of cleaning the home has been introduced which ensures that all areas are cleaned on a rota basis which includes the cleaning of furniture and equipment. At the time of arrival it was noted there was an unpleasant odour in the corridor leading to the lounge/dining area. This had also been noticed by the deputy manager and this had been addressed before the lunch was served. Some parts of the home have been redecorated, including the dining room which appeared light, airy and comfortable. We asked the new manager about what other provisions were in place as this room will not accommodate all people who use the service at the present time and when they increase their numbers. The new manager said that facilities are provided for people in the large communal lounge/conservatory area and people can if they chose have their meals in their room. There is an ongoing programme being worked through to decorate some of the bedrooms and one bedroom that is currently empty was seen Care Homes for Older People Page 21 of 34 Evidence: that had been completed. Several other bedrooms were seen and these were comfortable, clean and personalised. People spoken with were positive about their accommodation. We observed the outside garden area and were told that the water fountain has now been repaired. There are plans to replace the kitchen and contingency plans for the home have been devised as they will be without cooking facilities for six days. The improvements mean that produce can now be stored adjacent to the kitchen and that hygiene procedures will be easier to monitor and follow. We noticed that infection control procedures have been improved with staff wearing protective clothing on entering the kitchen area and whilst serving and assisting people with meals. We also observed that all food is covered when being served and transported around the home. We asked people in the surveys we sent them, is the home fresh and clean?, 3 people said always and 1 person said sometimes. Care Homes for Older People Page 22 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Changes to the staffing duty rotas and the appointment of more ancillary staff allow the care staff more time to meet peoples needs. However robust recruitment procedures must be in place to make sure people are safeguarded from possible risks of harm or abuse. Evidence: We discussed with the new manager the duty rotas and she told us about the changes that have been made to the numbers of care staff and ancillary staff. At the last inspection an extra member of care staff had been added to the morning shift and this has continued. The new manager has altered the times of the shifts as she feel this meets the needs of people who use the service better. An evening cook has been appointed and an additional domestic. We noticed that this has improved the cleanliness of the home. The new manager said that they no longer use agency staff as they cover any shifts with their own permanent staff or the homes bank staff. We spoke to both care and ancillary staff during the inspection and they all felt that the home has improved greatly. Staff said they feel better supported by the new manager and she is approachable and she is willing to help them. They also felt that the atmosphere has improved between the staff and they enjoy coming to work now. Staff confirmed they have access to an ongoing training programme. We asked people in the surveys we sent them, are the staff available when you need Care Homes for Older People Page 23 of 34 Evidence: them?, 1 person said always and 3 people said usually. We asked relatives/carers/advocates in the surveys we sent to the home for them to complete, Do you feel that the care service meets the needs of your friend/relative?, 2 had replied always, 2 replied usually and 1 replied sometimes. We also asked do the services care workers have the right skills and experience to look after people properly?, 2 replied always and 3 replied usually. We received the following comments; good attention is given to the welfare and comfort of all residents.This relative also complimented the staff on their responsiveness to their relatives recent illness. Other relatives said they communicate well with relatives and create a friendly atmosphere, and the staff need to ensure that any changes in residents needs are documented and passed on at hand overs to all carers. The home exceeds the recommended 50 per cent of care staff with an NVQ 2 or above in Health and Social Care. We expressed concerns at the last inspection that despite the home exceeding this we were concerned that staff were not putting into practice what they have learnt. Following the inspection in January the staff at the home have received training from external professionals and the new manager felt the staff skills are now improving and they also have access to an ongoing training programme. The homes AQAA states in relation to recruitment, we carry out robust recruitment procedures ensuring all potential staff have all checks in place prior to firm job offer and start date; audit now in progress plus further actions planned. An examination of the staff recruitment files was undertaken and found to be largely in order. One recently employed member of staff had not supplied a reference from their last employer in care and this needs to be addressed. There was also not a full employment history therefore the home could not explore any gaps and ask for written verification as to the reasons. The home were still waiting for the Criminal Records Bureau Disclosure (CRB) to be returned. This staff member should not have been working unsupervised until this information was received. We felt that the homes audit should have identified the shortfalls with the recruitment procedures for this new member of staff. At the time of the inspection the manager was in the process of developing a training matrix to improve the monitoring and planning of staff training. However the majority of staff were up to date with fire safety, first aid, health and safety and infection control training. Twenty six staff had also recently undertaken abuse awareness training. All new staff complete a basic induction of various topics which are signed off and then they undertake three or four shadowing shifts before commencing the Common Care Homes for Older People Page 24 of 34 Evidence: Induction Standards, which are hopefully completed within three months. Care Homes for Older People Page 25 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Changes made to the management arrangements and the implementation of effective quality assurance systems will help to make sure the home is now run in the best interests of people who use the service. Evidence: Since the last key inspection in January 2010 the Registered Provider has appointed a new manager. She started working at the home in March 2010 and was supported by a Representative from the Registered Provider. The new manager has many years experience working in the care industry with older people. She has been a registered manager at another care home prior to starting at this home and she has a degree in dementia studies. The new manager informed us she is in the process of applying to us to be considered for registration. Staff we spoke with during the inspection all praised the new manager and felt she has made a number of improvements. They felt she was approachable and they could go to her with any concerns they might have. Staff also felt she has improved the morale and they feel more positive about working at the home. Care Homes for Older People Page 26 of 34 Evidence: Prior to this inspection we requested an Annual Quality Assurance Assessment (AQAA) and we received this on time. It tells us where the service feels they are providing a good service and any areas they have improved on and their plans for future development. The AQAA also contains numerical date called Dataset. After the last key inspection in January we requested an improvement plan. We received this on time and referred to this during our inspection. The home has made some improvements and they have plans in place to address other shortfalls we identified. Only two regulation 26 inspections (where the Registered Provider or another person acting on their behalf undertakes an assessment of the service) have been completed in 2010, one in February and one in March. Following the inspection we did receive a regulation 26 inspection report for May 2010. Whilst some surveys have been distributed the new manager has yet to implement a full quality assurance process but a system using a number of quality audits is being introduced by the new manager. We were sent copies of the format the new manager plans to use and and where she as undertaken an audit. We did not examine the system the home has in place for the managing peoples monies at this inspection. The new manager has started providing formal staff supervision and the majority of staff have now had at least one session. Records showed that all fire testing and servicing had been completed and the home has an up to date fire risk assessment in place. Water temperature testing has been done regularly as well as Legionella tests. The home had a current gas safety certificate, all hoists and slings had been checked and serviced where required and electrical testing had also been completed and recorded. Whilst there was evidence that the lift was serviced annually and repairs undertaken when necessary there appeared to be no routine checking of the equipment. There have been occasional breakdowns, some which are dealt with by staff and some requiring a call out from an engineer. This appears to be mainly down to the age of the lift and it is recommended that more regular and routine checks are completed to monitor its efficiency and reliability. Following the last inspection we asked for the local Environmental Health Department and Fire Service to visit the home as we had concerns. Both agencies have visited the home and are in contact with them about where changes are required to the shortfalls they identified. Care Homes for Older People Page 27 of 34 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 14 The registered person must 30/04/2010 make sure that all people have an ongoing assessment of needs in place and this is kept under review and updated as required. This requirement remains outstanding since the last inspection. Timescale of 30/04/10. This will help to make sure that care staff have access to up to date information about peoples needs. 2 7 15 The registered person must 28/05/2010 make sure that people who use the service have care plans in place for all assessed needs. They must accurately reflect peoples current needs and be kept up to date. Progress has been made in meeting this requirement. This requirement remains outstanding timescale 28/05/10. This will help to make sure care staff have access to up to date information about how to meet peoples assessed needs. Care Homes for Older People Page 28 of 34 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 3 8 15 The registered person must make sure that people who use the service have risk assessments in place for all assessed risks. These must include how the care staff can manage these risks. Progress has been made towards meeting this requirement. Remains outstanding since the last inspection. Timescale 30/04/10 This will help to make sure that care staff have access to up to date information about how to meet people assessed needs. 30/04/2010 4 8 12 The registered person must make sure the home has a system in place to monitor peoples needs in relation to nutrition. Progress has been made towards addressing this requirement. This requirement remains outstanding. Timescale 30/04/10. This will help to make sure that the health and welfare of people who use the service is monitored. 30/04/2010 5 29 19 The registered person must make sure that if the home appoints a new member of staff without a full Criminal 30/04/2010 Care Homes for Older People Page 29 of 34 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 Records Bureau Disclosure being received that they; appoint a member of staff who is appropriately qualified and experienced to supervise the new worker, Ensure as far as possible that the staff member is on duty with the new member of staff, The new worker must not escort people who use the service away from the care home unless they are accompanied by the staff member. This requirement remains outstanding since the last inspection. Timescale 30/04/10 This will help to make sure that people are safeguarded form possible risk of harm or abuse. 6 29 19 The registered person must 30/04/2010 make sure all the required recruitment checks are in place prior to a new member of staff starting work at the home. This includes a full employment history together with a satisfactory written explanation of any gaps. This requirements remains outstanding since the last inspection. Timescale 30/04/10. This will help to make sure people who use the service are safeguarded from possible risk of abuse or Care Homes for Older People Page 30 of 34 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 harm. 7 30 18 The registered person must 30/04/2010 make sure that any new staff undergoing induction training are appropriately supervised and, appoint a member of staff who is appropriately qualified and experienced to supervise the new worker. Ensure as far as possible that the staff member is on duty with the new member of staff, The new worker must not escort people who use the service away from the care home unless they are accompanied by the staff member. This requirement remains outstanding since the last inspection. Timescale 30/04/10. This will help to safeguard people who use the service from possible risk of harm or abuse. Care Homes for Older People Page 31 of 34 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 Action must be given to ensure that medicines are given at appropriate times and that advisory information on medicines labels is followed. Patient safety information for one medicine must be obtained. To ensure medicines are given correctly and protect peoples health. 16/07/2010 2 29 19 The Registered Person must make sure that all the required recruitment checks are in place prior to a new member of staff starting work at the home. This includes a reference relating to the member of staff last period of employment which involved working with children or vulnerable adults. This will help to make sure people who use the service 30/07/2010 Care Homes for Older People Page 32 of 34 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 are safeguarded from possible risk of harm or abuse. 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 2 9 9 It is recommended that the medicine policy is reviewed to ensure that it always relevant at Highfield. It is recommended that staff receive assessments at suitable intervals to check that they are competent to give medicines safely. Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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