Care Home: Highfields Nursing & Residential Care Home

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What the care home does well Anyone new wanting to come to the home is assessed beforehand to identify what the person`s needs are and if the home is able to meet them. This information is then shared with staff so they know what they are expected to do. One person told us he had been visited by someone from the home before moving there. People have their healthcare needs met and are able to have medical support when they need it. One person said, "I feel happy at how I am hoisted, all the staff do it carefully". Staff make sure they see people take their medication. An activities coordinator is employed who oganises group activities and arranges for entertainers to come to the home. A resident said after a game of dominoes, "I enjoyed that, a long time since I`ve played." Visitors are welcome to come and see their friends and relatives in the home. People are able to make choices about their daily routines. One person told us, "I always say what I want to do, and the staff help me". People are happy with the food they receive and have a choice at each meal. Comments made about the food included, "The food is well presented and nutritious." and "I really enjoyed my lunch". People are given information about how to complain if they are not happy about anything. One person said, "If you say anything to them they will put it right." Staff know how to protect people in the event of any allegation and people told us they feel safe in the home. The home is kept clean and homely, and there are suitable arrangements for the disposal of waste products. A resident told us, "It`s a lovely building and they keep it so nice". There are sufficient and suitably trained staff on duty who have been through the required recruitment checks. One person said there were, `Jolly and happy staff`. There is a suitably qualified and experienced manager in post and people are encouraged to comment on how the home is run. The required health and safety checks and tests to the building and equipment are carried out. What has improved since the last inspection? Details of people`s needs and how these will be met are recorded in a care plan, which includes information about their capacity to make decisions for themselves. Residents and/or their relatives are able to be involved in determining what care is required, and how this will be provided. There has been an extension built which provides additional en suite bedrooms and an additional lounge area. What the care home could do better: Staff need guidance on how to complete the personal care records so these are all completed in a similar manner, and efforts should be made to make sure that all care provided is done in a manner that promotes people`s privacy and dignity. Positive comments were made about respecting peoples privacy and dignity, however one relative commented, `Stop referring to residents who require help with eating as `feeders`. When this is said in front of visitors and relatives, it is the only thing which lets down an otherwise excellent team of carers.` It would be more suitable to ask people to make their choice of meal on the same day the meal is to be taken. Key inspection report Care homes for older people Name: Address: Highfields Nursing & Residential Care Home Station Road Edingley Newark Nottinghamshire NG22 8BX     The quality rating for this care home is:   three star excellent 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: Stephen Benson     Date: 1 2 0 1 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 28 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) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Highfields Nursing & Residential Care Home Station Road Edingley Newark Nottinghamshire NG22 8BX 01623882441 01623882073 highfields@majesticare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Majestic No. 2 Ltd care home 49 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: 49 The registered person may provide the following category of service only: Care Home with Nursing - Code N To services users of the following gender: Either 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 Highfields Nursing Home is registered to provide residential and nursing care for 49 people. The home is owned by Majestic Luxury Care Homes. The home is located in the village of Edingley about 1 mile from Farnsfield, which has a variety of shops, pubs and a post office. There are 41 single bedrooms, 29 with en suite facilities, and a further 4 double bedrooms. Bedrooms are located on 2 floors and there is a passenger and a stair lift to Care Homes for Older People Page 4 of 28 Over 65 49 0 Brief description of the care home aid access for residents with limited mobility. The home has gardens that are well maintained and easily accessible. There is car parking available for approximately 15 cars. The current scale of charges range from £535.30 to £750. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent 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: The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people accommodated and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. This was our first visit to the home since 1st April 2009. This inspection involved one inspector; it was unannounced and took place in the daytime, including lunchtime. Prior to the visit an analysis of the home was undertaken from information gathered over the last year including that from the Annual Quality Assurance Assessment they completed. We sent survey forms entitled Have your say about... to a sample of service users and 9 of these were returned. The main method of inspection used is called case tracking which involved looking at the quality of the care received by a number of people living at the home. We also Care Homes for Older People Page 6 of 28 used evidence from our observations; we spoke with them about their experience of living at the home; we looked at records and talked with staff about their understanding of the peoples needs who they support. The premises were not inspected in detail but various areas of the home were visited as part of the inspection. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Care Homes for Older People Page 8 of 28 Staff need guidance on how to complete the personal care records so these are all completed in a similar manner, and efforts should be made to make sure that all care provided is done in a manner that promotes peoples privacy and dignity. Positive comments were made about respecting peoples privacy and dignity, however one relative commented, Stop referring to residents who require help with eating as feeders. When this is said in front of visitors and relatives, it is the only thing which lets down an otherwise excellent team of carers. It would be more suitable to ask people to make their choice of meal on the same day the meal is to be taken. 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 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessments are obtained before people move into the home, which are being used by staff to learn about the persons needs. Evidence: We were told in the assessment they completed that, Each service user has an individual pre-admission assessment to ascertain whether the home can meet their needs. The file for a recently admitted resident was seen, and this contained a detailed assessment of the persons needs prior to being admitted to the home. The manager said she carries out pre admission assessments and that the pre admission assessment is part of the care planning process. There are forms designed to carry out a pre admission assessment and these include a Mental Capacity assessment. Care Homes for Older People Page 11 of 28 Evidence: Staff were aware of the assessment process and said they are always told prior to anyone new moving into the home. Staff said they are given as much information as is available and the assessment forms are available for them to see. In our survey forms everyone said they had received enough information about the home before they moved in, and that they had received a contract. A recently admitted resident said yes when asked if he had been visited by someone from the home before he came to live there. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is an effective care planning system in place and peoples health, personal and social needs are normally being met in a dignified manner Evidence: In the assessment they completed they told us, The home uses a person centred care planning approach, which is evaluated at regular intervals. With agreement of the service user we work with the user, their relatives and carers in partnership, in order to provide the best support for the individual. In care files seen there was a life history, which had been completed by relatives. Plans were regularly updated and considered peoples mental capacity. There was references to making decisions in peoples best interests from prior knowledge and wishes from the family. The manager said she has just started to go through each care plan to make sure they are fully and correctly completed. Care Homes for Older People Page 13 of 28 Evidence: Staff said they had received training in the new care planning system and were now getting used to the new layout, which covers peoples needs in depth. Staff are required to complete a daily record of each persons personal care. These were being completed differently by different staff and did not show accurately what care was provided. Staff spoken with had different ideas on how these should be completed and as they do not have a designated time when they are to complete them this is done ad hoc ,and at one point were seen being completed whilst helping a resident eat their breakfast. In our survey forms everyone said they receive the care and support they need. One person commented that their relative is provided with all the care and support they need. There was a physiotherapist working with some residents during the morning, and staff said this happens weekly. Other routine health checks were recorded as taking place in the care plans and everyone said in our surveys that they receive the medical support they need. One person commented that more should be done to ensure that hearing aids are working properly. There was a well being assessment seen in one care plan which is used to show how the persons health can be improved. Staff were seen using a hoist to transfer one resident, and this was done in a relaxed and jovial manner. The resident told us, I feel happy at how I am hoisted, all the staff do it carefully. Part of the morning and lunchtime medication rounds were observed and these were being carried out in line with recommended safe practices. There is a system in place to ensure close monitoring of the use of controlled drugs, and records checked were found to be correct. One person had arranged with staff to use the call bell when they had finished their breakfast to let them know they were ready for their medication. There are two staff who are appointed as dignity champions within the home and staff spoke of a training session they had organised, which they had found very thought provoking and influenced how they went about some of their duties. There were positive comments made in our survey forms about the promotion of Care Homes for Older People Page 14 of 28 Evidence: peoples privacy and dignity, including, The staff respect the residents individuality and are mindful of privacy and dignity issues and Always dressed and looking lovely with clothes and outfits picked out with care. However some comments were made where it was felt peoples privacy and dignity are not fully promoted, one person commented, Stop referring to residents who require help with eating as feeders. When this is said in front of visitors and relatives, it is the only thing which lets down an otherwise excellent team of carers. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities to choose and take part in activities in the home. There are opportunities for people to exercise choice in their lives and they are provided with a varied and wholesome diet. Evidence: There is an activities coordinator employed who organises activities each week and arranges for any entertainers to visit the home. In the assessment they completed they told us, The care home encourages service users to become involved in activities and learn new skills should they wish to do so. The manager said that the activities coordinator is taking a course on engaging people with dementia. In our survey forms everyone said activities are arranged by the home they can take part in. One person said after a game of dominoes, I enjoyed that, a long time since Ive played. Visitors are welcome to the home and able to take residents out. Some visitors were seen in the home talking with staff during the inspection. Care Homes for Older People Page 16 of 28 Evidence: Staff said they provide people with choices where they can, and that they have done so more since being on Mental Capacity Act training. There are fortnightly religious services held in the home. Staff were seen offering people choices such as where did they want to sit, whether they wanted to walk or use a wheelchair and whether they wanted to take part in a game of dominoes. One person told us, I always say what I want to do, and the staff help me. There is a choice of meal at lunch and staff were seen asking people to choose what meal they would like the following day. This happened before lunch and the possibility of people being asked on the same morning was discussed. In our survey forms everyone said they always or usually like the meals in the home and one person commented, The food is well presented and nutritious. Other people commented that The food is very good and I really enjoyed my lunch. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems in place for people to raise any concerns, and staff know how to safeguard people. Evidence: We were told in the assessment they completed that, The home has a clear and accessible complaints procedure illustrating timescales and how complaints are dealt with. All service users are informed of the complaints procedure and would be fully supported by staff in making their complaint. There is a complaints procedure in the home and a book to record any complaints made. There were three entries which concerned frequency of baths, parking on the road and staff not being available in the lounge. All of these were satisfactory resolved. Staff were aware of the complaints procedure and knew what to do if they had a complaint made to them. In our survey forms seven people said they knew how to make a complaint and everyone said they had someone they could talk to. A resident said, If you say anything to them they will put it right. Staff said they had received training on safeguarding and were aware of different forms of abuse. Staff knew that any allegation of abuse must be reported and were aware of the whistleblowing policy. Care Homes for Older People Page 18 of 28 Evidence: The manager said there had been one safeguarding investigation, which had not been substantiated . Residents said, Everyone is very kind and You would never see anyone treated badly here. Care Homes for Older People Page 19 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and well maintained environment that provides a homely atmosphere. Evidence: There has been an extension built, which provides additional en suite bedrooms and an additional lounge area. We were told in the assessment they completed that, We ensure that the environment is well maintained and offers service users a homely place in which to live. The care home is maintained appropriately to reduce the risk of infection and cross infection. Staff said they were happy with the building and it does not cause any problems to them in carrying out their duties. In our survey forms everyone everyone said that the home is kept fresh and clean and one person commented that the home provided a Clean friendly and bright atmosphere. A resident said, Its a lovely building and they keep it so nice. Care Homes for Older People Page 20 of 28 Evidence: There is a handyman employed to carry out routine maintenance and designated domestic staff to keep the home clean. There is a system in place for the disposal of any clinical waste. There were supplies of protective clothing seen, and staff were seen using these as they went about there duties. There were supplies of hand wash located around the building. Care Homes for Older People Page 21 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared and supported by sufficient staff who have been suitably trained to meet their needs. Evidence: The rota showed that there are seven care staff on duty throughout the day and the manager said she can adjust the staffing numbers according to need. Staff and residents said they thought there were enough staff on duty and in our survey forms everyone said that staff are available when they need them. One person commented, Jolly and happy staff. We were told in the assessment they completed that, The home displays a rota which clearly shows what staff are on duty at specific times. All staff receive induction training and regular updates. It was also stated that 50 of staff are now trained to NVQ (National Vocational Qualification) level 2 and the manager said those staff who have no yet gained this qualification are working towards it. The files for some new staff were seen and these contained the required pre employment checks . It was stated on the assessment they completed that all staff who have started work in the home in the last 12 months had satisfactory pre employment checks carried out. Care Homes for Older People Page 22 of 28 Evidence: Staff training records showed that regular training is provided and there is a plan for future training. Staff said that the provider is good at providing them with training. Care Homes for Older People Page 23 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are suitable management arrangements in the home to ensure the home is run in the best interests of people living there. Evidence: The manager has worked in the home for many years and has a managerial qualification. The manager is on duty in addition to the staff on duty to cover the shifts and takes part in routine training that is provided for staff. Staff said they thought the manager was good at her job. We were told in the assessment they completed that, The home has a clear and accountable management structure appropriate for size. Records are kept to safeguard everyones interest for at last 7 years. The are home has up to date policies and procedures. Each service user is sent an annual satisfaction questionnaire so that we can monitor what we are doing well or not. Care Homes for Older People Page 24 of 28 Evidence: The home is due to renew its Investors in People status in February 2010. There are various systems in place for people to express their views on the services provided. These include regular surveys sent to residents and their relatives, relatives meetings and 3 monthly wine and nibbles evenings. the manager showed recent surveys that had been completed, and views expressed are acted upon. The assessment we ask the provider to complete and send back to us was returned on time. The information contained in this was detailed and reflected what we saw when we visited. It was stated on the assessment that, When a service user does not want to manage their finances or does not have capacity to do so we can offer to manage finances in best interests of the user. A sample of records were seen and these showed that a record is made of all transactions, which is witnessed by another person. We were told in the assessment they completed that equipment is serviced or tested as recommended by the manufacturer or other regulatory body. Dates were provided showing this to be the case. Staff said they did not have any concerns about health and safety within the home. Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 3 7 10 15 Provide staff with guidance about how the personal care records should be completed. Ensure that all practices in the home promote peoples privacy and dignity. Consider asking people to choose their meal on the day it is to be provided. Care Homes for Older People Page 27 of 28 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. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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