Care Home: Highgrove House

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What the care home does well People admitted to the home found the information they had received very useful. Comments such as `the manager and staff at Highgrove have provided all sorts of information and always answered any queries. They have been extremely helpful.` `We were also invited to spend a day and share a meal with other residents.` Before being admitted people had their needs assessed to establish if the service could provide the right care and support, before a placement in the home was offered. Records showed there was consultation with relevant people about the level and type of care required. Residents living in the home benefited from the support of a named worker referred to as a Key worker who took responsibility for their personal care. Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 6Resident`s also benefited from additional specialist support where needed, such as healthcare needs. Written comments from residents included, `If I become ill, or have a bad day, the staff will assist me with all personal care and will get a doctor if needed.` Good care planning meant residents were cared for as they wished and needed, and their needs regularly reviewed. Staff were instructed how to care for people safely and avoid unnecessary risks being taken. There was evidence the care people received had improved their well-being. For example one relative commented, `Both were very ill and in need of care, when they entered the home and are both much improved both mentally and physically.` Residents living in the home were treated with respect and their dignity maintained. Written comments from relatives included, `From what I have seen the carers treat the residents with respect and maintain their dignity`. And `Staff always treat the residents with cheerful politeness`.` `Although my aunt is suffering from dementia we feel the care she is receiving is satisfactory. Resident`s lifestyle was centred on them, and residents did not have to conform to any institutional practice such as set times for getting up or going to bed. There was evidence activities improved people`s confidence. Visiting arrangements were very good and the meals provided met with resident`s tastes and choice, and needs. Staff were observed as courteous and attentive when assisting those residents requiring support. People using the service had confidence to raise any issue of concern they may have. Information held at the Commission and comments from relatives included `I have never been unhappy with the way the home is run. I know my mother is in good hands, the level of care given is very high`. `I have never had any reason to complain`. Residents were encouraged to say what they wanted and were asked regularly if everything was all right. There was evidence to support the management respond quickly to vulnerable adult protection issues and follow correct safeguarding procedures when needed. They work well with other professionals to protect residents. staff were trained in adult protection and knew their responsibility of care in this area. Residents liked their accommodation. Written comments included ``It is also nice and bright, the decoration, especially in the bedrooms is bright and cheery`. And a relative said, `A bright clean home that looks attractive. There was an excellent record of routine safety checks completed by the maintenance manager and a member of staff ensured the home and grounds were kept in good order. Staff working in the home was considered to be, `Good quality of staff.` And `The staff are very cooperative if you need them for anything.` `People stay inpost so you can build up a relationship with the carers. I truly value this continuity in care.` Staff interviewed displayed a high degree of job satisfaction within a good team environment, and had good knowledge in understanding the needs of older people. Learning opportunities were very relevant to the homes purpose, and staff felt they were much appreciated for their work and were valued in the home. The training provided for staff was very good and the home is commended for the number of care staff having completed a National Vocational Qualification in Care. Staff meetings were `good practice` focussed and they received regular supervision. The manager and deputy`s skills combined demonstrated changes made for improvement in service delivery, the environment, and staffing was successful. Systems were in place to approach residents/relatives to give their view on the quality of services and facilities in the home. Residents had meetings and Quality Assurance carried out at the home showed `management were approachable and helpful`. Relatives commented, `They appear to run an efficient, professional service and yet genuinely care about the residents. I particularly value the regular management and staff, patient/family meetings and I feel problems are listened to.` Staff said `The manager is very supportive.` The home was very well managed and run in the best interests of the people living there. What has improved since the last inspection? Good practice recommendations from the last key inspection and random inspection in November 2007 have been dealt with. Staff responsible for the administration of medication was trained. Records of medication were kept up to date. 88% of staff was qualified to National Vocational Qualification in care level 2 and above. All staff working in the home had Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) register check prior to employment. Other improvements not requested have included: The manager and one deputy manager has gained the Registered Managers Award. The home has a comprehensive training plan that covers topics relevant to the residents such as courses in stroke awareness, death and dying, and theraputic activities. A separate activities person on each floor is appointed and logged on the rota. A quiet room is now available if any resident wishes to sit or entertain their relatives or friends. They have completed refurbishment of three en suite rooms, quiet room, and shower rooms. The stairway has been made safer for the protection of residents on the upper floor. Staffing levels have been increased in line with residents dependency needs. The manager and deputy manager have training in internal auditing. Care plans are more detailed and senior care assistants are more involved in care planning. What the care home could do better: To support residents with communication difficulties, medication to be administered `when required`, should have more detail of the circumstances or symptoms that staff must know about. To make sure residents are fully protected staff should sign an agreement in relation to the homes ruling on non acceptance of gifts, wills and bequests when they start work. In supporting a decision to offer employment, pre written testimonials should not be accepted for the second reference. CARE HOMES FOR OLDER PEOPLE Highgrove House Highfield Road North Chorley Lancashire PR7 1PH Lead Inspector Mrs Marie Dickinson Unannounced Inspection 3rd July 2008 10:00 X10015.doc Version 1.40 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highgrove House Address Highfield Road North Chorley Lancashire PR7 1PH Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01257 270643 01257 271260 highgrove@parklanehealthcare.co.uk Park Lane Healthcare (Highgrove) Limited Karen Denise Musker Care Home 43 Category(ies) of Dementia (43), Old age, not falling within any registration, with number other category (43) of places Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only - Code PC To people of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is 43. Date of last inspection 29th June and 5th July 2006 Brief Description of the Service: Highgrove House is a 43 bedded purpose built care home for older people, a small number of whom have dementia, which is situated close to Chorley Town Centre and is easily accessible by public transport. The home is purpose built and provides all single room accommodation on two floors. Four rooms are provided with en-suite toilet facilities, whilst the remainder are all fitted with vanity units. The home has a dining room and a lounge area on each floor, with a further communal area situated just within the reception area of the home. The homes gardens were easily accessible, secure, and furnished with a range of garden furniture. Information about the service is available from the home for potential residents in a Statement of purpose and Service User Guide. Weekly charges for personal care and accommodation range from £430 to £480 per week. The home has a top up fee of £29. These fees are reviewed annually. There are additional optional charges made for individual personal requirements such as hairdressing and private chiropody. Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. A key unannounced inspection was conducted in respect of Highgrove House on the 3rd July 2008. The inspection involved getting information from an Annual Quality Assurance Assessment completed by the manager, staff records, care records and policies and procedures. It also involved talking to residents, staff on duty, the manager, deputy manager and an inspection of the premises. Areas that needed to improve from the previous inspection were looked at for progress made. The home was assessed against the National Minimum Standards for Younger Adults. A random inspection was carried out on the 30th November to look at issues raised, which was linked to medication and resident care. The care of residents was found to be very good, however some improvement with medication practice was required. An Annual Service Review was carried out on 17th March 2008, and the findings were, the home had continued to provide good outcomes for residents living in the home. What the service does well: People admitted to the home found the information they had received very useful. Comments such as ‘the manager and staff at Highgrove have provided all sorts of information and always answered any queries. They have been extremely helpful.’ ‘We were also invited to spend a day and share a meal with other residents.’ Before being admitted people had their needs assessed to establish if the service could provide the right care and support, before a placement in the home was offered. Records showed there was consultation with relevant people about the level and type of care required. Residents living in the home benefited from the support of a named worker referred to as a Key worker who took responsibility for their personal care. Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 6 Resident’s also benefited from additional specialist support where needed, such as healthcare needs. Written comments from residents included, ‘If I become ill, or have a bad day, the staff will assist me with all personal care and will get a doctor if needed.’ Good care planning meant residents were cared for as they wished and needed, and their needs regularly reviewed. Staff were instructed how to care for people safely and avoid unnecessary risks being taken. There was evidence the care people received had improved their well-being. For example one relative commented, ‘Both were very ill and in need of care, when they entered the home and are both much improved both mentally and physically.’ Residents living in the home were treated with respect and their dignity maintained. Written comments from relatives included, ‘From what I have seen the carers treat the residents with respect and maintain their dignity’. And ‘Staff always treat the residents with cheerful politeness’.’ ‘Although my aunt is suffering from dementia we feel the care she is receiving is satisfactory. Resident’s lifestyle was centred on them, and residents did not have to conform to any institutional practice such as set times for getting up or going to bed. There was evidence activities improved people’s confidence. Visiting arrangements were very good and the meals provided met with resident’s tastes and choice, and needs. Staff were observed as courteous and attentive when assisting those residents requiring support. People using the service had confidence to raise any issue of concern they may have. Information held at the Commission and comments from relatives included ‘I have never been unhappy with the way the home is run. I know my mother is in good hands, the level of care given is very high’. ‘I have never had any reason to complain’. Residents were encouraged to say what they wanted and were asked regularly if everything was all right. There was evidence to support the management respond quickly to vulnerable adult protection issues and follow correct safeguarding procedures when needed. They work well with other professionals to protect residents. staff were trained in adult protection and knew their responsibility of care in this area. Residents liked their accommodation. Written comments included ‘‘It is also nice and bright, the decoration, especially in the bedrooms is bright and cheery’. And a relative said, ‘A bright clean home that looks attractive. There was an excellent record of routine safety checks completed by the maintenance manager and a member of staff ensured the home and grounds were kept in good order. Staff working in the home was considered to be, ‘Good quality of staff.’ And ‘The staff are very cooperative if you need them for anything.’ ‘People stay in Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 7 post so you can build up a relationship with the carers. I truly value this continuity in care.’ Staff interviewed displayed a high degree of job satisfaction within a good team environment, and had good knowledge in understanding the needs of older people. Learning opportunities were very relevant to the homes purpose, and staff felt they were much appreciated for their work and were valued in the home. The training provided for staff was very good and the home is commended for the number of care staff having completed a National Vocational Qualification in Care. Staff meetings were good practice focussed and they received regular supervision. The manager and deputy’s skills combined demonstrated changes made for improvement in service delivery, the environment, and staffing was successful. Systems were in place to approach residents/relatives to give their view on the quality of services and facilities in the home. Residents had meetings and Quality Assurance carried out at the home showed ‘management were approachable and helpful’. Relatives commented, ‘They appear to run an efficient, professional service and yet genuinely care about the residents. I particularly value the regular management and staff, patient/family meetings and I feel problems are listened to.’ Staff said ‘The manager is very supportive.’ The home was very well managed and run in the best interests of the people living there. What has improved since the last inspection? Good practice recommendations from the last key inspection and random inspection in November 2007 have been dealt with. Staff responsible for the administration of medication was trained. Records of medication were kept up to date. 88 of staff was qualified to National Vocational Qualification in care level 2 and above. All staff working in the home had Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) register check prior to employment. Other improvements not requested have included: The manager and one deputy manager has gained the Registered Managers Award. The home has a comprehensive training plan that covers topics relevant to the residents such as courses in stroke awareness, death and dying, and theraputic activities. Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 8 A separate activities person on each floor is appointed and logged on the rota. A quiet room is now available if any resident wishes to sit or entertain their relatives or friends. They have completed refurbishment of three en suite rooms, quiet room, and shower rooms. The stairway has been made safer for the protection of residents on the upper floor. Staffing levels have been increased in line with residents dependency needs. The manager and deputy manager have training in internal auditing. Care plans are more detailed and senior care assistants are more involved in care planning. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The admission processes ensured the residents’ were properly assessed, and their needs and wishes known and planned for, prior to moving into the home. People were given individual contracts/terms of conditions of residence that protected their legal rights. EVIDENCE: An information pack was given to people considering living in the home, that included all relevant information people needed to know about the home and what to expect. For people with visual difficulties an audio version was also available. Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 11 Written comments from residents living in the home indicated they were very happy the levels of information provided, and were also pleased with the admission procedure. Comments included, ‘Brochure available’. And ‘the manager and staff at Highgrove have provided all sorts of information and always answered any queries. They have been extremely helpful.’ ‘We were also invited to spend a day and share a meal with other residents.’ Several people had been admitted since the last inspection. The admission procedure involved visiting them in the community. This was to carry out an assessment of their needs and consider if the home had the right facilities, and staff expertise to meet those needs. The pre-admission assessment record identified personal, health, and social care needs. This provided information about the person’s circumstances and level of support required to enable them to have the right care. A summary of an assessment undertaken through care management arrangements, were in place and input from health professionals as needed. There was evidence individuals were involved in their assessment. Information received from the manager for this inspection said. ‘All prospective service users are given a tour of the home, any questions they may have, are answered honestly. No service user moves into the home without first having an in depth pre-assessment completed, this ensures all needs can be met’. Resident’s files showed people were issued with terms and conditions of residence that protected their legal rights. The contracts gave clear information such as fees and extra charges, and were signed by both parties. The range of needs of residents had been considered. Staff training programme-included full induction and essential training for example, moving and handling, dementia care, and protecting vulnerable adults. Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Care planning helped staff to provide the right personal care for residents, and ensured their healthcare needs was monitored. Care was given in a manner, which was respectful, and promoted privacy and independence, which supported residents right to live with dignity. Medication was managed safely. EVIDENCE: Resident’s, who completed a survey for this inspection and those who gave their views during inspection, considered they received the care and support they needed. They also considered staff were available when needed. Written comments from residents and relatives included, ‘I have always found the staff easy to talk to and very approachable, any request has always been attended to’. ‘’Everything alright, very good.’ ‘If I become ill, or have a bad day, the staff will assist me with all personal care and will get a doctor if needed.’ ‘Both Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 13 were very ill and in need of care, when they entered the home and are both much improved both mentally and physically.’ Staff worked to a key worker system, having responsibility to make sure care needs were personalised for residents. Staff considered care planning easy to use and information needed accessible. A brief record was made of residents past history. This helped staff to understand people as individuals, their likes, and dislikes. Each resident’s plan of care linked to his or her assessment of need, and outlined action to be taken to meet those needs, frequency, and person responsible. Risk assessments had also been completed to enable staff to care for people safely and ensure any identified risk was managed properly. These included nutritional screening, including monthly weight records, a health assessment, falls risk assessment, and a moving and handling assessment. Resident’s wishes for daily living was recorded and detailed the assistance each resident required with personal care. For example, identifying the level of independence with personal hygiene during review considered the resident was ‘more confident now and is washing and dressing herself, staff to supervise and assist where needed’. How people wanted the support was also recorded such as ‘Prefers to hold onto carers arm when walking for support’. Communication difficulties had also been considered such as poor hearing and sight. Records showed review of care plans were being carried out regularly, and changes made where needed. Staff were instructed on the basic principles of care. Staff and management are commended for their efforts in maintaining peoples dignity in the home. Observations showed care and attention had been given to resident’s appearance, and staff showed how in the course of their duties they were respectful to residents. Relatives written comments in relation to meeting different needs were, ‘So far Highgrove meets my parent in laws needs. I cannot comment on anything else. From what I have seen the carers treat the residents with respect and maintain their dignity’. And ‘Staff always treat the residents with cheerful politeness and have the time to listen if I have any concerns.’ ‘Although my aunt is suffering from dementia we feel the care she is receiving is satisfactory. Resident’s benefited additional specialist support where needed. This included healthcare, and records were kept of visits from medical professionals, and of routine health screening such as chiropody and eye tests. Pressure care was promoted and pressure-relieving aids were used on medical advice. Written comments from residents confirmed they received the medical support they needed. One relative commented, ‘When mum became bedridden and it was obvious that this state was a long term situation, they bought a special bed for her’. Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 14 The home operated a monitored dosage system for the administration of medication. This was audited by the supplying pharmacist. An appropriate recording system was in place to record the receipt, administration and disposal of medication. A record of medicines received into the home had been maintained and medication had been returned to the pharmacy for disposal. As good practice, medication given as when necessay should have more detail as to when this would be given recorded, particularly when the medication perscribed is for people with dementia. Information sent to the Commission by the manager showed staff responsible for medication administration had been trained. Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents had opportunity to take part in activities, and make choices and decisions about their lives. Visiting arrangements were very good. Residents were offered a balanced, varied, and nutritious diet that provided for their individual tastes and choice, and needs. EVIDENCE: Resident’s lifestyle was centred on them, and residents did not have to conform to any institutional practice such as set times for getting up or going to bed. Residents’ preferences in respect of choice in routine of daily living, linked to preference, and capabilities and was recorded into a plan of care. Residents personal daily record showed for example, up during the night therefore lying in bed this morning. Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 16 There were mixed views on the provision of activities. Written comments fro residents suggested ‘The bingo sessions are particularly good fun, also Christmas time making decorations and calendars, what a treat.’ And would like, ‘more activities in the evening.’ Could improve by, ‘more activities to occupy residents other than TV.’ Residents had meetings to discuss various issues such as activities and food provided. Last recorded meeting showed residents were asked to ‘consider why they don’t join in activities when they are provided, and if any one had some special activity they would like to do they could ask staff and it would be arranged’. An activities programme was displayed in the home; and there was usually something residents could do in the afternoons. Care notes show how social needs were recorded in assessment and care plans, and evidence to show how activities improved people’s confidence. One resident who had been withdrawn now ‘enjoyed baking’. ‘Joins in activities willingly rather than having to be coaxed’. There was evidence residents had been encouraged to bring their own personal possessions and furniture with them. Contact with family and friends was supported and visiting arrangements were good. A room was available for this purpose if needed. A couple of visitors were present during inspection. Residents spoken with said they could have visitors at anytime. Visitors were always made to feel welcome, and some of the residents were getting out and about with support from families and friends. All the residents spoken with said they were happy with the choice of meals provided, as choices were being offered within each course. Hot and cold drinks were provided throughout the day. The dining room provided a pleasant eating area for the residents. Place settings were used. The meal times observed were unhurried and relaxed. Staff were seen to be courteous and attentive when serving meals and assisting residents where needed, with one to one support. Special diets were catered for. Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The complaints procedure was available and used properly, which helped residents/relatives have confidence to raise any concern they may have. There were policies and procedures, and appropriate training for staff in professional conduct and adult protection issues. This meant residents rights, safety, and welfare was promoted EVIDENCE: Residents spoken to said they had no complaints against the staff. Staff were described as being ‘very good, and obliging’. One relative visiting said she would know who to speak to if unhappy about anything, but up to present never had any reason to make a complaint, as the management and staff were very good and available to speak to. The complaints procedure was given to residents when they were admitted to the home. A complaints recording system was in place. The procedure gave clear directions on whom to make a complaint to and the timescales for the process. Any issue raised was quickly dealt with by the manager who said Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 18 people are very open and would say if they had any concern. An anonymous complaint was received on 23rd November 2007 at the Commission. A random inspection was carried out on the 30th November to look at issues raised, which was linked to medication and resident care. The care of residents was found to be very good, however some improvement with medication practice was required. Residents and relatives, who were consulted, showed they knew who to talk to if they were not happy. People were confident to use the complaints procedure. Written comments included ‘. ‘I have never been unhappy with the way the home is run. I know my mother is in good hands, the level of care given is very high’. ‘I have never had any reason to complain’. Residents were encouraged to say what they wanted and were asked regularly if everything was all right. There was evidence during the inspection in November, the management is clear when an incident needs to be referred to the Local Authority as part of the local safeguarding procedures, and take appropriate action to protect residents. Staff working at the home said they were trained in adult protection and were aware of the written abuse policies and procedures, which included whistle blowing. They knew their responsibility in this area and were confident they would ‘report bad practice’ if ever the need arose. Knowledge and understanding in this area was checked during supervision sessions. In addition to this staff training was provided regularly to ensure new staff understand procedures. To fully safeguard residents, contractual arrangements for new staff should commence on appointment to cover the probationary period. This will ensure a formal agreement for staff to comply with the homes policies and procedures for example the ruling on non-acceptance of gifts, or being involved in wills or bequests. Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,24,26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home was well maintained, clean, and tidy, and provided a homely and pleasant environment for residents, visitors, and staff. EVIDENCE: Highgrove House is a purpose built residence, situated close to Chorley town centre. As in the last inspection, there is a move to bring the home up to a good standard of decoration and furniture and fittings. Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 20 The maintenance manager produced an excellent record of routine maintenance. Daily checks were completed around the home, and as routine nurse call checks, and water temperature checks were completed monthly. Automatic door releases had been planned to be fitted the following day, as residents requested doors made easier to open. A risk assessment was carried out on each room prior to a resident being admitted to the home with a view to ensuring that it met with individual needs. The process of refurbishing the home as identified in the last inspection had continued. Information for this inspection received at the Commission listed some improvements made. These included, completed refurbishment of three en suite rooms, quiet room, and shower rooms. A storage room has been made available upstairs. The stairway had been made safer for the protection of residents on upper floor. The information also outlined plans to continue to improve such as, provide a ramp at front for wheelchair access to main entrance of the home; widen the path outside the home making it more accessible to all residents, and install new lighting to both dining rooms and lounges. The garden was enclosed and safe, and during inspection the gardner/handyman was working in it. The lounges were decorated and furnished to a good standard and there was evidence of residents bedrooms being redecorated on a phased programme to accommodate individual residents needs. Bed linen provided was very good. Residents said they liked their accommodation. When people are admitted to the home, they can bring with them items of furniture and personal effects that can be reasonably accommodated. Laundry facilities in the home were suitable for purpose. The home was found to very clean during inspection, and policies and procedures were in place to help prevent the spread of infection. Staff were provided with disposable gloves and aprons. Residents who sent written comments to the Commission considered the home to be clean and fresh. Comments included ‘‘It is also nice and bright, the decoration, especially in the bedrooms is bright and cheery’. And a relative said, ‘A bright clean home that looks attractive.’ Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The numbers of staff employed, good recruitment and selection procedures, and relevant training, meant residents should be protected, and their needs effectively met. EVIDENCE: Most residents and relatives who sent written comments to the Commission considered staff were always available when they were needed. Relatives considered staff had the necessary skills to do their job. Comments included, ‘Staff are very good, friendly and helpful’. ‘Overall standard is high, but people always has to learn.’ ‘Good quality of staff.’ ‘The staff are very cooperative if you need them for anything.’ ‘People stay in post so you can build up a relationship with the carers. I truly value this continuity in care.’ Rotas completed showed the compliment of staff was sufficient to cover all essential duties in providing care, and maintaining essential standards in the home such as hygiene and catering, and senior staff were on duty at all times. Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 22 Staff files showed recruitment checks to be complete and met with legislative requirements for Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) register check being applied for, prior to employment. However more care is required with references. Although all employees had two references, one reference was a pre written testimonial as to the persons’ suitability, and therefore an additional reference should be sought. Most files showed interview notes had been taken. On appointment members of staff were not issued with a contract of terms and conditions of employment from Park House that covered their probationary period of three months. Staff who provided written comments for the inspection said they had received induction training, and training relevant to their role as carer. Records showed the induction-training programme carried out, covered essential training in basic principles of care, and safe working practice issues, such as moving and handling residents and health and safety. 88 of care staff hold a National Vocational Qualification in care level 2 or above and the carers who do not have this are to attend the relevant courses for this purpose. Staff interviewed displayed a high degree of job satisfaction within a good team environment. Communication, both formal and informal was seen as sufficient, open, and honest. There was impressive evidence of management going the extra mile to encourage individuals to maximise their potential. Equality of opportunity was demonstrated with training. Learning opportunities were very relevant to the homes purpose. All staff felt they were much appreciated for their work and were valued in the home. Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36,37,38 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The home is very well managed and run in the best interests of the people living there. EVIDENCE: Since the last inspection the manager of the home has been registered with the Commission. She is qualified and experienced in managing residential care homes. A deputy manager supports her in her work and their skills combined Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 24 demonstrated changes made for improvement in service delivery, the environment, and staffing was successful. Information received at the Commission informed us they attended training for internal auditing. They had also delegated responsibility to seniors for care planning. They intend to complete the cycle of internal audits; monthly accident audits, and continued improvements to staff structure. Equality & diversity, and Mental Capacity Act training was being organised for both management and staff. There is regular support for the manager through a named line manager and there are clear lines of accountability. Insurance cover is sufficient in ensuring against any loss or legal liabilities. The home is accredited with ISO 9001 status and has an annual assessment regarding this. The views of residents, relatives, staff, and other professionals are valued. Residents meetings and staff meetings were held regularly, and a six monthly residents survey has been implemented. Findings from the recent questionnaire were discussed and included meals, laundry, and environment improvements. Staff meetings were good practice focussed and staff confirmed they received regular supervision. Comments from visiting professionals were, ‘management were approachable and helpful’. Staff said ‘The manager is very supportive.’ Written comments from relatives showed the home was definitely run in the interests of the residents. Comments included, ‘‘Highgrove manager and staff have shown my parents in law and all family and friends, kindness and consideration during what has been a difficult time of adjustment. They have also dealt efficiently with the practicalities and provided much needed support and care for us all.’ And ‘Management walk the floor’. ‘Highgrove is a friendly, efficiently run care home. The staff are very good with my mother’. ‘As mum is a long term resident we have seen the changes brought in by the Park Lane take over. They appear to run an efficient, professional service and yet genuinely care about the residents. I particularly value the regular management and staff, patient/family meetings and I feel problems are listened to.’ The home sent us their annual quality assurance assessment (AQAA), that gave us information we asked for. For example, how equality and diversity issues were managed. We were informed, ‘Our care plan assessment includes religious, cultural, emotional needs, and expressing sexuality’. In addition to providing training for staff on this subject they intend to, ‘Obtain the whole of me resource pack to educate staff to the growing need of service users. Introduce an equality & diversity policy and update our service user guide to include equality & diversity’. Policies and procedures in the home were being reviewed and made available for staff. Confidential records were locked away. Record keeping and filing Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 25 systems were good and information required for this inspection were readily available. The home does not handle residents money or valuables however small amounts of individuals money can be held at the home for safekeeping, with regular auditing in place to protect people requiring this service. Health, safety, and welfare of people living and working in the home is a shared responsibility between Park Lane Healthcare and the manager. Weekly checks on the environment safety were carried out for example water temperature checks, fire alarms and emergency lighting. Information received at the Commission showed regular maintenance of services such as heating and electrical equipment had been carried out. Training in health and safety was also provided for staff. Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 3 4 3 4 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 2 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 3 3 3 Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 OP9 2 OP18 3 OP29 Refer to Standard Good Practice Recommendations More detail should be recorded when medication to be ‘given when necessary’ is to be given, particularly where residents are unable to communicate their needs. Staff should sign an agreement to follow the homes ruling on non-acceptance of gifts, wills, and bequests when they start work in the home. Pre written testimonials should not be accepted as a second reference. Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Highgrove House DS0000065791.V365443.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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