Care Home: Highlands Care Home

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What the care home does well Choice of home - Last time we inspected, we recommended that people`s assessments should be holistic i.e. not just focusing on their physical needs but also their mental health needs and their spiritual and social needs. Assessments for two people who have moved to the home since our last inspection showed that they have improved in detail. The manager was also able to tell us about their approach to gathering information about people, which demonstrated good practice. Health and Personal Care - We looked at the care plans for two people who had moved to the home since the new manager has been post and a care plan for someone with high care needs. The manager told us that she is currently working with the care planning structure that she has inherited. However, she plans to adapt this to reflect previoussuccessful care planning systems, which worked in previous homes that she has managed. The care plans are moving towards a more person centred approach. Both care plans held sufficient details for each individual`s care. For example, there is recognition of pain control, moving and handling needs and wound care. We saw that risk assessments are in place, and include falls and skin care. We saw records for mouth care and regular checks for the setting on a pressure relief mattress. Staff also told us that they had received recent training in skin care and how to support people with swallowing difficulties. We saw that records were up to date, including the toilet charts, and observed that people were regularly supported with their toileting needs. The home had no unpleasant odours, which included the toilet area, and people looked comfortable. We talked about the systems in place to ensure that people`s care is consistent, which included handovers, a communication book and sharing information with staff prior to people moving in. The manager has recently implemented a new system to ensure that the people providing the care are the same people who write up the care records. We talked with the manager and a senior carer about the support for someone with end of life care needs, although they were clear in discussion about when they would request help if someone had only drunk a little, this was not clear on the fluid charts. However, the fluid charts were up to date and showed that the person was receiving regular support with their drinks. We looked at the notes relating to health intervention for another person with complex health needs, and saw that these were of a high standard. We also saw recognition of how people can be made to feel safe and how they respond to the people around them, including the staff. We saw guidance about people`s communication needs. We saw staff recognising people`s changing needs, both during our visit, and through the home`s care records, which showed that the home contacted GPs and district nurses appropriately to discuss concerns. Daily records are detailed, recognise change and record the action taken. Records and discussion show that the manager has been an effective advocate for people to receive the care they are entitled to. For example, ensuring a review of people`s needs when they moved in and for one person arranging an audiology appointment and a community psychiatric nurse to assess the person as part of their admission assessment. However, staff told us that accessing mental health services has proved problematic despite repeated requests for a review of one particular person`s needs. Since our last inspection, the home has had made improvements to the way that medication is administered and managed. The provider has carried out a detailed audit on medication practice and we read the subsequent report and discussed the changes that have been implemented as a result. We were told there would continue to be a monthly audit and that the signing of cream charts was an area for improvement. We saw in one person`s daily notes how steps have been taken to ensure that medication did not run out. The home confirmed that there is appropriate controlled drug storage in place, and that there is an appropriate register in place. Further improvements to medication practice include a comprehensive medication policy and people`s medication is reviewed by a GP at suitable intervals. Daily Life and Social Activities - the requirement linked to this section will be checked at the next inspection. Complaints and Protection - During our last inspection, we made a requirement thatcomplaints must be recorded accurately and in detail, including the action taken. The new complaints log shows that the high standard of records comply with this requirement demonstrating good practice, a thorough approach with detailed records and action points. We were told that staff training in safeguarding awareness is work in progress, and the manager and the provider were able to tell us about steps they had taken to arrange suitable training. This requirement will be carried over and inspected at the next inspection. Environment - We saw that the home has responded to our recommendation to audit the rooms by producing a checklist, which has been completed to show that lights are suitable, call bells are working etc and the action taken. The provider accompanied us when we visited the bedrooms on the lower floor. They showed us the improvements that have been made, what steps have been taken to ensure room temperatures are more suitable and we heard them making arrangements for a further visit by a heating professional. The rooms that we visited in the basement felt warm and one no longer smelt musty. The manager also told us that staff had been reminded about ensuring that blankets kept in the lounge are kept clean. We saw a blanket being used during our visit in the lounge, which looked clean. There were no unpleasant odours in the home, which included the corridor and bathroom that we raised concerns about on our last visit. Since our last visit, this bathroom has been re-decorated to make it a more pleasant place to visit. The requirement relating to the Health Protection Agency will be carried over and inspected at the next inspection. Staffing - We were told that staff training is work in progress, and the manager and the provider were able to tell us about steps they had taken to arrange suitable training. Staff also told us about recent training and the benefits they had gained from this. This requirement will be carried over and inspected at the next inspection. No n What the care home could do better: There are outstanding requirements and recommendations which will be checked when the home is next inspected. No new requirements or recommendations were made onthis visit. Random inspection report Care homes for older people Name: Address: Highlands Care Home 56 St. Leonard`s Road Exeter Devon EX2 4LS one star adequate service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Louise Delacroix Date: 2 7 0 1 2 0 1 0 Information about the care home Name of care home: Address: Highlands Care Home 56 St. Leonard`s Road Exeter Devon EX2 4LS 01392499201 01392499201 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Highlands Care Home Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 26 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 26 26 The maximum number of service users who can be accommodated is 26. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia (Code DE) Mental disorder, excluding learning disability (Code MD) Date of last inspection Brief description of the care home The home is located in the centre of Exeter and has a small car park at the front of the building. To the rear is a mature garden which is secluded and quiet. This can be Care Homes for Older People Page 2 of 12 Brief description of the care home accessed from the ground floor by a passenger lift. The home has two lounges on the ground floor, one with a television and the other combines with a dining area. The majority of the bedrooms are single occupancy and do not have an en-suite facility. Bedrooms are situated on three of the four floors of the home and vary in size and outlook. Care Homes for Older People Page 3 of 12 What we found: The quality rating for this service is 1 star. This means the people using this service experience adequate quality outcomes. The inspection was unannounced and took place over five and a half hours. We spent time in the communal areas of the home, visited some of the bedrooms and spent time looking at written records and talking to people working at the home. The atmosphere in the home was open, welcoming and organised. On our arrival, people were being entertained by a visiting performer. There has been considerable improvement in the way the home is run and staff benefit from an experienced manager who has created a safer place for people to live. The home was registered with the Care Quality Commission (CQC) as a new service in April 2009. At that time there was a registered manager working at the home but they are no longer in post. As a result of concerns raised by visitors to the home regarding the quality of the care, a safeguarding referral was made by CQC following a random inspection on 5th August 2009. Subsequent safeguarding meetings have taken place, which included health and social care professionals. People living at the home have had their care needs reviewed. The provider has been invited to these meetings and demonstrated a commitment to improving the service, both through their discussions and their actions. CQC carried out two further random inspections on 27th August 2009 and 4th September 2009. These visits resulted in enforcement action being taken by CQC, with two statutory requirement notices being served on the home relating to care planning and health and welfare. We also undertook a key inspection on 8th October 2009 when the overall rating for the service was changed from new to adequate. The provider has now appointed an experienced manager to work at the home and they officially started working at the home in November 2009. The purpose of this inspection was to check on the homes compliance in respect of the statutory requirement notices and to make a judgment about whether the standard of care has improved. As a result of this inspection, we have made the judgement that the statutory requirement notices have been met. We also checked to see if the home had met the requirements made on our last inspection. What the care home does well: Choice of home - Last time we inspected, we recommended that peoples assessments should be holistic i.e. not just focusing on their physical needs but also their mental health needs and their spiritual and social needs. Assessments for two people who have moved to the home since our last inspection showed that they have improved in detail. The manager was also able to tell us about their approach to gathering information about people, which demonstrated good practice. Health and Personal Care - We looked at the care plans for two people who had moved to the home since the new manager has been post and a care plan for someone with high care needs. The manager told us that she is currently working with the care planning structure that she has inherited. However, she plans to adapt this to reflect previous Care Homes for Older People Page 4 of 12 successful care planning systems, which worked in previous homes that she has managed. The care plans are moving towards a more person centred approach. Both care plans held sufficient details for each individuals care. For example, there is recognition of pain control, moving and handling needs and wound care. We saw that risk assessments are in place, and include falls and skin care. We saw records for mouth care and regular checks for the setting on a pressure relief mattress. Staff also told us that they had received recent training in skin care and how to support people with swallowing difficulties. We saw that records were up to date, including the toilet charts, and observed that people were regularly supported with their toileting needs. The home had no unpleasant odours, which included the toilet area, and people looked comfortable. We talked about the systems in place to ensure that peoples care is consistent, which included handovers, a communication book and sharing information with staff prior to people moving in. The manager has recently implemented a new system to ensure that the people providing the care are the same people who write up the care records. We talked with the manager and a senior carer about the support for someone with end of life care needs, although they were clear in discussion about when they would request help if someone had only drunk a little, this was not clear on the fluid charts. However, the fluid charts were up to date and showed that the person was receiving regular support with their drinks. We looked at the notes relating to health intervention for another person with complex health needs, and saw that these were of a high standard. We also saw recognition of how people can be made to feel safe and how they respond to the people around them, including the staff. We saw guidance about peoples communication needs. We saw staff recognising peoples changing needs, both during our visit, and through the homes care records, which showed that the home contacted GPs and district nurses appropriately to discuss concerns. Daily records are detailed, recognise change and record the action taken. Records and discussion show that the manager has been an effective advocate for people to receive the care they are entitled to. For example, ensuring a review of peoples needs when they moved in and for one person arranging an audiology appointment and a community psychiatric nurse to assess the person as part of their admission assessment. However, staff told us that accessing mental health services has proved problematic despite repeated requests for a review of one particular persons needs. Since our last inspection, the home has had made improvements to the way that medication is administered and managed. The provider has carried out a detailed audit on medication practice and we read the subsequent report and discussed the changes that have been implemented as a result. We were told there would continue to be a monthly audit and that the signing of cream charts was an area for improvement. We saw in one persons daily notes how steps have been taken to ensure that medication did not run out. The home confirmed that there is appropriate controlled drug storage in place, and that there is an appropriate register in place. Further improvements to medication practice include a comprehensive medication policy and peoples medication is reviewed by a GP at suitable intervals. Daily Life and Social Activities - the requirement linked to this section will be checked at the next inspection. Complaints and Protection - During our last inspection, we made a requirement that Care Homes for Older People Page 5 of 12 complaints must be recorded accurately and in detail, including the action taken. The new complaints log shows that the high standard of records comply with this requirement demonstrating good practice, a thorough approach with detailed records and action points. We were told that staff training in safeguarding awareness is work in progress, and the manager and the provider were able to tell us about steps they had taken to arrange suitable training. This requirement will be carried over and inspected at the next inspection. Environment - We saw that the home has responded to our recommendation to audit the rooms by producing a checklist, which has been completed to show that lights are suitable, call bells are working etc and the action taken. The provider accompanied us when we visited the bedrooms on the lower floor. They showed us the improvements that have been made, what steps have been taken to ensure room temperatures are more suitable and we heard them making arrangements for a further visit by a heating professional. The rooms that we visited in the basement felt warm and one no longer smelt musty. The manager also told us that staff had been reminded about ensuring that blankets kept in the lounge are kept clean. We saw a blanket being used during our visit in the lounge, which looked clean. There were no unpleasant odours in the home, which included the corridor and bathroom that we raised concerns about on our last visit. Since our last visit, this bathroom has been re-decorated to make it a more pleasant place to visit. The requirement relating to the Health Protection Agency will be carried over and inspected at the next inspection. Staffing - We were told that staff training is work in progress, and the manager and the provider were able to tell us about steps they had taken to arrange suitable training. Staff also told us about recent training and the benefits they had gained from this. This requirement will be carried over and inspected at the next inspection. No new staff have been recruited since the last inspection so the requirement will carry over. Management and Administration - The home has been without a registered manager for approximately five and a half months, which is not best practice. We have advised the home that they must submit an application to register the current manager of the home to help to provide security to the home and confirm the suitability of the manager. We saw good evidence that quality assurance systems are being put in place and looked at the records relating to an audit of meals, rooms and medication, which had clear outcomes. The home recognise this is an area for development but are making good links with relatives and friends of people living at the home through social events. On our last inspection, we made a requirement that the person who provides the maintenance for the home must have appropriate training. We were told that a three day course in Health and Safety is being planned. We were also told that the arrangements for the laundry would be changing, which may address the concerns raised at the last inspection. However, the requirement linked to this section will be looked at in more detail at the next inspection. What they could do better: There are outstanding requirements and recommendations which will be checked when the home is next inspected. No new requirements or recommendations were made on Care Homes for Older People Page 6 of 12 this visit. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 12 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 12 16 People living at the home 02/11/2009 need to be supported to maintain their faith/spiritual beliefs and existing interests, including external interests. This is to ensure that peoples well being and individuality is maintained. 2 18 13 The responsible individual 01/12/2009 and staff must familiarise themselves with, and follow, the local authoritys multi agency guidance on safeguarding people to ensure that people living at the home are protected from abuse and harm. This includes updating the homes policy. (This requirement has been repeated. The original compliance date was 22/09/09). 3 26 16 Staff must receive training 01/12/2009 that is appropriate to the work they perform, including training on supporting people with dementia, and understanding behaviour that challenges the service, plus moving and handling and infection control. Page 8 of 12 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action To ensure that peoples diverse needs are met safely and appropriately. (This requirement has been repeated. The original compliance date was 22/09/09). 4 27 18 Staff must receive training 01/12/2009 that is appropriate to the work they perform, including training on supporting people with dementia, and understanding behaviour that challenges the service, plus moving and handling and infection control. To ensure that peoples diverse needs are met safely and appropriately. (This requirement has been repeated. The original compliance date was 22/09/09). 5 29 19 Recruitment must be more 02/11/2009 robust in the home, and include suitable written references and detailed employment histories to help safeguard people living at the home and ensure that staff are suitable to work at the home. . 6 31 10 You must carry on and manage the care home with sufficient care, competence and skill to ensure that care staff receive the leadership 11/11/2009 Care Homes for Older People Page 9 of 12 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action and direction they need so that peoples needs can be met. (This requirement has been repeated. The original compliance date was 22/09/09). 7 38 13 Unnecessary risks to the 01/12/2009 heath and safety of service users must be identified and so far as possible eliminated, with records kept of action taken. This is to ensure that people live and work in a safe and well maintained environment. Care Homes for Older People Page 10 of 12 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 Care Homes for Older People Page 11 of 12 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. Care Homes for Older People Page 12 of 12 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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