Care Home: Highroyd

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What the care home does well Overall we felt the standard of peoples care plans were good and they did focus on the individual person. People looked clean, well dressed and had received a good level of personal care. People said "The staff are really nice" "I`ve really settled it`s a marvellous place". Relatives said "Staff consistently treat people with care and tenderness at Highroyd ". Health professionals said that they felt the care delivered at Highroyd was "good and that staff treated people with dignity". A friendly, lively and welcoming feel was evident in Highroyd. People said that the home was "a friendly and happy place" this was evident on the day of our visit. All comments about the food were positive. People said the quality and choice of food served was very good. The home was clean and tidy. People and visitors said the home was always kept very clean. People said that they felt very comfortable in going to the manager or owner of Highroyd knowing that any concerns they may have would be addressed without delay. Staff said that they really enjoyed working at the home and got a lot of job satisfaction. We found that the staff were very enthusiastic and keen to improve the service further. What has improved since the last inspection? There had been positive action on the requirements listed within the last inspection report. All requirements and recommendations had been acted upon and resolved. Staff are monitoring peoples nutritional needs more closely. Kirklees council have recently awarded the home a `gold standard` for promoting `healthy choice eating`. There has been an improvement made in the medication procedures at the home. The dining room has been recently refurbished. New floor coverings have been fitted around various rooms in the home. Recruitment practices for employing staff have improved. What the care home could do better: Peoples` care plans still need further attention and more detail so that the staff know what to do for each person. Some medication practices and storage procedures need to improve so that people`shealth and welfare are protected. Some areas of the home are still in need of redecoration and refurbishment. Some further improvements are required in the homes quality assurance programme so that the home continues to be run in the best interests of people who live at Highroyd. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Highroyd Highroyd Lane Moldgreen Huddersfield West Yorkshire HD5 9DP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mike ONeil     Date: 0 5 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Highroyd Highroyd Lane Moldgreen Huddersfield West Yorkshire HD5 9DP 01484535458 01484423191 kim2highroyd@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Stuart Theobald,Mrs Elizabeth Theobald care home 19 Number of places (if applicable): Under 65 Over 65 19 old age, not falling within any other category Additional conditions: 0 Can provide accommodation and care for a maximum of two named service users aged over 65 years with Dementia (DE(E)) Can provide accommodation and care for two named service users aged over 65 years with dementia (DE(E)) Date of last inspection Brief description of the care home Highroyd is registered to provide personal care and accommodation for up to nineteen older people. It is situated in the Moldgreen area of Huddersfield within walking distance of a bus route, local shops and post office. Mr Stuart and Mrs Elizabeth Theobald own the care home. The residential accommodation is on two levels. A stair lift is in place. Sixteen bedrooms are for single occupation. The dining room receives good natural light, as does the communal lounge area, which is well used by residents throughout the day. There is a lawned area to the side of the home in front of the conservatory. Car parking is available. Care Homes for Older People Page 4 of 26 Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This is what was used to write this report. Information about the home kept by the Commission for Social Care Inspection. Information returned to us by 6 people who live at Highroyd, 2 relatives, 5 staff and a health professional who regularly visits the home. Prior to the visit the service had submitted an Annual Quality Assurance Assessment (AQAA) which detailed what the service was doing well, what had improved since the last inspection and any plans for improving the service in the next twelve months. The AQAA also included data as to when utilities and equipment at the home was serviced. Care Homes for Older People Page 6 of 26 Information from the AQAA is included in the main body of the report. An unannounced visit to the home. This was carried out by Michael ONeil, regulation inspector on 5th March 2009 and included talking to 6 staff and Kim Hirst, home manager about their work and the training they have completed. And checking some of the records, policies and procedures the home has to keep. Stuart Theobald, the registered provider and owner was also present during the course of our visit. Some time was spent observing staff supporting people and talking with 6 people who live at Highroyd. We wish to thank the people living in the home and the staff for their time, friendliness and co-operation throughout the inspection process. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. What the care home does well: What has improved since the last inspection? What they could do better: Peoples care plans still need further attention and more detail so that the staff know what to do for each person. Some medication practices and storage procedures need to improve so that peoples Care Homes for Older People Page 8 of 26 health and welfare are protected. Some areas of the home are still in need of redecoration and refurbishment. Some further improvements are required in the homes quality assurance programme so that the home continues to be run in the best interests of people who live at Highroyd. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 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 26 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. People were individually assessed prior to admission to ensure their needs could and would be met. Evidence: Three care plans checked showed that people within the service had been assessed before moving into the home. Risk assessments and a plan of care reflected any specialist interventions. The assessment forms checked were detailed and fully completed. The manager and staff liaised with professionals, the person and their families to find out about peoples needs. The manager visited people and undertook assessments, prior to admission. Care Homes for Older People Page 11 of 26 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. Peoples health is monitored and arrangements for dealing with health issues were met with support from health professionals. People were treated with respect and said they were very happy with the care they received. Some medication practices and storage procedures provided a risk to the peoples health and welfare. Evidence: Three peoples care plans were checked. The care plans contained details about the persons biography, personality and their preferences and choices. Overall we felt the standard of the plans were good and they did focus on the individual person. Risk assessments were included within the documentation and included moving and handling, skin integrity, and other risk factors. The care plans identified that a range of health professionals visited the home to assist in maintaining peoples health care needs. People said they had regular contact with their GP and other health professionals such as district nurses. There was evidence recorded to show that people Care Homes for Older People Page 12 of 26 Evidence: and/or their relatives were involved in drawing up and reviewing the care plans. There were three issues within the care plan documentation that did require staff attention. Staff were failing to record times they made entries in the plans. Staff must be reminded that peoples care plans are a legal document and must always be signed, dated and timed. Staff, when writing peoples daily notes, were not being reflective of the information actually recorded in the persons care plan. Therefore, there were no records to evidence that staff had met certain care needs of people over several days. Documenting, for example fine today or all care given is not sufficient or specific enough information when recorded, in isolation, in a persons daily record. One care plan had been amended and updated due to a persons changing health needs. However staff had not rewritten the care plan and it therefore contained out of date imformation.This meant that the care plan contained conflicting information about the persons care needs. We did spend time talking with the manager and senior care staff about ways to improve the care plan documentation. It was pleasing to hear the enthusiasm from the staff who clearly wanted to improve the documentation as much as they could. People looked clean, well dressed and had received a good level of personal care. People said The staff are really nice Ive really settled its a marvellous place. Relatives said Staff consistently treat people with care and tenderness at Highroyd Im kept informed about what is going on and whenever I visit the staff are always helpful. Health professionals said that they felt the care delivered at Highroyd was good and that staff treated people with dignity. Medication was securely stored in a locked trolley that was secured to a wall. Care Homes for Older People Page 13 of 26 Evidence: Medication records were up to date with no gaps. The Controlled Drugs Register was checked and this had been completed correctly with two signatures and a diminishing total. Staff said they had received medication training and records were seen of this training having taken place. However peoples health and safety was not fully maintained because not all Medicine Administration Records (MAR) and other medication procedures were adequate. Some medicines, which are controlled, were not being stored appropriately. The secure storage of controlled drugs is specified in the Misuse of Drugs (Safe Custody) Regulations 1973. In the 2007 Amendment the term nursing home has been replaced by care home. The main impact is that every care home must store controlled drugs in a controlled drug cupboard, including care homes registered for personal care. We spoke with the manager and registered provider about this requirement and they gave assurances that a cupboard would be purchased without delay. Staff had not used the appropriate coding on several MAR sheets to indicate why a medication had not been given. Some handwritten MAR sheets checked did not contain General Practitioners or two members of staffs signatures alongside any directions regarding the dosage of the medication or the time the medication was to be given. The other positive outcomes for people in this area have enabled an overall quality rating of good to be made under Health and Personal Care. However, we discussed the shortfalls with the manager and advice was given regarding the need to audit the medication systems in more detail on a more frequent basis. People were treated with respect and dignity and addressed by their preferred name. Staff were observed interacting in a friendly and pleasant way. Staff took time to explain what task or support they were about to offer people. Care Homes for Older People Page 14 of 26 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 had a choice of lifestyle within the home and were able to maintain contact with family and friends ensuring that they continued to be involved in community life. People were able to make choices about daily living and be involved in some social activities. Meals served at the home were of a good quality and offered choice to ensure people receive a balanced diet. Evidence: People said they were able to get up and go to bed when they chose and generally how they spent their day and evenings. They said they often went out with their families. Relatives said they were able to visit at any time and were made to feel very welcome. A friendly, lively and welcoming feel was evident in Highroyd. People said that the home was a friendly and happy place this was evident on the day of our visit. Some people said they enjoyed the activities available at the home, whilst other Care Homes for Older People Page 15 of 26 Evidence: people said that they chose not to join in with the activities arranged. Activities were advertised around the home. Activities that people had participated in were recorded in their care plans. We spoke with the activities coordinator employed at Highroyd. The coordinator showed great enthusiasm about her role and was keen to include as many people as possible in different types of activities. The door numbers on peoples bedrooms were very small and difficult to see this may cause difficulties for people with orientation around the home. There were clocks around the home that showed the correct time and boards in the corridors contained plenty of information about the home and what was going on in the local community. Displaying this sort of information will help people further with orientation to time and place. All comments about the food were positive. People said the quality and choice of food served was very good. Kirklees council have recently awarded the home a gold standard for promoting healthy choice eating. The mealtime experience for people in the home was very positive. The tables were set nicely with place mats, condiments and matching crockery. The meals were served in a relaxed unhurried manner by staff. People said they were always offered a choice and asked what they wanted for their breakfast, lunch and teatime meals. We heard staff asking people what their meal preference were. People said they were offered drinks on a regular basis throughout the day. Care Homes for Older People Page 16 of 26 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. Complaints procedures were in place and people and their relatives felt confident that any concerns they voiced would be listened to. Staff had an understanding of the procedures to be followed should they suspect any abuse at the home, so helping to ensure that people were protected from abuse. Evidence: People had been provided with a copy of the homes complaints procedure, which was also on display in the entrance hall and in peoples bedrooms. This contained details of who to speak to at the home and who to contact outside of the home to make a complaint should they wish to do so. People said that they felt very comfortable in going to the manager or owner of Highroyd knowing that any concerns they may have would be addressed without delay. Regarding safeguarding adults, the safeguarding policies and procedures were available to the staff. Staff said they had undertaken Safeguarding Adults training, and the manager was able to evidence this by producing the training records. Care Homes for Older People Page 17 of 26 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. The home was clean, pleasant and hygienic. Some areas of the home are in need of redecorating and refurbishing. Evidence: The home was clean and tidy. People and visitors said the home was always kept very clean. Lounge and dining areas were domestically furnished to a good standard. The dining room has been recently refurbished. The room is now bright and cheerful .New floor coverings have been fitted around various rooms in the home. Some bedrooms have also been refurbished and were bright and airy. Privacy screens were available in shared rooms. People said they were very comfortable at the home. Their bedrooms contained a variety of their own furniture and touches such as ornaments and pictures. This gave their rooms a homely feel. Some areas, particularly in the older part of the home, are in need of refurbishment and redecoration. A rolling programme of refurbishment should continue. Care Homes for Older People Page 18 of 26 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. Staff were employed in sufficient numbers and recruitment procedures promoted the protection of people. People receive care from a well-trained staff team. Evidence: People spoke highly of the staff team and said staff always listened and acted on what they said. People said that staff were always available when needed. Staff and the manager confirmed that staffing levels were adequate. Three staff files were checked at this visit. The files contained a range of information including two references and a declaration of health and identification. The staff had undertaken a criminal record bureau check (CRB), at the enhanced level. This confirmed thorough recruitment practices were in place, which was sufficient to safeguard people. Staff said that they really enjoyed working at the home and got a lot of job satisfaction. We found that the staff were very enthusiastic and keen to improve the service further. Staff were able to talk about the various training courses that they had Care Homes for Older People Page 19 of 26 Evidence: attended. A sample of development and training records were checked. These records showed when staff had completed mandatory training and refresher training. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The procedures and ethos of the home ensure that the home is run in the best interests of people who use the service. The homes procedures promote the health, safety and welfare of people who use the service and the staff. Evidence: The manager, Kim, has many years experience within the caring profession and has completed the Registered Managers Award. Kim has been a previous registered manager at Highroyd but left the home last year. She returned to her post of manager six months later at the end of 2008. Kim is aware that she needs to register with the CSCI as manager and she has already started the process. Staff and people spoke very highly of the manager and said she was always available and very approachable. The home had a quality assurance system. There was evidence of some internal Care Homes for Older People Page 21 of 26 Evidence: auditing of the homes environment, services and records. Staff meetings were held and minutes of these meetings were seen. One person told me that they were recently on the panel who interviewed a prospective member of staff for the home. The owner, Stuart Theobald, visits the home 3 to 4 times a week. People and staff said they saw him frequently and were able to talk to him at any time. However, a report, as required, wasnt being written following these visits. A report should be written, at least every month and kept at the home. The service has sent out satisfaction surveys to people and their families. A good number of surveys have been returned, however, the results of these surveys have not been published and made available to people. Overall, however, the quality assurance systems currently in place at Highroyd will help to ensure that the service is operating in the best interest of the people who live there. A sample of monies that was looked after on behalf of people living at the home was checked. Records were kept and money tallied with the records. The AQAA provided information of the dates that equipment and systems within the home had been serviced and maintained. A fire risk assessment was in place at the home. No issues requiring attention were highlighted in the assessment. Staff said they had received recent fire safety and other health and safety training .A sample of records showed that staff were receiving this statutory training. At the time of the visit fire exits were clear and hazardous products were safely stored in the home. This will promote the safety and welfare of the people. Care Homes for Older People Page 22 of 26 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 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Medication must be securely 01/07/2009 stored as required under the Misuse of Drugs Act and Regulations.In brief, the requirements for CD storage are: Metal cupboard of specified gauge Specified double locking mechanism Fixed to a solid wall or a wall that has a steel plate mounted behind it Fixed with either Rawl or Rag bolts Suppliers of CD cabinets can confirm that a cupboard meets the legal requirements. To protect people. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 24 of 26 1 2 3 4 7 7 7 9 The persons daily notes should reflect the information actually recorded in the persons care plan. Peoples care plans should be clear to read and reflect any changing health or social needs of the person. Staff should ensure that all written entries they make in peoples care plans are dated, timed and signed. The Medication Administration Records (MAR) should contain General Practitioners or two members of staffs signatures alongside any directions regarding the dosage of the medication or the time the medication is to be dispensed. Medication should be administered in accordance with instructions unless there is a documented reason why this was not done. (Coding systems on the MAR sheets) Signage should be improved to help people with orientation around the home. The programme of renewal of the fabric and decoration to improve the environment should be continued. The registered provider should produce a monthly written report on the conduct of the care home as required by regulation 26 of the Care Homes Regulations. The results of satisfaction surveys should be published and made available people and other interested parties. 5 9 6 7 8 12 19 33 9 33 Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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