Care Home: Highwell House

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What the care home does well People have access to written information about the home, which is clearly presented and easily available. Senior staff from the home carry out assessments before people move in, so that the home can be sure that it can meet people`s individual needs. People can be confident that their health and personal care needs will be met by competent and skilled staff. The home manages medication safely. The home provides some social and leisure opportunities, which are planned around people`s individual needs and wishes. Meals are appetising and provide a nutritious and balanced diet. The home makes sure that any specialist dietary needs are met. People can be confident that their concerns will be listened to and taken seriously. The home`s recruitment procedures help to protect people by making sure that only suitable staff are employed. Highwell House provides a pleasant, safe and comfortable environment for people to live. One person commented "it`s more like a hotel than a home". Infection control is well managed. Staff have the skills and knowledge to carry out their roles to a high standard. There are enough staff available to meet people`s care needs. The staff are kind and caring, and people told us "I`d give them top marks" and "they`re all so kind". The home is managed in the best interests of the people who live there. People can be confident that the manager runs the home efficiently and effectively. What has improved since the last inspection? Care plans are written in a way which emphasises each person`s wishes and needs, and promotes person-centred care. What the care home could do better: The records do not always make clear when medication, which has been prescribed to be given as required, should be administered. This means that staff might not have enough information to tell them the circumstances under which the medication should be given. The range of activities on offer may not meet everybody`s needs. The home has recognised that people might wish to have access to a wider range of activities, and has plans to appoint a Wellness Facilitator to meet this need. The Wellness Facilitator will plan and implement activities based on people`s individual needs and wishes, and will access complementary therapies as required. Because Highwell House is a busy home, with many people who require a high level of care, staff may sometimes not have as much time as they would wish to chat with people. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Highwell House Highwell House Highwell Lane Bromyard Herefordshire HR7 4DG     The quality rating for this care home is:   three star excellent 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: Sarah Blake     Date: 2 9 0 4 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 29 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.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Highwell House Highwell Lane Highwell House Bromyard Herefordshire HR7 4DG 01885488721 01885482882 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) : Karen Anne Rogers care home 34 Number of places (if applicable): Under 65 Over 65 34 0 old age, not falling within any other category physical disability Additional conditions: 0 34 The maximum number of service users to be accommodated is:34 The registered person may provide the following category of service only:Care home only- code N To service users of the following gender Both Whose primary care needs on admission to the home are within the following Old age, not falling within any other category- code OP Phyisical Disability -code PD Date of last inspection Brief description of the care home Highwell House is owned by Ms Karen Rogers, who also owns two other registered care homes in Herefordshire. Highwell House is situated at the end of a narrow lane half a mile from Bromyard town centre. It provides excellent views across the Froome Valley to the Malvern hills. There are car-parking facilities in the grounds but the situation of the home does not offer easy access to public transport. The schedule of fees is available from the home. Additional charges are made for hairdressing, personal newspapers and chiropody. A copy of this report can be viewed Care Homes for Older People Page 4 of 29 Brief description of the care home at the home. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection. One inspector spent a day at the home, talking to the people who use the service and the staff, and looking at the records, which must be kept by the home to show that it is being run properly. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. We looked in detail at the care provided by the home for three people. This included observing the care they receive, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. The service had previously completed an Annual Quality Assurance Assessment Care Homes for Older People Page 6 of 29 (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. Some of the managers comments have been included within this inspection report. We also received completed survey forms from people who use the service, their relatives and health professionals who work with the home. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. What the care home does well: What has improved since the last inspection? What they could do better: The records do not always make clear when medication, which has been prescribed to be given as required, should be administered. This means that staff might not have enough information to tell them the circumstances under which the medication should be given. The range of activities on offer may not meet everybodys needs. The home has recognised that people might wish to have access to a wider range of activities, and has plans to appoint a Wellness Facilitator to meet this need. The Wellness Facilitator will plan and implement activities based on peoples individual needs and wishes, and will access complementary therapies as required. Because Highwell House is a busy home, with many people who require a high level of care, staff may sometimes not have as much time as they would wish to chat with people. Care Homes for Older People Page 8 of 29 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 29 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 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to good information about the home. Senior staff from the home carry out assessments before people move in, so that the home can be sure that it can meet peoples individual needs. Evidence: The home provides written information for people who are considering moving into Highwell House. This is in the form of a Service User Guide, which gives detailed information about life at the home and what people can expect if they live there. The Service User Guide is also available on CD. In our surveys, everyone said that they had been given enough information to enable them to make an informed choice about whether the home would be the right place for them. We spoke to two people, who told us that they had visited the home and found the staff to be very welcoming. In the AQAA, the manager told us that when someone Care Homes for Older People Page 11 of 29 Evidence: moves into the home, an identified member of staff is allocated on each shift to support them for the first forty-eight hours and then a key worker will be appointed. We looked at the records for someone who had recently moved into the home. The records showed that a senior member of staff had visited the person before they moved in, to assess their needs and to tell them more about the home. We saw that the assessment contained detailed information, which would help staff to provide the correct care as soon as the person moved into the home. The assessment showed that the person required a special diet because they were diabetic and because they had difficulty in swallowing. By gathering this information before the person moved into the home, the home made sure that the food provided would meet their needs. Care Homes for Older People Page 12 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their health and personal care needs will be met by competent and skilled staff. The home manages medication safely. Staff provide care in a way which promotes peoples privacy and dignity. Evidence: The home provides a high level of personal care for many of the people who live there. most of whom have a dementia illness and may not be able to tell staff their needs and wishes; therefore it is very important that care plans clearly describe to staff exactly what care needs to be provided. We wanted to see how the home plans peoples care so that it is tailored to their individual needs. This approach is called person-centred care. The Alzheimers Society explains how person-centred care works: Instead of treating the person as a collection of symptoms and behaviours to be controlled, person-centred care considers the whole person, taking into account each individuals unique qualities, abilities, interests, preferences and needs. Care Homes for Older People Page 13 of 29 Evidence: We looked in detail at care records for three people living at the home, and spoke to staff to make sure that they knew what care needed to be provided. Staff were knowledgeable about each persons individual care needs, and were able to describe how people liked their care to be provided. The care records were detailed and person-centred, and we saw that the principles of dignity and choice were evident throughout. For example, one persons care plan stated listen to what A (name of person) wants and give A time to think and speak any self-initiated conversation and time to reply when spoken to. The records showed that people were asked if they had any preference for male or female carers. Records showed that people and/or their families had been consulted about care planning, and had read and signed the care plans to indicate their consent. This is good practice, as it gives people the opportunity to be involved in planning their own care. The care plans encourage staff to support people to be as independent as possible. We saw that one persons care plan stated she will help to dry herself with her left hand with encouragement. She enjoys choosing her own clothes, and another stated uses a beaker with a spout to enable her to take fluids independently. We saw that one person needed specialist equipment to help them to mobilise. The records included detailed risk assessments so that staff would know how to carry out moving and handling manoeuvres safely. We observed staff assisting someone to transfer from a chair into a wheelchair, and they explained exactly what they were going to do, and carried out the transfer safely and effectively. Some people living at the home have specialist nutritional needs. Records showed that the home carries out a nutritional assessment for everyone when they are admitted. These assessments are regularly reviewed, and people are weighed monthly to make sure that their nutritional needs are being met. We saw that one person had lost weight and was not taking in enough calories each day. The home had contacted the persons GP, who had prescribed nutritional supplements. The home had recorded the persons food intake at every meal, and staff had encouraged the person to eat. Records stated appears to be eating well food chart discontinued. This shows that the home has good procedures for managing nutrition. We looked at the medication records for two people. The records of administration were complete and an audit of several medications showed that the homes records were accurate. We saw that one person had been prescribed an antihistamine Care Homes for Older People Page 14 of 29 Evidence: medication to be taken when required. There was no information to tell staff under what circumstances this medication should be given. We would expect the home to have written information for staff, so that people can be sure that they will receive their medication if they need it. We saw that one person has an allergy to penicillin. This was written clearly on their care plan, and highlighted so that it was easy to see. However, the Medication Administration Record (MAR) sheet did not include information about this allergy. It is very important that this information is recorded on the MAR sheet, so that any visiting medical practitioner can clearly see if a person has an allergy before prescribing any medication. Throughout the inspection, we saw staff treating people with kindness and respect. The staff obviously knew the people living at the home well, and were relaxed and calm when supporting them. We saw that staff always knocked before entering peoples bedrooms, and took time to explain what they were going to do before carrying out any task. Care Homes for Older People Page 15 of 29 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. The home provides some social and leisure opportunities, which are planned around peoples individual needs and wishes. The range of activities on offer may not meet everybodys needs. Meals are appetising and provide a nutritious and balanced diet. Evidence: The home employs a part-time activity co-ordinator, and has plans to employ a Wellness Facilitator, who will take the lead in a wider range of activities and complementary therapies. In our surveys, although some people told us that the home provides enough activities, other people felt that they would like more activities. On the day of the inspection, we saw that there were people sitting in the lounge and dining room for long periods of time without much staff interaction. Although staff did stop to make sure that people were comfortable and had all that they needed, only once did we see a member of staff sit down and spend time with someone. One member of staff told us theres not really time to sit and chat with people. I dont think the residents get enough one to one time. Another staff member told us we have time to look after people, time to take people outside on a nice day. Care Homes for Older People Page 16 of 29 Evidence: The home has a monthly activity planner, which showed a low level of organised activities. These activities included tea and cakes, coffee and biscuits, and music and CDs. Records showed that some people had visited the local library and gone for coffee at the Hop Pocket within the past month, and a local farmer had brought some spring lambs in. We saw that each person living at the home has a plan for social and leisure activities, which is based on their individual wishes and choices. We saw that peoples individual activity records were not always fully completed and, from discussion with people living at the home and staff, do not give a full picture of all the activities at the home. The manager told us that one person looks after the houseplants, some enjoy patio gardening, and one enjoys dusting and putting clothes away. Some bedrooms have reminiscence boards with family photos. We saw photos of people enjoying activities, such as a visit from a small animal zoo, gardening and bingo. One person we spoke to said I dont get bored. The manager told us that the home buys daily newspapers so that people can keep up to date with current affairs if they wish. People living at the home chose which three newspapers they preferred. We saw that one person with a visual impairment was sitting in the lounge with a talking clock in front of them. The manager told us that the clock had been bought by the home to meet that particular persons needs. We saw that staff regularly made sure it was accessible to the person and that the batteries did not need changing. Regular church services are held at the home. Currently there are no people living at the home from other faiths, but the manager told us that the home would make sure that people of other faiths would have their needs met. In our surveys, everyone told us that they always or usually enjoy the food provided by the home. One person said the foods lovely, the cook makes lovely cakes. On the day of the inspection, lunch was roast chicken, with mashed potatoes and fresh vegetables, or cheese salad; followed by apple pie with custard or cream, or fresh fruit. The food looked appetising and was well presented. We saw staff offering people a glass of sherry before lunch. At lunchtime, we saw staff supporting people who needed help to eat. This support was provided in a way which promoted peoples dignity. The cook takes great pride in the food that she provides, and is keen to make sure Care Homes for Older People Page 17 of 29 Evidence: that people enjoy their food, and that they have plenty of choice. She told us that she talks with each person who moves into the home, so that she can make sure that she can accommodate their likes and dislikes. Meat is supplied by a local butcher, and fresh fruit is delivered to the home twice a week. All cakes are home-made, and the cook buys in doughnuts and iced buns occasionally as a treat. The cook showed a good knowledge of peoples specialist dietary needs, including diabetic diets and soft diets. People can choose what they would like to eat for breakfast, at a time to suit them, and cooked breakfasts can be provided on request. The menus are changed according to the seasons, and fresh seasonal produce is used wherever possible. The menus were varied and balanced, and provide people with a nutritious diet. We saw that a wide selection of drinks was available, including real coffee, decaffeinated coffee, and fruit teas. Cold drinks included bottled water, lemonade, two types of squash, and fruit juice. The cook told us that snacks such as toast, cheese and crackers, yoghurts, biscuits etc are always available. Care Homes for Older People Page 18 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their concerns will be listened to and taken seriously. The homes recruitment procedures help to protect people by making sure that only suitable staff are employed. Evidence: The homes complaints records showed that they had not received any complaints in the past year. We saw that the complaints procedure was clearly laid out, and was available in the reception area of the home. In our surveys, everyone told us that they knew who to speak to if they needed to raise any concerns. One person living at the home told us that they would speak to the manager and were confident that she would listen and take whatever action was required. A relative of someone who lives at the home told us if there was something wrong, Id say so, but there isnt. The home has policies and procedures for the protection of vulnerable adults. We spoke to staff, who showed a good knowledge of how to protect people from abuse or neglect, and how to report any concerns about peoples welfare. The home has robust recruitment procedures, which help to protect people living at the home by making sure that only suitable staff are employed. The home carries out all the required checks before new staff are employed. These include a Criminal Records Bureau (CRB) check, and two written references, one of which is from a Care Homes for Older People Page 19 of 29 Evidence: previous employer. Care Homes for Older People Page 20 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Highwell House provides a pleasant, safe and comfortable environment for people to live. Infection control is well managed. Evidence: The home is currently undergoing some development and redecoration, and the manager and owner have tried to make sure that this work is carried out with minimal disruption to people living at the home. The home consists of three wings: Sky with sixteen bedrooms; Meadow with seven bedrooms; and Brook with eleven bedrooms. The wings have been named, so that people have an address, rather than just a room number. The home uses a computerised call bell system, which includes a call logging system and different tones if a bell is left unanswered. The homes standard for answering bells is three minutes. The system logs any unanswered in that time, and the manager analyses the results. We saw that nearly all are answered to the standard. A touch screen tracks all call bells and any visits to rooms by staff. All the call bells are labelled in Braille. Night staff have pagers which are linked to the system. The new bedrooms are modern and well-finished, and have colour-co-ordinated furnishings. The manager told us that everyone moving into one of these rooms will be Care Homes for Older People Page 21 of 29 Evidence: individually assessed for grab rails so that the height will be correct. Toilet seats are placed so that they are higher than usual. The new bedrooms have wet rooms with rain showers with a hand-held attachment. Records showed that people are asked if they wish to hold a key to their bedroom. All the bedroom doors were seen to be newly painted white with door knockers, and the manager told us that they will have brass numbers, so that they look like front doors. People are encouraged to personalise their bedrooms with their own furniture and ornaments if they wish. All the beds are profiling beds with memory foam mattresses. Because many of the people who live at Highwell House have a dementia illness, it is good practice to use some means of identifying rooms such as toilets. This is so that people who are not able to read can easily identify these rooms. The toilet doors were not yet labelled, as decoration was ongoing, but the manager told us that they will have some way of identifying them, such as different coloured handles. The owner and the manager are keen to move away from any institutional decor such as coloured strips on walls and coloured doors. The home has a very spacious and airy lounge, with a large picture window which opens completely onto a paved area. The manager told us that this has been designed to bring the outside in. The armchairs are spaced to encourage interaction and to allow privacy for visits. There is a television at one end of the lounge, but this is not obtrusive. The dining room is a very pleasant room, which, like the lounge, has recently been decorated. The tables are well-spaced and were laid with linen and fresh flowers. There was a copy of the days menu on each table. At the top of the staircase is a remembrance area with a book for families to write in if they wish, to ensure that people who have ended their lives at Highwell House are not forgotten. In our surveys, people told us that the home is kept clean and fresh, and this was apparent on the day of the inspection. We saw that staff were using gloves and aprons appropriately, and that infection control measures, such as liquid soap and paper hand towels, were in place throughout the home. Care Homes for Older People Page 22 of 29 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 have the skills and knowledge to carry out their roles to a high standard. There are enough staff available to meet peoples care needs, but staff may sometimes be too busy to spend time chatting with people. Evidence: We received many positive comments about the staff at Highwell House. These included Id give them top marks, theyre all so kind and the girls deserve a medal. In our surveys, people told us that there are always or usually enough staff to meet their needs, although one person commented theyre rushed off their feet. One member of staff told us that there are enough staff for the numbers of people, but not for peoples individual needs. During the inspection, staff were indeed very busy but always had time to stop for a quick word with people as they walked through the lounge. The manager is supported by a team of nursing and care staff, and an administrator, with additional support from catering staff, housekeeping staff and a maintenance man, who also looks after the gardens and grounds. We spoke to staff, who told us that they receive a range of training to help them to acquire the skills and knowledge they need to meet peoples needs. Records showed Care Homes for Older People Page 23 of 29 Evidence: that staff receive all the training which is required, and that many staff have undertaken training in areas such as end of life care, dementia care and tissue viability. The staff we spoke to showed a good understanding of the specialist needs of people with a dementia illness. Everyone who lives at the home has a named nurse and a key worker. We spoke to one of the nurses, who explained that the named nurse is responsible for reviewing the care plans, and for supporting the key worker. One of the key workers explained clearly how they work with the named nurse, and how this supports people and ensures that their needs are identified and met. We have explained in the section on Complaints and Protection that the homes procedures for staff recruitment help to ensure that only suitable staff are employed by the home. In the AQAA, the manager told us that Highwell House has a high standard of team work, and this was confirmed when talking to staff at the inspection. One member of staff commented that Highwell House is the happiest and the nicest place Ive ever worked in. The owner had recently organised a trip to London to the National Care Awards for the staff, as one of the staff from the home had been nominated for an award. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed in the best interests of the people who live there. People can be confident that the manager runs the home efficiently and effectively. Evidence: The manager told us in the AQAA that the management of Highwell House has a vision that will provide a higher standard of care both in terms of environment and clinical care delivery than any other nursing home facility. The inspection showed that the home is making good progress towards this goal. It was clear at the inspection that the manager knows everyone who lives at the home, and staff clearly respect her and feel supported by her. One staff member described the manager as very supportive and another said its a very family orientated home; Angela (the manager) is very supportive, very understanding. The manager has undertaken additional training to enhance her skills and knowledge Care Homes for Older People Page 25 of 29 Evidence: so that she can provide a high standard of care for people with dementia. During the inspection, she showed an excellent knowledge of current good practice in dementia care. The owner of Highwell House, Karen Rogers, works closely with the manager to make sure that people receive a high quality service from the home. Comments on the day of the inspection from people living at the home, their relatives and the homes staff, showed how highly people regard the home. One person said theres nothing that could be changed - theyve got everything here and its more like a hotel than a home. Another relative expressed their gratitude to the manager for her role in ensuring that their family member could stay at Highwell House, and told us I cant thank them enough - this is the best hes been for a long time. The manager completed the AQAA when we asked for it. It contained detailed information about the home, and showed that the manager knows what needs to be done to improve the service. The home has robust procedures for ensuring the safety of peoples personal money. This is kept locked in a safe, and records and receipts are kept for every transaction. Health and safety is well managed through regular maintenance checks, the implementation of relevant policies and the provision of training to staff. Care Homes for Older People Page 26 of 29 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 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 You should ensure that, for any medication prescribed to be administered as required, there is a clear written protocol in the care plan and in the medication records. This is to ensure that people receive their medication as prescribed. You should ensure that any medication allergies are clearly identified on the MAR sheet and in the care plan. This is so that people are not put at risk of harm or injury. You should ensure that everyone living at the home has access to social and leisure activities which meet their needs. 2 9 3 12 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or 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) 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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