Inspection on 19/01/10 for Highviews

This is the latest available inspection report for this service, carried out on 19th January 2010.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Highviews 30/01/07

Highviews 12/12/05

Highviews 04/07/05

Highviews 10/01/05

Highviews 13/07/04

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Thorndene

Insight - Eastchurch

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Extracts from inspection reports are licensed from CQC, this page was updated on 10/04/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Highviews 47 Saltdean Drive Saltdean Brighton East Sussex BN2 8SD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lucy Green     Date: 1 9 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Highviews 47 Saltdean Drive Saltdean Brighton East Sussex BN2 8SD 01273390610 01273308672 drizem@yahoo.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Miss Niki Clarke,Mr Driss Zemouli care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 6 The registered person may provide the following category of service only: Care home only(PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning disability(LD) Date of last inspection Brief description of the care home Highviews is registered as a care home for up to six service users with mild to moderate learning disabilities; it does not provide nursing care. The home is a wellappointed detached property situated in a quiet residential area of Saltdean, close to shops, transport routes and other local amenities. There are three well-furnished communal areas in the home, including a quiet/music room. To the rear of the property is a large garden. Grab rails and ramps have been installed leading to the house and garden, and there are also grab rails in the toilets and bathrooms. A bath chair is available if necessary. Parking is easily available on the forecourt and on the road outside. The current range of fees at The Highviews, as of 19 January 2010, is £580 - £928 per week. Additional charges are made for hairdressing, holidays, Care Homes for Adults (18-65 years) Page 4 of 33 6 Over 65 0 Brief description of the care home toiletries and magazines. Further information about the service can be found in the homes Statement of Purpose and Service Users Guide, copies of which can be obtained directly from the Provider. Care Homes for Adults (18-65 years) Page 5 of 33 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The reader should be aware that the Care Standards Act 2000 and Care Homes Regulations 2001, uses the term service user to describe those living in care home settings. For the purpose of this report, those living at The Highviews are referred to as residents. This report reflects a key inspection based on the collation of information received since the last inspection, a site visit and a review of the homes Annual Quality Assurance Assessment (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. The AQAA was completed by the Registered Manager and returned when we asked for it. The site visit was carried out by two Inspectors over six hours between the times of 10:20am and 4:20pm on Tuesday 19th January 2010. We had a look around the home Care Homes for Adults (18-65 years) Page 6 of 33 and examined some care, medication and staffing records. We observed the interaction between staff and residents throughout the day. During the visit we met with the five people currently living at the home and spent time with three of them individually. The two providers, one of whom is also the Registered Manager and two carers were also present and involved in our inspection. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Adults (18-65 years) Page 8 of 33 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Prospective residents benefit from an admission process that ensures their individual needs are appropriately assessed prior to moving into the home. Care practices within the service do not always fully reflect the stated purpose of the service. Evidence: There have been no new admissions to the service since the last time we visited and as such we did not look again at the pre-admission information for the people currently living at the home. There was evidence in the care plans for each of the three people whose care was tracked, that their placements had been reviewed by their funding authority. Copies of these updated Social Care Assessments, confirmed that at the current time these individuals are appropriately placed at the service. The AQAA states that the home has updated the Statement of Purpose and Service User Guide and that a robust assessment process would be conducted for any prospective new resident. During a discussion with the two Registered Providers, it was highlighted that the home must ensure that it has systems in place to deliver its stated aims and objectives as outlined in the Statement of Purpose. The detail of this Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: matter is reported under the Individual Needs and Choices section of this report. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are heavily focused on disability and behaviour, rather than the strengths of individuals. Outcomes would also be improved if the documentation and knowledge about people were more strategically used to formulate life goals and develop more person centred approaches. Evidence: Throughout the site visit, it was evident from discussions with management and staff and from observing their practices and routines, that whilst they may have good relationships with the people they support, greater insight into how to support them with some of their specialist needs is required. The Inspectors tracked the care for three residents, which included a partial examination of their care plans, activity schedules and a discussion with the staff on duty. The Inspectors also met with each of these three residents during the course of the inspection. Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: Important information about care needs is located across a number of different files and the Inspectors found it difficult to gain a holistic view about the people living at The Highviews. At the start of the inspection, the Inspectors requested the care plan documentation for three people, a staff member supplied copies of care plans and health action plans. During a review of these documents, the Inspectors highlighted gaps in guidelines and a lack of resident involvement. When this was fed back to the Registered Providers at the end of the inspection, additional guidelines and person centred plans were produced. These documents, whilst in existence were located in the locked office upstairs and evidently not being used on a daily basis by staff. It was raised as an issue throughout the inspection, that the home needs to ensure that support and documentation is provided in a way that genuinely places the resident at the heart of the process. There is no value in having documentation in place simply because it is required, if it is not being reflected in the culture and practices of the staff. The care plan documents which are used by staff on a day to day basis are written in a way which focuses on disabilities and behaviours, rather than the person. For example the first page of one persons care plan states I have a diagnosis of learning disabilities, schizophrenia and clapped feet. For another person the first identified strength is recorded as I am able to recognise that sometimes I shout, swear, threaten and hit people. This was also reflected in the way both staff and residents spoke about each other, with the emphasis always being placed on the negative. The person centred plans shown to Inspectors at the end of the day, whilst more appropriately written, were clearly viewed as an add on to the care plan, as opposed to being integral to the way support is planned and delivered. Areas of more complex support require review and in particular how the service supports people with behaviour that challenges. The Personal and healthcare support section of this report highlights how medication may be being used inappropriately in respect of managing difficult behaviour. Whilst it is evident that referrals for external support have been made, guidelines must be more robust, regularly reviewed and utilised by staff who have received updated training in how to effectively support people when they present behaviour that is challenging. Staffing levels, particularly at night need to be reviewed in line with the plans of care to ensure that peoples assessed needs are being met. In undertaking this exercise, the home must consider how it supports those residents with incontinence issues at night when only a sleep in is employed. It is also not acceptable, that it is left for other residents to wake the sleep-in to support an individual who reportedly needs Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: regular early morning support with their anxiety. If this is a known difficult time for this person, then staff should be available and ready to provide this support discreetly. Care plans contain a range of risk assessments for each resident which cover the expected risks associated with daily living. From examining these documents for three people, it was highlighted that the assessment is generic and provides little detail about how judgements about safety have been reached. In addition, as these assessments indicate that all three people are at minimal risk of harm, it is not clear why their involvement in every day tasks around the home and their life goals are so limited. The homes own Statement of Purpose states that it is our aim is to give each service user individual attention and to help them reach their full potential capacity, physical, intellectual, emotional and social. Evidence gathered from documentation, feedback from residents and observation of staff practices, however does not currently support this aim. The home needs to become more progressive and develop the person centred process to support residents to more strategically identify and formulate life goals which develop their skills, experiences and independence. Care Homes for Adults (18-65 years) Page 15 of 33 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have opportunities to access the local community and to participate in activities they enjoy, but greater emphasis needs to be placed on how activities link with care plan objectives. People need more choice and control over their daily lives. Evidence: Discussion with residents and a review of the activity schedules and daily records for three people identified that residents have access to some social and educational activities that are meaningful to them. One resident talked to us about the day centre they attend and how they also go to a local advocacy group each week. This person was enthusiastic about the external activities that they do. The care plan for one resident highlights that they are able to access the local community independently, however, there is no plan in place for how such skills can be expanded. Similarly, another resident likes cooking, yet discussion with staff and Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: review of the weekly menu plan shows there is only the opportunity to become involved in this activity once a week. The home has a positive approach to enabling residents to maintain contact and relationships with families. There is evidence in the care plans that the home supports residents to meet with and receive visits from their relatives. One resident went out for lunch with a relative on the day of the inspection. Meals are prepared according to a four weekly rotating menu. The menu plan is pictorial and states that there is always a choice. It was however not clear what alternative meals were and the food records highlighted that the main meals people ate were generally the same as outlined on the menu. One resident was observed being given a choice of two options at lunchtime. Residents are not fully involved meal planning and preparation and the menu indicates that that there is a residents cooking programme on a Tuesday lunchtime. The Inspectors visited on a Tuesday and the extent of resident involvement in preparing the lunchtime meal was very limited. Care plans detail residents goals, but these were noted to be very basic and task orientated. For example, the goals for one person included losing weight and bathing. A review of this persons person centred plan indicated longer term goals such as moving to an independent flat had been considered, yet no support plan for enabling this individual to achieve this goal had been developed. In order to develop good outcomes in this area, the home needs to demonstrate how the activities and goal planning are linked to person centred plans of care which support individuals to achieve live goals and maximum independence. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and healthcare systems are in need of review to ensure that people are fully safeguarded and enabled by the support provided. Evidence: There is documentary evidence that each resident has a care plan which evidences that personal and healthcare needs are identified and support provided. It is evident that referrals are made to external professionals, including the community learning disability team, GPs, dentists. The home has recently implemented health action plans for each of the people living at the home. Despite general information about health needs being recorded, the action plan sections had not been completed. Personal care was observed to be being provided in a sensitive and respectful way during the course of the visit. The Inspectors raised the issue of how personal support is provided at night when there is only one staff member sleeping in. The AQAA states that two residents are singly incontinent and one person requires support using the toilet. Commodes were observed in two of the bedrooms. The home is required to Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: review this arrangement to ensure care needs are being met at night. A review of the Medication Administration Records (MAR sheets) highlighted the regular administration of a prn medication (prescribed as required necessary) prescribed for anxiety for one person. There was however, no written record on either the MAR chart or in the daily records to state the reasons why this medication had been administered. There was no copy of the prn protocol in the MAR chart folder. From a review of the daily records, the Inspectors were concerned that the medication had been given unnecessarily as there was no evidence of the individual presenting with anxiety or challenging behaviour preceding the administration of medication. Discussion with residents however, highlighted that early morning challenging behaviour is in fact a regular pattern for this person. When raised with the Registered Providers, they too confirmed that the individual frequently needs calming in the morning. It is the Inspectors judgement that whilst the medication may be being administered appropriately, staff failure to record the events leading up to this intervention is not safeguarding the individual by ensuring they are receiving the right support. If prn medication is being required on a daily basis, then the current protocols need to be reassessed by the relevant professional. It is therefore required that this matter is addressed as a matter of priority. No residents manage their own medication at the current time, although discussion with one resident identified that they could potentially be more involved in the management of their own medicines. This was raised with the Registered Providers who both agreed that some residents would be able to safely take greater responsibility for their medication. Care Homes for Adults (18-65 years) Page 19 of 33 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their visitors are encouraged to speak openly about their views of the service. Greater protection would however be afforded through the improved understanding and management of behaviour that challenges the service. Evidence: The home has a complaints procedure in place and an accessible copy is available for residents and visitors to access. The home has received two complaints from neighbours about its service since the last inspection and there was documentary evidence about the action that the home had taken in respect of these areas. In discussion with the Registered Providers, the importance of promoting understanding of equality and diversity issues within the local community was emphasised. The home seeks to operate an open culture where issues are openly discussed and opinions shared. Residents are encouraged to voice their opinions about the things they like and dislike, although the comments made about one individuals challenging behaviour highlighted that staff and residents need to ensure they are respectful in how they speak about the behaviour of other people. The training matrix identified that whilst most staff have completed training in safeguarding and managing challenging behaviour, for many these courses were completed several years previously. The Registered Provider confirmed that refresher training had been booked. The Inspectors reinforced the need for these courses to be Care Homes for Adults (18-65 years) Page 20 of 33 Evidence: regularly updated to ensure that staff continue to manage challenging situations in a way that appropriately safeguards all concerned. There are systems in place for supporting residents with their finances and financial declaration forms were found in the three care plans viewed which indicated residents consent to their money being held by the home. The home should however consider ways of supporting residents to become more independent in this area so that, where able, people have more control over their finances. Care Homes for Adults (18-65 years) Page 21 of 33 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. Residents benefit from a homely and comfortable environment, but would be further safeguarded if the highlighted health and safety issues were addressed. Evidence: We had a look around the home and three residents showed the Inspectors their bedrooms and pointed to things that they had chosen and which were important to them. It was evident that each of these people had been supported to personalise their bedrooms and took pride in their belongings. Communal areas provide sufficient space and there are enough toilet and bathroom facilities to meet the needs of the people currently live at the home. The parts of the home viewed, were found to be clean and tidy at the time of the inspection. There is evidence of an ongoing programme of maintenance and redecoration and some parts of the home have been upgraded since we last visited. Several health and safety matters were brought to the attention of the Registered Providers during our visit. Such issues included the current inadequacy of risk assessments pertaining to unguarded radiators and portable heaters, a large and worn Care Homes for Adults (18-65 years) Page 22 of 33 Evidence: rug in the reception lounge which posed as a trip hazard and the broken lock on the downstairs bathroom door. It was also observed that a number of light bulbs from wall lights on the ground floor had been removed. The Registered Manager stated that he had removed these to save energy. The Inspectors requested the Registered Manager ensure that these areas are still adequately lighted after dark. Care Homes for Adults (18-65 years) Page 23 of 33 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Current recruitment procedures are not sufficiently robust to fully protect the people who live in the home. Residents needs could be better met by increasing staffing levels and skills. Evidence: Through discussions with staff, residents and the Registered Providers it was identified that the rotas presented to the Inspectors were not an accurate reflection of the hours that staff work in the home. The rotas made available for inspection covering the period September 2009 to January 2010, contained no amendments to working patterns and detailed no information about staff sickness or annual leave. From discussion with one staff member it was evident that they had recently taken time of sick and the Registered Manager confirmed this. Maintaining an accurate rota of staff hours is required by law and as such a requirement has been made. As detailed in the Personal and healthcare support section of this report, the Inspectors highlighted that residents support needs may not be being fully met by the current sleep-in arrangement at night and this is also required to be reviewed. The home must also ensure that the five female residents are happy to receive any night time personal support by a male support worker, as with only one person on duty, if the staff member sleeping in is male, residents have no choice. Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: The Registered Providers stated that three staff members are usually on duty during the day and confirmed that no resident is funded for additional 1-1 staffing. At the time of the inspection, there were two support workers and the two Registered Providers working in the home. These levels were sufficient at this time, although as highlighted in one care plan, there is a resident who requires a lot of 1-1 support and re-assurance. As such day time staffing hours should also be kept under regular review in line with the care plan and behavioural support guidelines for this individual. One new staff member has been employed since the last inspection and the recruitment information in respect of this individual was viewed. The Inspectors raised concerns about the way this individual had been employed and identified that the Registered Providers had not taken appropriate steps to evidence that people living in the home are fully safeguarded. It was also not possible to establish an official start date for this individual as the documentation in place showed conflicting dates. A requirement has been made in respect of this matter. The home has compiled a training matrix since the last inspection. There was evidence that staff have access to mandatory training and the AQAA dataset states that all permanent staff have either completed or are working towards, National Vocational Qualification (NVQ) to at least level 2 in Care. As detailed under the Concerns, complaints & protection section of this report, it is required that all staff attend refresher training in managing challenging behaviour and in safeguarding. The Inspectors saw evidence of regular staff meetings and supervision sessions now being conducted with minutes recorded. It was however highlighted that supervision sessions are not conducted by the Registered Manager at The Highviews. The Registered Provider who is in fact Registered Manager of their sister home confirmed that she undertakes all staff supervision sessions. It was also noticed that one staff member had received supervision on 19/12/09, despite the rota indicating that they had not been working in the home that day. The Registered providers stated that this session would have been conducted at their sister home. Again the Inspectors reiterated the need for clear and accurate recording. Care Homes for Adults (18-65 years) Page 25 of 33 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements are unclear and there are significant shortfalls in the way services are being provided. The service is not sufficiently progressive in the way it supports and involves people in the provision of care. Evidence: The Registered Manager is also one of the Registered Providers. It was not clear throughout the inspection who actually responsible for managing the home. Key documentation, including the handling of complaints, staff supervisions and resident reviews were completed by the joint Provider who is the Registered Manager at the sister home of The Highviews. On the day of the inspection it was also this person who facilitated the inspection and who supported one of the residents with a healthcare appointment. The Registered Manager was unclear where some information was stored in the home and yet the joint Provider was able to locate items immediately. These issues were raised with both Registered Providers, who confirmed that the Registered Manager was in day to charge of the home. The importance of the registration certificate accurately reflecting who is responsible for the home was highlighted. Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: This inspection considered the Deprivation of Liberty Safeguards and concludes that the home is not currently accommodating any person who is the subject of an authorisation or referral for authorisation. The home has a system of quality monitoring in place which includes weekly residents meetings. There is also evidence that annual satisfaction surveys are sent out to stakeholders, although at the current time the results of these have not been formally collated and published and the Registered Manager was unclear about what he was going to do with the feedback that had been gathered. The home has various systems in place to ensure the health and safety of the home are maintained. The Inspector sampled some of the records in place and with the information supplied in the AQAA, concluded that the home has satisfactory recording and monitoring systems in place. As highlighted in the Environment section of this report, a number of maintenance issues need to be addressed in light of potential health and safety risks. This inspection has identified a number of shortfalls in the way the services at The Highviews are being provided. Concerns with the way prn medication is being administered, problems with how people with complex needs are supported and the judgements that have been made in respect of the way new staff have been recruited have affected our overall judgement about the way The Highviews is being managed. Furthermore there are some practice issues which need to be addressed to ensure that the home develops into a more progressive service which enables things to be done with residents rather than done for. Care Homes for Adults (18-65 years) Page 27 of 33 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 Adults (18-65 years) Page 28 of 33 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 6 15 Regulation 15(1)&(2): The Registered person must ensure that each service user has a written and up to date plan of care on which they have been fully consulted. To ensure that people are fully involved in the planning of their care and that their needs, wishes and aspirations are fully met. 01/05/2010 2 11 15 Regulation 15(1): The Registered Person must ensure that service users are supported to set, monitor and achieve both their long and short term goals and aspirations. The home should work with service users to identify goals and to support them to develop skills to achieve maximum independence and fulfilment. 01/05/2010 Care Homes for Adults (18-65 years) Page 29 of 33 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 3 19 12 Regulation 12(1)(a): The 01/04/2010 Registered Person must ensure that the proper provision is made for the health and welfare of service users. To ensure that each service user has robust guidelines which allow their health and welfare needs to be fully identified, reviewed and met. 4 20 13 Regulation 13(2): The Registered person must ensure that proper arrangements are made for the recording, handling and safe administration of medication. To ensure that prn medication is only administered in accordance with robust guidelines and that records of the administration of such medication are available for relevant professionals to review. 15/03/2010 5 23 13 Regulation 13(6): The Registered Person must make arrangements, by training or other means to ensure service users are safeguarded at all times. 01/05/2010 Care Homes for Adults (18-65 years) Page 30 of 33 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 To ensure that physical and verbal aggression by a service user is understood is and dealt with appropriately. 6 24 13 Regulation 13(4)(c) The Registered Person must ensure that unnecessary risks to health or safety are identified and so far as possible. To ensure that people are not at risk from unguarded radiators, free standing heaters, inadequate lighting and loose fitting rugs. 7 33 18 Regulation 18(1)(a): The Registered person must ensure that staffing levels are kept under review to ensure that there are sufficient numbers of competent and qualified staff to meet the needs of service users both during the day and at night. To ensure that service users are safely supported to lead their lives as identified in their individual plans. 8 34 19 Regulation 19(1)(a): The Registered person must be able to demonstrate that all persons employed to 15/03/2010 01/04/2010 15/03/2010 Care Homes for Adults (18-65 years) Page 31 of 33 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 work in the care home are fit to do so. To safeguard residents from harm and ensure that they are only supported by suitable people. 9 37 10 Regulation 10(1): The Registered Person must manage the care home with sufficient care, competence and skill. To ensure that the home is run safely and effectively in the interests of the people who live there and that appropriate action is taken to ensure the home fully complies with the Care Standards Act and Care Homes Regulations. 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 01/05/2010 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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