Inspection on 05/03/07 for 109 Higham Road

This inspection was carried out on 5th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

109 Higham Road 21/01/09

109 Higham Road 15/01/08

109 Higham Road 13/01/06

109 Higham Road 26/04/05

109 Higham Road 12/10/04

109 Higham Road 05/05/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 109 Higham Road Rushden Northants NN8 3AA Lead Inspector Stephanie Vaughan Unannounced Inspection 5th March 2007 08:30 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 109 Higham Road Address Rushden Northants NN8 3AA Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01933 358429 01933 358606 www.caremanagementgroup.com Care Management Group Ltd (trading as CMG Homes Ltd) Mrs Hilary Jennifer Watt Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To include 2 service users over the age of 65 years LD(E) Date of last inspection 13th January 2006 Brief Description of the Service: 109 Higham Road is a care home providing accommodation and personal care for six adults with a learning disability, owned by Care Management Group Ltd. It is situated close to Rushden and to Higham Ferrers town centres and is in close proximity to all local amenities, with good transport links by bus to Wellingborough and Northampton. Higham Road is a detached house in a residential street with a pleasant rear garden. All residents are accommodated in single bedrooms. Communal areas consist of a lounge, a pleasant dining room overlooking the garden, and a kitchen. The garden is enclosed and used during the summer for barbecues and other outside activities. Current fees range from £565.32 - £1,055.50 per week and exclude the cost of chiropody, hairdressing, clothing and personal items such as toiletries. 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Prior to this statutory inspection, a period of four hours was spent in preparation. This comprised reviewing previous inspection reports and associated requirements and recommendations; the service history, risk assessment, four returned comment cards from residents and one from a relative and other documentation. Since the last inspection the Commission have received one concern about the home, which was referred back to the provider for investigation and found to be not proven. A previous Safeguarding Adults incident that was ongoing at the time of the last inspection has now been fully investigated by the police and found to be unproven. However it was identified that staff had not had appropriate training in the management of challenging behaviour, this has now been addressed. A further recent allegation with Safeguarding Adults implications has been made to the provider. The provider has liaised with the Commission and Local Authority, in line with the local Safeguarding Adults protocol. An internal investigation is currently ongoing. The Commission have a focus on Equality and Diversity and issues relating to this are included in the main body of the report. This site visit to the home was conducted over a period of four hours during which the inspector made observations and spoke to residents and staff. A limited tour of the premises was conducted which involved viewing the communal areas and a selection of the private accommodation. Case tracking is the method used during inspection where of a sample of three residents were selected and all aspects of their care and experiences reviewed, including individual plans of care and associated documentation. The Registered Manager was not present during this visit. The current fees range form £ 565.32 to £ 1,055.50 per week with extra charges for Chiropody, hair dressing, clothing and personal items such as toiletries. 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 7 Staff have received training in the management of challenging behaviour. The manager has had training in Quality Assurance and these systems are being developed. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admission processes are in place to ensure that before a resident is admitted it has been established that the home is able to meet their needs. EVIDENCE: The home maintains an up to date Service Users Guide, which is provided to residents before they are admitted and circulated to existing residents on an annual basis. Through discussion with staff it was established that prospective residents are assessed prior to admission and that admission processes are in place to enable phased admissions to take place in order that residents and management know that the home is able to meet their needs. There has been one admission to the home since the last inspection. This resident came form another home within the group that works closely with 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 10 Higham Rd. The resident chose to move to the home, as she was able to have a room to herself. She knew the staff and residents well before moving in. Through observation and discussion it was established that the new residents had settled in well and integrated with other residents living in the home. 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are supported to make choices in their daily lives, which promotes their independence. EVIDENCE: Each resident has an individual plan of care, which identifies the resident’s personal and health care needs. These evidence detailed instruction to staff about how these needs are to be met, including the management of behaviour and other specialist requirements. Individual plans of care are developed and reviewed with the residents and their comments are included in the care plan. Care plans are reviewed on a regular basis and all residents have access to a key worker. Individual plans of care evidence that resident are able to make decisions about their lives and this was confirmed through discussion with residents and 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 12 staff. One resident stated how he had chosen to change his day care activities and that he was able to make choices about other activities, personal routines and food choices. Residents comment cards received prior to the inspection also support this. The residents are supported to manage their finances, the home holds small amounts of money for the convenience of residents, this is stored appropriately and accurate records are maintained. A spot check was conducted and found to correspond with the balance. Residents are supported to take risks in their lives examples include participation in activities such as outings, gardening, household tasks and food preparation. Risk assessments are conducted to support these activities and reduce any associated risks. 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are enabled to follow their prefererd lifestyle and be part of the local community. EVIDENCE: Individual plans of care evidenced that residents have access to a range of activities during the day. Each resident has a personalised activities programme, some residents attend their chosen day centre activities and also have some external activities for which they are paid. Other residents have chosen not to attend formal day centre activities and arrangements are in place for activities to take place within the home. Residents confirmed that they were able to access facilities in the local community such as the local shops, churches and work opportunities. 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 14 Residents confirmed that they are able to maintain links with their families and friends and to receive their chosen visitors at the home. Daily routines are flexible within the confines of their planned activities, residents were seen to be moving around the home and choosing when to have their breakfast, watch television and participate in activities. Resident’s rooms are fitted with privacy locks and residents confirmed that they are able to have a key if they wish to do so. Individual staff were seen to relate well to residents addressing them by name and in a pleasant manner. There was particularly good interaction between staff and residents as they all sat together around the dining table after lunch. Residents confirmed satisfaction with the food provided at the home and stated that they were able to make choices about the food that was served. Lunchtime service was viewed and seen to comprise chicken soup and a selection of sandwiches. Meals were well presented and of adequate proportion. Menus were viewed and seen to offer a varied and balanced diet with choices available. Appropriate records are maintained when residents chose to have alternatives form the menu. There is evidence that in general the residents are supported to maintain their equality and diversity. The provision of care is individualised and residents are supported to maintain their independence and exercise their choice. Staff spoken to were able to demonstrate an understanding of the need to promote equality and diversity and confirmed access to policies relating to the promotion of residents Equality and Diversity. 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of personal and health care does not constantly meet the needs of residents and places them at risk from injury and deteriorating health. EVIDENCE: Residents appeared well presented and individual plans of care evidenced detailed instruction to staff about the residents needs and preferences. Residents have access to a range of health care services including general practitioners, dentists, podiatrists and opticians. Residents also have access to specialists such as consultant psychiatrists and occupational therapists as necessary. However it was identified that one resident had continence needs and although predisposing factors had been ruled out through consultation with the General 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 16 Practitioner there was no evidence that guidance had been sought from the continence advisor. In addition for one of the residents with clearly definable age related health care needs there was no evidence that risk assessments had been conducted for, nutrition, pressure and movement and handling, falls and, falls from the bed despite the reference to a incident where the resident had actually fallen form the bed. Medication systems were reviewed and seen to be in good order a spot check was conducted and the Medication Administration Records were accurate and consistent with the remaining stock of medication. 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Complaints that are made to the provider are managed well, however the management of challenging behaviour puts the residents at risk of abuse. EVIDENCE: Since the last inspection a Safeguarding Adults investigation has now been competed by the police, the allegation was not proven, however it did raise concerns about the level of training that staff had received in the management of challenging behaviour, this has since been addressed by the provider. There have been two further allegations made about this service since the last inspection, one of these related to the residents holiday and associated financial arrangements. This has been fully investigated by the provider and found not to be proven. In addition the provider has recently received an allegation from an ex member of staff alleging poor care practices, which is currently being investgated. The provider has acted in accordance with current Safeguarding Adults guidelines and has liaised with the Commission and Local Authority. Individual plans of care evidence that some residents do exhibit some forms of challenging behaviour and specific individualised care plans have been developed to manage these circumstances. However it is of concern that in some cases the intervention prescribed is to deny access to the resident’s 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 18 sitting room for a period of 24hrs following an incident. This may be reasonably perceived as a reactive measure, which is inconsistent with the current guidance on the Safeguarding of Adults and must be addressed. 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment is good and meets the needs and expectations of the residents. EVIDENCE: The standard of the environment is good, the premises being fit for purpose, clean and hygienic. One of the resident’s bedrooms had a cupboard door that had become detached form its hinges, the residents confirmed that it had been reported and that arrangements were in place for it to be fixed, this was confirmed by staff during the inspection. Residents are able to make choices about the décor and furnishing of their rooms, which were comfortable and evidenced personalisation. Bathrooms were seen to be in good order with adequate facilities including hot water and 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 20 shower facilities. The communal areas were comfortable and well furnished. The premises were well light, ventilated and well heated. 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment processes, staffing and staff training contribute to the safety of residents. EVIDENCE: Staffing levels are adequate, there is one sleeping staff member on duty at night, at other times there is always two staff on duty. This complies with the guidance issued by the Residential Forum. The manager has dedicated management hours and residents confirmed that staffing levels were adequate. Staff files were unavailable on the day of inspection however staff were able to confirm a thorough recruitment process with the appropriate checks having been completed before the commencement of employment, including two written references and Criminal Records Bureau Clearances. 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 22 Staff spoken to were able to confirm access to induction training, training in the National Vocational Qualifications and other mandatory training such as Fire Safety, Basic Food Hygiene, First Aid, Movement and Handling, Challenging behaviour, Protection Of Vulnerable Adults and the Safe Administration of Medication. 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lack of formalised systems to support residents in expressing their views and the management of risk is not supportive of residnts rights and safety. EVIDENCE: The Registered Manager was not on duty on the day of inspection. However the Registered Manager has been registered with the Commission for several years and is therefore experienced in her role. There was evidence that quality assurance systems were in place within the home, there were examples of audits that had been conducted on file such as regular checks of the resident’s money, the hot water temperatures and checks to the first aid equipment. 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 24 Residents confirmed that they had regular meetings to discuss issues within the home and to give feedback about the services provided. However there is at present no formal way of monitoring residents’ satisfaction and obtaining their views in a private and confidential way. The Regional Operations Director confirmed that managers within the group have recently received training in the development of Quality Assurance procedures. The Regional Operations Manager conducts regular visits to the home and submits reports to the Commission. Safe working practices are supported by the provision of staff training, individual and general risk assessments, maintenance of equipment and health and safety procedures. However it was noted that the hot water radiators were domestic in nature with thermostat control devices. There were no radiator guards in place or any risk assessments to identify, reduce or manage the associated risks. The main entrance to the home is at the top of a flight of several steps which has the potential to put residents at risk of falls, there was no evidence that risk assessments had been conducted to reduce or manage the associated risks. 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 2 X X 2 X 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 26 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA19 Regulation 14.4 Requirement Timescale for action 01/04/07 2 YA23 13.6 3 YA42 13.4 4 YA42 13.4 Unnecessary risks to the health or safety of residents must be identified and so far as possible eliminated. The management of challenging 01/04/07 behaviour must e reviewed to ensure that residents are protected from abuse. Risk assessments must be 01/04/07 conducted to reduce and manage the risks associated with exposed high surface temperature radiators. Risk assessments must be 01/04/07 conducted to reduce and manage the risks associated with the access to the main entrance. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA19 Good Practice Recommendations Residents should receive treatment, advice and other services from any health care professional eg Continence DS0000012808.V331458.R01.S.doc Version 5.2 Page 27 109 Higham Road 2 YA39 Nurse Advisor Quality Assurance systems should be further developed to ensure that residents are able to express their views about the service in a private and confidential way. 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 109 Higham Road DS0000012808.V331458.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!