Inspection on 23/04/08 for Heathcotes Care (Sawley)

This inspection was carried out on 23rd April 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heathcotes Care (Sawley) 08/10/08

Heathcotes Care (Sawley) 25/04/07

Heathcotes Care (Sawley) 22/08/06

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 09/07/2008.

CARE HOME ADULTS 18-65 Heathcotes Care (Sawley) 1 Bradshaw Street Sawley Nottinghamshire NG10 3GT Lead Inspector Susan Richards Unannounced Inspection 23rd April 2008 09:30 Heathcotes Care (Sawley) DS0000064327.V363017.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 Heathcotes Care (Sawley) DS0000064327.V363017.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. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heathcotes Care (Sawley) Address 1 Bradshaw Street Sawley Nottinghamshire NG10 3GT 01159 636379 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) enquiries@heathcotes.net / sawley@heathcotes.net www.heathcotes.net Heathcotes Care Ltd Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th April 2007 Brief Description of the Service: Heathcotes Care Home is located in a quiet residential area of Long Eaton on the Derbyshire and Nottinghamshire border. The home is a purpose built and provides personal care and support for up to six adults with learning disabilities and who may have complex needs and associated challenging behaviours. In its Statement of Purpose the service aims are stated as being based on the principles of Valuing People as identified within the government’s white paper as a way forward in improving the lives of people with learning disabilities. The home comprises of two floors with each floor having three spacious bedrooms, each with its own en-suite facility. There are communal dining area, lounge, kitchen, bathroom, two showers and level access to an external garden to the rear of the property. Car parking is available at the front. The home is within a few minutes walk of local shops and amenities and within easy reach of the cities of Derby and Nottingham. The range of fees for the home is: Up to date information about the range of fees charged by the home was not available/provided at this inspection. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. For the purposes of this inspection we have taken account of the information we hold about this service. This includes our previous key inspection report of 25 April 2007 and the annual quality assurance assessment questionnaire, which we asked the home to complete in order to provide us with key information about the service. At this inspection there were four service users accommodated. We used case tracking as part of our methodology, where we looked more closely at the care and services that two of those people receive. We did this by talking with those people, looking at their written care plans and associated health and personal care records and their private and communal accommodation. We also sent out written surveys to residents, their relatives and to some staff before our visit to the home. We spoke with staff about the arrangements for their recruitment, induction, training, deployment and supervision and we examined related records and observed some of staffs’ interactions and approaches with people. We spoke with the regional and acting managers about their role and responsibilities for the management and administration of the home and examined associated records. All of the above was undertaken with consideration to any diversity in need for people who live at the home. At the time of our visit all people accommodated are of British white backgrounds and of Christian based religion (either practising or non-practising) and who each have a learning disability. What the service does well: People live in a home, which overall is safe and well maintained and which suits their needs. Informed choice is usually promoted for people in respect of choosing to live at the home and also within many aspects of their daily lives. People most receive personal support in the way they prefer and their health needs are met. People know how to complain and are provided with key service information is an alternative format, which may assist them. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 6 Staff employed, work hard within the resources available to them to develop good relationships with people and to assist and support them What has improved since the last inspection? What they could do better: Ensure that the home’s criteria for admission, (as detailed within its Statement of Purpose), considers when people can expect to receive key service information about the home, when they are admitted as an emergency. And that the home’s admission criteria, also considers the potential and ongoing compatibility of people who live there. Develop the service guide to include clear information as to the amount, range and method of payment for fees charged to people along with a standard form of contract. To better inform and promote their choice as to whether to choose to live at the home. Fully introduce the revised (person-centred) care-planning format in consultation with staff (including the necessary training) and each service user within the timescale given to better promote individual inclusion, choice and consistency of care and support. Consult and assist people to access local independent advocacy/self advocacy groups as may be available. Again to promote choice, respect for people’s wishes and their inclusion. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 7 More fully reflect people’s individual choices, capacities and abilities in respect of managing their own finances within their care planning information in accordance with the principles of the Mental Capacity Act. Ensure medicines records are always properly maintained and that people are more actively encouraged and supported where possible as part of their longterm goals, to retain and manage their own medicines within a risk management framework. So as to better promote people’s choice and also their independence. Provide staff with robust step-by-step procedures to follow for responding to suspicion or evidence of abuse or neglect, including whistle blowing, which sit alongside policy guidance now introduced. Ensure that physical aggression by any service user is understood by staff and dealt with appropriately with staff suitably trained in the use of physical intervention, which accord with the Department of Health guidance. Undertake recorded environmental risk assessments in respect of their being no fitted emergency call systems throughout the home where people have access and take action in accordance with any risks that may be identified, including where necessary reviews. Ensure sufficient staffing arrangements, including numbers and skill mix to better promote consistency of care, uninterrupted work with individuals, low rates for staff turnover and sickness and for the necessary administration, organisation, communication and support necessary for the day to day running of the home and management of emergencies. Ensure in relation to the conduct of the home, that good personal relationships are maintained between management and staff. Ensure records that must be kept are available in the home at all times and for the purposes of inspection. In this instance, report of the monthly visits by the registered provider and incident reports. Further develop quality assurance and monitoring systems in consultation with people to produce an annual development plan for the home and provide that the results of satisfaction surveys are published and shared with people. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 8 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. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 9 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 Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 10 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): 1, 2 & 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Service guide does not always best inform people in their choice to live at the home. EVIDENCE: At our last key inspection of this service we judged that people have the information they need to choose a home although admission procedures do not fully ensure peoples’ needs are to be met. We made a requirement to ensure sufficient pre-admission needs assessment information is provided for any person to be admitted to the home and that compatibility with other service users is demonstrated via the home’s admission procedure. We also recommended that service information be provided in formats suitable for people likely to be accommodated at the home. In our annual quality assurance questionnaire completed by the home, they say that they provide a comprehensive individual pre-admission and admission package, which can be evidence from what people say and records kept. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 11 They did not tell us what could be improved or what has improved over the last twelve months. They also told us that there they currently do not provide individual written terms and conditions between the home and individual service user. At this inspection we asked people if they were asked if they wanted to move into the home and if they received enough information about the home before they moved there so they could decide if it was the right place for them. We looked at the home’s Statement of Purpose and Service User Guide. And we looked at the recorded needs assessment information for those people case tracked. The home’s Statement of Purpose is provided in standard print format only and its Service User Guide in an alternative format, which may assist some people with a learning disability. Management said that the arrangements for people’s admission to the home had been reviewed and described staged transitional arrangements, which are described in the home’s Statement of Purpose. However, these do not refer to Considering the potential and ongoing compatibility of service users. There is no information provided as to the home’s policy and procedures for emergency admission or service user’s views of the home. Three of the four service users said they were asked if they wanted to move into the home and were provided with the information they needed. One person said they were not. This person was admitted to the home as an emergency. Two service users said they did not like living at the home because of the aggressive behaviour of another service user towards them. (See also the Concerns, Complaints and Protection section of this report). Each of the people we case tracked had fairly comprehensive needs assessment information recorded. The format for recording this is under review, with a revised format being introduced. (See Needs and Choices section of this report). Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 12 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): NMS 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The introduction of the revised care-planning format should promote a more person centred approach to people’s care in their better interests. Although this may not be best realised without the right staffing arrangements to underpin this. EVIDENCE: At our last key inspection we judged that people are involved in decisions about their lives and play an active role in the care and support they receive. But, that better identification of care needs would ensure more individualised care. We recommended that peoples’ wider long term goals and aspirations be considered with them to assist in preventing their institutionalisation. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 13 In our annual quality assurance questionnaire completed by the home, they say that people are well supported to enjoy their chosen lifestyle in and outside the home and to maintain contacts with their families and friends. They feel they have improved over the last twelve months by enabling better integration for people within their local community and also have developed more in depth activity programmes. They feel they could improve by developing occupational and educational access for people, promote their independent living skills and developing person centred planning, which they intend to do over the coming 12 months. At this inspection we asked people if they make decisions about what they do each day and talked to them about how they are supported. We spoke with staff about the arrangements for people’s care delivery and support and we looked at the written care plans and recorded risk assessment information for people case tracked. Of the four people accommodated, two said they sometimes make decisions about what they do each day, one said hardly ever and one said never. Comments received include, ‘I would like to visit my family more.’ ‘I would like to look at living more independently in the future.’ The written care plans we looked at for the service users case tracked varied in their content and format. This is because a revised care planning format is being introduced. An example of the new format was provided, which had very recently been completed for one of the people we case tracked. This is more comprehensive and person centred. It also better accounts for the support people may need to take risks as part of an independent lifestyle, whilst promoting their safety and that of others. For one person with particularly challenging behaviours, this format introduced, included individual procedures where they are likely to become aggressive. These focused on positive behaviour, ability and willingness. However, not all staff felt they have the right support, experience and knowledge to meet the different needs of people who use the service. This included risk management in respect of one service user who has challenging behaviours whilst being supported by staff when out in the local community. (See also the Management and Staffing sections of this report). Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 14 Comments received, included the need for a revised and up to date careplanning format, which is regularly reviewed. And which, staff is enabled to consistently work to. There are no clear or active arrangements for people to access to any local advocacy services and agreed care planning information is not clearly recorded in respect of people’s capacities, choices and abilities to manage their own finances. People case tracked had merely signed individual agreements for the home to manage and handle their personal monies. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 15 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): NMS 12, 13, 15 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complete introduction of the revised, person centred care-planning format should better determine people’s lifestyle opportunities with them. Although this may not be realised without the right staffing arrangements to underpin this. EVIDENCE: At our last key inspection of this service we judged that people are able to make choices about their lifestyle and are supported to develop their life skills. We recommended that healthy eating is promoted and encouraged for people and that the concerns they raised with us about a lack of drivers for the people carrier are discussed directly with them. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 16 In our annual quality assurance questionnaire completed by the home, they say that they promote opportunities for people to pursue appropriate educational activities, such as college, leisure pursuits and independent living skills. And that people are supported to maintain regular contact with families and friends. They feel they have improved over the last twelve months by promoting more in-depth activity programme and encouraging people’s integration into the local community. However, they say they could improve by encouraging people to access college, work placements and by broadening individual’s independent living skills, which they say they aim to do over the coming twelve months by way of introducing a more structured person centred care planning approach. At this inspection we asked people about their daily living arrangements and what they do during the day and at weekends and we examined related records. Two people said that they can usually choose what they do and often go out into the local community and two people said they could not always choose. They also said that they have some responsibilities for household tasks, which staff help them with and have keys to their own rooms. People also spoke about their holiday arrangements. One person, case tracked had a work placement arrangement although said she had not attended this for some time. The relative of one service user said that college attendance was discussed at their last care review, although no progress was made in respect of achieving this. They also said that they felt the resident spends too much time in the home doing nothing, and are not actively encouraged in terms of their occupation. We have also received concerns about a lack of activities in the home. The person raising these felt that this was possibly due to inadequate staffing arrangements. A variety of leaflets and information is provided in the home for people with regard to local activities and organisations. Staff felt that the service could further improve in terms of the provision for people to engage in activities, occupation and leisure pursuits of their choice. Examples of these included more regular access for people to work experience, college access, drop in centres, disco nights in Long Eaton and volunteer work. People said that they use community transport to access the local community. One of the people case tracked said she goes out a lot to visit her family. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 17 Staff feedback indicated that staffing ratios are not always adequate and compromise individual’s access to activities, occupation and leisure facilities. People said that they usually enjoy their meals. They also said that they get involved in their preparation, with staff support. Although one person, case tracked was said to have gained a substantial amount of weight since entering the home. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 18 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): NMS 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People mostly receive personal support in the way they prefer and their health care needs are met. EVIDENCE: At our last key inspection of this service we judged that people receive health and personal care based on their individual needs. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 19 In our annual quality assurance questionnaire (AQAA) completed by the home, they say that people receive personal care in a manner they prefer and that their health and meds needs are met. They say that over the last twelve months they have improved people’s access to outside health care professionals as and when required, but feel they could do better by promoting regular health checks for people. They aim to do this over the coming months along with encouraging healthy living/eating. At this inspection we asked people about the arrangements for their care and support. This included asking them about staff approaches towards them, how they access outside health care professionals, including their own GP and also about the arrangements for their medicines. With regard to the latter, we looked at the arrangements for the receipt, storage, recording and administration and disposal of the medicines for those people that we case tracked. People said that staff, always treat them well and always listen and act on what they say and that they have key workers with whom they get on well. There are good links with community nurses, including specialist community learning disability nurses and specialist medical support. Overall written care plans describe the care interventions required in respect of individuals’ personal and health care support needs, with evidence of inputs from outside specialist professional advice. They also account for many aspects of peoples’ preferences and choices. However, for one person case tracked, inconsistency of staff approaches were observed during our site visit with regard to dealing with their challenging behaviours. Concerns have also been raised with us separately about those inconsistencies in practise and the impact this has on everyone. (See Complaints, Staffing and Management sections of this report). There are suitable arrangements in place for the receipt, storage and disposal of peoples’ medicines. However, there are a few occasions where the recording and administration of peoples’ medicines did not accord with recognised/best practise. This included: Changes to the prescribed dosage of some medicines, which are not correctly amended on the medicines administration record (MAR) sheets. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 20 That staff may be signing that medicines have been fully administered before offering to the person for whom they are prescribed and ensuring that these have been taken by that person. Current arrangements for leave medication for one person, case tracked requiring review and agreement with that person’s GP (as the prescriber) and dispensing pharmacist. Since our inspection we have also received concerns regarding aspects of medicines practises in the home, which we have asked the provider to investigate through their complaints procedure. The home manages and administers all peoples’ medicines and each person has signed an authorisation for the home to do so. However, discussions with senior staff, advised that one person has the potential, with the right training and support, to manage their own medicines. There was no long-term goal/care plan in place in respect of this for that person. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 21 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): NMS 22 & 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People know how to complain but are not sufficiently protected from potential harm and abuse. EVIDENCE: At our last key inspection we judged that people who use the service are able to express their concerns. Although, the management of physical aggression and the home’s adult abuse policy and procedures did not adequately safeguard people living there. We made a number of requirements about complaints record keeping, ensuring the provision of a safeguarding policy and procedures for staff to follow and in ensuring clear records of any incidents occurring which may compromise peoples’ safety and welfare. We also recommended that the home’s complaints procedure be provided in a simple and easy to follow format for people, which includes the Commission’s contact details for people if they choose to contact us at any time for advice. In our annual quality assurance questionnaire (AQAA) completed by the home, they say that they have developed their complaints and safeguarding systems to ensure the better handling of complaints and that people are safeguarded from abuse. They say that staff is suitably trained to ensure people’s Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 22 protection from abuse. And is provided with relevant key policy and procedural guidance. They did not identify any further areas for development over the next twelve months. At this inspection we reviewed any concerns, complaints or allegations as received about the service. We looked at the home’s complaints procedure, its safeguarding policy and procedures and also procedures for staff in dealing with verbal and physical aggression. We looked at the home’s Complaints records, which we discussed with the regional manager and we asked staff about their roles and responsibilities with regarding to dealing with complaints and safeguarding people from harm and abuse. The home’s complaints procedure is displayed for people to see in a simple large print and picture format and includes the contact details of the Commission. The home gave us some data about complaints they have received over the last year within the AQAA, which they sent to us. This, details that they have received five complaints, with four resolved within 28 days and which are all upheld. The number of complaints awaiting an outcome is detailed as one. At our inspection visit we looked at the home’s record of complaints. These provide information about the nature of the complaint, investigation and outcomes, with the exception of one referred to below. Two of the complaints above were referred to the home via the Commission to investigate via their complaints procedure. On 29 February 2008, the Commission received an anonymous complaint alleging inadequate staffing arrangements, including a lack of training to deal with violence and aggression from services users resulting in staff and service users being hit on a daily basis by service users and also in terms of dealing with incidents. We referred these allegations to social services via recognised safeguarding procedures and they liaised with the home in terms of its investigation. We also wrote to the provider on 03 March 2008. They agreed to send us a report detailing their findings and the action they have taken. Whilst some verbal feedback has been provided, this is not conclusive and written confirmation has not been received to date. Since our inspection visit on 07 March 2008 there has been a further allegation of abuse of a named resident. This is currently being investigated via joint agency safeguarding adults’ procedures and is awaiting an outcome. The Commission has also received further concerns about the home. Some of these advise that matters continue with regard to the alleged physical abuse of service users (and staff) by a named service user and also raise other allegations relating to service users personal allowance monies and missing Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 23 medicines. These have been referred to social services via joint agency safeguarding adults’ procedures. A number of other concerns are also raised with the Commission during the inspection process. These allege inadequate arrangements for staff deployment and training, with particular reference to dealing with violence and aggression/challenging behaviours and including incident reporting (see also Staffing and Management sections of this report) and also medicines training, unsafe recruitment practises and the conduct of the care home in terms of personal and professional relationships amongst staff. These have since been referred to the provider in writing request investigation via the home’s complaints procedure and written advice as to the outcome of this. One relative surveyed said that the last care review seemed good regarding concerns raised, about care, but that proposed actions are not followed through. Since our last key inspection a safeguarding policy is in place, which provides general guidance for staff, including some reference to outside agencies, although with no specific and robust procedures provided for in terms of reporting stages and contact details/roles of external authorities. Staff spoken with at our inspection visit is conversant with their roles and responsibilities with regards to dealing with complaints, although there were gaps in some staffs knowledge about safeguarding procedures in relation to external agencies roles. More senior staff are conversant and advised that training is provided for staff on a fairly regular basis with regard to recognising abuse and safeguarding people. Most staff said they have knowledge in terms of dealing with service users challenging behaviours where de-escalation techniques are concerned, although not always in relation to one service user, where significant physical aggression is involved and where physical interventions may be necessary. All staff is supported to undertake NAPPI, level 1 training, which is accredited and focuses on recognition and de-escalation techniques. No staff member has undertaken NAPPI level 2 training, which focuses on safe physical restraint (as a last resort). We discussed this with the regional and acting manager at our inspection visit, in light of their stated intention within the AQAA to provide this. The home’s Statement of Purpose states that it is a specialist provision in caring for adults with learning disability, complex needs and associated challenging behaviours. It also states it commitment to the training and development of staff and list areas of training they are supported to achieve. This includes NAPPI 1 and NAPPI 2. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 24 The home’s policy on restraint is indicative that the use of physical restraint is only to be employed in exceptional circumstances and as a last resort to ensure people’s safety, and that only staff trained in restraint practises may restrain. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 25 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): NMS 24, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall people live in a safe and clean environment, which suits their needs. EVIDENCE: At our last key inspection of this service, we judged that the physical layout of the home provides that people live in a well-maintained and comfortable environment, which encourages their independence. In our annual quality assurance questionnaire completed by the home, they say that they the people continue to live in a clean, safe, comfortable and homely environment, which is furnished and decorated to a high standard, with safe outdoor garden. They say that they have improved their maintenance systems, although do not identify any improvements for the coming months. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 26 At this inspection we asked people about their environment and the cleanliness there. We looked at the private and communal accommodation for those people case tracked. Two service users said that the home is not always kept fresh and clean and two said is either usually is or always is. At the time of our inspection visit the home was fresh, clean and odour free. The home is well maintained and furnished and decorated to a good standard. People told us that they like their own rooms, which all have en suite facilities and are personalised, with lockable doors and storage facilities. Some told us that they had chosen the colour of the décor in their bedrooms. The two sofas in the lounge are ready for replacement. The regional manager advised that replacements are ordered. There is a sensory room, which people said they thought needed redecorating. The regional manager said this was planned with the involvement of residents. One person, case tracked said she particularly liked spending time in the sensory room. There is a separate laundry facility and people told us that they are able to do their own laundry with help from staff. The Environmental Health Officer had recently visited the home and made some requirements and recommendations about the kitchen in their report, which is kept at the home. People can access completely enclosed grounds, with a garden and barbeque area to the rear. The rear garden area was untidy and needed some attention and there was no seating set there. There is no fitted emergency call system throughout the home, although there is one fitted in the communal shower room and toilet. We discussed this with the regional manager, who advised that there are personal alarms that staff can carry where necessary, although, with the exception of the one stated, residents do not have access to a call system in the event of an emergency. There are no recorded environmental risk assessments in place with regard to the assessment of potential risks, which may arise from not having a fixed emergency call system throughout the home, which staff and people who use the service can use. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 27 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): NMS 32, 33, 34, 35 & 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Deficits in manpower planning and training arrangements, impact on staffs’ confidence, knowledge and approaches to aspects of care. This does not promote a consistently effective staff team, or peoples’ best interests. EVIDENCE: At our last key inspection of this service, we judged that staff is trained and provided in sufficient numbers to support the people who use the service, although better induction and supervision procedures would ensure that resident’s wellbeing is not put at unnecessary risk. We made a requirement that staff must be effectively supervised with records maintained as to their individual supervision. We recommended that staff recruitment files are properly maintained and with two written references in respect of each person employed at the home. And, that, records of staff induction provide greater detail. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 28 In our annual quality assurance questionnaire completed by the home, they say that they people are supported and protected by trained and competent staff. They say they have improved over the last twelve months by ensuring that all staff has undertaken part 1 of NAPPI training. They feel they could improve further by ensuring further staff training, including that for dealing with challenging behaviours and some medical conditions relating to peoples disabilities. And they say they intend to ensure that all staff will undertake part 2 of the NAPPI training over the coming months and any other training identified specific to individual service users needs and conditions. At this inspection we asked people about the support they receive and staff availability. We have referred to these in the Lifestyle and Personal and Healthcare sections of this report. We asked staff about the arrangements for their recruitment, induction, training and deployment and we examined related records, including the personal records for four of the most recent staff starters. People said that the induction they received covered everything they needed to know about the job when they started, although one said it did not at all. People also said that their employer carried out checks, such as CRB and references before they started, although one person said they started work at the home before these were returned. The regional manager said that there have been occasions where staff have commenced working in the home having obtained a POVA first check, whilst their CRB is awaited due to the need to commence staff to ensure that peoples’ needs are met. Which is satisfactory. We also asked people if they are being given training relevant to their role and if they feel there are enough staff to meet the individual needs of all people who use the service. People said that they do receive training relevant to their role, including their induction and most core health and safety training. There is a training plan in place to support this. However, all said they have not received Part 2 of the NAPPI training, which they identify as necessary to enable them to safely and competently practise this as a last resort where necessary. (See also Complaints and Protection section of this report). Also as the home’s restraint policy indicates that staff using inappropriate physical restraint may be subject to disciplinary procedures. During our inspection visit we observed some inconsistency in staff approaches to dealing with the challenging behaviour demonstrated by one service user we case tracked. (Although, there is a relevant care plan in place for that person, drawn up with the support of the specialist community learning disability nurse and as agreed via care management reviews). Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 29 Information provided within the AQAA return gave that out of ten care staff, there are five having at least NVQ level 2 and 1 working towards this. The majority of staff said there are not usually enough staff to meet people’s needs. (See also Complaints and Protection section of this report). Duty rotas detailed four staff throughout the day and two at night. Although sickness and absence affects this on a regular basis and whilst cover can sometimes be sourced from a sister home, this is not always, leaving three staff. Sometimes staff, work additional hours to cover sickness and absence, although staff can often working excessively long hours. Most staff said that they met with management often for individual supervision sessions, although one person said they had not received individual supervision for over a year. The regional manager advised that one resident has total 1:1 staff/resident ratio with additional episodes of care of a 2:1 staff/resident ratio, when necessary. The latter is reported to have been more frequent during January to March 2008 although management reported this to have lessened during April 2008. The other three people receive 1:1 staff/resident ratio whilst out in the community. There is also a further admission planned with transitional arrangements to due to commence. One relative survey received said that they felt people’s needs are sometimes met depending on staffing levels. At our inspection visit, interviews were in progress to recruit additional staff. The personal records for four of the most recent staff starters contained all required information and checks relating to their employment and also records of their induction, training and supervision. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 30 Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 31 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): NMS 37, 38, 3, 41 & 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not always consistently managed and run, in people’s best interests. EVIDENCE: At our last key inspection of this service we judged that the home is managed effectively although health and safety hazards create unnecessary risks to the welfare of people living in the home. We made two requirements relating to specified areas of risk assessment and staff training. These are complied with at this inspection. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 32 In our annual quality assurance questionnaire (AQAA) completed by the home they say that good health and safety practises ensure that people’s welfare is promoted. They did not identified, any key improvements that they had made since the last inspection or that they intend to make over the coming months. At this inspection we asked staff about the management arrangements for the home, including communication and information with them, arrangements to ensure safe working practises at the home and we made generally observations relating to safety during our inspection visit. We also looked at the arrangements for quality assurance and monitoring, including consultation with people, together with the arrangements for the regular servicing and maintenance of systems equipment at the home. There have been a number of management changes at the home since our last key inspection. The registered manager moved within the company. There has since been a series of two acting managers, including the current acting manager only very recently in post. Very recent changes to the external management structure have also been made. People said that the ways for passing information about people who use services between staff and including management usually works well, although one said it sometimes does, but said that staffing levels impact on this in terms of maintaining good record keeping. Another expressed some concerns about relationships between some staff and management, potentially affecting residents who are aware of this. Matters raised in our complaints and concerns section of this report and recently received about the service also reflect this view. Records of quality monitoring auditing systems were not available for inspection at our visit, including copies of the monthly reports of visit to the home by the registered person (or their nominated representative) and also results/outcomes any from satisfaction surveys. The regional manager advised that these are sent out periodically to service users and their families/representatives with few returns. However, we were advised that the newly appointed regional manager had undertaken a full service audit a few days before our inspection visit. There is currently no annual development plan in place for the service and survey results are not published for people to access. Comments made with regard to ensuring safe working practises under the Staffing section of this report (core health and safety training) apply here also Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 33 and are satisfactory. All staff also undertaken equality and diversity training and the home operates an equal opportunities recruitment policy. The arrangements for the servicing and maintenance of systems and equipment at the home are satisfactory. Matters stated under the Environment section of this report, regarding the need to ensure recorded risk assessments with regard to the lack of an emergency call system throughout the home apply here also. Accident and incident reports/audits were also not available for inspection at our visit. . Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 34 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 2 2 3 3 X 4 X 5 1 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 2 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X N/A 2 2 X 2 2 X Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 35 YES 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 YA1 Regulation 4(1)(c) Requirement Timescale for action 25/07/08 2. YA5 5(1)(b) & (c) 3. YA6 15(1) & (2) The Statement of Purpose/Service Guide criteria for admission information must include the home’s policy and procedures for emergency admission and to ensure that people receive the service information they need as soon as is reasonably practicable. The Service Guide must include, 25/07/08 the amount (range) and method of payment for fees and a standard form of contract for the provision of services and facilities by the registered provider to the service users. In order to promote informed choice for people as to whether to choose to live there. The revised care-planning 25/07/08 format must be fully introduced in consultation with staff (including the necessary training) and each service user and be regularly reviewed. To promote a consistent and person centred approach to peoples care and to provide staff with the information they need to meet peoples’ needs. DS0000064327.V363017.R01.S.doc Version 5.2 Heathcotes Care (Sawley) Page 36 4. YA20 13(2) 5. YA23 13(6) 6. YA23 13(6) Medicines administration records 25/07/08 must be properly maintained. Staff must not sign before any medicines is given and where it is refused enter the appropriate code denoting the reason for refusal. Changes of dose, where hand written must be recorded as a new instruction with the previous instruction discontinued by date. Hand written instructions must be signed and dated by the person recording the instruction and countersigned/dated by a witnessing staff member. Arrangements for individuals’ medication whilst out on leave must be reviewed and formally agreed with the appropriate medical prescriber, and supplying pharmacist. These are to ensure safe and recognised medicines practises, which are always in peoples’ best interests. 25/07/08 Procedures for responding to suspicion or evidence of abuse or neglect, including whistle blowing, and that ensure people’s safety and protection must be further developed to ensure they are robust. (This requirement had a timescale of 31/05/07. Whilst a policy has been developed, it is not sufficiently robust in terms of actual procedures to follow concerning the roles of outside agencies and particularly social services lead role and contact details in respect of safeguarding people). An extended timescale is agreed, which must be complied with. Physical aggression by a 25/07/08 service user must be understood DS0000064327.V363017.R01.S.doc Version 5.2 Page 37 Heathcotes Care (Sawley) 7. YA29 13(4)(c) and dealt with appropriately. Staff must be suitably trained in the use of physical intervention (only to be used as a last resort) in accordance with the Department of Health guidance. The home’s policy and procedural guidance must include mechanisms for review as to approaches to individual’s care plans where there are ongoing and sustained challenging behaviours, which compromise people’s safety. These are in order to protect the rights and best interests of the service user, being the minimum necessary and consistent with safety and to ensure they are protected from being placed at risk of harm and/or abuse or from actual harm and /or abuse. Recorded environmental risk 25/06/08 assessments must be undertaken in respect of there being no fitted emergency call system throughout the home, where service users have access. Action must be taken in accordance with any risks that may be identified, including where necessary reviews. To ensure unnecessary risks to the health or safety of service users are identified and as far as possible eliminated. Staff must have the skills and training appropriate for the work they are to perform including: Specialist skills to meet service users individual needs, including skills in communication and in dealing with anticipated behaviours; Understanding of physical and verbal aggression as a way of DS0000064327.V363017.R01.S.doc 8. YA32 18(1)(c) 25/08/08 Heathcotes Care (Sawley) Version 5.2 Page 38 9. YA33 18(1)(a) 10. YA38 12(5)(a) 11. YA39 26(4) & (5) communicating needs, preferences and frustrations; This is to ensure that people is consistently supported by competent and qualified staff. It must be ensured that at all 25/07/08 times there sufficient staff (by way of skill mix and numbers to: Provide uninterrupted work with individuals; Provide for the necessary administration, organisation, communication and support as may be necessary for the day to day running of the home and for the management of emergencies; Promote low rates of staff turnover and sick leave. This is to ensure that people, both individually and collectively, is consistently supported by an effective and efficient staff team. In relation to the conduct of the 25/07/08 home, good personal and professional relationships must be maintained between management and staff. So as to promote an open, positive and inclusive atmosphere and to ensure that service users benefit from the ethos, leadership and management approach of the home. The representative of the 25/06/08 registered provider responsible for undertaking monthly visits to the care home must prepare a written report of those visits. This shall include all matters described as 4(a) to (c) of that regulation and a copy of the report must be supplied to the manager of the home and copies kept at the home for the Commission to inspect. This is to demonstrate that the home is DS0000064327.V363017.R01.S.doc Version 5.2 Page 39 Heathcotes Care (Sawley) 12. YA42 effectively managed and run in peoples’ best interests and in consultation with them. 17(2)12(b) Records must always be kept in the home as to any incident, which is detrimental to the health or welfare of a service user and be available for inspection. To demonstrate that people’s rights and best interests are safeguarded by the home’s record keeping and it’s policies and procedures. To demonstrate the effective and efficient running of the business. Original timescale – 31 May 2007. 25/06/08 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. 2. 3. Refer to Standard YA1 YA7 YA7 Good Practice Recommendations Service guide information regarding the criteria for admission to the home should consider the potential and ongoing compatibility of people who live there. People should be consulted with and assisted/ supported to access local independent advocacy/self advocacy groups as may be available. People’s individual choices, capacities and abilities in respect of managing their own finances/financial arrangements should be more fully reflected within their care plans in accordance with the principles of the Mental Capacity Act. NMS YA 13 also applies here. The home should continue to develop individual’s access to appropriate activities, using person centred care planning as a basis for determining this. And with flexibility of staff time to more consistently enable this. Staff should be more actively encouraged and supported DS0000064327.V363017.R01.S.doc Version 5.2 Page 40 4. YA12 5. YA20 Heathcotes Care (Sawley) 6. YA39 where possible as part of their long-term goals, to retain and manage their own medicines within a risk management framework. Quality assurance and monitoring systems should be developed in consultation with people to produce an annual development plan for the home and to ensure that the results of satisfaction surveys are published and shared with people. Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 41 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Heathcotes Care (Sawley) DS0000064327.V363017.R01.S.doc Version 5.2 Page 42 - 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!