Inspection on 14/04/08 for Heighton House

This inspection was carried out on 14th April 2008.

CSCI found this care home to be providing an Adequate 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heighton House 06/04/09

Heighton House 24/04/07

Heighton House 28/11/06

Heighton House 18/05/06

Heighton House 22/11/05

Heighton House 22/06/05

Heighton House 21/01/05

Heighton House 27/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Heighton House 19 Barnwood Road Gloucester Glos GL2 0SD Lead Inspector Mr Richard Leech Unannounced Inspection 10:00 – 18:00 & 10:00 – 14 & 15 April 2008 18:00 th th Heighton House DS0000016458.V358855.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 Heighton House DS0000016458.V358855.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. Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heighton House Address 19 Barnwood Road Gloucester Glos GL2 0SD 01452 380014 01452 380014 heighton.house@craegmoor.co.uk www.craegmoor.co.uk Cotswold Care Services Limited 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) To be appointed Care Home 8 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (1) of places Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th October 2007 Brief Description of the Service: Heighton House is a care home that provides accommodation for up to eight adults with learning disabilities. The home is close to Gloucester city centre. All of the people living in the home have single bedrooms, some with en suite facilities. There is a large communal lounge, smaller lounge, sensory room and dining room as well as a large conservatory. Outside there is a car park and a spacious lawn. Craegmoor Healthcare owns Heighton House. The home has a Statement of Purpose and Service User Guide which set out information about the philosophy of the home and the facilities provided. Copies of these are available upon request and are supplied to people who are considering moving in. Up to date information about fee levels was not obtained during this visit, although the acting manager understood that the base fee was approximately £1200. Heighton House DS0000016458.V358855.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 1 star. This means that the people who use this service experience adequate quality outcomes. Before the visits to the home the acting manager completed an annual quality assurance questionnaire (AQAA). This provides information about how the home runs. It also gives some data, such as about staffing. Surveys were also sent out to different people with an interest in the home such as staff, relatives, care managers and the people living at Heighton House. This resulted in a good response rate. Two visits were made to the home. These took place on a Monday and a Tuesday from mid morning to late afternoon. All of the people living in the home were met, along with many of the staff team. The acting manager was present for the second day. During the visits various records were checked. These included examples of care plans, risk assessments, healthcare notes, staffing files and medication records. On the second day of the inspection some structured observation took place using the SOFI tool (Short Observational Framework for Inspection). This focused on the care and support offered to one person. The observation lasted for two hours. More general observation took place on both days of the inspection. What the service does well: People are supported to take part in a variety of activities in the home and community, and to maintain contact with family and friends. Routines are flexible and people are involved in running the home. The people living at Heighton House enjoy their food and are offered a varied and balanced diet. Bedrooms are pleasant and personalised. The home is spacious and there is a large and accessible garden. People’s personal care needs are met, with account taken of their preferences for particular routines and around the gender of the carer. Medication is generally well handled in the home, helping to keep people safe and well. Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 6 Staff are skilled and caring, and have access to some appropriate training. Systems are in place which help to monitor and improve the quality of care. The people living in the home are enabled to have a voice, helping them to feel listened to. What has improved since the last inspection? What they could do better: The home is clean and well decorated in parts. However, there are significant environmental shortfalls which impact on people’s safety, comfort and quality of life. Heighton House needs a permanent manager with the right qualifications, experience and skills. Although care plans have improved, there is still scope for them to be better. For example, they could be clearer about people’s goals. If there are any major restrictions then these need to be properly documented. Whilst healthcare needs are generally being met, record-keeping could be improved in order to ensure that nothing is missed. Procedures and record keeping of complaints needs to improve. This is so that people have the information they need and so that there is a clear log of complaints and of what was done as a result. Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 7 Arrangements are in place which help to protect people from harm and abuse. However, more could be done to promote an open culture whereby concerns are seen to be positively received and appropriately handled. Whilst appropriate training is provided there is potential for more specialist training in order to further develop the skills and knowledge of staff. Higher staffing ratios would help to improve the standard of care and people’s overall quality of life. Some of the people living and working in the home felt that more staff were needed so that more activities could be provided. Whilst recruitment and selection procedures are generally sound some aspects could improve. Some areas of health and safety were beginning to slip, presenting some risk to the people living in the home. Some other recommendations are made which should be given consideration. 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. Heighton House DS0000016458.V358855.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 Heighton House DS0000016458.V358855.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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Uncertainty about the assessment and admissions process increases the risk of inappropriate admissions being made. EVIDENCE: The Statement of Purpose and Service Users Guide were not checked in detail, although it was noted that they would need review due to the change of manager. No photographs had yet been added to the Service Users Guide, as recommended in the last report. The acting manager said that there had been no new admissions since the last key inspection. There was one vacancy at the time of the visit. It was reported the area manager had arranged for one person to see the room. The acting manager said that he had no information about the person. The acting manager said that he had never overseen an admission and expressed some uncertainty about the process. He said that he would consider compatibility with the other people living in the home and would arrange for visits, but would need support around the assessment and admissions process. Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 10 There was no reference in the AQAA to how the service aimed to meet the National Minimum Standards around admission. The organisation has an admissions procedure and forms which are used to assess the needs of people who may be moving into a home. Heighton House DS0000016458.V358855.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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst care plans have improved, more work could be done to ensure that they are truly person centred. People are being offered meaningful choices in their daily lives, although in some cases restrictions need to be documented in order that they are appropriate and in the person’s best interests. People are being supported to take risks as part of leading a full life, although the risk assessment process could be improved such that guidance is clear and progress towards greater independence is reflected. EVIDENCE: The AQAA noted that each person had a person-centred plan and that they were involved in developing these. Care plans for two of the people living in the home were looked at. Some person-centred formats had been completed. Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 12 Care plans were seen to cover significant areas such as health, finances, personal care, activities, communication, behaviour and independence. Whilst they provided clear and reasonable guidance in many cases the following observations were made: • • Some care plans did not refer to people’s strengths/abilities or to the potential for people to develop their skills in particular areas, such as around the management of finances. Plans which did refer to promoting skills were sometimes vague. For example, stating ‘to continue to be able to be independent at home’ referring to skills that the person wanted to develop. In response staff were required to ‘support me’. Other plans which referred to promoting independence also lacked detail. One care plan about independence only noted one skill which the person wished to develop and evaluations did not indicate whether this had been taken forward and with what outcomes. There was some duplication, such as a (brief) care plan about communication and a separate and much more detailed communication dictionary. • • Many of the plans did provide sufficient detail and included reference to promoting people’s independence. Some very thorough work had been done around behaviour management, communication and people’s specific needs and conditions. There was written evidence of most plans being reviewed regularly. However, some appeared not to have been reviewed since August or September 2007. In some cases the reviews could have offered more information about progress/development in the area under consideration; many review entries were largely identical from month to month. There could also have been more evidence of the involvement of the person in the review, whether directly or indirectly. There was documentary evidence of a recent review by the placing authority on one person’s file. This had been requested by the team. Seeking regular reviews from the placing authority is good practice. Examples of monthly keyworker reports were seen. Whilst these provided useful summaries it was noted that the sections referring to previous and future goals were not always very thoroughly completed. In one 2008 report the word ‘yes’ was written in these sections with no further explanation. Other sections of reports lacked detail, such as stating ‘to carry on promoting independence’ without indicating how. It was not always clear if the goals that were written had been expressed by the person or by the staff member, such as in one case ‘to lose weight’. It was suggested that there could be more detail given about how the goals had been agreed and what would then Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 13 happen to move them forward. It was also difficult to track what had become of certain previously expressed goals, such as in one example to ride a bike. Some reports had the month but not the year when they were written. As noted, care plans referred to communication. They also described how people made choices, and made reference to offering and promoting choices. Staff spoken with described how they involved people in decision-making, giving examples. During the visits people were seen to be offered choices, such as about activities and eating/drinking. People were also seen to have the confidence to make a choice, such as turning down an offer of a particular activity. This was also seen in daily records. Some of the staff had attended total communication workshops in 2006. Some work was being done around alternative ways of communicating, such as the creation of a photographic rota. However, there remained considerably more scope for developing total communication approaches in the home as noted in the last key inspection report. In the last report a requirement was made to record any limitations agreed with people as to their freedom of choice, liberty of movement and power to make decisions. One person’s taps in their bedroom had been cut off. It was stated that this was due to a flooding risk, but there was no reference to this in their care plans, risk assessments or any other documentation seen. Some staff were not aware that this had been done. This represents a significant restriction and requires appropriate documentation in terms of the National Minimum Standards/Care Homes Regulations but also within the framework of the Mental Capacity Act 2005. The AQAA stated that the service regarded risk taking as normal and that risk management was included as part of everyday discussions. Risk assessments for two people were looked at. These appeared to cover a range of appropriate areas and to generally provide clear guidance for risk management. However, some of the guidance lacked clarity, such as noting a need for ‘support’ without defining what this meant. In addition, whilst there was evidence of regular review, these evaluations could include more detail about progress. For example, whether a person had developed their road safety abilities in response to the actions described in the relevant risk assessment (staff were asked to ‘reinforce good traffic sense’). This would provide further evidence of the home achieving the stated aim of promoting independence. The AQAA noted that the home could do better at promoting people’s independence. Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 14 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 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are supported to take part in a variety of activities in the home and community, and to maintain contact with family and friends, promoting their quality of life. Routines are flexible and people are involved in running the home, helping them to feel valued and respected. People are offered a varied and balanced diet, promoting their health and wellbeing. EVIDENCE: Monthly keyworker reports gave summaries of people’s activities. Care plans were also seen referring to people’s activities. In addition the home has a Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 15 system of individual weekly activity planners and a related daily summary, examples of which were seen. Activities for two people over a two-week period in 2008 were checked through daily records. These provided evidence of people taking part in a variety of activities in the home and community. Activities generally corresponded to what had been planned. There was evidence of people making choices about activities, and of feeling able to say that they did not want to take part in a planned activity. Records referred to people using local facilities such as pubs, shops and the cinema, as well as more specialist facilities related to their needs and interests. Some daily entries could have given more detail about certain activities. For example, at times it was just noted that a person had gone for a drive, without saying where, for how long, if there had been a destination and whether they had enjoyed the activity. However, many entries did provide this information. The AQAA noted that one person liked to attend church. They were spoken with and confirmed that were supported to attend every week. There were plans for the person to make their own way there, promoting their independence. Staff described how new activities had recently been offered. For example, people had been gradually introduced to different types of aromatherapy massage. A local sports centre was being used once a week for an informal sports/activity session. Staff also reported that more day trips were taking place. On the day following the visit there was a trip planed to a farm. There was evidence in daily records of evening activities being offered, such as to social groups. During the visits people were encouraged to take part in activities in the home such as playing games in the garden or feeding the fish. Staff spoken with generally felt that activity provision was good and that people were leading full lives. However, there was some concern about activity budgets impacting on people’s opportunities. There was also concern that at weekends there was less scope to offer people activities due to lower staffing ratios, resulting in people spending time in the home and, in some cases, becoming bored. An example was given of one person who liked to go to markets and car boot sales but who was not being offered the chance to do these activities at weekends due to staffing constraints. Activities were seen to tail off a little at weekends according to daily entries, although there was evidence of staff making efforts to get people out and about a far as possible. One survey form from a person living in the home included reference to lower staffing at weekends meaning that activities were restricted. Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 16 The AQAA described the progress that had been made with people’s activity programmes though noted that the service could be better at supporting people to become more involved with the local community. Some of the people living in the home were asked about their activities and indicated that they had enough to do and were happy with how they spent their time. A relative wrote that their family member ‘has a variety of activities which [they] thoroughly enjoy’. At various points during the visit the volume of the television in the lounge was noted to be excessively loud for a long period of time with no staff intervention. Staff confirmed that there was no reason for this high volume in terms of people’s needs or preferences. Some plans for holidays had been drawn up earlier in the year, although nothing had yet been booked. Some brochures were being given to people in order to help them decide what they wanted to do. Staff said that this year people would be offered the chance to go away in smaller groups rather than all going away together. Care plans made reference to contact with family. Records provided evidence of regular contact with family in person and by telephone. Several survey forms were completed by relatives. These provided mixed feedback. Some concerns were mentioned including: • • • Not always communicating well with family about their relative or about developments in the home in general. Inconsistency around meeting the person’s needs and providing appropriate activities. Staffing levels being too low at times However, there was also positive feedback. This included reference to their relative being happy, being kept well informed, a good response when they raised issues, and of staff having a good knowledge of the person’s needs. They referred to staff as ‘excellent’ and ‘a credit to the organisation’, and referred to their family member making progress. People were seen moving freely around the home and grounds. Staff confirmed that people were free to access all areas, although in some cases supervision was required in the kitchen. People were seen accessing the kitchen and making drinks when they liked. One person was seen choosing to have a TV dinner. Daily entries provided evidence of people choosing when they went to bed. Staff confirmed that routines were flexible. There was also evidence of people choosing to have a lie-in at times. Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 17 During the visits people were seen helping out in the home. As noted earlier, there may be scope to further promote people’s independent living skills. Only one person had a key to their room. Another person was said to like having their door locked but had not been able to manage a key. Discussion indicated that there may be value in revisiting this and working with the person to overcome the issues that had presented at the time. There should be assessments in all files about keys to bedrooms, framed in terms of capacity and indicating whether the person wishes to hold a key. Menus were seen. These provided evidence of people being offered a varied and balanced diet. The lunch menu was seen to be less ‘snacky’ then previously. People spoken with indicated that they were happy with the food they were offered. For example, one person said that the food was ‘good’. Some mealtimes were observed and people appeared to be enjoying their food. Some people spoken with confirmed this. Fresh fruit and vegetables were seen in the home during the visits. Daily entries included information about what people had eaten on a given day. Heighton House DS0000016458.V358855.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): 18, 19 & 20 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s personal care needs are met, promoting their dignity and wellbeing. Whilst healthcare needs are generally being met, record-keeping could be improved in order to ensure that nothing is missed. Medication is also generally well handled in the home, although some areas of practice could be improved to promote people’s safety and wellbeing. EVIDENCE: Care plans were seen to provide guidance about the support each person needed with personal care. They included information about preferences around gender and routine. There was a daily record of what personal care had been given to people. People were seen to be dressed in ways which reflected their individuality. Staff described how they promoted choice of clothing. Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 19 Some staff spoken with were asked about personal care. They were able to describe the support that different people needed and how they provided this in a discreet and sensitive manner. Healthcare notes were checked for two people. Whilst there was evidence of people being supported to access routine and specialist services the notes were not clearly ordered. This made it difficult to track back and to be clear about when people had last seen different professionals. For example, it was not possible to be certain when one person had last visited the dentist for a routine check. Nor was it clear when another person had last seen an optician. It is recommended that healthcare notes be subdivided, with a different sheet for each specialism, rather than a purely chronological record of all healthcare appointments/interventions. Some care plans were seen about aspects of healthcare, such as the support needed when the person went to the dentist. However, review notes had become confused as they referred to a whole range of healthcare professionals. If there are support needs in relation to accessing other healthcare services then these should also be subject to care planning. Health action plans were completed for both of the people whose care was looked at in detail, although some of the information was becoming out of date and needed review. Up to date records of people’s weights were seen on file. As noted, one person apparently had a goal to lose weight but this had not yet translated into a clearly documented and agreed plan. Medication storage was checked and appeared to be satisfactory. Records were being kept of the temperature of the cabinet. Medication records were sampled and also appeared to be in order, although at 17:00 during one of the visits it was noted that one person’s 12:00 medication had not been signed for. Staff established that it had been administered, suggesting that greater vigilance was needed around recording. Records included photographs for the people living in the home, although one person’s photograph was not on the medication file. Protocols were seen for ‘as required’ medication. The acting manager said that nobody in the home was self-administering medication. He described how the service would respond to a request to do so. There was also a discussion about the service being proactive in promoting this where appropriate, within a risk management framework. One person was taking various over the counter supplements. It was agreed that people’s GPs should be approached to approve the use of these, and of any other homely remedies taken by different people living in the home where relevant/not recently done. The organisation has detailed policies and procedures covering all aspects of the handling of medication. Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 20 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): 22 & 23 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Procedures and record keeping around complaints need to improve in order that people have the information they need and so that there is a clear log of complaints and actions arising. Arrangements are in place which help to protect people from harm and abuse but more could be done to promote an open culture whereby concerns are seen to be positively received and appropriately handled. EVIDENCE: The organisation has a complaints procedure. Heighton House also has a more accessible version of this procedure with symbols and pictures which was on display in the office and by the front entrance. However, this needed updating as it contained old contact information for CSCI. There was a discussion about complaints received since the last inspection. According to the AQAA one complaint had been received in the last 12 months and this had not been upheld. However, this figure is at least three since one complaint was received in September 2007 and two in November 2007. These complaints were initially made to CSCI and passed to the service to investigate and report back. In addition we received information about another complaint made directly to the service in October 2007. The acting manager was not able to find any records of these complaints. The only complaints-related information found was a comment from earlier in 2007 in a complaints book Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 21 kept in an accessible area on the ground floor, with no indication of what, if any, action had been taken in response. This book contained sensitive information. It was pointed out that it needed to be stored securely. As such it was concluded that there appeared to be no records kept in the home of complaints, investigations, outcomes and actions. The most recent inspection itself had been in response to a complaint. This is available as a random inspection report dated October 3rd 2007. This had been about staffing levels and the quality of the food. It was found that there was no direct or firm evidence that staffing levels were too low although a recommendation was made to increase them. There was also no evidence that the quality of the food was unsatisfactory. Some of the people living in the home were asked whether they felt able to raise issues with the manager and staff. They indicated that they did feel able to and that the staff were good listeners. There was mixed feedback from family members about the complaints system in the home/service. One person commented that they knew how to make a complaint and that when they had done so it had been dealt with swiftly and professionally. Another respondent reported that they did not know how to make a complaint. A third person wrote that they knew how to complain but indicated that the service was not good at responding to the issues raised. Evidence was seen on file that staff were trained in the management of challenging behaviour. Staff spoken with confirmed this, though some considered that they needed more input in this area as they felt lacking in confidence. Staff confirmed that there was no restrictive physical intervention used in the home and there was no reference to such practices in daily entries and incident sheets. Clear and detailed care plans were seen to be in place around the management of challenging behaviour. Many of these had been created by a specialist working with the team. However, there was evidence in daily notes that staff had not been adhering to some aspects of one person’s behaviour management plan since they had been threatening to call the police and also indicating to the person that their behaviour may result in activities being withdrawn as a sanction. The specialist had picked this up during a recent review and had already taken steps to ensure that the plan was followed. Nonetheless it is concerning that staff were either disregarding or unaware of key aspects of the plan. However, the majority of notes provided evidence of behaviour management plans being followed and appropriate strategies being adopted. Staff spoken with described the approach that they used to prevent and manage challenging behaviour. Training records and discussion with staff provided evidence that adult protection training was being provided. The service was aiming for this to be Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 22 regularly repeated. This is good practice. Staff were able to describe their responsibilities around adult protection and said that they would report any incidents. However, some people expressed concern about what they saw as a lack of responsiveness when issues were raised and a defensive stance being adopted. The acting manager felt that this was not the case. Although this may be a perception it is nonetheless significant since it impacts on the willingness/confidence of staff to raise concerns and blow the whistle. Staff anxieties in this area should be explored and actions taken as necessary. It was understood that the area manager was due to meet some staff in the near future and that this may be one of the issues covered. Some of the people living in the home were asked if they felt safe. They indicated that they did. One person said, “yes – safe and sound”. Inventories were seen on people’s files. These appeared to be up to date, with recent entries made. Records of two people’s finances were looked at. Cash balances tallied with records. Receipts sampled could also be traced to the running record. A financial audit had recently been conducted by a team in the organisation. The outcome was positive. A recommendation was made to undertake balance checks on people’s finances at least weekly. However, records showed that this remained about fortnightly. During the most recent inspection some issues had been picked up with finances. It appeared that some of the people living in the home had been charged for items which they should not have paid for. The acting manager was not able to locate evidence that this had been investigated and refunds issued where necessary. However, evidence that this had been addressed was forwarded shortly after the visit. During the last inspection it was found that a shared loyalty card was in use and that this was in a staff member’s name. It was pointed out that this put staff in a vulnerable position, and that working out a fair distribution of accrued benefits would be difficult given the differing contributions made by the people living in the home. Staff reported that this card was no longer in use. Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 23 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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst the home is clean and well decorated in parts, there are significant environmental shortfalls which impact on people’s safety, comfort and quality of life. EVIDENCE: All of the communal areas and some of the bedrooms were checked. The following issues were noted: • • Carpets in many communal areas were heavily stained. This included the conservatory, lounges and some parts of the corridors and stairs. Some of the stair carpets were also sagging. Carpets in one of the bedrooms seen would benefit from replacement. The bedroom in question should also be redecorated since paintwork was tired and wallpaper borders were peeling. The acting manager said that this was being planned. DS0000016458.V358855.R01.S.doc Version 5.2 Page 24 Heighton House • • • • • • • • The carpet in the lounge was in two sections, with a significant gap which was unsightly and a potential trip hazard. The cabinet in the lounge had damaged wood and some missing handles. The ground floor shower room was becoming quite mouldy in parts. Some of the paintwork was becoming damaged, worn or stained, such as on doors, skirting boards and certain walls. Many areas would benefit from general ‘freshening up’. Some lights had no shades. The first floor bathroom had a very noisy fan. There was also no seat on the toilet. The window in the sleeping-in room had a cracked pane. The table in the conservatory was dangerously wobbly. Staff spoken with felt that a maintenance person was needed urgently in order to keep on top of the different jobs in the home. The acting manager reported that this was being addressed (see below). Bedrooms were seen to be pleasant and personalised. One bedroom was more minimally furnished. Staff explained the reason for this. According to one survey a bedroom was quite cold. The acting manager said that this had been investigated and the radiator bled. The acting manager reported that quotes were being obtained for replacing worn and stained carpets throughout the house. It was also stated that approval had been granted for refurbishing the kitchen in the near future. Staff reported that one of the showers was subject to significant fluctuations in temperature, to the point where it was sometimes scalding, representing a hazard. The acting manager said that this had been looked into and seemed to be related to when the cold water supply was in use elsewhere in the house. He indicated that the configuration of the plumbing made this difficult to resolve. Nonetheless if the temperature variations pose a risk to people there needs to be a system to regulate this or an automatic cut-out. The shower which was leaking at the time of the last inspection had been fixed. There were ants on some of the kitchen work surfaces. Staff reported trying to eradicate them with chemicals. The garden was seen to be well used during the visits. There is a flat and accessible lawn as well as some equipment for people to use. According to the AQAA there were plans for a new shed. The garden fence and patio had been improved. The acting manager said that consideration was being given to moving the office to the ground floor in order that management was less remote. Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 25 Policies and procedures were seen covering different aspects of infection control. Staff described the measures in operation in the home and the equipment that was available. The home appeared to be clean throughout. Staff reported that undertaking all of the cleaning was a major drain on their time and felt that there should be a dedicated cleaner. This had been reported before. The acting manager said that a maintenance person was being recruited imminently and that cleaning would also form part of their role. Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 26 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, 33, 34 & 35 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are skilled and caring, helping to promote the quality of care. Appropriate training is provided, although a systematic approach is needed to ensure that all staff have the input they need. Higher staffing ratios would help to improve the standard of care and people’s overall quality of life. Some aspects of recruitment and selection could improve, thereby promoting sound decision-making. EVIDENCE: According to the AQAA 50 of the staff either had or were working towards a relevant NVQ (National vocational Qualification). People living in the home were positive about the staff. There was also good feedback from relatives, as noted previously, although others had some concerns about the ability of the service to meet their family member’s needs. Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 27 Staff were observed interacting with the people living in the home in a warm and supportive manner. They were seen encouraging people to take part in activities or household tasks and also calming a situation where one person was upset. An entry was seen in the communication book written by an external professional. They praised the staff for the way in which they were working with one person resulting in fewer incidents of challenging behaviour. Staff spoken with demonstrated a reasonable knowledge of the needs and conditions of the people living in the home, and of people’s care plans (although as noted earlier some significant deviations from one person’s behaviour support plan had recently been picked up). A care manager wrote that staff had ‘a good knowledge of care support needs’. During the hours of structured observation using the SOFI tool staff interaction with one person was considered. Interactions were seen as positive, with the person responding to communication, being offered choices and being encouraged to take part in activities. However, it was passed on to the acting manager that there could have been more engagement with the person. There was a period of about 45 minutes where there was no communication from staff, following by a stretch of 40 minutes without any attempt to engage. During previous visits team members have commented on staffing levels, many feeling that they were too low, particularly on weekday mornings and at weekends when there are generally just three people on shift (excluding the daycare coordinator and management team). During this inspection many staff raised the same issue, again highlighting that they are also having to undertake cleaning duties. As noted, many staff felt that activity provision at the weekend was inadequate and that higher staffing ratios would be of great benefit to the people living in the home. Since the previous inspection three new staff had started work at the home, although only one of these remained in employment. The reasons for this were discussed with the deputy manager. The experience had resulted in a change of approach to aspects of recruitment and selection. The organisation has policies covering different aspects of recruitment and selection. The acting manager described how he went about recruitment. This included interviewing using standard questions. He said that he interviewed on his own and keep no records of the interviews. It is recommended that there be at least two appropriate people on the interview panel and that records are kept of candidate’s responses to questions/scenarios. The manager said that since then he had attended training about recruitment and selection. The staffing file of the remaining new starter was checked and found to be satisfactory. Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 28 A training planner was seen, along with evidence of various training booked for the near future. Training records for two staff were checked. These provided evidence of a wide range of training being provided. This included mandatory training as well as input in areas such as total communication, adult protection, equal opportunities, epilepsy, infection control and challenging behaviour. However, it was not possible to establish whether one long-serving staff member had ever received first aid training and nor was this booked. There were other occasional gaps in the records making it unclear whether some staff had received certain key training. This suggests that a systematic audit should be done to ensure that all staff have the training that they require. There had been reference to a training audit in a recent Regulation 26 report (written by a representative of the organisation following a formal visit) but the acting manager was not aware of this having been done. Staff expressed general satisfaction with the training that they were provided with, although some people felt that some additional specialist training would be helpful. Areas cited included the management of challenging behaviour, mental health input (as relevant to people living in the home) and autism, although some people had received input in some of these areas. In addition, there was a lack of confidence by the acting manager and staff about the Mental Capacity Act 2005, indicating that additional training would be beneficial. Some literature was available in the home about this legislation. Team leaders were beginning to undertake supervision sessions with other staff. It was agreed that some training/input about conducting supervision may be helpful. Some people expressed an interest in taking more detailed medication training. Although there was evidence that staff had undertaken some training about medication, more in-depth input should be considered where identified as learning need. The AQAA noted plans to ‘provide more specialist training in areas required for the changing needs of our service users’. This would accord with the observations made above. In surveys forms further comments were made about the need for more specialist training. One person wrote, “If we had more knowledge we would provide better care”. Handover sheets were seen conveying key information between staff on different shifts. One entry for 14/04/08 stated that a person had attended an activity which they had not. Caution needs to be exercised to ensure that these records are accurate. The most recent staff meeting minutes were dated 11/09/07. The manager said that there had been a meeting since then although no records could be found. Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 29 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): 37, 39 & 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The appointment of a competent, experienced and suitably qualified manager should help to improve outcomes for the people living in the home. Systems are in place which help to monitor and improve the quality of care. Some areas of health and safety are beginning to slip, presenting some risk to the people living in the home. EVIDENCE: As noted, at the time of the visits there was no registered manager. The deputy manager was acting up pending the appointment of a new manager. It was understood that interviews were taking place and that an appointment Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 30 would be made in the near future. This was later confirmed by the area manager. Staff expressed some concern about how the home had been run in the recent past. Common themes were that there had been a lack of consultation with staff and that communication between management and staff could have been better. This was echoed in some staff surveys. People reported that there had been no notice of the manager’s departure, leaving them feeling surprised. As noted earlier, concern was also expressed about what was seen as a lack of responsiveness when issues were raised and some defensiveness. There were reports of staff morale being low. Clearly the above will need to be taken into account by the new manager and steps taken to address theses perceptions and concerns. The acting manager said that he attended regular managers’ meetings and found these helpful. He said that he was receiving sufficient support in his current role whilst acting up. The organisation has a series of audits covering different areas. Some recent audits were seen including for health and safety, facilities, food safety, infection control and care. High scores were recorded. As noted, there had been a recent financial audit by a representative of the company. This resulted in some recommendations although the overall outcome was positive. Craegmoor operates a ‘Your Voice’ forum whereby people from different homes in a region get together and exchange ideas and feedback. Three people from the home were reported to attend this from time to time. We are being sent copies of the reports made the area manager about the home (as required under regulation 26 of the Care Homes Regulations). These formal visits take place about once a month. Minutes were seen of some residents’ meetings. These were said to take place about every six weeks. Some staff were spoken with about health and safety. They generally felt that this was managed reasonably well although as mentioned concern was expressed about a shower which fluctuated in temperature. Records of different health and safety checks were seen. The following issues were noted: • • The fire risk assessment was dated December 2006. This would benefit from review. The last recorded fire alarm test had been on 17/03/08. Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 31 • • Emergency lighting records showed that the last test had been on 03/01/08 Hot water temperatures were scheduled to be done each month. Those for February 2008 were reasonable though some were on the cool side. No tests were recorded for March 2008. The above indicated that there had been some slippage in basic checks, although other areas appeared to be satisfactory. One person had a number of electrical devices connected to a multi-socket unit. Some of the cables were fully taught but not quite long enough to allow the unit to sit on the floor meaning that it was suspended at one end. This should be addressed. Ideally more sockets should be installed in the room. A check by Environmental Health had taken place in March 2008. There were some recommendations but a rating of three stars (good) was awarded. A health and safety file was seen with a range of policies and procedures covering different areas. Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 32 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 2 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 1 23 2 ENVIRONMENT Standard No Score 24 1 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 2 36 x 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 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 x 3 x x 2 x Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? YES 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 YA7 Regulation 17 (1) a. Sch. 3.3 Requirement Record any limitations agreed with people as to their freedom of choice, liberty of movement and power to make decisions (see example in text). Timescale of 31/07/07 not met. Update the complaints procedure such that the contact details for CSCI are correct. Ensure that there is a record of all complaints about the service and actions taken as a result kept in the home. Replace heavily stained, worn and damaged carpets as appropriate in communal areas and bedrooms. Take steps to remove the mould in the ground floor shower room. Redecorate as necessary. Provide a toilet seat in the first floor bathroom. Replace the wobbly table in the conservatory. Investigate whether the temperature fluctuations in a first floor shower pose a risk to people living in the home. Take any necessary action such as fitting a regulator or cut-out. DS0000016458.V358855.R01.S.doc Timescale for action 31/05/08 2 YA22 17 (2). Sch. 4 (12) 22 (7) 30/06/08 3 YA24 16 (2) c 23 (2) d & e 23 (2) d & e 23 (2) 13 (4) 23 (2) 13 (4) 31/07/08 4 5 6 7 YA24 YA24 YA24 YA24 31/07/08 09/05/08 09/05/08 09/05/08 Heighton House Version 5.2 Page 34 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 YA2 YA6 Good Practice Recommendations Consider ways of making the Service Users Guide more accessible, such as by adding photographs. The acting manager should have more training/support around the admissions process, including needs assessment. Monthly keyworker reports should provide sufficient detail/explanation to back up statements made. Goals should be clear and there should be description of how they were arrived at/the person’s involvement and how they will be worked towards. See examples in text. Ensure that documents have the full date (including year) Care plans should make more reference to people’s strengths/abilities and to the potential for people to develop their skills in particular areas. Ensure that care plans are clear and provide sufficient detail, avoiding more vague terms such as ‘support’. Audit care plans for unnecessary duplication/repetition. Rationalise/remove care plans as necessary. Ensure that all care plans are regularly reviewed. Aim to include more information in evaluations about progress and developments. Also include more evidence of the involvement of the person in care plan reviews. Continue to train staff in total communication principles and to apply these creatively and individually in the home. Ensure that risk assessments provide sufficiently clear guidance about how risks are managed. Evaluations of risk assessments could include more detail about progress (see example in text). Daily entries should give sufficient detail about activities, such as describing the destination and duration of a drive and whether the person enjoyed the experience. 4 YA6 5 6 YA6 YA9 7 YA12 Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 35 8 9 YA12 YA16 10 YA19 Aim to offer more activities at weekends, in accordance with individuals’ needs and interests. Ensure that television volume is set at a reasonable level rather than being left at a high volume for long periods of time. People should be offered a key (or suitable locking device) to their room if they want one. Where this is not appropriate there should be a written assessment describing how this decision has been reached. It is recommended that healthcare notes be subdivided, with a different sheet for each specialism, rather than a purely chronological record of all healthcare appointments/interventions. Keep health action plans under regular review. Ensure that medication administration records are consistently signed immediately after the person had taken their medication. The medication file should include a photograph of all of the people living in the home. Seek individual GP approval for the over the counter remedies/supplements in use in the home. Create a central and systematic log of all concerns and complaints, including investigations, findings and actions. Ensure that all of the people living in the home and their representatives know how to make a complaint. Explore/consider staff anxieties around the management of challenging behaviour (see text) and whether any further training/guidance is required by all or some staff. Ensure that all staff are familiar with, and fully adhere to, support plans around the management of challenging behaviour. Explore and address the staff perception of inaction or a defensive stance when concerns are raised or there is a whistle blowing incident. Promote a culture whereby concerns raised by staff in good faith are positively received and appropriately handled. Undertake balance checks on people’s finances at least weekly. Ideally this should be done at least once a day. Redecorate bedrooms where paintwork/décor is tired and worn. Replace the damaged cabinet in the main lounge. 11 YA20 12 YA22 13 YA23 14 YA23 15 16 YA23 YA24 Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 36 Redecorate communal areas of the home where paintwork is tired, worn, stained or damaged. Provide shades for all lights. Investigate the reason for the fan in the first floor bathroom being noisy. Take steps to address this. 17 18 19 20 YA24 YA30 YA32 YA33 Replace the cracked windowpane in the sleeping-in room. Arrangements for maintenance should be formalised urgently such that the home has a dedicated maintenance person. It is strongly recommended that a cleaner should be recruited and start work in the home as soon as possible. Ensure that shift handover records are fully accurate. There should be a minimum of four care staff on each shift, not including the daycare coordinator and manager/deputy manager. Consider also increasing staffing ratios at weekends in order to offer more activities. It is recommended that there be at least two appropriate people on the interview panel and that records are kept of people’s responses to questions/scenarios. A systematic training audit should be done to ensure that all staff have the training that they require. Consider also the specialist training needs of staff (see examples in text). This should include training about the Mental Capacity Act 2005. Staff undertaking supervision sessions should have some training/input about this. Consider whether all or some staff would benefit from more in-depth training about the safe handling of medication. Review the fire risk assessment Test fire alarms at least once a week. Emergency lighting should be tested at least monthly. Hot water temperatures should be consistently tested every month. Take prompt action if found to be too hot or cool and retest to check if rectified. Resolve the issues resulting in a partially suspended multisocket unit in one person’s bedroom. Ideally more sockets should be installed in the room. DS0000016458.V358855.R01.S.doc Version 5.2 Page 37 21 22 YA34 YA35 23 YA42 24 YA42 Heighton House Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Heighton House DS0000016458.V358855.R01.S.doc Version 5.2 Page 38 - 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. 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