Inspection on 18/05/06 for Heighton House

This inspection was carried out on 18th May 2006.

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

The inspector found 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 27 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 14/04/08

Heighton House 24/04/07

Heighton House 28/11/06

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 Ms Tanya Harding Key Unannounced Inspection 18 and 23rd May 2006 08:45 th Heighton House DS0000016458.V300806.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.V300806.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.V300806.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 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) Cotswold Care Services Limited To be appointed Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd November 2005 Brief Description of the Service: Heighton House is a residential care home that provides accommodation for up to eight adults with learning disabilities who may also have challenging behaviours. Five service users are currently living in the home. The home is a large two storey detached house situated approximately one mile from the centre of Gloucester and is sited on a busy main road with good access to public transport. Accommodation on the ground floor is spacious, consisting of a laundry, kitchen, dining room, lounge, a large conservatory, toilets and one bedroom. Part of the dining room has been equipped as a sensory/ relaxation area. On the first floor there are seven bedrooms and a sleep-in room. One of the bedrooms has its own en suite facility with a bath. There are also two communal bathrooms, one of which has a walk-in shower, a separate toilet and an office. Heighton House is owned by Craegmoor Healthcare. The Organisation has a policy about admission. The home has a Statement of Purpose and Service User Guide documents which sets out information about the philosophy of the home and about the facilities provided. This is available on request to prospective residents and their families. Fee levels for the home range from £929.19 to £1269.41 per week. Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place in May 2006 and included two visits to the home on May 18th and May 23rd. The inspection lasted for over eight hours during which people living at the home were spoken with and their care was observed. Both visits were supported by the deputy manager as the home manager was on leave. Discussions took place with three members of staff and with the activities coordinator. The care of three people living at the home was case tracked. This involved looking at their records, discussing their care with staff and observing them during the visit. Other information examined included staff files, health and safety records, and medication administration records. A pre-inspection questionnaire was returned to the Commission after the visit. Five surveys have been returned completed by the service users (with staff support). The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? The home has a new manager and deputy and this has given the home a new focus and direction. Staff morale appeared lifted and comments received from the staff showed that they now feel more valued in their work. The home manager is experienced in supporting this service user group and the benefits of her expertise in running a care home and supporting the staff team were evident during this visit. Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 6 Progress has been made in revising plans of care and risk assessments. Three new service users have moved into the home and appeared to have settled in well. The additional numbers have further secured the financial viability of the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 7 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.V300806.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Outdated details in the Statement of Purpose and the Service User Guide are likely to give an inaccurate perception of the home and facilities to any prospective service users. Steps are taken as part of admission to the home to re-assess the needs of individuals and people are supported with the transition in order to help them settle in. EVIDENCE: There have been significant changes in the home since the last inspection and the Statement of Purpose and Service User Guide need to be updated to reflect these changes. Both documents need to be in formats which are meaningful and accessible to the service users. Once updated, copies of the above documents must be forwarded to the Commission. The Organisation has an admissions procedure. It was not possible to make a full assessment of how this was used when three service users were admitted to the home a few weeks prior to the inspection. This is because these admissions were as a result of a closure of another Craegmoor home and not at the request of the service users. Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 9 Records seen during the inspection showed that re-assessments of need have taken place with the relevant placing authorities and service users had a number of visits to the home to see their new rooms and to meet the existing residents and staff. All of the new service users were met and two were able to comment about the move to Heighton House. One person confirmed that they came to look around the home before the move and knew which bedroom they would have. Both service users said they liked the home and the staff very much. Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Improvements to care plans should provide staff with a better overview of people’s needs and of how these should be supported. Remaining shortfalls need to be rectified as soon as possible to ensure consistency of approach. Risk assessments may not be sufficiently robust to protect service users from harm and some may restrict people’s freedom unnecessarily. EVIDENCE: Previously there have been concerns about the quality of care plans and support guidance. Significant shortfalls were identified in care plans in past inspections which showed that many of the service users’ assessed needs were not being addressed. Files for three service users were examined on this occasion. A number of improvements were noted but much work remains to be done to bring all of the care guidance to the acceptable standard. Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 11 Some of the revised care plans and risk assessments appeared quite generic, lacking information which would be unique to a particular service user. For example the risk assessments / care plans about ‘out and about’ were seen for two differed service users. The information in these was almost identical. One person has significant mobility needs and may require a wheelchair on occasion. This was not mentioned in their care plan. The same person has behaviours which may compromise their safety whilst out (running off). Again there was no mention of this in the care plan although there was a risk assessment regarding home visits, which did talk about this behaviour. Other risk assessments seen did not provide a comprehensive overview of hazards and may potentially limit service users in what they are able to do without a good reason. Staff skills in putting together care plans and carrying out risk assessments are discussed in Standard 35. Caution should be exercised when duplicating information and using care plans of other service users as examples. This is to avoid information which belongs to other service users being left in someone else’s file. For example the contract on one persons’ file had a name of another service user included (presumably by mistake) in the text. Also, care guidance found on one file belonged to another service user in the home. An observation is also made about the quality of care plan evaluations and the team leader reports. These methods of monitoring whether changes to care guidance may be necessary are not being completed with the detail which could usefully serve the intended purpose. The home should review the use of these records and consider more informative ways of monitoring how care plans work in practice. An Essential Lifestyle Plan was seen for one service user and this provided detail of who contributed to the information. This is good practice. The missing persons details could only be found for the three new service users. The manager should establish whether missing person’s details exist for other residents in the home and if not these must be put in place with reminders about the relevant policy issued to all staff. A box file containing personal records of a number of service users was found in one bedroom. The bedroom was occupied by a service user. Leaving sensitive records in an area, which leaves them open to misuse, is seen as a significant breech of the regulations about keeping such records safe and confidential. The files were removed from the bedroom immediately and stored in a more appropriate place. The home must ensure that all information belonging to the service users is stored securely at all times. Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home who are able to voice their views may be consulted about their preferences for activities from a range of social, education and work opportunities. However, there may be lack of meaningful consultation with service users who have communication difficulties and it is possible that they are not offered activities in line with their needs and preferences. Contact with family and friends is encouraged and supported. Service users autonomy of movement may be compromised through lack of guidance and understanding of acceptable risks by staff. Meals provided in the home appear varied but should be assessed for nutritional balance. EVIDENCE: Previously concerns were raised about lack of meaningful and appropriate activities for the service users. Care plans about people’s interests and how Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 13 they will need to be supported in taking part in valued activities need to be developed. The activity co-ordinator also explained that before the new manager came to the home there was no clarity over how activities were being funded. This caused a number of difficulties and limitations on which activities the service users could access. One of the new service users was very keen to find out what local activities they could join in and staff were facilitating this by taking the person to different venues. This is good practice. It was observed that there are some restrictions on service users around the home. People are restricted from leaving the house without staff support. The front door has a combination lock, which the service users were unable to use and the front gate is padlocked. One person was observed coming out of the house and standing by the gate. Staff were keen to get the person back into the house and this involved physical intervention. (see also Standard 23). It is accepted that some service users in the home may have little awareness of danger and the proximity to the main road would further increase their vulnerability if they were to go out unsupported. However, in this instance as the precautions were already in place (the locked gate) it was difficult to see why the person was being prevented from standing outside. Risk assessments are being compiled for community activities and this must also be done for activities in the house, to include access to the garden and other restricted areas. Robust risk assessments would enable the service users to be more autonomous and would encourage greater independence. It is for these reasons that the home would greatly benefit from a more secure garden. There are also restrictions on accessing the kitchen. From discussions with staff there appeared to be an ad-hoc management for managing this and could lead to inconsistency of approach. Consideration needs to be given to enabling those service users who may be able to use the key / key-pad to have greater independence in accessing the kitchen, the garden and the community within a comprehensive risk assessment framework. There was evidence from the records in the home and from discussions with care staff that cultural needs were taken into account when providing meals for one specific service user. There was also an acknowledgement that the person may not be able to make an informed choice on this and would not be prevented from having certain foods if they choose to. Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 14 Staff explained that following the departure of the previous manager, some of the routines for service users have changed for the better. One example given was that a particular service user who finds mealtimes difficult, is now offered an alternative area in which to have their meals. Records of the choice made by the person and whether there are any difficulties during the meal are kept. Staff felt that since this flexibility has been introduced, the service user has enjoyed their meals more and the frequency of undesirable behaviours has significantly decreased. This is seen as very positive for the resident. In the previous report the home was asked to find out more information about how a particular food allergy affected one service user. Details of this were not found in care records. The person’s key-worker followed this matter up with the relatives and established that the allergic reaction is potentially life threatening. Advice must be sought from the medical professionals as to the severity of the condition and about the reactive strategies which will be required in the event of an allergic reaction. There is a four-week rolling menu which incorporates a number of traditional foods, light meals and healthy options. Fruit and vegetables feature every day. Information about foods consumed is recorded in the daily notes. As part of the recent complaint investigation the home was required to consult with a dietician to assess nutritional value of the diet for one specific service user. This is because there were concerns about the person having too much sugar and this having an adverse effect on their dental health. There was no evidence that this requirement has been addressed. This requirement is repeated. Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is better monitoring of assessed needs around sleeping patters and improved guidance about clinical procedures for one person. However, further clarity in care guidance is necessary to ensure that service users’ health needs are being met consistently and that people’s privacy and dignity is not compromised. Shortfalls in the way medication records are being completed could lead to errors to the detriment of the service users. EVIDENCE: Care files contained guidance about supporting people with their emotional needs and with personal care. More comprehensive information has been provided with regards to managing stoma care for one person and the person’s sleeping patterns. One person was observed communicating with aid of signs. Staff were seen to be responding verbally to the person. Although there was good understanding by staff of what the service user was saying, lack of response using the sign language is likely to devalue the individuals’ preferred method of Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 16 communication. Previously a requirement was made for staff to receive training in Total Communication and steps must be taken to address this. Some information was seen on care files about how individuals communicate. This could be further expanded. A requirement to implement a care plan with detail on how to support a specific service user who has epilepsy has not been addressed. This is seen is a critical matter and must be addressed promptly. A requirement to provide a protocol for the use of ‘baby’ monitor was examined. This talks of the receiver being placed in the staff room. It was noted that this is actually an area next to the kitchen and is part of the registered communal space, which should be used for the benefit of the service users. (See Standard 28). The protocol advocates the use of the monitor for night-time only. However, there were conflicting statements in the protocol about its use. More specifically, the protocol states that the monitor will be switched off during the day, but another instruction was seen which states that the monitor will remain switched on when the service user for whom this listening device is intended, goes into their room. This protocol must be revised to give clear guidance as to when this device is to be used, for what reason and how the person’s privacy will be protected when the device is in use. It is not seen as acceptable for the monitor to be left switched on in a communal area where everyone can hear what the service user is doing in the privacy of their own bedroom. Records of health related appointments are maintained, with outcomes being recorded in individual files. However, quality of these varied. For example for one person the last entry on the health record was for a flue injection in November 2005. In a team leaders record for May 2006 it talked about the service user ‘still requiring a blood test’. No reference could be found in the health records as to why the blood test was needed and why this has not been carried out as yet. Monitoring of weights is taking place. A number of medication records were examined and overall these were in order. However, on two occasions (in March 2006) tippex had been used to make an alteration to the staff signatures. There were also some gaps in signatures for April 2006 where it was not clear whether medication was actually administered and if so, by whom. These shortfalls could lead to confusion and errors. The home is reminded that the Medication administration records must be accurately maintained at all times. Staff spoken with advised that the temperature of the medication cabinet is not being monitored as previously required by the Commissions’ pharmacist. This requirement is repeated. Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 17 Staff confirmed that the medication cabinet keys are kept by the shift leader who carries the responsibility for administering medication on their shift. Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Better guidance around behaviour management for service users should help staff to respond to difficult behaviours and ensure their approach is respectful and non restrictive for the benefit of the service users. EVIDENCE: There have been no complaints about the home since the last inspection. A number of requirements made following the complaint investigation in November 2005 have not been addressed and are included in this report. It is understood that the home has an allocated activities budget, although for some activities the service users would be expected to pay for themselves. In the absence of the home manager it was not possible to be clear as to how this is monitored and further discussion on this matter may be necessary at future inspections. In order to ensure that all service users and staff are clear about who pays for what and there is no scope for confusion and misuse of moneys, the home is asked to check whether there is a clear and documented procedure for this and to remind staff of its contents. If no such procedure exists, this must be compiled. The home is asked to forward a copy of this procedure to the Commission for reference. The home is carrying out some behaviour monitoring for service users. A reactive strategy was also seen for one service user. However, it was noted that some of the behaviours are not being monitored and no strategies on how to respond to these have been developed. Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 19 It was also observed that staff use physical intervention to redirect service users where there are perceived dangers. Previous requirements were made for the home to identify all restrictive practices and to record the use of all physical intervention and report any such incidents to the Commission. This is not being done. Staff spoken with felt that physical intervention is not used, although breakaway techniques may be used on occasion. As the use of physical intervention was observed on this and previous occasions (see Standards 11-17 and the last inspection report) this matter requires further discussion and implementation of clear guidance as to when staff may be required to use physical intervention. Any such protocols must be in line with the Department of Health Guidance on the use of restrictive physical interventions. Care files for two service users who were case tracked contained behaviour care plans. There was an emphasis on consistency of approach by staff. There was also some guidance on prevention through anticipation of the potential problems. For example one person becomes very anxious if some one new is visiting the home. There is guidance about how to relieve this anxiety and to avoid any possible confrontation. Preventative strategies are seen as good practice. Some behaviour monitoring charts are being used. However, it is likely that more work will be needed in this area to relate information on behaviours to the support guidance. The home should seek guidance from a suitably qualified professional about compiling behaviour strategies. Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall environment of the home is very pleasant and provides service users with space and facilities for comfortable living. However, some parts of the environment may be unsafe for people and restrict individuals’ independence. EVIDENCE: There are spacious community areas for the use by the residents. There is a lounge with soft seating and a large conservatory which is primarily used for activities and as an additional dining area, to offer people a choice of where to have their meals. There is a large dining room with part of the space being used as a relaxation and sensory area. This appears to work well, as the dining room is only used at meal times. There is a small seating area next to the kitchen which is favoured by some of the residents as it is at the heart of the home. This is also used for storing daily records and other administrative tasks. There is a large notice board and a daily communication board where plans for the day are written. It appears that this room is also known as the staff room. This is not the case as this space forms part of the registered communal area for use by the residents. Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 21 Consideration should be given to making this area more homely by making administrative and staff related aspects more discrete or relocating the staff board to a more suitable area. All of the bedrooms have a hand washbasin, however there is no water supply to at least two of the rooms. The reasons for this must be documented in the individual care files and justification of the decision must be evident. The home has a very spacious garden and this could be used for the benefit of the service users. However, in its current state there are a number of significant hazards which prevent some residents from using the garden independently. This is seen as very restrictive for people and must be addressed as quickly as possible. The deputy manager confirmed that finances for carrying out the necessary improvement works have been approved. No date has been given for when this work will commence. Another hazardous area, which has not been rectified, is the damaged concrete path next to the gate. This is the main route used to go out into the community and for visitors who are coming into the home. This area must be made safe by removing the tripping hazard. A number of maintenance issues were noted during this visit and must be addressed as follows: a) A suitable window restrictor must be fitted in Bedroom 5 and restrictor in another bedroom adjusted to a safe width; b) A wobbly bed in one bedroom must be repaired or replaced; c) The hole left following in replacement of the door lock in one bedroom must be filled (or door replaced to ensure compliance with fire safety regulations); d) Ripped and uneven lino in the small sitting area next to the kitchen (the red room) must be replaced; e) Lighting in the ground floor shower room must be improved. f) The adaptable chair in the shower room is in poor condition. The home needs to consult with the Occupational Therapist about a suitable replacement. It is also recommended that: a) The boiler in the kitchen should be boxed in; b) Vegetation growing in the gutters should be cleared. There was no evidence that the home has carried out a consultation with the Environmental Health officer about the use of the laundry for storing clinical waste. No record could be found of when the kitchen was last inspected. Some parts of the kitchen were not clean to a satisfactory standard during the visit. The home must carry out a consultation with the EHO and aim to arrange an inspection visit to address the above matters. Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment process in the home incorporates measures for vetting of staff who may be unsuitable to work with vulnerable service users. Staff may not have the necessary skills in supporting the specialist needs of the service users and could be employing strategies which may not be in the best interest of the service users. EVIDENCE: A large proportion of the staff team have been employed from abroad. The necessary checks and authorisation forms were seen on personnel files. Staff spoken with during the two visits demonstrated a satisfactory command of English language. A number of staff files were examined and contained the necessary recruitment checks. It is recommended that translation of references supplied by staff in their native language is done by a certified interpreter (and not an employee of the home). No new staff have been employed since the last inspection. Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 23 Staff rotas provided evidence that there are four staff on duty on during the day in addition to the manager. There are two night staff (one waking and one sleeping in). Staff are offered overtime to cover for absences and this results in some staff working regular double shifts and working on their days off. It is understood that the number of hours worked by each staff is monitored by Craegmoor personnel office. Some nights are staffed by two male staff and this may not be appropriate if the female service users require personal care for example. The home should check its policy on providing gender appropriate support with personal care and ensure that this is reflected in the way the home is staffed. Requirements were issued in the last inspection report for all staff to receive additional training in how to respond to aggression and behaviour challenges, training in Autism, Total Communication, working with People with Learning disabilities and Person Centred planning. Some training about person centred approaches was delivered in December 2005. However, no evidence of other training as above was seen. These are key areas which would be of benefit to staff to ensure they have the necessary understanding and skills to support the service users. Staff have not received formal training in epilepsy as required in the last report. Key staff are asked to write care plans and risk assessments for the service users but their skills in carrying out these tasks are limited. It is acknowledged that the care plans and risk assessments which have been updated and revised are much better than the previous ones. However, some are not sufficiently explicit about approaches which staff are asked to employ. For example where risk assessments talk about ‘removing the service user’, lack of detail on what is meant by ‘removal’ could lead to inappropriate actions by staff and does not promote consistency. Also as noted under Standards 6-10, care plans should reflect the needs and preferences of the individual service users. Staff with the responsibility for compiling care plans advised that some information has been given to them including sample care plans by a Craegmoor representative. This should be built on further. Without suitable training, staff are likely to produce care plans which are more general and repetitive for different individuals (as was seen to be the case already). Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management of the home have a good understanding of shortfalls which once addressed should promote the rights and best interests of people living there. The home’s quality assurance programme could be improved to better involve people living at the home in the review of services being provided and to ensure accuracy and relevance of records. Systems are in place for enabling the home to provide an environment that promotes the welfare and safety of people living there, but better health and safety monitoring is needed to ensure people are protected as necessary at all times. Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 25 EVIDENCE: The home has had a considerable a period of time without a registered manager. The previous home manager had submitted an application to register with the Commission but was dismissed from the home before this was completed in January 2006. The home has failed to meet a large number of requirements with some being carried over from previous inspection reports. This report presents an overview of where progress has been made. It shows that improvements have been slow and this could be attributed to lack of an experienced manager and absence of a robust quality assurance systems. Since the departure of the previous home manager, an acting manager was appointed for an interim period of approximately three months and should be given credit for maintaining the focus on keeping the service users safe and the staff team motivated. She has now returned to her post as an activities coordinator. Staff spoken with felt the recent management changes have improved the team morale. The new home manager has started in April 2006, following her transfer from another Craegmoor home which had closed. The deputy manager and three service users also transferred from the same home. The new head of home has several years of experience of running a service for people with learning disabilities as a registered manager. In her new post she is required to submit a new application for registration with the Commission. There was evidence at this inspection that the new management team had began to address the shortfalls from previous inspections and appeared to have a clear vision of areas for improvement. The new manager has a considerable task on her hands and should be supported by the Organisation to implement the necessary improvements as quickly as possible. There has been a change in the area manager whose role is to support the home and to carry out unannounced visits in line with Regulation 26. It was not possible to locate the Regulation 26 reports on the day of the visit. The registered provider must supply to the Commission evidence that Regulation 26 monitoring visits have been carried out to the home since the last inspection in November 2005. All service users should receive an annual care review from their placing authority. The manager should check whether such reviews have taken place in the last 12 months for all service users. Where this is not evident, a review should be requested. This is in addition to the care reviews which the home is obliged to carry out every six months. Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 26 Water temperatures are checked weekly. Records of these showed that temperature in some water outlets is unacceptably high. This was in the laundry, the kitchen and the in the sleeping in room. This should be investigated and rectified where necessary. Records of fire alarm tests and fire drills showed these were done regularly. The cupboard containing chemicals was not secured at the time of the visit. The deputy manager advised that there is an expectation for this to stay locked when not in use. In addition to this a chemical agent was left out on the kitchen worktop posing another hazard to some of the service users. The home is reminded that where a hazard analysis / risk assessment shows that chemicals need to be kept away from the service users, this must be adhered to. Despite a recommendation in the last report to check if all windows have properly fitted and functioning restrictors, the window in bedroom 5 did not have a restrictor and potentially presented a significant risk to the service user. Some of the information supplied in the pre-inspection questionnaire was incomplete and the home is asked to provide the following information to the Commission: 1. 2. 3. 4. 5. 6. 7. 8. Confirmation of arrangement for disposal of soiled and clinical waste; Confirmation about last fire lecture / fire safety training for all staff; Confirmation of the fire equipment check being carried out in 2006; Confirmation of the necessary electrical safety checks (PAT); Confirmation of any maintenance arrangements for wheelchairs; Policy on use of physical intervention in the home; Information on training attended by all staff to date; List of staff who have left the home in the last 12 months and reasons for leaving. Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 27 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 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 2 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 2 29 2 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 1 1 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 2 X X 2 X Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 28 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 and 5 Requirement Updated copies of the Statement of Purpose and Service Users guidance must be forwarded to the Commission. Care plans must accurately reflect the assessed needs of the service users and provide guidance on how these will be met. Care plans must be developed around family contact and uptake of activities. Service users and other people significant to them must be consulted about what is important to them and distinguish between the aspirations of the individual and expectations of others. (Previous timescales of 31/04/05, 31/10/05 and 31/01/06 have not been met although significant progress has been made) The manager needs to DS0000016458.V300806.R01.S.doc Timescale for action 31/08/06 2. YA6 12, 14 and 15 31/08/06 3. YA9 13(4)(6) 31/07/06 Page 29 Heighton House Version 5.2 4. YA9 13(4) establish whether missing person’s details exist for other residents in the home and if not these must be put in place with reminders about the relevant policy issued to all staff. Risk assessments must be 31/08/06 completed for community activities. Risk assessments must also be carried out where necessary for activities in the house, to include access to the garden and other restricted areas. Risk assessments must clearly identify the needs of each individual. The home must ensure that all information belonging to the service users is stored securely at all times. All restrictive practices used in the home must be identified and evidence recorded in care plans of a multidisciplinary agreement that such approach is in the best interest of the service user. Care and support guidance must provide clear detail of any restrictive practices (reference to ‘removal’ of service users). (Timescales of 31/10/05 and 31/01/06 not met) Advice must be sought from the medical professionals as to what actions staff will need to take in the event of one service user having an allergic reaction to a DS0000016458.V300806.R01.S.doc 5. YA10 12 and 17 31/07/06 6. YA16 13(6) and 15 31/07/06 7. YA17 12 31/07/06 Heighton House Version 5.2 Page 30 particular food. 8. YA17 13(6), 17(1), Sch. 3 Consult with a dietician to 31/08/06 assess service user’s nutritional needs and assess whether food provided promotes his health and wellbeing (particular reference to the amount of sweet foods and drinks given). 9. YA18 10. YA18 (Timescale of 31/12/05 not met.) 12 The protocol for the use of a 31/08/06 listening device (baby monitor) must be revised to give clear guidance as to when this is to be used, for what reason and how the person’s privacy will be protected when the device is in use. 12(1)(2)17(1)(a) Consult with the speech and 31/08/06 language therapist and collate information on how one specific individual expresses their needs as guidance to staff. Collate a care plan which supports a two way communication between the service user and staff. (Timescale of 31/01/06 not met) There must be clear and detailed information (care plan) about the types of epileptic seizures which the service users are likely to experience. This must be collated in consultation with external professionals with expertise in this area. (Timescale of 31/12/05 not met) 11. YA19 12(1), 17(1)Sch. 3 31/07/06 Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 31 12. YA20 13(2) The temperature in the medicine cupboard to be monitored daily and all medicines kept at the correct temperature as indicated by the manufacturers. (Timescale of 15/12/05 not met.) 31/07/06 13. 14. YA20 YA23 13(2) 13(6)(7)(8) Medication administration 31/07/06 records must be accurately maintained at all times. Systems of monitoring, 31/08/06 recording and responding to behaviour challenges by service users must be implemented in line with the Department of Health Guidance on restrictive physical interventions and the relevant guidance from BILD. This must include written protocols which give clear guidance to staff on any agreed approaches including use of physical intervention and ‘as required’ medication. (Timescale of 31/01/06 not met – although progress has been made) All staff must receive 31/10/06 additional training in responses to aggression and challenging behaviours. Notify the Commission of any incidents where restrictive physical intervention has been used by staff or any other events which may be detrimental DS0000016458.V300806.R01.S.doc 15. YA23 13(6) 16. YA23 37 30/07/06 Heighton House Version 5.2 Page 32 17. YA23 13(6) and 17(2), Sch 4(8) to the service users. (Timescales of 11/10/05 and 22/11/05 not met). Ensure there is a clear and documented procedure about the use of service users money. Provide a copy of this procedure to the Commission for reference. A number of maintenance issues were noted during this visit and must be addressed as follows: a) A suitable window restrictor must be fitted in Bedroom 5 and restrictor in another bedroom adjusted to a safe width; b) A wobbly bed in one bedroom must be repaired or replaced; c) The hole left following in replacement of the door lock in one bedroom must be filled (or door replaced to ensure compliance with fire safety regulations); d) Ripped and uneven lino in the small sitting area next to the kitchen (the red room) must be replaced; e) Lighting in the ground floor shower room must be improved. f) The adaptable chair in the shower room is in poor condition and the home needs to consult with the Occupational Therapist to establish whether this is still suitable for the service user who uses it. Another hazardous area, which has not been 31/07/06 18. YA24 23 31/07/06 Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 33 19. YA24 23 20. YA28 23 21. YA33 13(6) and 18(1)(c) rectified, is the damaged concrete path next to the gate. This is the main route used to go out into the community and for visitors who are coming into the home. This area must be made safe by removing the tripping hazard. Address the damage caused 31/07/06 by a water leak on the main staircase. (Timescales of 31/10/05 and 31/03/06 not met) Works to make the garden 30/09/06 more accessible and safe for use must be carried out. (Timescale of 31/10/05 and 31/03/06 not met) 30/08/06 Staff must receive formal awareness training about epilepsy and more specific awareness on the type of support required for the individual service users if they are experiencing a seizure. (Timescale of 31/01/06 not met.) Staff must receive training relevant to their work and in key areas such as Autism, Total Communication, Person centred planning, Learning disabilities, Care Planning and Risk Assessments. Timescale of 31/12/05 not met. Application to register the new manager must be submitted to the Commission. A robust quality assurance system must be implemented which DS0000016458.V300806.R01.S.doc 22. YA35 18 30/09/06 23. YA37 8 and 9 31/07/06 24. YA39 24 (1)(3) 31/08/06 Heighton House Version 5.2 Page 34 provides evidence of critical analysis of all aspects of the service. Evidence of consultation carried out with service users and their representatives as part of this quality assurance system must be available for inspection. Timescale of 31/03/06 not met. The registered provider must supply to the Commission evidence that Regulation 26 monitoring visits have been carried out to the home since the last inspection in November 2005 to date. Some of the information supplied in the preinspection questionnaire was not incomplete and the home is asked to provide the following information to the Commission: 1. Confirmation of arrangement for disposal of soiled and clinical waste; 2. Confirmation about last fire lecture / fire safety training for all staff; 3. Confirmation of the fire equipment check being carried out in 2006; 4. Confirmation of the necessary electrical safety checks (PAT); 5. Confirmation of any maintenance arrangements for wheelchairs; 6. Policy on use of Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 35 25. YA39 26 31/07/06 26. YA41 17 31/07/06 physical intervention in the home; 7. Information on training attended by all staff to date; 8. List of staff who have left the home in the last 12 months and reasons for leaving. 27. YA42 13(6) Chemical agents must be stored securely at all times. 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations Changes should be made to how care plans are evaluated and monitored to ensure any such evaluation is meaningful and highlights any changes which may be needed to the care guidance. Consideration should be given to enabling those service users who may be able to use the key / key-pad to have greater independence in accessing the kitchen, the garden and the community within a comprehensive risk assessment framework. The home should check its policy on providing gender appropriate support with personal care and ensure that this is reflected in the way the home is staffed. The home should seek guidance from a suitably qualified professional about compiling behaviour strategies. Prescriptions from doctors to be seen and copied in the home before being sent to the pharmacy. Resident’s consent to medication to be obtained and recorded in the care plan. All medicine containers (other than MDS packs) to dated when first opened to allow correct stock rotation. Check whether all window restrictors have been fitted in DS0000016458.V300806.R01.S.doc Version 5.2 Page 36 2. YA16 3. 4. 5. 6. 7. 8. YA18 YA23 YA20 YA20 YA20 YA24 Heighton House accordance with the relevant safety guidance. It is also recommended that: a) The boiler in the kitchen should be boxed in; b) Vegetation growing in the gutters should be cleared. 9. YA24 The use of the new bathroom should be monitored and any difficulties with service users accessing this should be identified and appropriately addressed. Consideration should be given to making the area next to the kitchen more homely by making administrative and staff related aspects more discrete or by relocating the staff board to a more suitable area. The home should use a certified interpreter to carry out translation of references supplied by staff in their native language. The manager should check whether placement reviews have taken place in the last 12 months for all service users. Where this is not evident, a review should be requested. The reasons for very high temperatures in some water outlets should be investigated. Consultation may be necessary with the Environmental Health officer regarding safe parameters. 10. YA24 11. 12. YA34 YA39 13. YA42 Heighton House DS0000016458.V300806.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 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. 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