Inspection on 22/11/05 for Heighton House

This inspection was carried out on 22nd November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 18/05/06

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 Unannounced Inspection 22nd November 2005 1.00 Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 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.V268511.R01.S.doc Version 5.0 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.V268511.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Heighton House Address 19 Barnwood Road Gloucester Glos GL2 0SD 01452 380014 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) heighton.house@craegmoor.co.uk Cotswold Care Services Limited To be appointed Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd June 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, conservatory, large activity room, and one bedroom. Part of the dining room has been equipped as a sensory/ relaxation area. On the first floor there are eight bedrooms although one is used as the sleep-in room. One of the bedrooms has its own en suite facility with a bath. There are also two bathrooms, one of which has a walk-in shower, a separate toilet and an office. Heighton House is owned by Craegmoor Healthcare. Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place over four hours. The home manager was present throughout the visit and the area manager was in the home for part of the inspection. The main focus of the inspection was to assess compliance with previous requirements. A number of care files were examined and care of two service users was examined in detail. The majority of the service users are not able to comment about the care they receive and some of the inspection time was spent observing interactions between staff and service users. Several staff were attending in-house training in the home at the time of the visit. At the request of the CSCI Regulation Inspector for this home a CSCI pharmacist inspector carried out a specialist inspection of the arrangements for handling medication (Standard 20 National Minimum Standards Care Homes for Adults 18 – 65). This inspection took place over three hours during the afternoon of Tuesday 22nd November 2005 and examined some stocks and storage of medicines, a sample of Medication Administration Record (MAR) charts, other medication records, the medicine policy and procedures. There were discussions with the manager. Since the last inspection the Commission has carried out an investigation into concerns about care practices in the home and the summary and outcomes of this are detailed under the relevant standards. Following the investigation a meeting took place with the home manager and the area manager to discuss how the home intends to address the large number of resulting requirements. This inspection provided evidence of continued non-compliance and the Commission will be considering what action to take to ensure that shortfalls identified in this and previous reports are addressed. What the service does well: What has improved since the last inspection? The communal bathroom has been refurbished and now provides a much more welcoming and homely environment. Window restrictors have been fitted where necessary and bedroom locks have been provided. Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 6 There was evidence of staff receiving in-house training in a number of areas. 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.V268511.R01.S.doc Version 5.0 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.V268511.R01.S.doc Version 5.0 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): Not assessed. EVIDENCE: There have been no new admissions to the home for a considerable amount of time. The Organisation aims to fill the three existing vacancies by April 2006. However, this report comments about the shortfalls in care practices and care guidance which are evident in the home. There are also examples that the needs of the current residents are not always being met in a safe and satisfactory manner. It is therefore difficult to see how any prospective service users can be accommodated safely in the home. Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 9 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, 7, 9 and 10 Shortfalls in care guidance may mean that service users’ assessed and changing needs are not responded to appropriately and consistently. Personal information is not stored and handled appropriately thus compromising confidentiality. EVIDENCE: The requirements made in the last two inspection reports about reviewing and updating of care plans and other support guidance have not been met. The manager advised that there has been a delay in addressing these requirements because of the proposed change to the care planning systems within Craegmoor. It was felt that whilst the introduction of new formats is being awaited, it is still important to ensure that information in care plans is accurate, corresponds to the assessed needs of the residents and is up-todate. The recent complaint investigation found a number of significant shortfalls in care guidance and separate requirements were made to up-date care plans by 31st December 2005. The manager advised that this was still her aim, whilst acknowledging that the task was sizeable and possibly unachievable within set timescales. Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 10 Service users’ files examined on the day of the visit contained care plans dated May and August 2003. Some guidance in these care plans was seen to be contradictory and could lead to service users being put at risk. For example a care plan about supporting one service user to take letters to the post box talks about staffing levels being one to one and in the same care plans another reference is made to staffing levels requiring to be two to one when the person goes out. Monthly review comments are very brief and frequently state ‘ no change’. This type of evaluation is seen to be ineffective as it does not provide evidence of actual evaluation of events/ incidents and any other contributing factors, such as behaviours, individuals wishes and preferences, staff competency and so on. Care plans about how service users should be supported with managing their finances were generic and did not talk about individual needs. A risk assessment about calling the emergency services was not dated and from this it was not possible to determine the currency of this guidance. A risk assessment about an allergy for one person does not give guidance about actions to be taken in the event of an allergic reaction. For another person a risk assessments about walking stated that the person ‘may refuse to move when half way across the road’. However, there was no guidance on how this would be managed. Overall examination of risk assessments showed that the information provided is limited, does not identify the level of risk and the actions to be taken to reduce/ eliminate risk. It was observed that service users’ files were being stored in a box on the floor of the communal area. Staff confirmed that previously records were kept in a filing cabinet in the same room, but that for at least two weeks prior to the inspection these have stayed on the floor. In addition to this some information was pinned to the notice board which contained personal information about the service users. The home is required to ensure that all personal information is stored securely at all times. Staff must be reminded of policy on confidentiality. Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 11 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, 16 and 17 Service users have opportunities to take part in planned activities, although these may not always be offered regularly enough or be appropriate to people’s needs. Service users’ rights, ability to exercise choice and freedom of movement may be compromised through use of unsanctioned restrictive practices. EVIDENCE: Upon arrival one service user went out for a walk with two members of staff. The person was appropriately dressed for the weather and looked eager to get on with their walk. One service user was due to go out to visit their relatives but this was postponed due to staff training. For the rest of the visit all service users remained in the home and were supported by two staff. One person was encouraged to spend time in the relaxation area. All service users have a timetable of activities from Monday to Friday, with a weekly group trip also on offer. Records of activities were examined. Staff write on the timetable for that week which scheduled / planned activities they have supported the service user with. On some occasions entries made by Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 12 staff provided evidence that the scheduled activity did not take place and was replaced with another, such as a drive out. It would appear that absence of any record against a specific day of the week would indicate that no activity was offered. Requirements were made following the recent complaint investigation about improving the quality of the records made about how the service users are occupied. There was no evidence that this recording has been improved. Care plans provided evidence of restrictions being imposed on service users. However, there was no evidence of how these decisions were made and whether the restrictions were appropriate. For example a care plan about community supervision for one person stated that if the service user displays certain behaviours whilst out, they would be told that ‘it is not a good thing’ and ‘ that there will be consequences’. This care plan was written in August 2003 and there was no evidence of a satisfactory review. It was unclear as to what was referred to by ‘ consequences’. Records examined for one service user provided evidence that the staff team are encouraging the person to have meals in the main dining room with others. Staff stated that previously there have been issues around meal times and the person could have their meal in another room. However, this practice has now ceased. Monthly key-worker reports showed that there are still problems during meal times but no records provided any indication of why the person no longer has the option of having their meal elsewhere. It appears that this flexibility has been withdrawn and the person is expected to conform even though they may be indicating a different choice. Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 13 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 Some aspects of service users’ personal care may be compromised due to lack of up-to-date and satisfactory guidance. There are some good practices in the management of medicines in the home but in some areas these need to be enhanced to ensure the medication needs of all residents are met. EVIDENCE: The recent complaint investigation highlighted a shortfall in care guidance about supporting service users’ emotional and psychological needs as well as health needs. Requirements were made to address this in care plans. There was no evidence at this inspection of any progress towards this. For one service user records detailed that the person experiences anxieties around family relationships and this may be communicated through aggression. Some records did provide evidence that staff were supportive towards the person and gave reassurance, although some responses recorded were less appropriate as they referred to punishment of behaviour. Previous requirement about identifying any restrictive practices in the home and challenging the origin and ethos of these is repeated. Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 14 The home has made two referrals to the Community Learning Disabilities Team, but only after they were prompted in doing so through complaints and concerns from external professionals. This demonstrates lack of proactive strategies and as evidenced throughout this report, has had a detrimental effect on the quality of the service provided to the residents. Medication audit. Recently the home has changed the pharmacy that dispenses medicines and these are still provided in a monitored dose system (MDS) with printed Medication Administration Record (MAR) charts. The manager felt the new arrangements are an improvement. This pharmacy has provided a new training course for the manager with assistance from a pharmacist (but still to be completed). All staff need such training with input from a person with relevant specialist knowledge rather than cascading between staff. Staff have received some external training and information was given about courses on safe handling of medicines provided by local colleges to help ensure that staff handling medicines are correctly trained. This must include an assessment as competent in the practice of medicine administration. Repeat prescriptions are not seen or a copy kept in the home before being sent to the pharmacy as recommended. This is a useful way to ensure the most up to date dose directions are available to the pharmacy and allows sight of the only document relating to medication signed by the doctor. Secure storage is provided for medicines but the keys to medicine cupboards need to be kept securely rather than left in a drawer as found at the inspection. The cupboard location is not ideal and may be too warm (the manager said there are no alternative places). The temperature in the cupboard at the inspection was measured as 24°C. One medicine stated maximum storage as 22°C. Most medicines should not be stored above 25°C. The temperature in the cupboard must be recorded daily with corrective action taken if it becomes too warm. Insulation of the hot water pipes close to the cupboard may help. Space is needed in the medicine cupboard to hold the additional stock during the monthly changeover period rather than in the office. Medicines are given to one resident at a time, generally adjacent to the medicine cupboard. If medicines are transported around the home this must be in a safe way to ensure safety of all residents and no risk of the wrong person being given the wrong medicine. MAR chart records are generally correctly kept. Points for improvement are to complete the allergy box at the top of each chart even if it is ‘none known’ as this is an indication of this matter being considered. Handwritten entries on the chart must be signed by the trained staff member writing this with a signed check that it is correct by a second trained staff member. The information as contained on the label from the pharmacy must be copied exactly onto the chart – this was missing on one chart. Dose directions must always be clearly stated for any medicine included on the MAR chart. Protocols were seen for medicines prescribed ‘as required’ and the manager is in the process of reviewing these. The use of rectal medication kept for two Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 15 residents need review particularly as there has been no indication for use in a long time and staff are not trained in this method of administration. Assistance from the ambulance service would be requested if necessary. Two care plans looked at contained some information about medication use but this was not up to date. The plans also need to contain each resident’s consent to medication. This may have to be recorded by describing the way in which each person is willing (or not) to accept medication from care staff. Examples of good recording and audit records were seen with checks documented at each shift change. Writing the date on a medicine container when opened is still needed (except for MDS packs) as a means to rotate stock correctly within the best practice guidelines provided. Medicines received into the home are all documented. These records need to clearly distinguish what is new stock and what is a stock balance carried forward from a previous month. Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 16 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 Concerns about care have not been responded to as necessary and have resulted in complaints being made about practices in the home. Some approaches used by care staff may not be in line with good practice guidance and could be detrimental to the welfare of the service users. EVIDENCE: A complaint has been made to the Commission about the care provided for one specific service user. The issues identified in the complaint have already been discussed with the home and the complainants felt that these were not responded to appropriately. The CSCI has investigated the issues and the outcomes are as follows: The complaint detailed three areas of concern: 1. Approach to and management of personal care and healthcare for a named service user (including dental care, stoma, epilepsy, diet, sleep, and psychological wellbeing). The investigation found significant shortfalls many aspects of managing health and welfare needs of the service user. This part of the complaint has been upheld. 2. Aspects of the service in relation to activities and occupation offered to the named service user and whether these meet the person’s needs. The investigation did not provide sufficient evidence to uphold this aspect of the complaint. This part of the complaint is unresolved. Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 17 3. Staff support and behaviour management (to include monitoring of selfinjurious and other challenging behaviours and staff approach including physical intervention). The investigation found significant shortfalls in staff practices around monitoring and managing of challenging behaviours, shortfalls in staff skills and knowledge around use of physical intervention and communication as well as lack of guidance on these matters. This part of the complaint has been upheld. Following the investigation a large number of requirements were made in order for the home to achieve the minimum standard in a number of areas for the benefit of all service users in the home. An action plan has been supplied to the Commission by the Registered Provider agreeing to implement the necessary improvements within set timescales. However, this report provides evidence that many of the requirements made a result of the CSCI investigation have not been addressed. The Adult Protection Policy was displayed on the staff notice board. It was observed that one service user was continuously attempting to grab at others, staff, service users and visitors. Staff responded to these behaviours by taking the person to another area of the home. Staff spoken with confirmed that additional monitoring of behaviours for this person has been taking place. This was seen to be a tick chart with headings for different behaviours. Staff were required to tick against the behaviours displayed by this individual. However, the list of behaviours did not include grabbing others and this was surprising as this appears to be a frequently displayed behaviour and one which affects other people. On file for the same person an ABC (antecedent/ behaviour/ consequence record was found completed on 9/10/03. This detailed the person displaying violence towards staff. No other ABC charts were evident after that date and staff spoken with confirmed these are not being filled out. This type of detail may provide valuable information about the origins of behaviour, possible triggers and reactions to responses which can then form part of an agreed plan of care for that individual. At the end of the visit the service user was displaying behaviour challenges and was being supported by a staff member on the staircase. The inspector assessed the incident to be high risk as well as detrimental to the service user as their dignity was being compromised. However, no notification of this incident has been received from the home since the inspection as required under Regulation 37. The recent Regulation 26 report refers to two incidents. However, there have been no Regulation 37 notifications made to the Commission with details of these incidents. The necessary notifications must be made without delay verbally and in writing. Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 18 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 Some improvements to the environment have been made and may benefit the service users, but other areas, which pose hazards, remain. EVIDENCE: Improvements have been carried out to the first floor bathroom and this is now more welcoming and pleasant for the service users. It could not be established at this visit whether outside professionals such as Occupational Therapists, have been consulted on whether this facility can meet the needs of those using it in a safe way. The use of the new bathroom should be monitored and any difficulties with service users accessing this should be identified and appropriately addressed. A window restrictor has been fitted in the vacant room, as discussed at the last inspection. However, it should be checked that this complies with the required safety regulations, as the extent to which the window can be opened appeared to still be hazardous. Door locks have been fitted to all bedrooms. Suitability of these will be revisited at future visits. Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 19 Work on making the garden more accessible for the service users has not been carried out at the time of the visit, although the manager was anticipating that this will be done. The water damage to the wall on the main staircase has not been rectified and the concrete path to the main gate remains hazardous. Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 20 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 and 33 Staff may not have the required competency and understanding in order to respond to the needs and behaviours of the service users in an appropriate way and this could compromise the autonomy and safety of the service users. EVIDENCE: At the time of the inspection the area manager was delivering awareness training on responsive strategies. The majority of the staff team were present and two staff were supervising the service users. There have been several staff changes since the last inspection and a large proportion of the staff team currently are from abroad. The acting manager acknowledged that there are a number of cultural differences which may become evident in the way in which staff support the service users. Interactions between staff and service users on the day of the visit showed that staff respond to behaviours in the way they feel is appropriate although this may not be an agreed response. There was also evidence from records that staff may not always understand the specific needs and diagnosis of the individuals. For example monthly key-worker plans for one service user stated that the person’s behaviour was ‘up and down’ and a future goal was identified as ‘trying to improve behaviour’. The October 2005 record stated that the person ‘continues to play up, sometimes hits staff. The person is told this is wrong and is sent away to think about what they had done’. The service user has complex needs and may not be able to take on board the consequences of their behaviours, which would Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 21 make the above actions by staff inappropriate and unnecessarily restrictive. However, this is not reflected in the guidance. All care plans and guidance must be sufficiently detailed and up-to-date as this would ensure consistency of staff approach and minimise any potential for staff to develop responses and practices which may be inappropriate. Staff spoken with during the visit provided evidence that information from the complaint investigation about shortfalls in care practices has been shared with the team. Staff confirmed that recording of food intake for a specific service user has re-started. Staff said that no additional guidance has been given to them about what to include in daily records as required following the complaint investigation. Some daily records seen were very brief. For example a record made on 13/11/05 stated ‘Good shift! No problems. Agitated and a little aggressive’. This information is clearly limited and says very little about how the service user spent their day and reasons for their agitation are unclear. There was evidence from rotas and discussions with staff that some staff regularly work 15 hour shifts. There are generally 3-4 staff on each shift. Two scheduled staff meetings have been cancelled. An administrative assistant has been employed since the last inspection and has the responsibility for payroll, on-line shopping orders and petty cash returns. Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 22 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 and 39 The quality of the service has been significantly compromised through lack of competent management and poor monitoring processes. EVIDENCE: The acting manager has been working at the home since September 2004. She has withdrawn her application to register with the Commission and plans to move on to another post in January 2006. The manager has always appeared responsive during inspections and past visits and demonstrated a good grasp of the issues which needed to be addressed. The last inspection report makes some positive comments about some aspects of management approach and the commitment to make the necessary improvements in the home. However, this report provides evidence that compliance has not been achieved in some critical areas, such as care plans, risk assessments and care practices. The recent complaint investigation has provided evidence of many shortfalls, including communication between the manager and the staff team. Concerns have been shared with the area manager and the registered provider about Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 23 some of the information which was provided by the home manager but could not be evidenced. Lack of consultation with the outside professionals appears to have had an adverse impact on the care practices and on ability of staff to meet the needs of the service users. This report provides evidence that the quality of the service at Heighton House has been significantly compromised in a number of ways. This could be due to an inexperienced manager, lack of clear leadership and a significant turn over of staff. It is felt that the home would greatly benefit from a manager who has a proven record of managing a care establishment and in developing a staff team as well as having a significant experience of working with people with learning disabilities, mental health and behaviour needs. The Organisation should ensure that a suitably competent person is found. The Organisation has an established quality assurance system. Regulation 26 visits form part of this with various checks about aspects of the service being carried out during unannounced visits to the home. Some of the more recent reports completed under Regulation 26 suggest that the home was running well and was on its way to achieving a high standard of service. The findings of this report raise questions about the robustness of this quality assurance process as well as about the support and guidance offered to new and inexperienced managers by the Organisation. The inspector hopes to raise these questions with the Responsible Individual separately. Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 24 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 1 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 X X 1 1 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 X 16 2 17 Standard No 31 32 33 34 35 36 Score X 1 X X X X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Heighton House Score 1 2 2 x Standard No 37 38 39 40 41 42 43 Score 1 X 2 X X X X DS0000016458.V268511.R01.S.doc Version 5.0 Page 25 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 YA6 Regulation 12, 14 and 15 Requirement Care plans must accurately reflect the assessed needs of the service users and provide guidance on how these will be met. 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 timescale of 31/04/05 and 31/10/05 have not been met) Care plans, risk assessments and all care guidance must be up-to-date and sufficiently comprehensive to ensure staff have the guidance about providing support in the right way. All care plans, including those which cover medication needs for each resident, must be regularly reviewed. (Still within timescales at time of this inspection). Risk assessments must provide clear and detailed information about assessed risks including DS0000016458.V268511.R01.S.doc Timescale for action 31/01/06 2. YA6 15 and 17 31/01/06 3. YA9 13(4) 31/01/06 Heighton House Version 5.0 Page 26 4. YA20 5. 6. YA20 YA20 7. YA23 8. YA23 the level and severity of risk, and agreed actions to be taken to reduce/ eliminate risk (to include staffing ratios when supporting individuals and groups in the community and in the home). 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. 13(2) Keys to the medicine cupboards must be kept on the person of a designated staff member. 13(2) Handwritten entries on MAR 17(1) charts must be complete and be signed by authorised staff with a second staff signature as an accuracy check 13(6) and All restrictive practices used in 15 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 (Timescale of 31/10/05 not met) 13(6)(7)(8) Systems of monitoring, 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. All staff must receive additional training in responses to aggression and challenging behaviours. DS0000016458.V268511.R01.S.doc 15/12/05 15/12/05 31/01/06 31/01/06 31/01/06 9. YA23 13(6) 31/01/06 Heighton House Version 5.0 Page 27 10. YA24 23 11. YA27 23 12. YA30 23 13. YA20 13(2) and 18 14. YA34 18 15. YA35 18 16. 17. YA37 YA39 8 and 9 24 (1)(3) Address the damage caused by a water leak on the main staircase. (Timescale of 31/10/05 not met) Works to make the garden more accessible and safe for use must be carried out. (Timescale of 31/10/05 not met) Consultation must take place with the Environmental Health Department with regards to storage and disposal of clinical and soiled waste. (Previous timescales for this requirement of 31/04/05 and 31/10/05 have not been met.) Determine through consultation with the GP whether the use of rectal medication is required for individuals. If the use of this medication is necessary, staff must receive the relevant training. Evidence of how service users need to be supported with epilepsy must be available for inspection. (Timescales 31/10/05 not met). Provide evidence of when CRB disclosure has been obtained for a specific member of staff. If this cannot be determined, obtain a new CRB check (To be checked at the next visit). Staff must receive training relevant to their work and in key areas such as Autism, Total Communication, Person centred planning and learning disabilities (within timescales at this inspection– to be checked at the next visit). An experienced and suitably qualified manager must be appointed to run the home. A robust quality assurance system must be implemented which provides evidence of DS0000016458.V268511.R01.S.doc 31/03/06 31/03/06 01/03/06 31/01/06 31/01/06 31/12/05 01/03/06 31/03/06 Heighton House Version 5.0 Page 28 18. YA17 13(6), 17(1), Sch. 3 19. YA18 12(1), 17(1) Sch. 3 20. YA33 13(6) and 18(1)(c) 21. YA18 13(6) and 12(4) 22. YA18 12(1) 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. Consult with a dietician to 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). 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. 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. Provide a protocol for the use of baby monitor (and any other alarms and monitors) demonstrating clearly the need for such devices and how service user’s privacy will be protected. (Time scale of 31/10/05 not met) Develop systems for monitoring the sleeping pattern for a specific service user; in order to identify possible links to activities in which the person takes part, occurrence of epileptic seizures and any other significant occurrences (such as changes in routine, medication etc). DS0000016458.V268511.R01.S.doc 31/12/05 31/12/05 31/01/06 31/01/06 31/12/05 Heighton House Version 5.0 Page 29 23. YA18 12(1)(2) 17(1)(a) 24. 25. YA33 YA19 18(1) 15(1)(2) 26. YA23 17(1)(2) 27. YA23 37 Consult with the speech and 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. Provide staff with formal training in stoma care. Revise the care plan about how the service user is to be supported with stoma care. (Timescale of 30/11/05 not met) Ensure comprehensive records are maintained about all aspects of care for service users. (Timescale of 11/10/05 not met). Notify the Commission of any incidents where restrictive physical intervention is being used by staff or any other events which may be detrimental to the service users. (Timescale of 11/10/05 not met). 31/01/06 31/01/06 31/01/06 31/01/06 22/11/05 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 YA18 Good Practice Recommendations Care guidance on support with personal care for service users who require this should be reviewed to establish whether approaches used are still effective. Evidence of the outcome of such reviews should be recorded Check whether all window restrictors have been fitted in accordance with the relevant safety guidance. The use of the new bathroom should be monitored and any difficulties with service users accessing this should be identified and appropriately addressed. DS0000016458.V268511.R01.S.doc Version 5.0 Page 30 2. 3. YA24 YA24 Heighton House 4. 5. 6. YA20 YA20 YA20 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. Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 31 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. Extracts may not be used or reproduced without the express permission of CSCI Heighton House DS0000016458.V268511.R01.S.doc Version 5.0 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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