Inspection on 24/04/07 for Heighton House

This inspection was carried out on 24th April 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heighton House 06/04/09

Heighton House 14/04/08

Heighton House 28/11/06

Heighton House 18/05/06

Heighton House 22/11/05

Heighton House 22/06/05

Heighton House 21/01/05

Heighton House 27/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Heighton House 19 Barnwood Road Gloucester Glos GL2 0SD Lead Inspector Mr Richard Leech Unannounced Inspection 24 & 26th April 2007 10:30 th Heighton House DS0000016458.V336862.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.V336862.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.V336862.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heighton House Address 19 Barnwood Road Gloucester Glos GL2 0SD 01452 380014 01452 380014 heighton.house@craegmoor.co.uk www.craegmoor.co.uk Cotswold Care Services Limited Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) To be appointed Care Home 8 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (1) of places Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th November 2006 Brief Description of the Service: Heighton House is a care home that provides accommodation for up to eight adults with learning disabilities. The home is close to Gloucester city centre. All of the people living in the home have single bedrooms, some with en suite facilities. There is a large communal lounge, smaller lounge, sensory room and dining room as well as a large conservatory. Outside there is a car park and a spacious lawn. Craegmoor Healthcare owns Heighton House. The home has a Statement of Purpose and Service User Guide which set out information about the philosophy of the home and the facilities provided. Copies of these are available upon request and are supplied to prospective service users. Up to date information about fee levels was not obtained during this visit. At the time of the last inspection in November 2006 they were reported to range from £929.19 to £1269.41 per week. Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection began on a Tuesday morning, lasting until early evening. A second visit took place on the following Thursday from mid morning to late afternoon. During these visits all of the people living in the home were met, along with many of the staff team. The manager and deputy were present at all times. Some feedback was received from other people with an interest in the home and significant findings are included in the report. During the visits a range of records were checked. These included selected care plans, risk assessments, medication charts, training and staffing files and policies & procedures. What the service does well: What has improved since the last inspection? The Statement of Purpose has been reviewed and updated. Copies of the Service Users Guide (including the complaints procedure) have been given to each person living in the home. There have been some improvements to care planning and risk assessment in the home, although there is much more work to do in this area. The ways in which people are offered choices has developed and the manager is looking at how to give the people living in the home more freedom and control. The team is also looking at how to help people to communicate in different ways to support them to express themselves more. There has been progress with identifying how people like to spend their time and aiming to respond to people’s wishes and needs in this area. Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 6 The ways in which challenging behaviour is responded to have changed. With expert help the team have altered their approach, resulting in much less physical intervention. As a result the atmosphere in the home is generally calmer and more relaxed. Some improvements have been made to the environment. This includes replacing some furniture and worktops as well as fitting new carpets. A flat lawn has been created which is already being well used. Considerable training has been provided for staff. A training audit has been done showing where any gaps remain. The company’s quality assurance systems are being implemented. Copies of reports made by representatives of Craegmoor are now being forwarded to CSCI. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Heighton House DS0000016458.V336862.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.V336862.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some shortfalls in the admission process may result in service users’ needs and wishes not being fully ascertained before they move in. EVIDENCE: In the last report three requirements were made under standard one. A requirement was made to review and revise the Statement of Purpose and Service Users Guide. The manager said that a revised copy had been forwarded to the company’s head office to be put into the appropriate format and returned to the home. A copy of the new Statement of Purpose was supplied to the inspector. The manager said that all of the people living in the home had been given a copy of the updated Service Users Guide, though in some cases would find this difficult to understand. There was a discussion about making the documents more accessible such as by adding photographs. The service has complied with a requirement to seek a variation to categories to reflect the ages of the people living in the home. One person had moved in to the home in Autumn 2006. As noted in the last report, the person had visited Heighton House before moving in. The manager Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 9 described the admissions process including consultation with other people involved in the person’s care. She confirmed that the person had registered with a local GP and that a meeting was planned with the Community Learning Disability Team covering the area to make arrangements for transfer of care. Whilst there was evidence of background information having been gathered as part of the admission, as also noted in the last report the service did not complete or request an up to date needs assessment. This should have been done, regardless of prior knowledge of the person. Discussion with the person and with staff provided evidence that they were generally settling in well, although some issues were beginning to present which required skilled care planning and specialist intervention (see next section). Heighton House DS0000016458.V336862.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Plans to overhaul the care planning system should result in people using the service having their needs, goals and wishes more fully recorded and met. People living in the home are offered choices in day-to-day life and plans to further develop total communication approaches and to improve access around the home should result in people feeling even more in control of their lives. Some ongoing shortfalls in the systems for risk assessment may result in risks not being clearly identified and appropriately managed. Arrangements for the handling of personal information need to be improved in order to ensure that people’s confidentiality is not compromised. EVIDENCE: The manager said that the organisation was introducing some new personcentred care planning formats. Some work was already beginning on this and Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 11 examples were seen. It will be important to ensure that service users are fully engaged in the process and that the staff overseeing implementation have the necessary skills and training. A behaviour specialist had begun working with the team and some of the people living in the home. This was predominantly to conduct assessments and produce guidance about the management of challenging behaviours and also about the impact of different conditions experienced by people using the service. Examples of guidance about communication, challenging behaviour and individualised impacts of autistic spectrum conditions were seen. These were very clear and detailed. The manager said that some work was also taking place using a new assessment tool which explored people’s life histories. She said that this was proving very useful and that much more information about people’s backgrounds was coming to light. The manager said that keyworkers would be going through this with each person. Pending the above being fully implemented the majority of people using the service still had older-style care plans in place. Many of these were headed ‘problem/need’ and covered areas such as finances, medication, independent living skills and personal care. The following observations were made: • Some care plans did not acknowledge the person’s skills, strengths, potential and goals in particular areas. For example, one care plan about finances stated ‘I am unable to control my own finances’ followed by a list of support measures with no reference to the person’s skills or goals in this area. Some care plans were of a generic (rather than truly individualised) type seen in many other settings run by the same organisation, such as ‘for me to be proactive in my own life within the residential care home setting’. Many care plans were hand written making them harder to read. They should be typed where possible. Many of the interventions listed were confused and hard to understand. For example, an anger management plan consisted of a few sentences such as, ‘if my behaviour can be diffused this minimises physical outbursts’. Other guidance was incomplete such as, ‘you must be aware of my signals when I need to go to the toilet’ without stating what these signals were. Some accompanying daily records included inappropriate terminology such as, ‘[service user] started to be naughty’. There was written evidence of care plans being regularly reviewed, although some just stated ‘no changes’ contrary to guidance provided by Craegmoor and included in many care planning files. Some assessments seen did not include a date or author. • • • • • • Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 12 The above underlines the importance of implementing the new more personcentred and modern approach. Examples of monthly keyworker summaries were seen. In some cases there was no indication of the author or the date was incomplete (e.g. saying the month but not the year). Some people’s goals were listed as ‘same as before’ rather than being a proper review of the goals and the extent to which they had been met. In some examples seen there was no evidence of how/whether the person had been involved in the goal planning and review process. Caution needs to be exercised to ensure that the goals really are those of the person, rather than being written by staff without appropriate consultation. For example, the manager agreed that the goals for one person ‘to not copy staff’ were probably written by staff rather than being an issue which the person themselves had raised. Some external feedback was received which indicated that there were inconsistencies in aspects of care provision, such as around one person’s morning routine. This underlines the need to develop sound support plans to promote consistency and best practice. Care planning has been the subject of requirements during previous inspections. Whilst progress has been made, there will need to be significant further progress made towards addressing this requirement. Failure to do so may result in enforcement action. The manager and staff described ways in which people living in the home were offered choice and the progress that had been made. For example, one person with significant communication difficulties was now being supported to make a choice of clothing. Another person was starting to initiate activities such as painting, having previously being reliant on prompting and encouragement from staff. The manager talked through some developmental work taking place around total communication, showing some examples. It is hoped that this will promote real choices and decision making by people using the service, for example about their diet. The manager described the restrictions in place in the home, saying that fewer areas of the home were now locked. She said that the door to the garden was now unlocked, allowing people to have access when they wished to. Some people have been given keys to the kitchen and were seen using them (although one person said that they had mislaid theirs – this was reported to the manager). However, there was no written assessment on people’s files documenting the decision-making process about whether people were offered these keys or not. Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 13 The manager said that the laundry was locked but that the team would like this room to be accessible. It was agreed that the first step would be a risk assessment. Discussion with the manager, staff and service users provided evidence of there being no set times for getting up or going to bed. People living in the home were seen to get up at different times. Some comments about choice from a survey form were relayed to the manager. Examples of risk assessments for two people were seen. Many of these were judged to be unclear. For example, an assessment about the risk of falls did not clarify what the mobility issues for the person were. An assessment about aggression did not say what to do if the person became aggressive or how their aggression was likely to manifest. A risk summary table categorised headings such as ‘carrying ID’ and ‘clothing and laundry’ into high, medium or low without being clear about what specific risk(s) were being considered in each case. However, some risk assessments were seen to be clear and sufficiently detailed, in particular some more recent typed examples. Regarding the issue of aggression cited above, staff reported that this had become much more of an acute issue recently and some felt that they did not have clear guidance about what to do/how to respond. The manager said that the behavioural specialist who had begun working with the team would now be assisting with behaviour management plans for the person. It was agreed that this was urgent in view of the issues presenting. A requirement about adding some information to the missing person’s documentation was seen to have been met. In the last report a requirement was made about keeping confidential information securely. During the visits to the home the filing cabinets containing care plans were locked. However, some personal information was still displayed on a notice board in a communal area. Much of this was removed during the inspection, but further work was needed to ensure that sensitive material was appropriately stored. In addition the communication book was accessible. Handover between shifts was also observed to take place in a communal area with people living in the home using or passing through the room. Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are supported to take part in a variety of activities in the home and community and to maintain contact with family and friends, promoting their quality of life. Arrangements are in place which help to promote service users’ rights and to support them with their responsibilities. People using the service enjoy a varied and balanced diet, promoting their health and wellbeing. EVIDENCE: Daily records and activity recording sheets for three people were checked. These provided evidence that people using the service were being supported to take part in a range of different activities in the home and community. This included accessing activities in the evenings and at weekends, as well as using Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 15 local facilities such as bingo clubs, college, pubs and leisure centres. Staff reported that some people attended church. A person living in the home confirmed this. Some staff expressed concerns about service users doing fewer activities than they used to, partly as there were not always enough people to take them out now that the home was full. People mentioned that the lack of a cleaner and a maintenance person were impacting on activities as staff were having to fulfil these roles (see staffing section). Other staff felt more confident that people living in the home were accessing an appropriate range of individual activities. The home has a dedicated activities coordinator who is supernumerary, who had recently accessed an in-depth course about the provision of activities in care settings. This had helped with identifying priorities for the service which included: • • • • Focussing more on people’s individual needs and wishes Introducing new ideas and proposing these to people living in the home Developing more appropriate client-led goal plans Expanding the range of equipment and facilities available to service users There was evidence that the course had been very positive and had helped to energise and refocus the team on providing activities which reflected people’s needs and interests. It was reported that the team leaders may also take this course in the future. Some of the people were asked about their activities and indicated that they had enough to do and enjoyed how they spent their time. The manager and staff described plans for a holiday in May. Staff stated that the new lawn was a valuable asset. People living in the home were seen exercising, playing games and relaxing on the lawn. Discussion with staff and people living in the home provided evidence of appropriate support being offered to maintain contact with family and friends. Records provided further evidence of this and care plans also made some reference to promoting this contact. People living in the home were seen moving around freely. As noted earlier certain restrictions were in place, though there were plans to reduce these if assessed as safe. People were also seen helping with household tasks in a very natural way. There was a discussion with the manager about terms of address. Over the course of the inspection staff were heard to use various terms such as ‘darling’ ‘good girl’ and ‘sweetheart’. Whilst the tone was warm and friendly, the use of Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 16 these terms should be considered in accordance with Standard 16.5 (Staff use service users’ preferred form of address, which is recorded in the individual plan). One person was referred to as ‘silly girl’ (not in their presence), albeit in an affectionate manner. This is disrespectful terminology and must be avoided as part of people’s right to be treated with dignity. The manager confirmed that people living in the home were on the electoral register and that, where appropriate, people would be offered the opportunity to vote. It was agreed that this important aspect of citizenship needs to be the subject of individual assessment considering people’s capacity. Some mealtimes were observed. The food was well presented and people said that they were enjoying their meals. The atmosphere was calm and relaxed. Staff described the menu planning arrangements, saying that people’s preferences were taken into account. It was stated that people could have alternatives to what was on the menu but that generally they tended to all eat the same main meals. People were seen being offered different lunchtime options and making individual choices. Staff demonstrated an awareness of people’s likes and dislikes The manager acknowledged that there was scope to improve people’s choices around diet. She said that work was beginning on making more accessible menus using symbols as part of working towards greater choice and variety. It was suggested that photographs could also form part of this approach. The home has introduced themed days which include preparing traditional dishes from different countries. At the time of the visits people were working towards an Irish themed event. In the last report a requirement was made to consult with a dietician to assess one person’s nutritional needs and assess whether the food provided promotes their health and wellbeing. The manager said that the person’s GP had been contacted and that, although in their opinion such a referral was not necessary, they would request Community Learning Disability Team input. The manager reported that they were still awaiting this input. No reference could be found to this conversation in the person’s medical notes. Such conversations should always be fully recorded. Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s personal care needs are met, promoting their dignity and wellbeing. Whilst healthcare needs are generally being met, there is scope to modernise and improve practice in order to optimise people’s health and wellbeing. Although arrangements for handling medication are generally satisfactory there is potential to tighten up some practices in order to further safeguard people using the service. EVIDENCE: Care plans covered issues around personal and health care where relevant. The new care planning system being implemented should provide a clearer picture of people’s preferences about how their personal care support is delivered, including about the gender of the person assisting them. This will be considered during future inspections. Staff described how they provided personal care with regard for people’s privacy and dignity as well as their preferences. Staff were seen responding sensitively and flexibly to people’s requests for support. People living in the Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 18 home were seen to be dressed smartly and appropriately. External feedback also referred to people being dressed appropriately and looking well. Some risk assessments included reference to maintaining people’s privacy and dignity. Staff described the protocol for use of a listening device for one person who experiences seizures. Records of medical contacts provided evidence that people were being supported to access routine and specialist healthcare services. There was a discussion with the manager about the quality of some of these records. For example, an entry for November 2006 for one person about breast screening stated “she refused”, without saying what had happened and in what way the person’s behaviour had been interpreted as a refusal. The manager described what had taken place. It was agreed that this raised complex issues about capacity, consent and best interests which would need further discussion with the involved healthcare professionals. In addition the same person had been diagnosed with a medical condition affecting their sight which was likely to raise similar issues about capacity and best interests. See also the comment about recording under Standard 17. Health action plans for the people using the service were not in place. The manager understood that new care planning formats from the company included a healthcare section. Local formats for health action planning have also been devised. Whatever format is used, the outcome should be that service users each have a comprehensive health action plan in line with the ‘Valuing People’ paper. Some feedback obtained from the Community Learning Disability Team was discussed. It was agreed that there should be direct dialogue by the manager with the CLDT to explore the issues raised. It is essential that the team at Heighton House engage with the CLDT in a constructive way in order to provide the best possible standard of care. Medication storage, records and procedures were checked. Whilst in general these were found to be in order the following observations were made: • • • An over-the-counter cream being stored had an expiry date of September 2006. A recent refusal by one person to accept medication had not been not been recorded on the MAR with the appropriate code. Some ‘as required’ protocols had been drawn up by a team leader. These should ideally be checked with, and countersigned by, the prescriber. Records of the temperature of the medication cabinet showed that it did not exceed 25°C. Discussion with staff and checking training records provided evidence that team members were receiving appropriate training about the safe handling of medication before becoming involved in administering medications. Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place which support people living in the home to express unhappiness or to complain. There are also a range of measures which help to safeguard people from the risk of harm and abuse. EVIDENCE: According to the pre-inspection questionnaire there had been no complaints since the last inspection. There is a complaints procedure in text as well as more accessible formats. One service user spoken with pointed out their copy of the complaints procedure when asked what they would do if they were unhappy about something. Some of the people living in the home would have difficulty raising a complaint formally. Staff spoken with were able to describe indicators that particular people may be unhappy and what they would do in response. This is another area that could be worked upon in terms of broadening the use of total communication approaches in the home. The organisation has a new policy about the protection of vulnerable adults dated December 2006. There is also a whistle blowing policy dated February 2007. Staff spoken with demonstrated understanding of issues around abuse and adult protection, although there was some variability in people’s confidence on these issues. However, all staff spoken with said that they would report any Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 20 concerns and that they were sure that the issues would be handled appropriately. Records indicated that most staff had attended recent training about adult protection. Some people’s inventories were checked. It was noted that one person’s newly purchased trampoline had not been added to their list. As mentioned earlier, a specialist had begun working with the team about the management of challenging behaviour and the impact of certain conditions on people’s behaviour. Staff spoken with felt that the quality of the resulting guidance was high. It was agreed with the manager that work needed to begin urgently on equivalent support plans for one person who had recently begun to express challenging and potentially dangerous behaviour (including in the home’s vehicle). The manager said that the Community Learning Disability Team were also being engaged about this issue. In the last report comments were made about the use of physical intervention in the home. The manager said that changes to support plans and practices had resulted in such intervention not happening in the home. Daily records and reports of incidents did not make any reference to restrictive physical intervention and staff spoken with said that they were not now having to restrain people. Training records provided evidence of staff undertaking appropriate training about physical intervention. The manager said that the behaviour specialist was also planning to do some training with the team. The manager did not have a copy of the Department of Health’s guidance about restrictive physical intervention. A website link for this was forwarded. Some risk assessments were seen to be in place about the risk of financial abuse. Examples of financial records for three service users were checked. These appeared to be in order although the team could consider numbering receipts. The manager reported that there had been no notifiable incidents since the last inspection. Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A clean, comfortable and homely environment is provided. However, greater care is needed to ensure that potential hazards are promptly identified and addressed in order to protect people’s health and safety. EVIDENCE: All communal areas were checked, along with some bedrooms upon invitation. It was agreed that, although in general the décor was satisfactory, some areas would benefit from being freshened up. The deputy manager described plans for a programme of repainting to take place at the end of May when the people living in the home would be on holiday. The glass shade of a lamp in the main lounge was broken, posing a risk. This was removed during the inspection. Greater vigilance and reporting of hazards may be needed to ensure that such issues are promptly dealt with. Further evidence for this was that the cupboard containing hazardous chemicals was found to be unlocked. The lock was later reported to have been broken. Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 22 Some new furniture had been purchased in the main lounge. A new worktop was fitted in the kitchen two months prior to the inspection. A requirement about replacing the carpets on a landing had been met. Some bathrooms contained large piles of towels on surfaces, some of which were very tatty and threadbare. This was brought to the attention of the managers, who said that they would take action to find more appropriate storage and to replace threadbare towels. One person expressed satisfaction with their room though said that they would like a chair. This was provided immediately, though raises questions about whether the team could be more proactive in asking people if they are happy with their rooms or whether there is anything that they would like to have changed. The same person indicated that they would like their room repainted a different colour. Other people spoken with indicated that they were happy with their rooms. As noted, staff said that the new lawn was an asset to the home. The home appeared to be clean throughout. As noted, staff were having to do the cleaning as there was no dedicated cleaner. Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 24 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care is provided by a skilled and competent staff team, enhancing service users’ wellbeing. People generally have the training that they need for the job, but some shortfalls need addressing in order to further promote the safety of people using the service. The service’s recruitment and selection procedures help to protect the people living in the home. EVIDENCE: People living in the home were complimentary about the staff team. One person said that they were ‘very nice’, and others made similar comments. Staff spoken with had a reasonable knowledge of conditions such as autism and demonstrated a good understanding of people’s support needs. Observation provided evidence of people being given appropriate support. Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 24 Training records indicated that, excluding the manager, two out of 13 staff had achieved NVQ level 2 or above in health and social care. A further six people were taking NVQ qualifications. As noted, some people felt that staffing levels were having an impact on activities and that this was exacerbated by not having a dedicated cleaner or maintenance person. The manager said that as well as recruiting a cleaner and maintenance person they were aiming also to employ an extra carer for about 30 hours per week. The rota and other records provided evidence of successful efforts being made to cover any daytime shifts when fewer than four staff were working. Staff reported that at times the numbers on shift fell to three, making activity provision more challenging. The manager, deputy and activities coordinator were supernumerary. The manager said that she and the deputy planned to become more involved in the day to day running of the home, including supporting activities, which may help this situation. The company had a new recruitment and selection policy from November 2006. No new staff had been recruited since the last inspection. Three staffing files were checked. These included necessary information, although as pointed out at the last inspection, where a person has previously worked in a position which involved contact with children or vulnerable adults, there will need to be written verification of the reason why they ceased to work in that position where reasonably practicable to obtain. This will be checked in future visits. In one case a Criminal Records Bureau check was being done as no evidence could be found of one having been undertaken in the past. One file was found to have a personal character reference. These should be regarded as supplementary only and, where possible, all references should be professional. The manager indicated that there were no formal ways in which the people living in the home were involved in recruitment and selection, although applicants are invited to visit the home and to meet the people living there. The communication book provided evidence of a wide range of recent training being provided for staff. Staff confirmed that they had taken various courses and expressed general satisfaction with the training programmes. The manager had recently updated a summary of training completed/required accompanied by supporting certificates. This exercise had highlighted that, whilst in many cases training was up to date, some people were overdue in areas such as moving & handling, fire safety, food hygiene and first aid. Training records provided evidence of staff accessing a wide range of training including adult protection, medication, infection control, mental health, care planning, epilepsy, equal opportunities, the management of challenging behaviour, and health & safety. This is good practice. Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Better management of the home has improved outcomes for service users, though there is potential for further development. Various systems are in place which help to monitor and improve the quality of the service. Health and safety is generally well managed, although there are some areas where further progress may help to protect the people living and working in the home. EVIDENCE: At the time of the inspection the manager was applying for registration with CSCI. She had previously been a registered manager for another home run by Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 26 the same organisation. The manager had attained the Registered Manager’s Award and was working towards NVQ level 4 in care. The manager had been there for about a year and felt that, after initial challenges, the home was now ‘getting on the right track’. She described her priorities for the next 6-12 months as: • • • • Overhauling the care planning system (as described earlier) Working with the behaviour specialist to make further progress with the appropriate management of challenging behaviour in the home Redecorating certain areas of the home. Developing the use of total communication approaches in the service. Staff spoken with generally felt that the home was well run, though there was a feeling among some people that the manager was a little remote from the team/too office based. Some external feedback also described the manager as being ‘detached from day to day work’. The manager was aware of this issue and described various ways that she and the deputy hope to become more involved with the day to day running of the home. Some staff felt that communication in the home was good, though others felt that at times some important information was not conveyed as quickly as it could be. A policy about quality assurance dated January 2006 was seen. The service has a number of audit tools, both internal and external, covering different areas of operation such as finances, health & safety and medication. There is also a more wide-ranging overview audit tool. Examples of completed audits were viewed. These appeared to be very thorough. Reports of visits made under Regulation 26 are being forwarded to CSCI. Minutes from some recent residents’ meetings were seen. Staff said that some of the people living in the home are able to express their views directly but in other cases there is greater reliance on team members advocating for them. The organisation also has a wider-ranging forum for people using the services, with representatives from different homes. An event related to this was planned for June 2007 and a ‘Your Voice’ facilitator had been nominated to cover the geographical area which includes Heighton House. Staff spoken with said that they had no major health and safety concerns, other than in some cases indicating that the guidance for the management of challenging behaviour needed to be further developed to include other people using the service. As noted earlier some behaviours were reported to pose health and safety risks, for example, in the vehicle. Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 27 Records for routine health and safety checks (including for fire safety) were seen. These appeared to be in order. However, it was pointed out that for a fire drill on 25/02/07 the time taken to complete evacuation was recorded as 40 seconds, but an accompanying note stated that one person refused to leave the building. The manager said that the person consistently refuses to leave and that staff are required to ensure that she is safe behind a fire door. It is strongly recommended that the team consult with the local authority fire officer about this practice in order to check the latest guidance and how to consider issues such as this in the fire risk assessment. There is a regular internal health and safety audit of the home. One was due in the days following the inspection. There was a discussion about the kitchen becoming too hot at times and the possibility of leaving a (fire) door to the outside open. It was suggested that the team liaise with the fire officer and also with the environmental health department. Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 2 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 x 3 x x 2 x Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 12, 14 and 15 Requirement The registered person shall after consultation with the service user or their representative, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met: 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. Support plans must include appropriate guidance for staff about the management of challenging behaviour. Previous timescales of 31/04/05, 31/10/05, 31/01/06 and 31/08/06 and 31/03/07 have not been met although some progress has been made. Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 30 Timescale for action 31/08/07 2 YA7 17 (1) a. Sch. 3.3 (q). 3 YA10 17(b) Record any limitations agreed with service users as to their freedom of choice, liberty of movement and power to make decisions (see example in text about access to the kitchen). The registered person shall (b) ensure that the record referred to in sub-paragraph (a) is kept securely in the care home - in relation to display and accessibility of confidential information in communal areas. Timescale of 31/12/06 not fully met. In addition, ensure that the care home is conducted in a manner which respects service users’ privacy and dignity, with reference to the arrangements and location for handover noted in the text. Ensure that people’s inventories are up to date and accurate with regard to significant purchases in order to minimise the chance of any future ambiguity about who owns what. Ensure that unnecessary risks to service users’ health and safety are identified and, so far as possible, eliminated (see examples in text about the chemical cupboard and a broken lamp). Ensure that all staff have training appropriate to the work performed including about moving & handling, fire safety, food hygiene and first aid. The manager must apply to register with CSCI without delay. 31/07/07 31/05/07 4 YA23 12 (1) 30/06/07 5 YA24 13 (4) 31/05/07 6 YA35 7 YA37 13 (3), (4) & (5). 18 (1) c (i). 23 (4A) Care Standards Act S. 11 & 12. 30/09/07 31/05/07 Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA1 YA2 Good Practice Recommendations Consider ways of making the Service Users Guide more accessible, such as by adding photographs. For each admission ensure that an up to date needs assessment is completed by the team and/or requested from others involved in the person’s care before they move into the home, regardless of any prior knowledge of the person. Ensure that all documents record the author and the date in full. Goal planning and review as recorded in keyworker summaries should be thorough (see example in text). Care should be taken to ensure that the goals really are those of the person living in the home. Take into account the bullet points listed in the text about care planning and accompanying documentation when reviewing the care planning process and implementing the new person-centred tools. Staff should use service users’ preferred form of address, which is recorded in the individual plan; review the use of some terminology as noted in the text. Ensure that the outcomes of discussions and appointments with healthcare professionals are consistently recorded in full. Implement health action planning. Note the bullet points in the text about medication. Consider numbering receipts in respect of service users’ finances to provide a clearer audit trail. Keyworkers and other staff could consider way of being more proactive about establishing whether people are satisfied with their rooms or whether there are any changes that they would like made. Intensify efforts to recruit a cleaner and maintenance person. Take forward plans to increase staffing levels. As far as possible all references should be professional. The manager should take forward plans for becoming more involved in the day-to-day running of the home/less office DS0000016458.V336862.R01.S.doc Version 5.2 Page 32 3 4 YA6 YA6 5 YA6 6 7 8 9 10 11 YA16 YA19 YA19 YA20 YA22 YA24 12 YA33 13 14 YA34 YA37 Heighton House 15 YA42 based. There should be consultation with the local authority fire officer about the practice of leaving a service user who refuses to evacuate in the building, including about how to consider issues such as this in the fire risk assessment. Heighton House DS0000016458.V336862.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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