Inspection on 28/11/06 for Heighton House

This inspection was carried out on 28th November 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 18 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 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 Ms Lynne Bennett Unannounced Inspection 28th November 2006 09:30 Heighton House DS0000016458.V320717.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.V320717.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.V320717.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heighton House Address 19 Barnwood Road Gloucester Glos GL2 0SD 01452 380014 01452 380014 heighton.house@craegmoor.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Cotswold Care Services Limited To be appointed Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th May 2006 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. The home is situated close to Gloucester city centre. Spacious accommodation is provided. All people have individual bedrooms some with en suite facilities. There is a large communal lounge, small lounge, sensory room and dining room plus a large conservatory. The grounds around the home are due to be renovated. Craegmoor Healthcare owns Heighton House. The home has a Statement of Purpose and Service User Guide documents which set out information about the philosophy of the home and about the facilities provided. Copies of these are available in the entrance hall or available upon request. Fee levels for the home range from £929.19 to £1269.41 per week. Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This inspection took place in November 2006 and included two visits to the home on 28th and 29th November. The manager was present through part of the inspection. The care of people living at the home was observed and two people gave verbal feedback about the service they receive. Two people living at the home returned comment cards. Records examined included care plans, staff files, health and safety information, quality assurance audits and medication administration records. What the service does well: What has improved since the last inspection? People are being involved in person centred plans. More plans are being developed involving people with their support networks. Although not all of the requirements from previous inspections have been complied with there is evidence that the management of the home are striving to put systems in place to improve standards in the home. Staff have received training in areas specific to the needs of people living at the home including autism, epilepsy and total communication. Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 6 The home are involving healthcare professionals in developing strategies and systems to improve the quality of care provided. 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.V320717.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.V320717.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): 1 and 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective admissions are not provided with the information they need to make an informed decision about whether they would like to move into the home. The needs of people transferring to the home are reassessed to ascertain their needs and wishes. EVIDENCE: The Statement of Purpose and Service User Guide have been reviewed and copies displayed in the entrance hall. People living at the home have copies of the Service User Guide in their personal files along with a residency agreement. One person has transferred to Heighton House from another home in the organisation and they need to have a copy of the Service User Guide and residency agreement for Heighton House. This person indicated that they had made visits to the home prior to moving in and that they are happy with the service they are receiving. Although Heighton House did not complete an assessment of their needs all information from their previous home was made available prior to and upon the move to the home. There is evidence that care plans are being developed with the Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 9 person and that gradually all information relating to their previous home is being replaced. The home has no further vacancies. One person living at the home is now over 65. A minor variation to include this category (LDE) as part of the registration of the home must be made. This also needs to be reflected in the Statement of Purpose. Heighton House DS0000016458.V320717.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 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A person centred approach is being introduced to ensure that people living at the home are involved in identifying their needs and wishes. There has been a significant improvement in the way in which people are supported by staff to make choices about their lifestyle empowering them to make decisions about activities of daily living. Improvements in the risk assessment process ensure that any steps towards independence are done as safely as possible. Storing personal information securely will respect the confidentiality of personal information. EVIDENCE: The care of three people living at the home was case tracked. This involved examining their care plans, other information and medication and financial records. Their care was observed during the visits and two people indicated in Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 11 comment cards that they are happy with the care they are receiving. Staff were also questioned about the care they provide. The home is in the process of changing over to person centred planning producing an essential lifestyle plan. Some information in their files was in this format. Care plans are being regularly monitored and reviewed with monthly key working notes that indicate progress made towards achieving individual goals and any changes that have been noted. This is a significant improvement. As mentioned in previous inspections some of the care plans and risk assessments are generic and occasionally refer to ‘him’ when they are referring to a female. There did however appear to be some personalising of these documents relating to the needs of the people being case tracked. Staff have received training in care planning and risk assessment since the last inspection. The introduction of person centred planning will go some way to addressing these problems. There was evidence that some people are signing their care plans. The manager confirmed that they are encouraged to do this as part of their monthly review with their keyworkers. The manager confirmed that placement reviews have been arranged for all people. A copy of one review was examined. People were observed being supported to meet their identified objectives in goal plans. One person who is being helped to go to the toilet independently was observed going to the toilet without staff prompting. Staff praised her for doing this. Another person was observed making a drink in the kitchen with the help of staff. A number of the people living at the home need help and support to express their wishes and needs. Some staff were observed using makaton sign language. A team leader confirmed that staff have attended training sessions with the speech and language therapist. A letter was examined which gives staff guidance about which key words they should use in sign with people living at the home. Communication profiles are in place. There are posters in the entrance hall providing information for people about local advocacy organisations. The manager said that no one at the home presently has an advocate. House meetings have not been held but the manager has been advised by the organisation to put these in place. She discussed how people living at the home are involved in choice of meals and activities. Some restrictions to access are in place and there are risk assessments that indicate the reasons for these. People were observed having access to the kitchen at times when hazards were minimised. For instance the door was locked during cooking and when the floor had been washed. Supervision is needed in the gardens and gates are locked due to the close proximity of the main road again risk assessments are in place. Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 12 Risk assessments are being regularly monitored and reviewed and where appropriate refer to the relevant care plan. Missing person’s information was available for all people except the newly admitted person. Not all information contained a current photograph, which would be advised. Since the last inspection information relating to staff has been removed from communal areas but there is still information relating to people living at the home such as their individual care plan goals and monitoring of personal care that are displayed in communal areas. It was also noted that the cabinet containing care plans was not locked during the visits. Care must be taken to respect the right to confidentiality of people living at the home and ensure that any personal information is stored securely. Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 13 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 and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been a significant improvement in the range of leisure and social activities being offered to people living at the home, enabling them to live a fully inclusive lifestyle accessing a range of local community facilities and activities. Relationships with family and friends are developed and maintained with the help of staff. Staff enable people living at the home to participate in activities of daily living promoting independence and choice. A varied menu is provided which recognises the cultural diversity of people living at the home. Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 14 EVIDENCE: Comprehensive records are being maintained for all people’s activities. Each person has an activities schedule each week to which any changes or alterations are made. The activities co-ordinator then uses this to inform any changes to the schedule should an activity be regularly refused or another activity become preferred. During the visits people attended college courses, day care, went for a drive and to buy a magazine. People use local shops and go into the city centre. One person said they like to go to church and records confirm that they go each Sunday. Throughout the summer day trips were organised to places of interest such as Blenheim Palace and West Midland Safari Park. The activity co-ordinator produces a report of activities each person has been involved in for the year. Care should be taken when producing these reports that they are personalised and reflect the activities completed by each person. One report suggested that a person who had recently moved into the home had taken part in fourteen-day trips that had been organised throughout the year. People were observed enjoying a music session during the visit as well as using the small lounge to listen to music and doing painting in the dining room. They also have access to the conservatory that has musical instruments and craft facilities as well as the sensory room. On the evening of the first visit people were looking forward to going to one of the three social clubs they attend each week. Aromatherapy/reflexology sessions were also being provided during the visit. Most people had their feet or hands massaged and this was done in the lounge where people were doing music. This is not appropriate and the manager needs to consider whether people would benefit from having these sessions in the privacy of another environment such as the sensory room if they feel uncomfortable having the treatment in their rooms. One person has a full body massage and this is done in their room. Daily notes, monthly key working reports and activity records provide evidence of regular contact with family and friends. Some people like to keep in touch over the telephone and others have regular visits to the home. One person said that their brother and niece are due to visit and they are really looking forward to this. People who have moved to Heighton House from other homes are supported to keep in contact with their friends. For some this is done by continued attendance at social clubs and day centres, visits to their friends or arranging social events together. Care plans indicate how staff should support people to be as independent as possible in activities of daily living. Staff were observed supporting people to make drinks, to do their laundry and to help with tasks in the dining room. One person said that they enjoy helping staff to clean and tidy up. Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 15 Not all people have keys to their rooms but each room has a privacy lock so that when shut people cannot access the room unless they override the lock. Care plans provide consent for staff to do this. One person has a key to their room that they were observed using. Menus are planned on a four-week rolling plan that provides a range of meals including freshly prepared or convenience foods. On the day of the visit people had a lunch of burgers in rolls with salad, which they said they enjoyed. Fresh fruit is provided. People were observed helping themselves to drinks throughout the day. An individual record of meals and snacks is kept in each person’s daily notes. A team leader said that the provision’s budget is sufficient for the needs of the home. One person who was previously identified as having an allergy to pineapple has been retested and it was found that the allergy no longer exists. This information needs to be removed from the menus. Menus also indicate that some people like a spicy food or curries recognising their culturally diverse needs. These are provided. The manager confirmed that attempts have been made to contact a dietician but they are still waiting for a response. This requirement will be repeated. Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 16 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 and 21. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The way in which the people living at the home would like to be supported is clearly recorded ensuring that staff have access to the information they need to meet their personal care needs. People living at the home have access to healthcare professionals making it possible to meet their healthcare needs. Systems for the administration and control of medication are significantly better although there is still room for improvement to ensure that people living at the home are not put at risk. EVIDENCE: The way in which people wish to be supported is detailed in their care plans indicating their likes and dislikes, emotional needs and personal care. Discussions with staff confirmed their understanding of people’s needs. The manager should ensure that the people’s preferences for either male or female support with their personal care is highlighted in their care plans. Several people indicated that they prefer to have female support. Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 17 The manager confirmed that a listening device is still used to monitor whether a person may be having a seizure during the night. The protocol still needs to be amended to give staff specific guidance about when this device is to be used and when it should be switched off giving due regard to the dignity and privacy of the person. People are having regular access to a range of healthcare professionals. Records of appointments are maintained with outcomes of individual appointments being recorded. Monitoring forms are also in use. There was evidence that body charts are being used to monitor any injuries or bruising. A chiropodist visits the home regularly. Staff indicated that treatment is carried out in communal areas. The manager needs to assess whether this is appropriate and provide alternative private facilities. (See also Standard 12). Medication administration systems were found to be mostly satisfactory. Staff were attending medication training on the day of the first visit. Robust stock controls are in place for medication prescribed in boxes and ‘as necessary’ (PRN) medication. Protocols are also in place for the use of PRN medication. Information on one file was contradictory. For instance a risk assessment for agitation did not indicate a maximum dose for the use of PRN medication in line with the PRN protocol. Staff must remember to label tubes of cream with the date of opening. The temperature of the medication cabinet is now being monitored and shows that the temperature does not rise above 24°C. Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Making accessible and current complaints information available to people living at the home will enable them to express concerns. Better guidance around behaviour management for people living at the home will help staff to respond to difficult behaviours and ensure their approach is respectful and non restrictive safeguarding people from possible harm. EVIDENCE: The home has a complaints policy and procedure which is displayed in the entrance hall. The home has not received any complaints since the last inspection. Two people living at the home indicated that they would speak to the manager or staff if they have concerns. People have a copy of the complaints procedure on their bedroom doors although it was noted this is not the current version. The complaints procedure displayed in their rooms is also not in a version appropriate to their needs. This must be put in place. The organisation has produced a complaints procedure in a format using text and symbol. Copies of this are on each person’s file. Staff receive training in Crisis Intervention which provides them with a non violent approach to the management of challenging behaviour. Staff have also completed training in challenging behaviour, abuse and the protection of vulnerable adults. Discussions with staff confirmed their understanding of issues around abuse. Care plans examined although identifying that people Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 19 may become agitated or angry did not provide a strategy or protocol for staff to follow. Staff indicated that they do not use physical intervention although during the visits staff were observed guiding and moving people to prevent incidents occurring. This has been repeated in previous reports and the home must discuss with the specialist healthcare professional appropriate strategies that may be used in line with the Department of Health Guidance on the use of restrictive physical interventions. On arrival for the first visit staff introduced the inspector to one person who becomes anxious when people visit the home. This did not happen at the time of the second visit because the person was having a rest and as a result they became distressed requiring staff to physically intervene to redirect the person. On the day of the second visit a healthcare professional visited the home to start assessments of people with a view to providing specialist behavioural input to staff. She confirmed that behaviour management plans would be put in place and she would be providing additional profiles for people with autistic spectrum disorder. Accident records for an incident in July 2006 indicated that one of the people living at the home had assaulted another person resulting in retaliation which caused a nose bleed. The Commission had not received a notification of this incident. Any incidents affecting the wellbeing of people living at the home must be reported to the Commission. There was no evidence that either person had been advised of their right to press charges for assault or how this had been dealt with internally. Financial records for people were examined. Each person has a financial risk assessment in place giving consent for staff to support them in the management of their personal money. The manager said that financial balances are checked each day. Receipts are kept and where appropriate people sign for any withdrawals they may. The balance for one person was incorrect. It is recommended that the manager occasionally audits these balances and initials to indicate when this has been done. Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a comfortable and homely environment which provides ample space providing them with accommodation which meets their needs. Plans to redesign the gardens will substantially improve the external facilities and provide a safe environment for people living at the home. EVIDENCE: Heighton House provides comfortable and spacious accommodation for people. They have access to a large lounge, small lounge, conservatory and dining room with adjoining sensory room. People were observed making good use of all areas. Some changes have been made to the small lounge near the kitchen where daily records and people’s care plans are stored. Staff information has been relocated to an area in the kitchen which is not accessible to visitors or people living at the home. Some information is still displayed in this area (See Standard 10). Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 21 The manager confirmed after the visits to the home that work will be starting on the reconstruction of the garden to provide a safe environment for people living at the home. This will include new fencing around the garden creating a new entrance to the front door. The manager confirmed that all maintenance issues highlighted in the last report have been dealt with. Discussions centred on the carpets on the first floor which are stained and are in need of attention on the stairs between the office and bedrooms. These carpets were due to be cleaned after the visits. The home does not have a cleaner so staff share the cleaning duties. People living at the home said that they also help. At the time of the visits the home was clean and tidy. Paper towels should be provided in the laundry instead of a hand towel. Staff are provided with personal protective equipment. Hazardous products are stored securely and COSHH data sheets are kept. Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Providing staff with behavioural strategies and approaches will safeguard people living at the home from possible harm. Improvements to recruitment and selection processes will protect people living at the home. Training for staff has significantly improved providing them with the knowledge and skills to care for people living at the home. EVIDENCE: Staff appeared to be accessible and approachable. They were observed spending time supporting people living at the home and communicating with them is a positive way. Staff spoken with said that morale within the home has significantly improved. Staff confirmed that they have an induction upon appointment. A copy of a completed induction programme was examined. Staff said that they have access to a NVQ programme. Three members of staff have a NVQ award and seven people are completing their awards. Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 23 Staff need to have access to strategies and guidelines to support people with behaviour which may present with challenges. This needs to include proactive and reactive approaches which will avoid using restrictive physical interventions. (See Standard 23) One person had been appointed since the last inspection. An application form, two references and an occupational health questionnaire are in place. The references did not request the reason for leaving former positions in care. The manager must make sure that she uses a reference request form which asks for this information. The Criminal Records Bureau check was examined and disposed of after the visit. The person was not appointed prior to the receipt of this document. Evidence of identity and a photograph are also in place. Training records confirmed that staff have access to a range of training which includes refresher training. During the visit staff were attending medication training. Training highlighted in previous reports has now been put in place. This includes training in communication, epilepsy, person centred planning, learning disability and risk assessment. Autism training is scheduled to take place. A training co-ordinator from Craegmoor visited the home during the second visit to monitor training needs and to help the manager set up a training manual. Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is beginning to address some of the outstanding issues and to improve quality in the home to the benefit of people living there. The quality assurance system involves the people living at the home and their representatives. Health and safety systems need improving to ensure that standards are maintained to protect the wellbeing of people living at the home. EVIDENCE: The manager started at the home in April 2006 and has not yet registered with the Commission to become the registered manager. This must be done. She is experienced in this area of care, having previously been the registered Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 25 manager of a care home and is completing the NVQ Registered Manager’s Award. Since the last inspection she has started to address some of the shortfalls identified at previous inspections. Although there are still a significant number of requirements at this inspection there was evidence that improvements are being introduced and that some of these are being addressed. It is hoped that a large number of these requirements will be complied with by the time of the next inspection. Staff spoke positively of the manager and felt that standards within the home as well as staff morale are improving. Monthly unannounced visits to the home have been taking place sporadically. The last report received by the Commission was in September. The registered manager said that a Regulation 26 visit had taken place in November. Regulation 26 reports must be sent to the Commission until further notice. Craegmoor have introduced an internal audit system which representatives from the organisation complete. Copies of audits for health and safety, medication, infection control, food safety and overview audits were examined. Craegmoor also has a forum for feedback from people living at their homes called ‘Your Voice’ and in July/August 2006 produced a report summarising the feedback they have received. The home has systems in place to monitor health and safety within the home. New procedures have been introduced by Craegmoor and the manager is due to implement these before the end of the year. Records for fridge and freezer temperatures, water temperatures and fire drills are up to date. Fire records did not appear to have been completed in September and October, although the deputy manager said that he now has responsibility for doing these. Records for November were completed. Most of the food in fridges was labelled with the date of opening. Temperatures for fridges indicated that the fridge is frequently outside safe parameters. The fridge did not feel unduly warm and the manager thought that staff may be testing the fridge when it had been opened frequently at mealtimes. The manager is advised to either purchase another thermometer or stagger times for testing the temperatures. Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 1 LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 X 3 1 X 3 X X 3 x Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 6 (a) Requirement The registered person shall (a) keep under review and, where appropriate, revise the statement of purpose and the service users guide. The registered person shall supply a copy of the service user’s guide to (the Commission) and each service user. The registered person shall apply for a minor variation to the registration of the home to include LDE for the person over 65. 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 Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 28 Timescale for action 31/12/06 2. YA1 5 31/12/06 3. YA1 6 CSA 31/12/06 4. YA6 12, 14 and 15 31/03/07 people significant to them must be consulted about what is important to them and distinguish between the aspirations of the individual and expectations of others. Previous timescales of 31/04/05, 31/10/05, 31/01/06 and 31/08/06 have not been met although significant progress has been made) 5. YA9 13(4)(c) The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (Missing person’s information needs to be put in place for the new admission. Previous timescale of 31/0706 partially met.) 31/12/06 6. YA10 17(b) 7. YA12 12(4)(a) The registered person shall 31/12/06 (b) ensure that the record referred to in subparagraph (a) is kept securely in the care home – in relation to display of confidential information in public areas of the home and locking of cabinets containing personal information. The registered person shall 31/12/06 make suitable arrangements to ensure that the care home is conducted – (a) in a manner which respects the privacy and dignity of service users. (In relation to providing a private area for aromatherapy massage.) DS0000016458.V320717.R01.S.doc Version 5.2 Page 29 Heighton House 8. YA16 13(6) and 15 The registered person shall 31/03/07 make arrangements, by training staff or by other measures to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. (All restrictive practices used in the home must be identified and evidence recorded in care plans of a multidisciplinary agreement that such approach is in the best interest of the service user. Care and support guidance must provide clear detail of any restrictive practices (reference to ‘removal’ of service users). (Timescales of 31/10/05, 31/01/06, 31/08/06 not met although work is in progress.) 9. YA17 13(6) 31/03/07 The registered person shall make arrangements, by training staff or by other measures to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. (Consult with a dietician to assess service user’s nutritional needs and assess whether food provided promotes their health and wellbeing particular reference to the amount of sweet foods and drinks given. Previous timescale of 31/12/05 and 31/08/06 not met although contact is Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 30 being made.) 10. YA18 12 The registered person shall make suitable arrangements to ensure that the care home is conducted – (a) in a manner which respects the privacy and dignity of service users; (The protocol for the use of a listening device (baby monitor) must be revised to give clear guidance as to when this is to be used, for what reason and how the person’s privacy will be protected when the device is in use. Previous timescale of 31/08/06 not met.) The registered person shall supply a written copy of the complaints procedure to every service user. The complaints procedure shall be appropriate to the needs of service users. The registered person shall ensure that no service user is subject to physical restraint unless restraint of the kind employed is the only practicable means of securing the welfare of that or any other service user and there are exceptional circumstances. On any occasion on which a service user is subject to physical restraint, the registered person shall record the circumstances, including the nature of the restraint. Systems of monitoring, recording and responding to Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 31 31/12/06 11. YA22 22(2)(5) 31/03/07 12. YA23 13(7)(8) 31/03/07 behaviour challenges by service users must be implemented in line with the Department of Health Guidance on restrictive physical interventions and the relevant guidance from BILD. This must include written protocols which give clear guidance to staff on any agreed approaches including use of physical intervention and ‘as required’ medication. (Timescale of 31/01/06 not met - although progress has been made.) The registered person shall 31/12/06 give notice to the Commission without delay of the occurrence of (e) any event in the care home which adversely affects the well-being or safety of any service user. (Previous timescales of 11/10/05, 22/11/05 and 31/12/06 not met). 14. YA24 23(2)((b) The registered person shall 31/03/07 having regard to the number and needs of the service users ensure that – (b)the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally.(In regard to the condition of the carpets on the first floor landing). The registered person shall 31/03/07 having regard to the number and needs of the DS0000016458.V320717.R01.S.doc Version 5.2 Page 32 13. YA23 37(1)(e) 15. YA28 23(2)(b) Heighton House service users ensure that – (b)the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally (With regard to the gardens around the home – work is in progress. Previous timescale of 31/10/05, 31/03/06 and 30/08/06 not met) 16. YA34 19 Schedule 2.4 Where a person has previously worked in a position which involved contact with children or vulnerable adults, written verification of the reason why he ceased to work in that position unless it is not reasonably practicable to obtain such verification. The registered provider shall appoint an individual to manage the care home. A person shall not manage a care home unless he is fit to do so. (With regard to the application for registration of the manager. Previous timescale of 31/07/06 not met.) The registered provider shall supply a copy of the report to be made under paragraph 26(4)(c) to the Commission. 31/12/06 17. YA37 8(1) and 9 (1) Care Standards Act Section 11 31/12/06 18. YA39 26(5)(a) 31/12/06 Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA6 YA9 YA12 YA18 Good Practice Recommendations Person centred planning should be put in place for all service users. Missing person’s information should include photographs of service users. Activity reports for the year should reflect what each individual has participated in. The home should check its policy on providing gender appropriate support with personal care and ensure that this is reflected in the way the home is staffed. All liquids and creams are to be marked with date of opening and disposed of after one or three months as advised by the pharmacy. A risk assessment for agitation should indicate the maximum dose of PRN medication to be given before consulting the GP. Financial records should be monitored regularly and the manager should initial the record to show that this has been done. A new thermometer should be purchased. Times for testing temperatures of fridges should be staggered. 5. YA20 6. 7. YA23 YA42 Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 34 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. Extracts may not be used or reproduced without the express permission of CSCI Heighton House DS0000016458.V320717.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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