Inspection on 06/04/09 for Heighton House

This inspection was carried out on 6th April 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heighton House 14/04/08

Heighton House 24/04/07

Heighton House 28/11/06

Heighton House 18/05/06

Heighton House 22/11/05

Heighton House 22/06/05

Heighton House 21/01/05

Heighton House 27/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOME ADULTS 18-65 Heighton House 19 Barnwood Road Gloucester Glos GL2 0SD Lead Inspector Ms Lynne Bennett Unannounced Inspection 6th April 2009 14:00 Heighton House DS0000016458.V374478.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.V374478.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.V374478.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) Manager post vacant 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.V374478.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th April 2008 Brief Description of the Service: Heighton House is a care home that provides accommodation for up to eight adults with learning disabilities. All of the people living in the home have single bedrooms, some with en suite facilities. There is a large communal lounge, smaller lounge, sensory room and dining room as well as a large conservatory. Outside there is a car park and a spacious lawn. Craegmoor Healthcare owns Heighton House. The home has a Statement of Purpose and Service User Guide which set out information about the philosophy of the home and the facilities provided. Copies of these are available upon request and are supplied to people who are considering moving in. The base fee for the home was £933. Heighton House DS0000016458.V374478.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection took place in April 2009 and included two visits to the home. The acting manager completed an AQAA (Annual Quality Assurance Assessment) as part of the inspection, providing considerable information about the service and plans for further improvement. It also provided numerical information about the service (DataSet). Because people with learning disabilities are not always able to tell us (The Commission) about their experiences, we have used a formal way to observe people in this inspection to help us understand. We call this a Short Observational Framework for Inspection (SOFI). This involved us observing three people who live in the home for two hours and recording their experiences at regular intervals. This included their state of wellbeing and how they interacted with staff members, other people living in the home and their environment. We talked to three people using the service, and asked staff about those peoples needs. We also looked at the care plans, medical records and daily notes for these three people. This is called case tracking. We looked at a range of records including staff files, medication systems, quality assurance audits and health and safety documents. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: What has improved since the last inspection? Heighton House DS0000016458.V374478.R01.S.doc Version 5.2 Page 6 There had been significant improvement in the range of activities and opportunities being offered to people on a regular basis. Staff had worked with health care professionals to support people to manage their anxieties and anger. The number of incidents had significantly decreased. Their skills and knowledge have developed improving the quality of life of people living in the home. There have been environmental improvements around the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Heighton House DS0000016458.V374478.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.V374478.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): 1,2,3,4 and 5. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have access to the information they need enabling them to make a decision about whether they wish to live at the home. An assessment of the person’s wishes and needs are taken into consideration before offering them a place. EVIDENCE: The Statement of Purpose and Service User Guide had been reviewed and were available in the home. The acting manager was reviewing the Service User Guide with people living in the home to produce a version that would be personalised and include photographs of their room and staff. One person had been involved in visits to the home with a view to moving in. The acting manager had completed an assessment of need and their placing authority had provided an assessment and care plan. Health care professionals involved in their care had also provided other information. There was evidence that arrangements had been made for a transfer of support from these health care professionals to the local team once the person had settled into the home. Staff training was being arranged to ensure they had the skills and knowledge to support this person. Heighton House DS0000016458.V374478.R01.S.doc Version 5.2 Page 9 They had visited the home prior to staying overnight. Their family and placing authority had also been involved in the transition process. Other people living in the home had been involved in this process and they said they were looking forward to them moving into the home. Each person had a statement of terms and conditions in place which had recently been reviewed indicating their current level of fees and the service they should expect from the home. Heighton House DS0000016458.V374478.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 and 9. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A person centred approach to care planning provides the opportunity for people to makes decisions about their lifestyles. People need to be confident that their changing needs are being recorded in their care plans. Risks are being managed safeguarding them from possible harm. EVIDENCE: The care of three people was case tracked and other files sampled. Each person had a person centred plan in place with corresponding support plans, risk assessments and behaviour management plans. From each person’s assessment of their physical, intellectual, social and emotional needs support plans were developed which were being regularly evaluated by key workers. People living in the home said they were involved in this process with their key workers and some had signed some documents on their files. The acting manager said that she was evaluating the process of person centred planning and how people were being involved. She had recognised that Heighton House DS0000016458.V374478.R01.S.doc Version 5.2 Page 11 people’s wishes and aspirations had not been identified in the process currently used. Staff were completing training in person centred thinking and spoke about how they would be involving people in making decisions and choices about their lifestyles. Plans were being reviewed in line with this training and the team were evaluating the records currently being used. The long-term plans were to minimise duplication of documents and recording required by staff. Monthly key working summaries were being completed in addition to monthly evaluation sheets for each support plan and risk assessment. New evaluation sheets were being introduced which would replace the need for the additional monthly reports. There was evidence that each person had a review with their placing authority in 2008 with copies of their assessment of need and care plan on their files. Actions identified in two of these care plans had not been implemented by the home in relation to people’s health care needs and their diet. (See Lifestyle and Personal and Healthcare Support). There were inconsistencies in the quality of report writing in evaluation of support plans and in daily notes. In some plans the quality of report writing was good with key workers reflecting on outcomes for people and noting any changes and the action taken. Some reports commented that there ‘had been no problems’ or ‘no changes’. Supervision notes indicated that the acting manager had identified this and was supporting staff to develop their skills in report writing. Staff spoken with had a good understanding of the needs of people and they were observed supporting people in line with their plans during the visits. For instance one person’s plan indicated they might become anxious which could lead to them not managing their behaviour. Staff were observed calmly interacting with them and helping them to identify what was wrong and to ‘put it right’. For those people with Autistic Spectrum Disorder there were individual profiles in place which had been developed by a Psychologist. These provided staff with clear information about how people liked to be supported and the routines that were important to them. An Impairment Social Communication assessment was also provided with this profile giving staff prompts on how people communicated their needs. Communication support plans in place alongside a communication dictionary. Staff were observed using Makaton sign language with people as well as objects of reference. Some records had been produced using a mixture of text and pictures such as the complaints procedure. There could be greater use of photographs around the home to illustrate staff rotas, menus and activity schedules. Heighton House DS0000016458.V374478.R01.S.doc Version 5.2 Page 12 There were some restrictions around the home such as keypads to the front door and the kitchen which need to be reviewed in light of the Deprivation of Liberty Safeguards (DOLS). If necessary the appropriate assessments and documentation will need to be completed. Training was being provided for staff in DOLS and the Mental Capacity Act. Support plans indicated where people needed help to manage their finances. Records were in place evidencing debits and credits, cross referencing receipts and showing an audit trail was in place. Craegmoor send financial auditors to the home. There was evidence that this had just been completed and accounts reconciled. Risk assessments were in place identifying hazards and ways in which they should be minimised. These were being regularly evaluated. Records of incidents were being kept and monitored by Craegmoor. Heighton House DS0000016458.V374478.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): 11,12,13,14,15,16 and 17. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live at the home make choices about their lifestyle, and are supported to develop life skills. They have the opportunity to take part in social, educational and recreational activities and keep in touch with family and friends. People have a nutritional diet and their diverse needs are catered for. EVIDENCE: One person said they go to a local church each Sunday. The spiritual preferences of people were highlighted in their care plans. Support plans did not reflect where people have chosen not to practice the spiritual beliefs they were born into. One person’s care plan supplied by their placing authority indicated that they no longer followed their spiritual beliefs which impacted on their diet. This had not been amended in the home’s care plan. Staff said that the dietary restrictions formerly in place were no longer followed. Each person had an activity schedule in place which was supported by a weekly copy of this record which had been amended to show which activities Heighton House DS0000016458.V374478.R01.S.doc Version 5.2 Page 14 they had taken part in outside of the home. Some entries in the daily diaries were inconsistent with these records. Entries were examined for four weeks in March and April indicating that one person spent 8 days ‘wandering’ or ‘watching television’. Their support plan had stated the importance of occupation and offering the opportunity to be involved in ‘meaningful activities.’ If the person had been offered and refused activities then this should be recorded. The person’s ASD profile indicated they liked music and staff said they would sing when happy but at no time was music put on during our visits. During the use of the SOFI tool this person was observed watching people involved in arts and crafts and being encouraged to join in with the activity. They chose not to participate. Observations also indicated that whereas two people involved in the activity had interactions with staff for over 90 of the time, this person had interactions with staff for just 43 of the time. The acting manager and staff acknowledged that supporting people with short concentration spans was a challenge and enabling them to participate in activities was an area that they needed to consciously promote within the home. The AQAA indicated that budget restrictions had impacted on people’s range of activities as well as access to drivers but that the home was looking at the range of activities offered which were cost effective. People said they liked to go to social clubs in the evenings and were going to these four evenings a week. People were also having access to horse riding, swimming, the cinema, shopping trips, day trips, day centres and colleges. An Aromatherapist and Music Therapist also visit the home frequently. People were observed using the sensory environment, trampoline and participating in ball games during the visits. They were also taken out to the park and for drives as well as helping with the shopping. Some people spent time in the lounge or conservatory and others were in the dining room. At a recent house meeting they had talked about work opportunities. Comments from a health care professional included “people are supported well to access a range of leisure and recreational activities – according to their interests.” The acting manager said that as person centred planning evolved it was hoped that people would develop their skills and become more independent. People said they help with the laundry and clearing away. They were observed helping themselves to drinks and were regularly offered snacks. Some people have keys to their rooms. The acting manager stated they were looking at assistive technology for those people unable to use keys so that their possessions could be safeguarded. People had access to the home’s transport but also used local buses and taxis. Contact sheets indicated that people had regular contact with family and friends either by visits or using the telephone. Two people had friends they visit at other homes in the county and were being supported to maintain this Heighton House DS0000016458.V374478.R01.S.doc Version 5.2 Page 15 contact. One person said they had friends at the local church who they enjoyed meeting each week. The main meal was being prepared each evening and the menus indicated that a range of freshly produced meals were available using fresh ingredients. One person liked to eat curries and these were available. Another person was being supported to monitor their weight and offered a low carbohydrate and low fat diet. A dietician had been involved. Fresh fruit was observed being offered to people to snack on during the visits. Heighton House DS0000016458.V374478.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 20. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There needs to be greater vigilance with the monitoring of some appointments to ensure people have access to all health care professionals. Improvements in the administration of medication need to be implemented to safeguard people from the risk of error or possible harm. EVIDENCE: The ways in which people would like to be supported were clearly recorded in their support plans. Their likes and dislikes were recorded. Staff spoken with appeared to have a good understanding of the needs of the people they support. There was no evidence on the plans read that they had been consulted about the gender of staff providing personal care. Times for getting up and going to bed were flexible. One person liked to get up around 6.00 am and retired to their room in the early evening. Others preferred to go to bed later and rise later in the morning. Each person had a Health Action Plan. The acting manager stated that new health action plans had been put in place and they were presently with their Doctor to complete. Records of people’s appointments with their Doctor, Heighton House DS0000016458.V374478.R01.S.doc Version 5.2 Page 17 Optician, Chiropodist and consultant psychiatrist were recorded with an outcome of each appointment. Two people’s Placing Authority care plans stated that they must have regular appointments with a dentist. Neither had records indicating that they had seen a dentist in 2008 or 2009. People were having access to the local Community Learning Disability Team where appropriate. Additional equipment had been provided upon the recommendation of an Occupational Therapist and a referral had been made to a Speech and Language Therapist. The home employed the services of a Psychologist to support them to develop behaviour management plans for several people. There was evidence that this support was having beneficial effects within the home and staff understanding of people’s anxieties and how to manage their behaviours. The number of incidents had significantly reduced. Comments from a health care professional indicated that “the progress in the home had been significant and that the staff team deserve credit for this.” The systems for administration of medication were examined. The home used a monitored dosage system and staff were completing accredited training in the safe handling of medication. The temperature of the medication cabinet was being monitored and the acting manager had plans to alter the room in which it was stored to improve systems for administration. Staff were observed dispensing medication to a person. It appeared they signed the medication record as they were potting up the medication and before the person had received the medication. The acting manager described the process for administration of medication that she would expect to be followed which clearly required medication to be given to people before the record was signed. Protocols were in place for the administration of ‘as necessary’ medication which had been authorised by the Doctor. Homely remedies were in use but the homely remedy list could not be found. Stock records were being maintained for all medication not supplied in blister packs. The acting manager said that competency audits would be completed with staff. Heighton House DS0000016458.V374478.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. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Systems are in place that enable complaints and concerns to be raised by people using the service or on their behalf. Recording of incidents needs to be improved to make sure that people are being safeguarded from possible harm. EVIDENCE: The home had a copy of the current complaints procedure displayed in the hall. This had been produced in a format using text and pictures. The AQAA indicated that they had personal copies of this in their rooms and on their files. People said they would talk to staff if they had concerns and the surveys returned confirmed this. A house meeting had been held this year where people were given the opportunity to discuss any concerns or issues. A representative from the home also meets at an area meeting with people from other homes and the Area Manager. The DataSet indicated that no complaints had been received by the home. Staff were completing training in the safeguarding of adults with Craegmoor. They also had the opportunity to attend training in the Mental Capacity Act and DOLS. Staff spoken with had a good understanding of the home’s whistle blowing procedure and abuse. They said they would report any concerns to the acting manager or Craegmoor. Staff were completing training in the management of challenging behaviour. They stated that physical intervention was not used. Incidents were being recorded in daily notes making reference in some instances that a Heighton House DS0000016458.V374478.R01.S.doc Version 5.2 Page 19 corresponding incident record had been completed. These forms were copied to Craegmoor for their monitoring purposes. One entry in a daily record indicated that a person had hit another person and a member of staff. There was no corresponding incident record for this. We would also have expected to be informed about an incident of this nature under Regulation 37. The person who was assaulted has the right to press charges and staff must be aware of their rights. The acting manager stated that she was not aware of this incident. Other entries in daily records had not been recorded on incident records. It is important that incident records are completed and that we are notified when people are put at risk of harm. Comments from a health care professional and statements in the AQAA indicated that staff have a better understanding of people’s non verbal behaviours and actions. This had resulted in a “more settled homely environment” and “ fewer periods of unsettled behaviours.” Records and discussions with staff confirmed this. During our visits the atmosphere of the home was calm and staff appeared to manage people’s anxieties in a positive and respectful way. Craegmoor had audited people’s finances just before our visit and a report with actions would be produced. The acting manager checks bank statements with the home’s records. It is advised that she sign and date these as this is completed. Heighton House DS0000016458.V374478.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. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is safe, clean and well maintained which recognises their diverse needs creating an environment that matches their personal requirements. EVIDENCE: A walk around the home was conducted and some people showed us their bedrooms. Some redecoration was taking place during our visits of communal areas and bedrooms. The acting manager described long-term plans which included changing the small lounge adjoining the kitchen into a dining room. The dining room would then be converted into two offices and create a private area for the sensory environment. The upstairs office would be converted into an additional area would could be used for meetings or for people to use computers. A maintenance person had been appointed to help with day-to-day repairs and until they started in post help was provided from a nearby home. The garden was well kept and people were observed enjoying the space it now provides. Heighton House DS0000016458.V374478.R01.S.doc Version 5.2 Page 21 During the visits the home was clean and tidy. A shower curtain in the upstairs shower room needed cleaning or replacing. The acting manager confirmed this was done immediately after our visit. During both visits to the home an extension lead was placed across the hallway and the door to conservatory. This was to provide power for training in the conservatory during our first visit. It was still in place during our second visit. The acting manager confirmed this had now been removed. Staff were still involved in the cleaning of the home and people living there were helping out occasionally. Personal protective equipment was provided and liquid soap and paper towels supplied in communal toilets and hand washbasins. Hazardous products were stored securely and COSHH data sheets in place. Heighton House DS0000016458.V374478.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): 32,33,34 and 35. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Peoples’ needs are met by a competent staff team, who have access to a comprehensive training programme that provides staff with the opportunity to gain knowledge about the diverse needs of people living at the home. Improvements need to be made to recruitment and selection processes to make sure people are safeguarded from possible harm. EVIDENCE: The acting manager stated that the home was fully recruited but that where necessary, to cover long-term absence, bank staff or staff from other homes were being used. Staffing levels were confirmed as 3 care staff each shift rising to 4 on some afternoons. A waking night carer was supported by a carer sleeping in. Staff said that staffing levels were appropriate and that were mostly impacted on by the numbers of staff available to drive. The acting manager said that the rota was drawn up bearing this in mind. The AQAA indicated that 30 of staff had a National Vocational Qualification (NVQ) in Health and Social Care and that a further 30 were working towards their awards. New staff confirmed that they had completed an induction programme. The acting manager stated that this was equivalent to the Skills Heighton House DS0000016458.V374478.R01.S.doc Version 5.2 Page 23 for Care Foundation Programme. Staff did not have access to the Learning Disability Qualification although the acting manager thought that Craegmoor were looking into providing this. Healthcare professionals indicated that “people are treated in a dignified and respectful manner” and “they seem to be a lot more focussed on the purpose and knowledgeable about the individuality of the service users.” Recruitment and selection files were examined for three new members of staff. A checklist was in place on two files confirming when records were received. Application forms were in place and for two people provided a full employment history. One person had not supplied dates for college courses so it was not possible to ascertain whether there were any gaps in their employment history. Reference request forms did not request the reason for leaving. The home needs to make sure they use the most recent reference request form supplied by Craegmoor that asks for this. Evidence of identity and current visas were in place. Craegmoor has a robust training programme that includes taught and electronic open learning as well as access to external courses. There was evidence that individual training needs were being monitored by Craegmoor and brought to the attention of the acting manager. During our visit staff were completing training in Food Hygiene and Protection of Adults. Staff confirmed access to a range of training including specialist courses in Autism and Epilepsy. The acting manager indicated that mental health training would be provided for staff. Heighton House DS0000016458.V374478.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. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are benefiting from a manager who is providing clearer direction and leadership. By ensuring robust recruitment and selection procedures are in place she will safeguard people from possible abuse. Effective quality assurance systems are in place involving people. Clarification about evacuation procedures in case of fire will make sure people are safe from possible harm. EVIDENCE: The acting manager had considerable experience working in residential care and with people with a learning disability. She had the Registered Managers Award and was completing a NVQ Level 4 in Health and Social Care. Staff spoke positively about her management skills and positive changes she had Heighton House DS0000016458.V374478.R01.S.doc Version 5.2 Page 25 made in the home. This was confirmed by comments from health care professionals. She had supplied an AQAA to us on time. This provided information about long term developmental plans for the home. Recruitment and selection procedures need to be robust to ensure that all information was being obtained prior to appointment and the correct reference requests were being used. There were some restrictions around the home such as keypads to the front door and kitchen that need to be reviewed in light of the Deprivation of Liberty Safeguards (DOLS). The acting manager stated that people were free to leave the building because the garden was no longer secure but at times both kitchen and front doors are locked. An assessment should be completed. Craegmoor have robust quality assurance systems in place which include self assessments by managers which were being completed monthly and audits by external staff. People living in the home had taken part in a survey last year and had copies of surveys to complete for this year. A representative from the home was involved in the Area and Regional forums of ‘Your Voice’. Records of minutes were in the office. There was evidence of information on notice boards about how people living in the home should be included in the recruitment and selection of staff. The Area Manager was conducting unannounced visits to the home and producing a written report each month. Some systems for the monitoring of health and safety within the home were inspected and found to confirm information supplied in the AQAA. Records were being maintained for fire systems and water and fridge/freezer temperatures. A fire risk assessment was in place which indicated that some people would not evacuate the building at times of fire. Advice must be sought from the local fire service about the risk assessment that needs to be in place. Night staff did not appear to be doing fire training or fire drills regularly. Heighton House DS0000016458.V374478.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 3 2 3 3 3 4 3 5 3 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 3 X X 2 X Heighton House DS0000016458.V374478.R01.S.doc Version 5.2 Page 27 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement The registered person must make sure that any changes to a person’s needs are reflected in their care plans. This is to make sure that that people’s needs are being met. The registered person must make sure that people have access to dental examinations on a regular basis. This is to make sure that their healthcare needs are being met. The registered person must make sure that medication is administered safely. The medication record must be completed after people have taken their medication. This is to make sure that people are given the correct medication and to prevent errors from occurring. The registered person must make sure that any incidents affecting the wellbeing of people living in the home are reported to us. This is in respect of an DS0000016458.V374478.R01.S.doc Timescale for action 31/07/09 2. YA19 13(1) 31/07/09 3. YA20 13(4) 30/05/09 4. YA23 37 30/05/09 Heighton House Version 5.2 Page 28 5. YA23 13(6) 6. YA34 19 assault by a person on another person living in the home. This is to safeguard people from harm. The registered person must make sure that people are protected from possible harm. This is in respect of assaults from other people living in the home. The registered person must make sure that all records needed by us in respect of recruitment and selection are obtained. This is in respect of a full employment history and the reason for leaving former positions in care. This is to safeguard people from possible harm. The acting manager must apply to become registered with us. 30/05/09 30/05/09 7. YA37 8. YA42 Care 30/05/09 Standards Act Section 11 It is an offence to carry on management of an establishment without registration. 23(4A) The fire risk assessment and 31/07/09 evacuation procedure must comply with the Regulatory Reform (Fire Safety) Order 2005. This is to safeguard people from possible harm. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations Promote a person centred approach which involves people in developing their plans identifying their strengths, needs, DS0000016458.V374478.R01.S.doc Version 5.2 Page 29 Heighton House 2. 3. YA6 YA7 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. YA7 YA11 YA14 YA18 YA20 YA23 YA23 YA23 YA32 YA35 YA42 wishes and aspirations. Build upon improvements in report writing to ensure a consistent approach by staff team. The rationale for the use of keypads on the front door and kitchen need to be reviewed in light of DOLS and if necessary the appropriate assessments and records completed. Consider using photographs to illustrate menus, activity schedules and staff rotas. Where changes occur in people’s spiritual beliefs these should be noted in their care plans. Activity records should evidence when people have been offered activities and refused, and what people have been involved in during their day. People’s preferences for the gender of staff providing their personal care should be recorded. Seek individual GP approval for the over the counter remedies/supplements in use in the home. Incidents affecting the well being of people living in the home should be recorded on the home’s incident records. Staff should be aware of the rights of people who have been assaulted. Bank statements should be signed and dated as they are checked. Staff should have access to the Learning Disability Qualification. Staff should have the opportunity to increase their knowledge and skills in mental health. Night staff should have access to frequent fire drills and training. Heighton House DS0000016458.V374478.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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.V374478.R01.S.doc Version 5.2 Page 31 - 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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