Inspection on 13/07/06 for High Trees

This inspection was carried out on 13th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

High Trees 13/12/05

High Trees 06/09/05

High Trees 28/01/05

High Trees 16/11/04

High Trees 03/02/04

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Southfields

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

CARE HOME ADULTS 18-65 High Trees Lympne Place Aldington Road Lympne Hythe Kent CT21 4PA Lead Inspector Mrs Sue Gaskell Unannounced Inspection 13th July 2006 10:00 High Trees DS0000039200.V299375.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 High Trees DS0000039200.V299375.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. High Trees DS0000039200.V299375.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Trees Address 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) Lympne Place Aldington Road Lympne Hythe Kent CT21 4PA 01303 260453 www.hft.org.uk Home Farm Trust Miss Melony Isaac Care Home 4 Category(ies) of Learning disability (4) registration, with number of places High Trees DS0000039200.V299375.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th December 2005 Brief Description of the Service: High Trees is a care home registered to accommodate up to four service users with a learning disability. The fees are £1932 per week. Home Farm trust is the Registered Provider and the home is managed by Ms. M Isaacs. The home is one of several units operated on the Lympne Place site by the Trust. High Trees was purpose built with a specific client group in mind and currently provides for an all male client group with autism. The home is situated in a rural setting but within easy travelling distance of the towns of Hythe, Ashford and Canterbury. High Trees DS0000039200.V299375.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 13th July 2006 between 10.00 and 1.30pm. with a second site visit on 18th July between 11.00am and 12.30pm. to examine staff files and recruitment and staffing practices. There are 4 people living at the home. 2 residents were still away on holiday with staff at the time of the first inspection and all residents were at home at the time of the second inspection. The inspector spoke to the 4 residents, and 3 members of staff. The residents have limited communication and therefore the inspector spent as much time with them as possible in order to see whether they appeared relaxed and comfortable. The inspection process consisted of information collected before and during the visit to the home, and care management feedback after the site visit finished. Other information seen included incident report forms, assessment and care plans, medication records, duty rota and staff employment and induction paperwork. What the service does well: What has improved since the last inspection? 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. High Trees DS0000039200.V299375.R01.S.doc Version 5.2 Page 6 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 High Trees DS0000039200.V299375.R01.S.doc Version 5.2 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5. Quality in this outcome area is good. . This judgement has been made using available evidence including a visit to this service. The statement of purpose, service user guide and individual statement of terms and conditions, clearly says what service will be offered. Prospective residents can be confident that their needs will be assessed and can be met. EVIDENCE: There have been no admissions to the home since the last inspection visit and there have been no changes to the previously reported admission process. All prospective service user contact is initiated via the HFT Social Worker who, together with staff from the home, undertakes a pre placement assessment in the prospective resident’s home or current placement, and compiles a profile of needs. Prospective residents and their families or advocates are encouraged to participate in the decision making process. Trial visits are arranged but are only offered if appropriate. The home does not take emergency admissions. All staff have experience in working with adults with a learning disability and further training is offered, specifically autism awareness. All residents have now been issued with a copy of their terms and conditions of residence and a service user guide. Both are in a pictorial format. High Trees DS0000039200.V299375.R01.S.doc Version 5.2 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is good. . This judgement has been made using available evidence including a visit to this service. The service user plans are easy to use and descriptive. Residents’ choices are respected and their decision-making is well supported. Residents are supported in taking risks in the daily and social activities that form part of an independent lifestyle. EVIDENCE: The home continues to use a “person centred” care planning model which enables residents to have as much input as possible to any decision affecting their lives and clearly shows the individual resident’s views. All of the care plans include details on short and long term goals and how the home will assist residents in achieving their goals. Residents have key workers who monitor their individual needs and activities and help them understand the contents of their care plans. Comprehensive risk assessments have been prepared and include specific guidelines. Care plans and assessments have been reviewed. High Trees DS0000039200.V299375.R01.S.doc Version 5.2 Page 9 The inspector was informed that the home maintains a staff level of three per shift plus the manager during the day in order to reduce risk and offer the opportunity for more activities. However on the first day of the inspection 2 of the residents were still on holiday and therefore there were only 2 staff on duty. On the second day of the inspection there were 4 residents on the premises but due to staff sickness there were still only 2 staff on duty. Whilst this may not have presented a risk to residents, it clearly limited the activities that could be offered to the residents. It is still considered necessary to limit unsupervised access to the main site and to that end the garden gate is fitted with a baffle lock. Issues relating to confidentiality are addressed during the induction period. All records are stored in a lockable office and there was no public display of confidential or personal information. High Trees DS0000039200.V299375.R01.S.doc Version 5.2 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is good. . This judgement has been made using available evidence including a visit to this service. Daily life generally meets the residents’ lifestyle preferences and expectations. Residents’ ability to engage in appropriate leisure activities could be compromised occasionally by lack of staff. Residents have regular contact with their families and friends and receive a nourishing and balanced diet. EVIDENCE: Residents’ daily records confirmed that they have access to a wide range of activities during the day, such as horse riding, trampolining , swimming, and college cookery courses, and that this is generally according to a pre-planned programme. Most of the activities have to be carried out with the assistance of staff but staff said that residents are encouraged to be independent whenever appropriate. The staff shortage on the second day of the inspection meant that residents could not carry out some of their normal activities. It was not High Trees DS0000039200.V299375.R01.S.doc Version 5.2 Page 11 possible to obtain full answers from residents due to their communication needs but staff confirmed that residents would not have to do something if they did not wish to and this was also referred to in one resident’s daily records. The menus and contents of the store cupboard were seen to be varied and appropriate for a balanced diet. Staff said that special attention is given to the needs of residents’ with specific needs and this was referred to in nutrition assessments, a food intolerance report and guidelines. The food seen on the day of the inspection appeared appetising and nutritious. Staff said that residents are encouraged to make suggestions about the menus by using a selection of laminated photographs. High Trees DS0000039200.V299375.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents’ choices over their care are respected. Residents’ care plans are reviewed and their health care needs are met. Residents are protected by the home’s policies and procedures for dealing with their medication. EVIDENCE: The 2 residents who were on the premises were seen to be relaxed and comfortable interacting with staff. Residents care plans and daily records referred to clear guidelines on providing support and monitoring health care and social care needs. There was evidence to show that residents had been referred for specialist help whenever necessary. Both members of staff showed a high level of awareness of residents’ needs and referred to issues, such as a food intolerance report, being included in the care plans. The home has sound medication procedures. Staff confirmed that only trained staff who have been “signed off” would administer medication and that all staff have to read the High Trees DS0000039200.V299375.R01.S.doc Version 5.2 Page 13 procedures stored in the medication file. Medication was stored securely and appropriately. High Trees DS0000039200.V299375.R01.S.doc Version 5.2 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. . This judgement has been made using available evidence including a visit to this service. Residents can be confident complaints will be listened to and dealt with appropriately and they will be protected from abuse. EVIDENCE: Although it was difficult to obtain information directly from the residents due to their communication needs, staff said that every effort is made to ensure that residents can communicate their feelings if they are not happy with something. The home uses complaints forms that have been produced in a pictorial format and there was evidence to show that these had been used by residents. The home has adult abuse procedures in place and staff confirmed that they have received training on adult protection awareness and are aware of “whistle blowing”. High Trees DS0000039200.V299375.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. . This judgement has been made using available evidence including a visit to this service. Residents live in a homely,comfortable and safe environment. The home is hygienic and clean. EVIDENCE: All bedrooms and living areas are furnished and decorated to a good standard, and contained the type of furniture and equipment necessary to provide a homely environment. Residents indicated that they are pleased with their new bedrooms and that they had chosen colours, furniture etc. All areas were seen to be clean and hygienic but there are several areas requiring maintenance or attention, eg some plasterwork in the hall and 1 bedroom, some tiles have recently been pulled off the bathroom wall, and the carpet in the hall. Staff said that quotes have been obtained for re-plastering and redecoration and the replacement of the carpet. The tiles are not likely to present a health or safety hazard and staff said that they would be attended to by the maintenance man in the very near future. Windows are fitted with restrictors. There is a secure well maintained garden. There are no outstanding health and safety issues. High Trees DS0000039200.V299375.R01.S.doc Version 5.2 Page 16 Maintenance certificates were current and there are no outstanding health and safety issues. High Trees DS0000039200.V299375.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 & 35 Quality in this outcome area is good. . This judgement has been made using available evidence including a visit to this service. Service users benefit from a team with a wide range of skills. Staffing numbers are adequate to meet the current number of service users’ needs and wishes. Recruitment practices are sound. Training provision is adequate. EVIDENCE: Although there is no separate cook or domestic staff, staff said that this does not present a problem and that also is enables residents to participate in normal daily activities such as cooking, laundry etc. Staffing on the first day of the inspection was 2 staff for 2 residents but on the 2nd day there were 2 staff for 4 residents. Whilst this posed no risk to residents it did limit their activities. Staff confirmed that they are all required to provide references, CRB checks etc prior to their employment, and staff files included an application form, references, CRB checks, evidence of identity, and supervision notes. There is a good proportion of staff who have completed NVQ training, and all staff have attended training in core requirements such as basic food hygiene, moving and High Trees DS0000039200.V299375.R01.S.doc Version 5.2 Page 18 handling, and health and safety. Staff turnover remains low and staff commented on the good working atmosphere and support from the organisation. High Trees DS0000039200.V299375.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 Quality in this outcome area is good. . This judgement has been made using available evidence including a visit to this service. Residents are supported and protected by the effective management of the home. The company encourages input from residents and regularly reviews its procedures, thus benefiting the residents lifestyle and safety. Health and safety in the home is promoted. EVIDENCE: The inspector observed that residents’ views and feelings are constantly monitored, either through talking to them or through other forms of communication. Staff said that quality assurance is given a high priority and any feedback from residents and/or their families or advocates is acted upon. The general management of the home and completion of records are of generally of a good standard. Although there are some minor maintenance High Trees DS0000039200.V299375.R01.S.doc Version 5.2 Page 20 works to complete there were no obvious hazards around the home and there was evidence to show that health and safety issues are taken seriously eg wet floor signs. The maintenance file also contained current certificates to show that regular checks eg gas, electricity, are carried out. The manager had very recently updated records of checks on the environment and risk assessments. High Trees DS0000039200.V299375.R01.S.doc Version 5.2 Page 21 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 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 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 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 4 x 3 X 3 3 3 3 X High Trees DS0000039200.V299375.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action 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 Ensure that all records and assessments etc are dated. 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