Inspection on 30/10/06 for High Trees Care Home

This inspection was carried out on 30th October 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 no outstanding requirements from the previous inspection report, but made 28 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

High Trees Care Home 03/01/08

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 High Trees Care Home 4 Persehouse Street Walsall West Midlands WS1 2AS Lead Inspector Lesley Webb Unannounced Inspection 30th October 2006 08:30 High Trees Care Home DS0000067426.V317605.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 Care Home DS0000067426.V317605.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 Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Trees Care Home Address 4 Persehouse Street Walsall West Midlands WS1 2AS 01922 615761 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) Chatha Care Homes Limited Mrs Susan Mary Smith Care Home 12 Category(ies) of Learning disability (12) registration, with number of places High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The present service users may remain living at the home once they reach 65 years of age unless their needs cannot be met by the home. No new service users over the age of 65 years may be admitted to the home. 28 February 2006. Date of last inspection Brief Description of the Service: Hightrees is a privately owned care home that provides accommodation to twelve service users for reason of learning disability. The home is made up of two converted Victorian houses, which is attached to all main services. The accommodation is domestic in nature and consists of eight single bedrooms and two double rooms, with some of the rooms being very spacious. In addition, there are two lounges, a dining room and a separate kitchen, a hair dressing facility and several bathrooms and toilets. The home is situated close to Walsall town centre with facilities such as shops, public transport, places of worship and pubs with the near vicinity. There is an enclosed garden to the rear of the property with on and off road parking. High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken by 1 inspector with the home being given no prior notice. During the visit time was spent talking to service users and staff, examining records and observing care practices before giving feedback about the inspection to the registered manager and proprietor. The people who live at this home have a variety of needs. This was taken into consideration by the inspectors when case tracking 3 individuals care provided at the home. For example the people chosen consisted of both male and female, with differing communication and care needs and from various backgrounds. There were no relatives of service users available during the inspection. The home is registered to provide care for adults with learning disabilities. The majority of the residents are able to comment on the care they receive and offered positive feedback praising staff, the manager and the proprietor. A number of records and documents were also examined as well as case tracking. Other information was gathered prior to the inspection from notification of incidents and pre-inspection documentation. Information supplied to the Commission for Social Care Inspection by the home includes the fees charged for living at the home, this being £429.12 per week. The inspector would like to thank everyone for his or her co-operation and assistance during the visit, where the atmosphere was welcoming and inclusive. What the service does well: The home is good at making efforts to involve service users in decision-making processes. This includes involvement in their own assessments of needs, compilation of care plans and encouragement to attend monthly meetings with their key workers. In addition to this regular service user meetings occur where various subjects are discussed including activities, policies, special events and other matters relating to the running of the home. All the service users that the inspector spoke to confirmed that they are supported by staff to make decisions. For example one service user explained, “I have just been on holiday to Australia to visit my family. Staff asked me if I was sure I wanted to go on such a long journey, telling me what it would be like, helping me to make my mind up. It was tiring but I really enjoyed it”. Throughout the visit staff were witnessed treating service users with respect and dignity. For example staff addressed service users by their preferred names, asked their opinions and offered assistance discreetly. Service users also praised staff in supporting them to raise concerns. As one service user explained, “staff tell me to never bottle things up, if I’m unhappy to talk to them so that they can try and help me, they’re lovely”. High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 6 In relation to records the home is good at ensuring staff recruitment documentation is in place prior to them commencing work at the home, notifying the Commission For Social Care Inspection of events in line with Regulation 37 of The Care Homes Regulations 2001 and completing safe working practice risk assessments. All of these ensure service users are protected. The home is also good at ensuring the health of service users is properly managed. All records confirm that service users receive regular appointments with specialists including those for chiropody, dentist, opticians and general practitioners. Prompt referrals to specialists also take place when emergency action is required. What has improved since the last inspection? What they could do better: Many areas of the home require attention to make it safe and comfortable for people to live. For example the leak in the ceiling must be addressed, water damage made good, damp investigated in a service users bedroom, worn carpets replaced and uneven slabs and pathways made safe (see requirements section of this report for a full list of requirements relating to the environment). Major consideration must be given to future maintenance and improvements to the home. Since the last inspection there has been deterioration in training provided to staff. This must be addressed to ensure staff are suitably qualified to undertake their duties. Training required includes all those associated with safety for example food hygiene, moving and handling and infection control, as well as specialist training specific to meet needs of service users such as High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 7 understanding downs syndrome, communication, epilepsy and challenging behaviour (see requirements section of this report for a full listing of requirements relating to training). Some medication practices must also be improved. These include maintaining accurate records, disposing of out of date stock and clarify medication instructions. Work must also be undertaken to ensure any complaint or issue raised by service users is fully investigated, with records maintained. Improvements must also be made to menu planning. Currently these do not always demonstrate that service users are offered nutritionally balanced diets. Action must also be taken to support service users with weight gain, with advice sought from a professional such as a dietician. Other areas where improvements must be made include ensuring care plans and risk assessments are completed in detail for specific needs such as behaviour and epilepsy, continuing with the implementation of a quality assurance system, reviewing of contracts of residency and maintaining full and accurate staff rotas that detail all shifts undertaken. For a full listing of areas where improvements must be made please read the requirements section of this report. 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. High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 8 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 Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although service users have needs assessments in place these require reviewing in order that the home is confident it can meet individual needs. Generally contracts inform people about the service they will receive. EVIDENCE: Documentation supplied to CSCI prior to the inspection details that a person living at the home has mental health needs. The inspector investigated this, as the home is not registered to provide this category of service. The manager states that the home previously had a condition of registration in place allowing for up to two people with mental health needs to reside at the home. It appears that when a later application for variation was submitted by the home this condition was not included in the application. The inspector informed the proprietor that an application must be made. Three service user files were sampled with all containing needs assessments either completed by the relevant placing authorities or the home. The homes own assessment covers all subjects as listed in Standard 2.1 of the National Minimum Standards for Younger Adults. The age range of people living at the home is 42 years to 72 years, with many residing at the home since 1984. Information gathered during the inspection and from documentation supplied to CSCI prior to the inspection indicates that the needs of some people may be changing. The inspector strongly recommends that a multiHigh Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 10 disciplinary team formally reassess any service user who has lived at the home for 10 years or more in order that the home can be confident of meeting their needs. All files sampled contained copies of contracts of residency that have been signed by both the manager and service user. These detail services included in the fee for living at the home and those excluded. None of the contracts sampled specified the room to be occupied or the new fee charged for living at the home. High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 11 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): 6,7,8 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Where possible individuals are involved in decisions about their lives. Although care planning has improved further work is still required to ensure the needs of people living at the home met in full. EVIDENCE: A previous recommendation to introduce person centred planning remains outstanding. The manager states that the home obtained paperwork regarding this but is yet to implement it. She also states that she is in the process of arranging training to support its introduction. All files sampled contained care plans that have been generated from initial needs assessments. Although improved from when last inspected the inspector found that the contents varied and do not always demonstrate how needs are managed. For example for service users who have been identified with additional needs such as communication, epilepsy or behaviour, care High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 12 plans are either missing or lack detail, specific aims or goals and in some cases corresponding risk assessments. All files contain evidence that the home reviews its care plans but all those sampled state that no changes have occurred despite other documentation evidencing changes of needs. All files did however contain evidence that monthly meetings occur between service users and their key workers. Observation of care practices, discussions with service users and viewing of documentation demonstrate that in the main service users are fully supported to make decisions about their lives. For example service users were observed being asked their opinions by staff and records confirm that regular service user meetings now take place. Since the last inspection many service users have moved bedrooms. The manager explained that this had taken place due to the health needs of a particular person and that she had spoken to and gained consent from all service users and their families. Records were only available to confirm that 2 service users consent has been obtained in relation to this. The inspector was also concerned that a service user whose behaviour can be challenging has been moved into a shared room without supporting documentation such as a risk assessment. The manager states that approval from the social work team has been given, but again no records were available to demonstrate this. Generally risk assessments were found to be adequate. However further work is required to ensure they are reviewed within agreed timescales and are in place for all identified needs. High Trees Care Home DS0000067426.V317605.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, 14,15,16 and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use this service are able to make some choices about their life style. Further work is required to ensure activities meet individual’s expectations and that service user receive nutritionally balanced diets. EVIDENCE: Observations made during the visit confirm that in the main service users routines are flexible. Service users were observed moving around the home freely, choosing where to sit and who to interact with. Two people usually have keys to their rooms, but these have been lost with the manager stating they are in the process of obtaining new ones. The inspector was pleased to observe that the service users were addressed with respect and staff knocked doors before entering. Policies and procedures are in place for pets, keys to bedrooms and rules relating to alcohol, smoking and drugs are also included in the contracts of residency. Several service users confirmed that they are allowed to go out when they choose as long as they inform a member of staff. High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 14 A previous requirement to ensure activities are recorded in detail, monitored and evaluated is now part met. Many files sampled contained weekly activity planners that detail events such as attendance at day centres, work placements, in-house activities and outings in the community. Further work is still required in some instances when records state ‘out with support worker’ but do not detail what activity has actually taken place. In addition to the planners activity evaluation sheets are now in place, but again not for all activities undertaken. It was also noted that some choices raised in service user meetings have not occurred with no written explanation as to why. The home should be commended for its efforts to support service users understanding of relationships. Since the last inspection the counselling service Relate has visited the home and talked to service users and some people have also attended individual counselling. Menus supplied by the home prior to the inspection indicate that service users are not offered at least 2 choices of a main meal each day. This was investigated during the inspection with the manager stating new planners have been introduced in order that choices can be obtained. The inspector instructed that choices must be included in the menus and not be in reaction to service users not wanting the meal of choice for that day. The inspector also instructed that further work be undertaken in relation to the menus as they do not demonstrate service users receive nutritionally balanced diets. For example for one week examined no fish (apart from that provided at the chip shop), rice, pasta or fresh products were included on the menu. All files sampled contained nutritional risk assessments and monthly weight records. No evidence could be found of advise being sought from professionals in relation to service users gaining weight, despite one person gaining over two stone in eighteen months and another a stone in twelve months. High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 and 21. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally the health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. Further improvements to some medication systems will offer further protection to service users. EVIDENCE: Service users are supported to manage their own health care. They choose their own GPs, and receive support from staff to manage their own medical conditions. Service users are able to see medical professionals in the privacy of their own rooms. Records seen by the inspector demonstrated that the service users health needs are monitored by the home, with prompt referrals made when required. All service users have regular check-ups with the dentist, optician and other specialists in accordance with their needs. Service users confirmed that staffs support them with their health care, assisting to attend appointments if required. Since the last inspection further improvements to health records have been made ensuring the home fulfils its obligations in this area. High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 16 Medication systems were examined. The home uses a monitored dosage system for administration of medication and a sample of policies were viewed and found to be appropriate. Training documentation confirms that 4 of the 8 staff (one of these being the manager) hold accredited medication training. Some improvements to medication are required, including clarifying ‘as directed’ instructions with the general practitioner or dispensing pharmacy, ensuring staff sign medication administration sheets for all medication administered and disposing of out of date medication (further actions are detailed in the requirements section of this report). Two recommendations are also made, firstly that the home obtain a thermometer and monitor temperatures in the medication cabinet and secondly that a lockable facility be purchased for the storing of fridge lines as currently these are stored on a shelf in the fridge that service users have access to. It was pleasing to find that 3 service users are currently being assessed by the home with the aim to be self sufficient in administering their own medication. The home should be commended for its efforts to obtain information relating to personal wishes and effects after death. All files sampled contained evidence that service users wishes have been obtained in relation to funeral arrangements and personal belongings, with evidence that this information has been sought sensitively. Currently one service user who has resided at the home for several years is terminally ill resulting in them now staying in a hospice. Prior to this the home made every effort to ensure this person could be cared for at home. High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. Staff attempt to support service users to express their concerns. Staff have a good knowledge of protecting people from abuse. Improvements to policies and procedures will offer further protection to those living at this home. EVIDENCE: All service users that the inspector spoke to confirm that they felt confident to raise concerns or complaints and that staff support them when required. Since the last inspection the residents ‘grumbles book’ has been reintroduced as an aid to address issues before they escalate to formal complaints. Upon examination of this book the inspector found 5 issues have been raised from March 2006 to September 2006. The inspector instructed that records must be maintained that evidence these and any others raised in the future are fully investigated, including outcomes, as the present system does not reflect this. Also since the last inspection service user meetings have increased with records confirming these take place every 2 months. Again these are used as a forum for raising issues before they escalate to formal complaints. The formal complaints record details no complaints. However when examining service user files the inspector found a record of a complaint raised by a service user relating to a member of staff. No record could be found of this being formally investigated. Pre-inspection documentation states that the complaints policy was reviewed in 2006, however when looking at this policy the inspector found that it still contained the old address for the CSCI. High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 18 The home has an abuse policy that details different forms of abuse but it does not include procedures to be followed if an allegation is made. A copy of the updated local authorities adult protection procedures was available in the office. The inspector recommends that the old ones are removed from premises (these were available to staff in the dining room) and that the home ensure staff are made aware of the new document. A restraint policy was viewed, again with home instructed to review it to ensure it complies with legislation. The policy also requires expanding to include physical and verbal aggression. Records confirm that 6 of the 8 staff employed at the home have undertaken adult protection training. Further training in challenging behaviour and aggression is required, as currently no one at the home has undertaken this despite one service user who resides there having needs in this area. Financial practices were examined. The proprietor has all but one service users monies paid into a company bank account, bringing their personal funds to the home each week. Each service user has own money tin in their bedroom, with the manager holding the keys. Each service user has their own bank account to save additional funds. A record book is kept in each service users rooms with their money tin. The inspector questioned this system, with the manager and proprietor stating it was inherited from the previous owners. The proprietor agreed to review the present system and look at alternatives that support a person centred approach based on individual needs and capabilities. High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 19 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 poor. This judgement has been made using available evidence including a visit to this service. Maintenance of the building is not always occurring in a timely fashion, resulting in some areas of the home not being safe or comfortable to live. EVIDENCE: Hightrees consists of 2 Victorian residential dwellings that have been combined to form a twelve-bedded residential home. Due to the age of the building it requires constant attention and repair in order that it is safe and homely. On the day of inspection many areas were found to require attention. These include making safe all uneven slabs at the front and rear of the premises, marking all raised and/or steep steps, ensuring all opened food products are appropriately covered and dated, removing the debris at the side of the home (and completing a risk assessment until this has been completed), not using service users bedrooms for storage when away from the home and locking of their rooms, removing of generic wheelchairs, increasing screening in both double bedrooms, replacing all worn carpets, repairing the glass in the ceiling window (this was made safe during the inspection), investigating and repairing the leak to the ceiling in the High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 20 hairdressing salon along with repairing the water damage to the walls, repairing the water damage to the ceilings and walls at the top of house 5, providing headboards in one of the double rooms, repairing the sink and flooring in the out of use toilet room, and addressing the smell of damp and decorating the bedroom of a named service users. Some requirements and recommendations relating to the environment have been addressed since the last inspection. These include converting a disused kitchen into the laundry (as previously this had been located on the third floor and was inaccessible to most service users), the cellar has ceased being used to dry laundry, a self closing devise has been fitted to the dining room door and a path leading to the patio has been widened. Outstanding requirements are to decorate the dining room and repair the loose banister in the stairwell to landing 4. Records and discussions with the proprietor and manager confirm that the fire department inspected the home August 2004 with all requirements actioned and the environmental health department visited the home April 2006 making 5 requirements again of which all have been actioned. The home had a health and safety audit completed August 2006 that states 6 areas for improvement, 4 of which have been actioned and 3 outstanding. Training records confirm 3 of the 8 staff employed at the home have received training in infection control. The inspector discussed in detail the environment, maintenance work, the needs of the service users living at the home and the implications for the future this may have with the proprietor and manager. The proprietor informed the inspector that she is considering making some ensuite facilities so that they could be registered for people with physical disabilities. The inspector explained that the entire building would have to meet National Minimum Standards and that it would be unlikely they would be able to achieve this due to door widths, lack of lift, long corridors etc. The inspector advised the proprietor to complete a feasibility study as responsibility lies with proprietor to meet requirements in order for registration. High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 21 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): 32,33,34,35 and 36. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although recruitment practices and procedures are good the lack of specialist training has the potential to result in service users needs not being met. EVIDENCE: Documentation supplied to the CSCI prior to the inspection does not demonstrate that care staff are on shift at all times. This was explored during the inspection with the manager confirming that when the majority of service users are out of the building at day placements she undertakes care responsibilities. In addition to this the proprietor confirmed that she regularly undertakes care shifts, however this is not recorded on the rota. The inspector instructed that the rotas be expanded to detail how many service users are present in the home at any time, that all persons undertaking care shifts be recorded and any care undertaken by the manager be identifiable on the rota. Two service users have been allocated additional funding for one to one hours due to their changing needs. Again none of these hours are being recorded on the rota. As in previous inspections the manager takes responsibility for arranging training, with staff that work at the home having completed an in house induction. The manager confirmed that presently there is no training and High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 22 development plan for the home and that individual assessments have not completed for all staff. No staff training has taken place since the last inspection, with the manager stating, “Training has been put on the back burner due to the care of residents coming first”. The majority of staff are still required to undertake leaning disability award framework accredited training, equality and diversity, dementia, understanding of downs syndrome and communication training. Work is also required to ensure all staff achieve national vocational qualification at level 2 or above in care. Recruitment records for 3 staff members were examined and found to contain all required information and documentation as listed in Schedules 2 and 4 of the Care Homes Regulations 2001. This includes enhanced criminal record bureau checks, 2 references and forms of identification, contracts of employment, application forms and interview notes. It was noted on one persons file that the application form did not give a full employment history and no evidence was on file that demonstrated the home had explored any gaps. All files contained evidence that staffs receive regular supervision and in addition to this regular staff meetings occur, with the home on target to meet national minimum standards in this area. High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 23 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): 37,39,40,41 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 recognises that quality assurance systems must continue to be implemented, in order that the home can measure if it is meeting its aims and objectives. Improvements have been made to record keeping. Further work is required to ensure the health, safety and welfare of service users is promoted and protected. EVIDENCE: The registered manager has been in position for several years, holding a number of qualifications. Recently she has obtained the Registered Managers Award as required for the position she holds. Everyone (service users and staff) that the inspector spoke to praised the manager and her approach to running the home. the inspector was shown a quality assurance system that the home is in the process of implimenting supplied by the National Care Homes Association. As yet this is still in its infancy with the home still High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 24 required to devise a development plan for the home, obtain views of people and complete an annual audit. Since the last inspection the home has altered its systems for storing service users documentation. The new system is good, allowing for information to be easily retrievable yet secure. The manager stated she aims to review systems relating to other records maintained in the home in the near future. Documentation supplied to the CSCI prior to the inspection states that all the homes policies and procedures were reviewed September 2006. The inspector instructed that a review occurs again as some sampled contain incorrect information (see complaints and protection) or may not reflect changes in legislation or good practice (e.g. restraint and smoking policies). High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 25 The home commissions an health and safety consultant who completes annunal audits for the home, with the last one taking place August 2006. it is recommended that all actions identified within this report be addressed. Records demonstrate that the servicing and maintence of gas and electrial items are being completed appropriately and that a Legionella assessment has been undertaken October 2006. previous requirements to review the fire risk assessment and obtain data sheets and risk assessments for all products regulated by Control of Substances Hazardous to Health legislation are now met in full. As mentioned in the staffing section of this report there has been no training provided for staff since the last inspection. Records viewed by the inspector confirm that some hold certificates in moving and handling, health and safety, first aid and food hygiene, however further work must be undertaken to ensure all staff undertake training in all these areas. It was also noted that the manager has still been unable to obtain certificates from a training provider to validate staff have received training in fire awareness. Work has been completed by the home resulting in risk assessments being in place for all safe working practices as listed in standards 42.2 and 42.3 of the national minimum standards for younger adults. in addition to these records confirm that fire drills, testing of emergancy lighting and call points take place at appropriate intervals. It was however noted that since June 2006 the amount of detail relating to those who attend fire drills has decreased, with the inspector instructing action be taken in this area. In relation to safe working practices the inspector was concerned that no staff were witnessed using personal protective equipment when preparing meals and that staff were seen bringing frozen food items from the freezers located in the cellar in their bare hands. These concerns were discussed with the proprietor and manager who agreed to take appropriate action. A requirement first identified in 2004 to provide a business plan for the home is now met, with the inspector having sight of this during the visit to the home. High Trees Care Home DS0000067426.V317605.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 X 2 3 3 2 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 1 33 2 34 3 35 1 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 X 2 2 3 2 X High Trees Care Home DS0000067426.V317605.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 YA3 Regulation CSA 15(1) Requirement The home must apply for a variation to its registration category for any service user with mental health needs. Service users contracts of residency must be reviewed to reflect the new fees charged and rooms occupied. Care plans must be in place for any identified needs including communication, epilepsy and behaviour. These must be completed in detail and contain specific aims and goals. Care plans must be reviewed to reflect any changes in needs. Behaviour management guidelines must be in place for an identified service user. Where service users have been asked to move bedrooms written consent must be obtained from each person and their representative, including social worker. Risk assessments must be DS0000067426.V317605.R01.S.doc Timescale for action 31/01/07 2 YA5 17 31/01/07 3 YA6 15(1) 30/11/06 4 YA7 12(2) 30/11/06 5 YA9 13(4) 30/11/06 Page 28 High Trees Care Home Version 5.2 completed for any identified need including communication, mobility, epilepsy and behaviour. Risk assessments must be reviewed within agreed timescales. 16(2)(m)(n) Activities must be recorded in detail, monitored and evaluated – Part met. Requirement originally made July 2005. 16(2)(i) Menus must offer at least 2 choices of a main meal each day. Menus must offer nutritionally balanced meals. The home must obtain professional advice regarding its menu and healthy diets for service users. 6 YA14 30/11/06 7 YA17 30/11/06 8 YA17 16(2)(i) 31/12/06 9 YA20 13(2) The home must be able to demonstrate that it is taking action to support service users who have gained excess weight. 01/11/06 The home must clarify ‘as directed’ instructions for any prescribed medication with the general practitioner and/or dispensing pharmacist. Hand written medication administration records must contain the same details as pharmacy dispensing labels. Medication administration records must include what part of the body creams/lotions etc are to be applied. Staff must sign for all medication they administer. Out of date medication must not be used. 10 YA20 13(2) 30/10/06 High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 29 11 12 YA22 YA22 22(7) 22 13 YA22 22 14 YA23 13(6) Medication no longer required must not be stored with medication still in use. The complaints policy requires the address of the local office of CSCI. A full and detailed record must be maintained that details investigation and outcomes for issues recorded in the ‘grumbles’ book. The home must investigate the complaint raised by a service user (as discussed at inspection). A report of the finding of this must be sent to CSCI. The home must review and amend its abuse policy ensuring that it includes procedures to be followed if an allegation is made. The home must review its restraint policy to ensure it complies with relevant legislation. The restraint policy must be expanded to include physical and verbal aggression. All staff must undertake challenging behaviour and aggression training. All uneven slabs and ground at the front and rear of the building must be made safe. All raised and/or steep steps at the front and rear of the building must be clearly marked. All debris must be removed from the outside of the home and a risk assessment completed until such time as the debris is removed. 31/01/07 30/11/06 30/11/06 31/01/07 15 16 YA23 YA24 13(6) 23(2) 31/01/07 31/12/06 High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 30 Screening must be increased in both double bedrooms. All worn carpets must be replaced. The broken windowpane in the ceiling window must be replaced. The leak to the ceiling in the hairdressing salon must be addressed and any water damage repaired. The water damage to ceilings and walls at the top of house 5 must be addressed. Headboards must be provided. The sink and flooring must be repaired in the toilet. The odour, damp and decorating in the named service users bedroom must be addressed. Service users bedrooms must not be used to store household items. Service users bedrooms must be kept locked when they are away from the premises of extended periods of time. Generic wheelchairs must be removed from the premises. The dining room requires decorating – not met. Requirement originally made July 2005. The loose banister in the stairwell to landing four requires attention – not met. High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 31 17 YA24 23(2) 01/11/06 18 YA24 23(2) 30/11/06 19 YA24 23 20 21 YA30 YA32 13(3) 18(1) Requirement originally made July 2005. A maintenance improvement 31/01/07 plan must be forwarded to CSCI detailing how the home intends to manage repairs to the building, including consideration of the age and size of the building and any future needs. All staff must undertake 31/01/07 infection control training. All staff must undertake 01/11/06 training in: Equality and diversity. Dementia. Understanding downs syndrome. 22 YA33 18(1) Communication. Staffing rotas must be expanded to include: The name of everyone undertaking work at the home. All shifts/hours undertaken at the home, including any specific hours allocated to named service users. Any care hours the manager undertakes. Numbers of service users present in the building at morning, afternoon and evening. 31/01/07 23 YA35 18(1) A training and development plan for the home must be introduced. Individual training and development assessments must be completed for all staff. 31/01/07 High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 32 All staff must undertake LDAF training, with certificates maintained on file for inspection. The home must ensure all staff either hold a national vocational qualification or are enrolled to undertake this. The home must obtain the views of families, friends and stakeholders in the community. The results of all surveys/questionnaires must be analysed, published and included in the annual review of the homes development plan – Part met. Requirement originally made December 2004. The home must continue to implement the quality assurance system, including devising an annual development plan. The home must review its policies and procedures to ensure they contain accurate information and comply with relevant legislation. Certificates must be maintained on file to demonstrate that all staff undertake two fire-training sessions per year- not met. Requirement originally made July 2005. Detailed records must be maintained of staff and service users who attend fire drills. All staff must undertake training in: Moving and handling. Health and safety. High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 33 24 YA39 24 31/01/07 25 YA40 17 31/01/07 26 YA42 23(4) 30/11/06 27 YA42 18(1) 31/01/07 First aid. Food hygiene. 28 YA42 16(2)(j) Fire awareness. All persons undertaking food preparation must wear appropriate personal protective equipment. All food products must be appropriately covered when being transported from the freezer in the cellar. All opened food products must be appropriately covered and dated. 01/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA2 YA6 Good Practice Recommendations It is strongly recommended that any person who has resided at the home for 10 years or more be formally reassessed. It is recommended that person centred planning is introduced to the home and that the manager undertakes comprehensive training in this area – Recommendation originally made July 2005. It is recommended that a thermometer be purchased and records maintained of temperatures within the medication cabinet. It is recommended that a lockable facility be purchased for storing medication in the fridge. It is recommended that the old local authority adult protection procedures be removed from the premises and that staff are made aware of the new, updated version. It is recommended that the proprietor review the current system for managing service users finances. It is recommended that the proprietor carry out a DS0000067426.V317605.R01.S.doc Version 5.2 Page 34 3 4 5 6 7 YA20 YA20 YA23 YA23 YA24 High Trees Care Home 8 9 YA34 YA42 feasibility study of the building to inform future planning. It is recommended that written records be maintained where the home has explored gaps in employment for potential new staff. It is recommended that the home addresses all recommendations contained within the health and safety audit. High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 High Trees Care Home DS0000067426.V317605.R01.S.doc Version 5.2 Page 36 - 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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