Inspection on 07/11/08 for High View Care Services Ltd.

This inspection was carried out on 7th November 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

CARE HOME ADULTS 18-65 High View Care Services Ltd. 9 High View Road Upper Norwood London SE19 3SS Lead Inspector James Pitts Unannounced Inspection 7 November 2008 11:33 th High View Care Services Ltd. DS0000069894.V371995.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 View Care Services Ltd. DS0000069894.V371995.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 View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High View Care Services Ltd. Address 9 High View Road Upper Norwood London SE19 3SS 020 8653 2420 020 8653 2420 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) High View Care Services Ltd Manager post vacant Care Home 5 Category(ies) of Past or present alcohol dependence (5), Past or registration, with number present drug dependence (5), Dementia (5) of places High View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories:Past or present drug dependence - Code D Past or present alcohol dependence - Code A 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 5 19th November 2007 Date of last inspection Brief Description of the Service: High View is registered to accommodate people between the ages of 18 to 65 who have been assessed as having alcohol and drug related problems, dementia resulting from alcohol and drug misuse, challenging behaviour due to substance misuse, learning disabilities or acquired brain injury. Accommodation is spread over three floors, with no lifts the home is not suitable for people who have difficulties using stairs. Bus and train links are close by and the home is within walking distance of other public amenities. High View Care Services Ltd. DS0000069894.V371995.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 2 stars. This means people who use this service experience good quality outcomes. The charge for the service is presently £1,000 to £1300 per week dependent on degree of care and support needs. This visit took place during the daytime and there was one person who uses the service. The people who live at the home are able to clearly express their views and questionnaires were left for each to complete if they wish. The Commission will take any views that may be subsequently expressed into consideration at such time as any may be received. Standard required records were examined which included care plans, staff recruitment and policy documentation (which are kept centrally at another service that the registered provider operates, and were seen at that service earlier in the same week as this inspection site visit took place). The Commission, as a part of this inspection, also took into consideration the annual quality assurance assessment that was completed by the registered person and other information that has been received since the service was first registered in 2007. What the service does well: What has improved since the last inspection? This is the first inspection of the service since it began operating; therefore no previous improvement requirements have been made. High View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 6 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. High View Care Services Ltd. DS0000069894.V371995.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 High View Care Services Ltd. DS0000069894.V371995.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): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Standards1, 2, 3, 4 & 5 was assessed at this inspection. The people who use this service and others are told what the home does and how it will do it. The service does, however, need to ensure that assessments of people who are referred, even if for respite care, are focused on whether the home can meet the needs within the aims and objectives of the service. EVIDENCE: Information on its aims and objectives and the guide lists what services they offer. It is offered in a standard format. None of the contracts were available at this inspection and the registered provider must provide written evidence, including dates of signatures and by whom. Both of the people who live here are recent arrivals, one having transferred from another service that is owned by the same registered person and the other on respite care for a short period. For the one permanent admission it was seen that the assessment of need matched the ability of the service to meet those needs. However, in the other case it was noted that the respite care client did not have needs for which the service is registered. This issue was also identified at the other service that the registered person High View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 9 operates and that was inspected a few days before this service. This is therefore another example, even if it is only a short term placement, that the service has accepted someone for admission that is not appropriate for the stated aims and objectives of the service. The Commission will make a requirement in this report that further inappropriate admissions must not be permitted to occur. If the home is seen to fail in this area in future the Commission will consider commencement of enforcement action without further discussion. Discussion was held about the registration categories for the service. It is evident that the registered person is somewhat confused about what degree of need the service is registered for and able to provide. As a result of these discussions clarification about what is considered an acceptable range of needs was provided and the registered provider was referred to the Commission’s regional registration team to discuss the necessary variation to the home’s conditions of registration, which were far too broad. High View Care Services Ltd. DS0000069894.V371995.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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Standards 6, 7, 8, 9 & 10 were assessed at this inspection. The person who is permanently using this service can feel confident that staff know what they need. They can also be assured that the staff have protocols in place to ensure that they have the opportunity to live the sort of life that they can meaningfully chose to. EVIDENCE: This home provides care for people who have drug or alcohol dependence and they often have associated illnesses and disabilities so have complex needs. For the permanent service user their care plan outlines the background and recent history leading to the person’s support needs. Both of the care plans that were looked at during this inspection show that preferences and choices are in evidence and sufficient detail exists as to how these should be met (please refer to the previous sub section of this report for comment on the fact that a respite service user should not have been placed High View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 11 here to begin with). However, the care plan for the person who is permanently in residence is neither dated nor signed. Care plans must accurately reflect the time of review and be signed to confirm acceptance of the content. Monthly care plan review and updates are expected to be carried out by the allocated key worker. As the home has only recently begun operating it is too early to assess if this process is adhered to as expected. This area will be examined again at the next inspection in order to assess the performance of the service. Interventions designed to safeguard people living in the house are documented, and continue to be instigated only after a multidisciplinary meeting that would be attended by the person living in the home, staff and other professionals involved with their support. This was in evidence on the records for the person who is in permanent residence. Files contained risk assessments that had been completed in respect of the people who live at this home. These risk assessments promote independence whilst outlining the measures that should be implemented to minimise risk and their potential harm. Personal information is stored in the office in a locked filing cabinet and there are clear procedures in place to ensure that confidentiality and data protection protocols are observed. High View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Standards 11, 12, 13, 14, 15, 16 & 17 were assessed at this inspection. The person who currently is in permanent residence at this service can feel confident that the staff of the home will provide active support for them to participate in the community both in terms of the activities of daily life and leisure interests. The opportunity to maintain personal and family relations is encouraged and supported by the staff team. EVIDENCE: The person who is in permanent residence of the home does not require staff support when going out, and it has been assessed as safe for this person to travel independently. The registered person employs an activities coordinator at the other service that she operates and this person also provides input for this service. The activities of the person in permanent residence are outlined week by week on a High View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 13 wipe board in the office and are in line with activities and interests that are identified in care plan. Records show that the person in permanent residence keeps in contact with family and stays with their family at weekends. Visitors are welcome and they can be seen either in the communal areas of the house or in an individual’s own bedroom if they wish to receive a visitor in more private surroundings. The homes guide sets out the expectation that people living in the home will participate in daily housekeeping tasks such as cooking, cleaning their own bedrooms and doing their personal laundry. Encouragement and practical assistance is provided to re acquaint, and learn, self caring skills not least with preparing meals. Considering that the service is designed to support people who have had addiction problems they may have had poor unhealthy diets in the past it is seen as important that healthy and nutritious meals are prepared and provided. High View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Standards 18, 19, 20 & 21 were assessed at this inspection. The person in permanent residence who uses this service can feel confident that they will get the right support to take care of their personal and healthcare needs. Staff of the service have written guidance and training about handling and administration of medicines. EVIDENCE: It is apparent from discussions and interactions observed that staff understand the concepts of using a person centred approach when working with the people living in the home. The person who is in permanent residence of this home is registered with a local GP and there was evidence on record that they are assisted to seek medical attention when needed. The files also contained psychiatric, psychologist and other assessments as required (the temporary service user maintains contact with their own original GP in another area). The fees include the costs of a weekly meeting with the homes own psychologist; the meetings are managed in a flexible and responsive way at High View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 15 the home. Notes are kept of the meetings (the temporary service user does not need to use this aspect of the service but the permanent service user does), and samples of these were seen. The permanent service user supported to manage their own medication (inhalers for asthma) and staff check regularly to see that this medication does not run out. . The person who is placed here temporarily does require support to take their medicines and the administration records were examined during this visit. The home has the medication dispensed into blister packs by the chemist who also produces record sheets referred to as MAR sheets. Guidelines for medication that is not taken regularly but only occasionally when needed (PRN medication) are in place, although no one who lives at the home presently requires PRN medication. How the home would support people as they become older and face death is addressed and evidence of expressed wishes is recorded where people have decided to wish to engage in this discussion. High View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 22 & 23 were assessed at this inspection. The people who use this service can feel confident that the staff team at the home know what to do if there are complaints or concerns about abuse. EVIDENCE: A folder system designed to separately record the details, investigation and outcome of each complaint is in place, but has not as yet needed to be used. There is clear written guidance and information for staff about what to do if they think that anyone who lives here is being hurt or abused by another person, or if an allegation is made by a third party. Training is provided to staff about safeguarding and this type of training is a standard aspect of the induction process for new employees. No concerns regarding abuse have been reported since the home commenced operating. High View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Standards 24, 25, 26, 27, 28, 29 & 30 were assessed at this inspection. The people who use this service can feel confident that they are living in a well maintained, clean, comfortable and pleasant home. EVIDENCE: The building is an attractive attached house that is well decorated in a contemporary style and is comfortably furnished. A tour of the home showed that the bedrooms are spacious, appropriately decorated, furnished and reflect the preferences of the individual using each room. There are an appropriate number of toilet and bathing facilities although the design of the house would prevent anyone with a significant mobility difficulty being able to live here. High View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 18 As well as a separate dinning room and comfortable lounge there is a conservatory with a table and comfortable seating. The kitchen is quite large and has the necessary storage space, cooking, refrigeration, freezing and utensils for the number of people that the home, when full, would accommodate. The house is also kept very clean and is well maintained. High View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Standards 31, 32, 33, 34, 35 & 36 were assessed at this inspection. The people who use this service can feel confident that there are staff provided to meet their needs and that these staff are safe people to support them. The registered person, now that it is in operation, needs to be mindful of establishing a specific and dedicated staff team for this service rather than sharing staff with the other service that they provide. EVIDENCE: All of the staff that currently work at this home also work at the other registered service that the registered person operates. Three staff files were examined (which are held at the other registered service and were looked at during the inspection that took place at that service earlier in the same week as this inspection) and these show that there is a proper and diligently applied recruitment policy. Background checks that include criminal records bureau checks are undertaken and two references are obtained. A copy of photographic identification and the recruit’s application, a health declaration and other documents are in place as required in Schedule 2. High View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 20 The majority of staff hold an NVQ qualification in care. Records show that training undertaken includes adult protection, first aid, care planning and health and safety. There were a variety of supervision notes on staff files, some being far more regular than others. The registered provider, who has applied to be the registered manager of both of the homes that they operate, has introduced a monthly supervision schedule to address the need to ensure that this happens at least six times per year. This will be checked again at the next inspection of the service to determine if it has succeeded in meeting this standard for staff support. Staff appraisals were most recently completed in late 2007 but update on development and training plan progress has not occurred, as it should do. This was made a requirement in the report of the other service and will not be made again here. However the registered person should remain mindful of the need to consider establishing a permanent staff team dedicated to working specifically at this service. High View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Standards 37, 38, 39, 40, 41 & 42 were assessed at this inspection. The people who use this service can feel confident that they are living in a home that has begun operating with effective management oversight. EVIDENCE: The former manager, who was registered last year, left the home a few weeks ago. The registered provider has applied to the Commission to be the registered manager (she did hold that position previously) and is completing the process with the Commission at the present time. The registered person also owns and manages another home within a short distance of this service. High View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 22 Concern was raised about an inappropriate admission to the home, albeit as a respite care client. This has been referred to in the first section of this report and a statutory requirement will be made in this report. People’s rights and best interests are protected by the homes policies and procedures. As the registered provider is also managing the home the visits required under regulation 26 are not presently required. In conversation with the registered person it was stated that consideration is being given to whether to appoint a manager in the future. She must remain mindful to adopt the correct regulation 26 monitoring procedures should a separately registered manager be appointed. She also said that there might be a separate person tasked to carry out these visits in any case to further assesses the quality of the service. This which would be recognised as good practise should this be implemented. An annual development plan has not been compiled as the home has only recently commenced in operation. The registered provider must remain mindful to establish a system for this to occur at some point within the first twelve months of the service operating. The standard health and safety checks and certification documents were also examined and it was seen that these show that due regard is given to keeping everyone safe from unnecessary hazards. The only exception is that the fire extinguishers have not been serviced since 17th September 2007 and this must now occur without delay. High View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 23 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 1 3 3 4 3 5 1 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 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 3 3 3 3 3 3 3 3 2 3 High View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 24 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 YA2 Regulation 14 (1) (d) Requirement The Registered Person must ensure that no further inappropriate admissions occur to the home. None of the contracts were available at this inspection and the registered person must provide written evidence, including dates of signatures and by whom. The Registered Person must ensure that Care plans accurately reflect the time of review and be signed to confirm acceptance of the content. The fire extinguishers have not been serviced since 17th September 2007 and The Registered Person must ensure that this occurs without delay. (The labels on each extinguisher show this date and have not been proven to have been serviced since) Timescale for action 15/12/08 2. YA5 5 (1) ( c ) 15/01/09 3. YA6 15 (2) (b) 15/01/09 4. YA42 4 (a) & ( c ) (i) & (iv) 15/01/09 High View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 25 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 YA33 Good Practice Recommendations The registered person should remain mindful of the need to consider establishing a permanent staff team dedicated to working specifically at this service. High View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 View Care Services Ltd. DS0000069894.V371995.R01.S.doc Version 5.2 Page 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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