Inspection on 30/01/08 for High View Residential Unit

This inspection was carried out on 30th January 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

High View Residential Unit 17/05/07

High View Residential Unit 13/12/06

Similar services:

Ashlong House

Norbury Crescent (30)

Agar Grove & St Augustine`s Alcohol Treatment & Rehab

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

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

CARE HOME ADULTS 18-65 High View Residential Unit 84 Thurlow Park Road Dulwich London SE21 8HY Lead Inspector Ann Wiseman Key Unannounced Inspection 30th January 2008 10:00 High View Residential Unit DS0000066673.V358057.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 Residential Unit DS0000066673.V358057.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 Residential Unit DS0000066673.V358057.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High View Residential Unit Address 84 Thurlow Park Road Dulwich London SE21 8HY 020 8670 0168 0845 331 2725 manager@highview.com 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 Children`s Services Ltd vacant post Care Home 7 Category(ies) of Past or present alcohol dependence (0), Past or registration, with number present drug dependence (0), Dementia (0), of places Learning disability (0) High View Residential Unit DS0000066673.V358057.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th December 2007 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. People living in the home benefit from large bedrooms with en suite facilities. One bedroom has a small window with only a restricted view which makes the room dark, this room may only be used for respite care and must not be used by anyone as long term accommodation. There is a well-maintained garden to the rear of the property. There is limited off-road car parking to the front of the building, however there is parking within a short walk from the home. Bus and train links are close by and the home is within walking distance of other public amenities. The cost of this service is between £1000 and £1200 per week. High View Residential Unit DS0000066673.V358057.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced inspection. When we arrived the people who live in the house were preparing to go on an outing arranged by the new activities coordinator, they returned later in the afternoon and we talked to three people who told us what they thought about their home. We had also sent them surveys previously to allow them to make comments anonymously if they wanted to and five were returned to our office. The manager was on duty and answered our questions and produced the files and information we asked for. We spent 5½ hours at the home. The manager had already sent us the Annual Quality Assurance Assessment (AQAA) he had completed. The AQAA is a self-assessment that focuses on how well outcomes are being met for people living in the home. It also gave us some numerical information about the service. There was enough information to determine that the manager had an understanding of the needs of the people who live in this home, but the answers were short and it would have benefited from more explicit answers with examples to back up some of the statements that were made. We used the information it contained as part of this inspection. A random inspection was carried out on 4th December 2007; some issues were raised on that occasion and will be referred to in this report. What the service does well: What has improved since the last inspection? All previous requirements have now been addressed and a health and safety coordinator has been appointed and is undergoing specific training to the post. He has also set up a programme of safety checks that will ensure that they are completed as they should be, so that the people living in the home are kept safe. Grab rails have been fitted on the stairs and hallway on the lower floor. High View Residential Unit DS0000066673.V358057.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 Residential Unit DS0000066673.V358057.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 Residential Unit DS0000066673.V358057.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): Standards 1,2,3,4 and 5 have been assessed on this occasion. People who use the service receive Adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People who have been referred to this home are given information about the service the home provides and undergo an assessment. The home has not always established that they are able to meet people’s needs before offering them a place. People can visit and “test drive” the home before deciding to move in permanently and will be given contracts once they do. EVIDENCE: Details that are given to people considering moving into this home gives basic information on it’s aims and objectives and the guide lists what services they offer. It is offered in a standard format. Two people’s files were examined during this inspection. Both files contained contracts but only one was signed by the person living in the home and the manager. The files contained assessments that have been carried out by the home as well as the community care assessment. They covered all areas of the people’s lives. The parts that look at aspirations and needs held some information but the people that use this service often have complex needs and are not always able to express themselves freely, so they would benefit from a deeper exploration of their individual aspirations and more consideration being given to how their needs will be met. High View Residential Unit DS0000066673.V358057.R01.S.doc Version 5.2 Page 9 A random inspection was carried out on 4th December 07 and we were informed of a recent admission. During discussions with the manager, staff and on examination of the person’s file it became apparent that neither the manager nor the staff had a good understanding of the persons medical condition. They have the expertise needed to care for someone with this degenerative disease. The care plan did not contain information on how the home would be able to meet their special needs. Nor had they developed risk assessments that would show how they intended to safely manage their mobility problems in a building that is not suitable for a person using a walking frame and wheelchair and needed a lot of support from carers when using the stairs. There is normally three staff on duty, two of who would have been needed to support this person. This could lead to the other people being insufficiently supported generally and more so in the event of an emergency, such as a fire. No planning had been put in place for this eventuality. This person’s health could have been put at risk because of the lack of knowledge of their condition, complications may not have been recognised and responded to appropriately. The admission had been an emergency and the home had expected the local authority to have found them permeate accommodation by 9th December 2007. A requirement was made at the random inspection that every effort must be taken to make sure that this person’s stay was not extended and that proper risk assessments should be carried out. The person did move out of the house within the proposed timescales and the manager has undertaken to make sure that the home does not offer accommodation to people they do not have the skill or facilities to care for in the future. High View Residential Unit DS0000066673.V358057.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): Standards 6,7,8,9 and 10 have been examined during this inspection. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Care plans are in place and have been updated. People living in the home are able to make decisions about their lives, are consulted and are able to participate in all aspects in the home. Personal information is handled appropriately. 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. The care plans carry a lot of detail in relation to background and recent history leading to the person’s disability. We examined two people’s files, one person had moved into the home recently and the other had lived in the house since it had opened. Each contained a lot of information, but not a lot of detail about how people wanted to receive personal care. People would benefit from more details being recorded about how they would prefer their personal needs to be met. High View Residential Unit DS0000066673.V358057.R01.S.doc Version 5.2 Page 11 We saw copies of monthly reviews that are carried out by the key worker. They draws together information of the last month’s events such as medical appointments, their outcomes and daily activities. The summaries were dated and signed by both the person and the staff member. If interventions have been put in place to safeguard people living in the house, they are 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. Evidence of one of those meetings was seen on file. The manager assured us that if someone preferred to discuss their needs with a person of the same race, age, sexual orientation, religion or faith arrangements would be made for them to speak to someone they felt comfortable with or an advocate would be arranged. Files contained risk assessments that had been completed in relation to people in the home, these promoted independence whilst minimising risk and potential harm. It was apparent, from the records and observed interaction between staff and people living in the home, that people are included in the decision making processes. Personal information is stored in the office in a locked filing cabinet. High View Residential Unit DS0000066673.V358057.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): Standards 11,12,13,14,15.16 and 17 have been judged on this occasion. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Where possible people living in this house are supported to work and they all have an opportunity to take part in appropriate activities within the local community. Personal contacts are maintained and people are expected to take responsibility in their daily lives. EVIDENCE: Most of the people who live in this home have to be supported when going out, but when it has been assessed as safe people travel independently and two people have a paid occupation. The home has employed an activities coordinator since the last inspection and although she has only been in post a few weeks she has already developed a schedule of activities. When we arrived she and some of the people living in the house were just leaving for a trip out in the homes minibus. On their return people said they had enjoyed their time at the swimming pool. High View Residential Unit DS0000066673.V358057.R01.S.doc Version 5.2 Page 13 Records of the activities are kept in the daily notes. We spoke to the coordinator who told us that she had spent time getting to know the people living in the home before she arranged anything and had read the care plans. She intends to add details to the care plans as she gets to know the people better and said that future trips will be discussed and planned during house meetings. Records show that people keep in contact with family and friends and person often stays with family at weekends. Another person told us that when they have visitors they could take them to their room if they want to. The homes guide clearly 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. We arrived at the home while breakfast was being prepared and several people had congregated in the kitchen. We talked about the food over a cup of tea and someone said that they were able to help themselves and cook their own meals if they wanted to. There was some good-hearted banter and the atmosphere was relaxed. It was mentioned that the carer cooking the breakfast made very good cakes and after some gentle persuasion she agreed to make one for tea. A carer told us that when the home had someone staying that that was a Muslim halal meat, that is meat prepared in a way that makes it acceptable to eat within their Muslim faith, was supplied for them and was cooked separately. From time to time the manager likes to cook a special meal for everyone and during the Inspection he started to make preparations for one he had planned for that evening. When asked what his cooking was like one person joked poison! but then quickly assured us it was good and that the meal was treated as a special occasion. High View Residential Unit DS0000066673.V358057.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): Standards 18, 19,20 and 21 have been examined during this visit. People who use the service receive Adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People receive care in a way they prefer but it is not always recorded in the care plan. Physical and emotional needs are met and medication policies are in place but recording is not up to standard. There is no evidence that aging, illness and death is discussed with the people living in the home. EVIDENCE: While talking to staff it was apparent that they understood the concepts of using a person centred approach when working with the people living in the home. Staff talked about allowing people to make up their own mind and to help themselves where they could. They also said that they would respect a decision even if they did not agree with it. One carer said, “We can’t impose our values on them, they won’t come to any harm if they don’t shower every day, but I would try to talk them round if they refused all the time.” So, if staff use a person centred approach people will receive personal support in the way they prefer but the care plans do not always record their preferences. High View Residential Unit DS0000066673.V358057.R01.S.doc Version 5.2 Page 15 People living in the home agreed that staff listened to them and did not force them to do things against their will. One person who is not able to leave the house on their own said they felt restricted sometimes as staff are often busy and were not always able to take them out when they wanted, but also said he understood why he couldn’t go out alone. All of the people living in this home are registered with the local GP and there was evidence on file that they were assisted to seek medical attention when needed. The files also contained psychiatric, psychologist and speech and language assessments. The fees include the costs of a weekly meeting with the homes own psychologist, the meetings are not rushed and are held in the home. Notes are kept of the meetings and were seen. People who do not want to participate can opt out but do not receive a reduction of fees. One person is supported to manage their own medication and when they away from home, staff will phone to remind them to take it. The medication is checked in when it is delivered to the home and when they is given a new supply it is recorded in his daily record so staff can keep track of its usage. The Medication, its storage and 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. There were gaps in the MAR sheets where staff had not signed to indicate that the medication had been given. We checked the blister packs and the medication had gone. It may be that the carer had given it but had not signed the sheet afterwards. It is important checks are made and that the manager investigates mistakes. One person was prescribed medication after the monthly cycle had been started, the details had been hand written and not countersigned. It is unsafe to handwrite medication details on records because if it is recorded wrongly or the handwriting is poor it will lead to mistakes being made that may affect the health of the person receiving the medication. This practice is against the Royal Pharmaceutical guidelines, they recommend that instructions should be printed by the pharmacy that dispensed the medication and only hand written if it really can’t be avoided and then the entry must be checked by two people and both must sign the entry as correct. Guidelines for medication that is not taken regularly but only occasionally when needed (PRN medication) have been introduced since the last inspection but need to be more detailed. PRN guidelines should carry an explanation of what the medication is and why the person needs it, as well as under what circumstances it should be taken. The guidelines should also give details of the maximum dose that can be given in a 24-hour period and what action should be taken if that dose is exceeded. Instruction should be given to staff about where to record the PRN medication that has been given. This should be on the back of the MAR sheet and separately in a PRN book that staff will complete every time PRN medication is given stating who gave it, who authorised it and High View Residential Unit DS0000066673.V358057.R01.S.doc Version 5.2 Page 16 what effect it had on the person taking it. The staff dispensing the medication must always sign this record. How the home would support people as they become older and face death is not fully addressed either in their statement of purpose, user guide or in peoples care plans. The home’s stated purpose is that they support people to develop their living skills to enable them to eventually live independently in their own homes. Evidence that they develop plans and work with people to achieve this aim was seen in people’s files. However they sometimes support people with serious illnesses that can be life threatening so it is important that they know how the people in the home want to be cared for as their health deteriorates. For example do people want to be cared for at home or would they feel safer in hospital and who would they like to be notified is the event of a serious illness or death and are there any special instructions in the way they want to be buried or for their body to be handled either from personal preference or for religious needs? High View Residential Unit DS0000066673.V358057.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): Standards 22 and 23 very inspected on this occasion. People who use the service receive Adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. There are polices and procedures in place concerning complaints and the people living in the home know how to make a complaint and feel that they would be taken seriously. The complaint recording is poor and will have to be addressed. Staff receive protection of vulnerable people training. EVIDENCE: During the visit we asked people if they understood the homes complaints procedures and if they knew who to complain to. They said they did and person said that a carer had helped them when they wanted to make a complaint and they were happy with the way it was dealt with. There is a complaints leaflet that sets out the home’s complaint procedure. The way that the home records complaints does not allow the complaint to be followed from start to finish. A hard covered notebook is used, the date and the detail of the complaint only was recorded. Who investigated it or what the outcome was is not recorded and several pages have been cut out of the book, the pages were not numbered. The required form is one that clearly lists the complaint, who made it and the date it was received. Also the record will include details of the investigation, High View Residential Unit DS0000066673.V358057.R01.S.doc Version 5.2 Page 18 what the outcome was and details of further action taken. Each stage will be dated to show that it was dealt with within the homes own set timescale. Pages must be numbered and must not be removed or defaced, their absence could indicate that the facts have been changed or evidence destroyed to avoid scrutiny. If a mistake is made it should be deleted by having a line drawn through it so it can still be read. A letter of complaint and investigation notes were found in one person’s file, copies should also be stored in the complaints file. The Annual Quality Assurance Assessment, completed by the manager, acknowledges that improvement is needed in this area and mentions their desire to deliver greater transparency but does not determine how it will be done. Consideration should be given to logging details of when people raise issues that would be classed as a concern rather than a complaint and how they were dealt with, this will show a willingness to listen and act on peoples concerns. We were assured that staff have now received protection of vulnerable adult (POVA) training. One of the staff files showed evidence that it had been done. Staff confirmed that they had taken part in a training session that was held at the house. When questioned displayed a knowledge of how they would disclose an abusive situation they had witnessed or suspected. Another staff file examined was the newest staff member’s and it was not apparent that they had undertaken POVA training. She confirmed that she had not had the training yet. It is important that staff receive adult protection training within the first few weeks of employment as part of an induction programme. The home has policies and procedures about responding to suspicion or evidence of abuse. There are records that show the home has followed that procedure in referring suspected abuse to the appropriate authority and that they cooperated with the investigation. High View Residential Unit DS0000066673.V358057.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): Standards 24,25,26,27,28,29 and 30 were judged during this inspection People who use the service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The home is suitable for it’s stated purpose and bedrooms reflect the personality of its occupant and meet individual needs and lifestyles. People have their own bathroom facilities and where needed adaptations have been made to enable people to maintain independence. The home is clean, comfortable and homely. EVIDENCE: The building is an attractive town house, well decorated in a contemporary style and is comfortably furnished, is clean and well maintained. We had a tour of the home and saw the bedrooms that were spacious, appropriately decorated and furnished. One is not occupied at the moment and will only be used for short assessment visits because of its position in the house and restricted view from the window. High View Residential Unit DS0000066673.V358057.R01.S.doc Version 5.2 Page 20 All of the bedrooms have locks and people living in the home are encouraged to lock their rooms when they leave the building. It is important that carers are able to get into the bedroom if the person inside has an accident or becomes ill and needs assistance. The locks that have been fitted are basic Yale locks and the occupant can disable the ability to open the door from the outside by setting the snib lock. A different type of lock that allows access in an emergency must be fitted. People have their own possessions and have made the rooms individual to themselves. When asked they said they were happy with their rooms. As well as a separate dinning room and comfortable lounge there is a room that has a snooker table that people can use freely. The kitchen is quite big and there is an area where people can sit while food is being prepared so that everyone can feel involved in the process. When people are assessed as needing specialist equipment the home will make arrangements for it to be supplied. Grab rails have recently been fitted to the corridor and stairs on the lower floor to assist someone who had difficulties walking and using stairs. High View Residential Unit DS0000066673.V358057.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): Standards 31, 32, 33, 34, 35 and 36 have been assessed. People who use the service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Care staff are clear of their roles and responsibilities and the people living in the home are protected by the home’s recruitment policies and procedures. Staff have undertaken appropriate training and are qualified but have not received sufficient supervision. EVIDENCE: Two staff files were examined and we were able to talk with three members of the staff group. The home’s recruitment policy and procedure is as required and evidence was seen in the staff files that confirmed that it was carried out; criminal records bureau checks are undertaken and two references are obtained, the file also contained photographs and copies of the recruits application, a health declaration and other documents as required in Schedule 2. The majority of staff hold an NVQ qualification in care. The home benefits from having a suitably equipped and furnished room for training. Records show that training undertaken includes adult protection, first aid, care planning and health and safety. The manager has identified a need for further training in the High View Residential Unit DS0000066673.V358057.R01.S.doc Version 5.2 Page 22 area of acquired brain injury and rehabilitation and is making plans to provide it. All of the staff we spoke with demonstrated a commitment to providing a caring and supportive environment for the people living in the home. We saw staff working and talking to the people living in the home in an open, respectful and friendly way. Staff meetings are held regularly and notes were seen that indicate one to one supervisions occur but they are not happening as often as required which is at least six times a year. There were few supervision notes on staff files, the latest was dated September 2007. Supervision is not only an opportunity to give direction and assess training needs but allows staff to air concerns and make suggestions and regular meetings nurture a feeling of be listened to, of being involved and of being taken seriously. A recommendation will be made that the manager must establish arrangements to supervise staff and carry out annual appraisals on a regular basis. High View Residential Unit DS0000066673.V358057.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): Standards 31,32,33,34,35 and 36 have been judged during this inspection. People who use the service receive adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The day to day running of the home is all good but sometimes it is not always clear who is leading and managing it. People living in the home feel they are listened to and policies and procedures are in place that protects their health and safety, rights and interests. Required insurances are in place to protect people from loss or damage. EVIDENCE: At the last key inspection on 17th May 2007 we found that the home had not had a registered manager for some time and the owner assured us that the person then acting as manager on was going to take up the post permanently. He would be apply to be registered with us immediately. High View Residential Unit DS0000066673.V358057.R01.S.doc Version 5.2 Page 24 During a random inspection on 4th December 2007 we were informed that he had been through the process and was now registered, however while the registration certificate was being checked the post was still shown as vacant. When asked why the new certificate was not on display we were told that it was in the groups other home, he had been registered for that and not this home. When questioned further both the manager and owner said that they were under the impression that if he was registered for one home he was also registered to manage another. It was explained that if a registered manager had a proven record of being able to effectively manage one home he could be considered to become registered for another. However he would be expected to undertake the registration process for both. The manager has confirmed that he has now applied for registration at this home. The home is organised and while we talked it was apparent that the manager has a good understanding of the people living in the home and their individual needs. People said they liked him, that he listened to them and let them have their say in the running of the home. House meetings are held and records of them were seen. Some of the staff we talked to felt that the home was well run but we did receive some negative comments. Not all staff feel that the lines of accountability are clear and said that the manager’s instructions have been countermanded on occasion by the owner and that has lead to people being unsure of whose lead to follow and unease in relationships. Concerns were raised about people being admitted who the staff had difficulty supporting because they were not trained to meet their needs, the building was not suitable and the staffing level was not adequate. This has arisen because of a poor management decision to admit a person whose needs were greater than the home could manage and has already been discussed in another area of this report. People’s rights and best interests are protected by the homes policies and procedures and information given in the Annual Quality Assurance Assessment indicated that they have been reviewed and updated in the last year. Previous health and safety requirements were done very quickly. A health and safety representative has been appointed and has been booked onto the specific training he will need to carry out that role. He will also be responsible for making sure that safety checks are carried out and recorded. When the random inspection was carried out in December 07 it was found that a fire risk assessment for the home had not been carried out, a requirement was made that it must be done, it has been and we have seen the assessment. A safety issue regarding the type of lock on people’s bedroom doors has been raised in another section and a requirement has been made. High View Residential Unit DS0000066673.V358057.R01.S.doc Version 5.2 Page 25 The owner of the home carries out regular Regulation 26 visits, this regulation asks that someone who is not involved in the day to day running of the home visits, unannounced, and inspects the home and a sample of records. They should speak to the people living in the home and the staff on duty and produce a report of the visit. The regulation reports were examined. The inspections are not always recorded appropriately, some are written in a way that does not protect confidentiality of either the staff or the people living in the home and some of comments made are unprofessional and inappropriate. They mention people by name and comment on personal issues that should be considered confidential and staff are named and talked about in a very critical manner. If the owner is so close to the home that she is unable to complete the report in an objective and professional manner she should consider using an independent agency that will carry out the visit and produce a report that is designed to meet the standard. High View Residential Unit DS0000066673.V358057.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 2 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 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 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 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 2 3 2 2 2 2 3 3 2 2 2 High View Residential Unit DS0000066673.V358057.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 2 Standard YA22 YA26 Regulation 22 13 Requirement Timescale for action 30/06/08 A clear procedure must be developed to record complaints. Locks on bedroom doors must be 30/06/08 of a type that will allow staff access in an emergency. 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 YA20 Good Practice Recommendations It is recommended that all staff must have their training on the safe handling and administration of medication undated and have their abilities to work within the homes medication policy and procedures reassessed and these assessments must be retained on file. PRN Medication guidelines should be developed further and a system of recording its proper administration must be put in place. It is recommended that the manager establish an arrangement to supervise staff and carry out annual appraisals on a regular basis. If the owner is unable to undertake and report on the regulation 26 visit in an objective and professional manner she should consider using an independent agency to carry DS0000066673.V358057.R01.S.doc Version 5.2 Page 28 2 3 4 YA20 YA36 YA39 High View Residential Unit out the visits. High View Residential Unit DS0000066673.V358057.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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. 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