Inspection on 10/07/08 for Highbray

This inspection was carried out on 10th July 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Highbray 24/08/09

Highbray 31/07/07

Highbray 22/06/06

Highbray 20/10/05

Highbray 08/06/05

Highbray 23/09/04

Highbray 06/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Highbray 84 Mount Pleasant Road Exeter Devon EX4 7AE Lead Inspector Louise Delacroix Key Unannounced Inspection 10th and 25th July 2008 10:15 X10015.doc Version 1.40 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 Highbray DS0000021947.V365569.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 Older People. 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. Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highbray Address 84 Mount Pleasant Road Exeter Devon EX4 7AE 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) 01392 676863 Mrs Josefa McLeod Ms Lesley Ann McLeod Care Home 3 Category(ies) of Learning disability over 65 years of age (3), registration, with number Mental Disorder, excluding learning disability or of places dementia - over 65 years of age (3) Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st July 2007 Brief Description of the Service: Highbray is a semi-detached end of terrace house in a residential area and less than a mile to the centre of Exeter. It provides care and support for up to three people. It is registered to offer care for people over sixty five with either a learning disability or mental health needs. The home has three single rooms with a shared bathroom. All the bedrooms are on the first floor and there is no shaft lift or stair lift. There is one lounge. Meals are served in the dining-area of the kitchen. The staff, the manager and the owners are all members of the same family. The weekly fee is £450; additional charges are made for hairdressing, toiletries and sweets. The inspection report is displayed on the home’s kitchen notice board. Highbray DS0000021947.V365569.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 using this service experience adequate quality outcomes. The inspection took place over two days as on the first day, which was unannounced, staff and people living at the home were going out for the day so we returned on a second day to complete the inspection, which we arranged with the manager. This was announced because we had tried to complete the inspection on another day but nobody was home. In total the inspection lasted two and half hours. During the inspection, the manager and two people living at the home contributed with information and their views of the service. As part of the inspection, we looked at medication, peoples’ individuals plan of care, maintenance, finance and fire records, and a tour of the building took place. Surveys were sent to GPs, district nurses and relatives. Two surveys were received from relatives and one from a GP. Three people currently live at the home, and two people shared their views of the service with us. The manager has completed an annual quality assurance assessment (AQAA) and information from this has been used within the inspection, although information on the document was minimal. What the service does well: People living at the home have a plan of care, which is usually clear and outlines peoples’ needs. People living at the home have good access to health care, and medication is well managed. People living at the home are supported to use local resources and helped to keep in contact with people important to them and to make choices. Meals are varied and offer a good range, including breakfast. The complaints procedure is clear and the home responds to concerns, working with other professionals where necessary. The home is well maintained and clean. It is has sufficient staff, some of whom have received mandatory training e.g. first aid and medication training. The staff group is small and remained stable since the last inspection. The manager is experienced and provides care to people living at the home, as well as managing paperwork. Safety checks are generally well managed. Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 3,5 and 6. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Written assessments to confirm prospective residents needs can be met do not take place as part of people’s admission to the home. Staff have not attended training to up date their knowledge in the needs and support required by the client group that the home is registered for, which has the potential to put people at risk. EVIDENCE: We looked at the care records for someone who has moved to the home since the last inspection. The manager told us that this person had visited the home before moving in and that staff at the home already knew the person. However, there is no written assessment to confirm that the home could meet their care needs and no record that they had visited the home. The home is registered to meet the needs of people with a learning disability and/or mental disorder. However, none of the staff have had training in this Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 9 area, despite the manager recognising that the people they support have complex needs. In the last two years, all the people living at the home have changed. Previously, staff had known the people living at the home for a number of years and had explained on previous inspections that this length of time enabled them to provide appropriate support. However, with new people moving into the home with differing needs, this is no longer the case. Two visitors felt that the service always met the needs of their relatives and understood them well. The home does not provide intermediate care. Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 7,8,9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some areas of care planning and issues around privacy need further work, in order to promote the safety, well-being and dignity of people living at the home. However, the management of medication records have improved. EVIDENCE: We looked at three people’s plans of care, which were generally clear and outlined the support each person needs. There has been some improvement in recording how risks are managed, which we discussed with the manager i.e. reducing the risk of self-harm. However, an entry in one care file recorded that a person had been involved in a road accident. The home had responded appropriately with ensuring they received medical treatment and the manager was able to tell us how the risk had been assessed but there were no written risk assessment. Daily records, which are detailed, are completed approximately every three days and are written by the manager but monthly reviews are not taking place. Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 11 People living at the home, have not signed their own care plans, which is not good practice, as they should agree the content. Records show that people living at the home have contact from a range of health care professionals and advice is recorded. The manager was able to give examples of how changes in people’s health, both physical and mental, have been recognised and acted upon. People are supported in a variety of ways to access health services; either from visits to the home by professionals, staff accompanying people or people choosing to attend appointments by themselves. This was shown by correspondence, entries in the visitors’ book and daily records. A person living at the home confirmed to us that they had access to a GP, and this was also recorded in their care plan. A GP confirmed in their survey that they were satisfied with the way the home operated. Medication is kept in a locked cupboard. We checked medication records and blister packs and saw that medication was well managed. The manager has stated in their AQAA that the home does not have controlled drugs on the premises. We looked at whether peoples’ privacy and dignity is maintained, although little interaction was seen between the manager and the people living at the home as people were sitting in the garden during the inspection or out for the day, and the manager was assisting with the inspection as they were the only staff member on duty. We have been told that a person uses the top floor of the home who is not staff. We visited the top floor and saw that there were two rooms used for storage plus a desk with a laptop. The manager told us this was not a laptop used by the home and that a family friend regularly visited to use it. The provider has written to us explaining the situation. However, this still raises concerns about how people’s privacy who live at the home is maintained. Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals’ need for contact with people who are important to them is recognised and supported by staff, and community resources are well used. Staff support people to maintain control over their lives but recognise when to intervene if a person’s action potentially puts them at risk. The meals in this home are good, offering choice and variety. EVIDENCE: Records showed that a range of social activities available in the community had been set up for people living at the home, and that they were supported to attend. A person living at the home confirmed that these had taken place while another person expressed frustration that they did not have enough to occupy them, although records showed that a number of steps had been taken to address their concerns. A visitor to the home also confirmed the work that the home had undertaken to respond to their friend’s frustration The manager spoke about how the home helped people maintain contact with close friends, Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 13 and supported them in keeping in contact with people important to them. This support is documented in daily records and was confirmed by relatives. We looked at how people are supported to make choices in the home. Through daily records in care plans and discussion with the manager, it was evident that although people’s independence was promoted, steps were taken when their behaviour put them at risk. Daily records showed how people living at the home have made choices over how they spent their time. One person gave us the example of choosing where they spent their time in the home, and when they got up and went to bed. Menus showed that the meals provided are varied and offer a good range, including breakfast. One person living at the home said the arrangements were generally satisfactory and another praised the quality of the food. Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints procedure, and works with other professionals to resolve concerns. However, improvements are needed to ensure the safety of people living at the home. EVIDENCE: The manager confirmed there had been no complaints since the last key inspection. CSCI have not received any complaints. The home has a clearly written complaints procedure. Health and social care professionals have visited the home since the last inspection, and discussed concerns raised by a person living there. Letters from these professionals, and from looking at records showed that the manager at the home was involved in these discussions and that concerns have been addressed. The home has a copy of the Alerter’s guide, which provides guidance about safe-guarding issues. A visitor has access to areas of the home, which are used by people living at the home but the home has not shown how they have ensured that people living at the home are not put at risk. Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 19, 21 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained but a minor improvement is needed to reduce a risk to people’s safety. EVIDENCE: The home is well maintained and clean. The home has one lounge, with the former second lounge now being used by the owners, who the manager said live on the premises. The lounge still provides over the recommended communal space for each resident and is smoke free. There is no lift or stair lift and therefore the home would be unsuitable for people with mobility difficulties. Each bedroom has a call bell system. The manager said that first floor rooms have windows that are restricted for safety reasons. Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 16 There is one bathroom, which also contains the toilet, and is on the first floor close to all three single bedrooms, which is shared with the owners and visitors. The manager has previously sought guidance from the Environmental Health Officer regarding the prevention of cross infection as the washing machine is in the kitchen. She has agreed that individuals’ laundry is bagged in their rooms. This is then carried through a staff room and stored in the garage. In the evening, the kitchen in then entered by staff via the backdoor after all food has been prepared. The washing machine is beside the backdoor, which ensures that soiled laundry is not carried though the kitchen. There are issues of infection control linked to incontinence in the home but the AQAA states that the home has no infection control policy. Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 27,28,29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Sufficient staff are on duty to support people using the service, but staff training needs further development. EVIDENCE: All staff are over 21 and the manager said the cover at night times is by the owners, who provide sleep in cover. The staffing levels are appropriate for the needs of the people living at the home. We looked at duty rotas. The manager said that one member of the staff team mainly covers sickness and annual leave but does not provide personal care. Rotas now reflect the people who are working at the home. There have been no staff recruitments since the last inspection. All four staff have CRB checks in place and these were all seen during a previous inspection. None of the staff group have a NVQ qualification, which would up date their practice and knowledge, but some of the staff team have undertaken training in first aid, health and safety, and medication. The manager has obtained the GSCC codes of conduct for the staff group. There has been no recent training on moving and handling for people working at the home. However, the manager said that people living at the home did not need support in this area Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 18 of care. The staff team have not undertaken recent training linked to the client categories of the home. (See standard 4). Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We looked at standards 31,33,35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally well managed but people living at the home would benefit from the registered manager updating their training. EVIDENCE: The registered manager holds no recognised qualification in social care. From management of this home she has considerable experience of working with older people. She should be making arrangements to ensure that she updates her training so that it is based on best practice. The manager said that people living at the home managed their own money and daily records showed how one person living at the home was supported to Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 20 have access to their finances. We also saw billing arrangements with the home. Since the last inspection, there has been a change in who is living at the home, and the manager said that as yet surveys to gain feedback about the service had not been sent out to those who have contact i.e. families, GP etc. She recognises that this needs to happen on an annual basis. Record keeping has improved since the last inspection. We looked at how safety issues were managed in the home. Records show that fire equipment is checked regularly. The home has insurance in place and the AQAA states that equipment in the home has been serviced. During a telephone call on 30th July the owner confirmed that all bedrooms have covered radiators to reduce the risk of burns. Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 1 x 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x 3 x x x x 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 3 x x 3 Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes. 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 OP3 Regulation 14 (1) (c) Requirement Timescale for action 01/09/08 2. OP4 18 (1) (a) The manager must be able to demonstrate through written records how the care needs of people have been assessed to confirm the home is suitable. Staff must undertake appropriate 01/12/08 training in the areas of mental health and learning disability to update their knowledge and ensure best practice when working with the people living at the home. (This is a repeated requirement with the previous date of 01/12/07 not met). 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 OP5 Good Practice Recommendations The home should record the visits of people planning to move to the home. Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 23 2. 3. 4. 5. 6. 7. 8. 9. 10. OP7 OP7 OP7 OP10 OP18 OP26 OP28 OP31 OP33 The care plan should be agreed and signed by the person it concerns. Care plans should be reviewed at least once a month to reflect changing needs. Identified risks should be recorded and reviewed i.e. road safety. The manager should document how people’s privacy and dignity is maintained when people who are not staff have access to communal areas in the home. The manager should document how they have confirmed the suitability of people, who do not live or work at the home, having access to communal areas of the home. Procedures for infection control i.e. the management of laundry should be recorded in a policy format and reviewed. A minimum of 50 of care staff should hold a NVQ level 2 in care. The registered manager should make enquiries at a local college for a relevant NVQ to update her own knowledge. The manager should seek feedback from people who live and visit the home and record their views and any action taken. Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Highbray DS0000021947.V365569.R01.S.doc Version 5.2 Page 25 - 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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