Inspection on 22/06/06 for Highbray

This inspection was carried out on 22nd June 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Highbray 24/08/09

Highbray 10/07/08

Highbray 31/07/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Highbray 84 Mount Pleasant Road Exeter Devon EX4 7AE Lead Inspector Louise Delacroix Key Unannounced Inspection 22nd June 2006 10:00 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.V293646.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.V293646.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.V293646.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th October 2005 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 service users. 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 £350; additional charges are made for hairdressing, toiletries and sweets/biscuits. The home does not currently display the inspection report. The manager has been informed that this must be rectified and she has agreed to display the report on a notice board in the communal kitchen and inform the residents. Highbray DS0000021947.V293646.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over three hours and during this time the owner and the manager contributed with information and their views of the service. As part of the inspection, medication, residents’ individuals plan of care, maintenance, finance and fire records were looked at, and a tour of the building took place. Surveys were sent to GPs, district nurses and care management teams; one care manager responded but unfortunately they had not visited the home for a number of years so their views were not included in the report. Surveys were also received from two relatives and their views have been included. The three residents spoke to the inspector but only gave limited information. What the service does well: What has improved since the last inspection? What they could do better: A requirement has been made that staff attend Moving and Handling training due to the increased frailty of residents, with a second requirement relating to health and safety checks. A third requirement was made to ensure that the duty rota is kept up to date and reflects the staff on duty. A further requirement was made relating to activities and maintaining a residents’ dignity. The home needs to improve the amount of activities they provide at the home so that residents social needs are met. Highbray DS0000021947.V293646.R01.S.doc Version 5.2 Page 6 A recommendation has been made to record regular entries in the daily notes of residents. Two further recommendations were made relating to training and monitoring hot water temperature. 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. Highbray DS0000021947.V293646.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.V293646.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Minor amendments to the revised service user guide/statement of purpose will help current residents to know what the service can offer them. EVIDENCE: The statement of purpose and service users’ guide now contains most of the required information in a clear format, which includes terms and conditions but needs additional information added to recognise a recent change in the use of communal rooms. Room numbers have now been recorded appropriately and contracts are in place. No new service users have moved to the home since the last inspection. The home does not provide intermediate care. Highbray DS0000021947.V293646.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Personal care needs are generally well met. However, there was poor practice in relation to maintaining dignity for a resident. Health care needs are well met and good plans describe care to be given. However, there is a poor review of care. Daily recording is poor meaning that it is difficult to carry out care reviews. The home has improved its medication procedures, including staff training, meaning the health needs of residents’ are well met. EVIDENCE: Care plans are based on a thorough assessment of need for each individual resident. Core information is well written, clear and generally contains clear instructions of how to meet the individual needs of each resident. Residents have signed them, which is good practice. However as on the last inspection, there is generally poor recording of the daily lives of residents. For example, Highbray DS0000021947.V293646.R01.S.doc Version 5.2 Page 10 for one resident there is a gap of over seven weeks between entries and no monthly review that covers all aspects of their care. Records show that residents have contact from a range of health care professionals and advice is recorded. On the day of the inspection, a health professional visited the home and gave positive feedback about the service. The manager was able to give examples of how changes in residents’ health, both physical and mental, have been recognised and acted upon. For example, a continence nurse has given advice. Residents are supported in a variety of ways to access health services; either from visits to the home by professionals, staff accompanying residents or residents choosing to attend appointments by themselves. A resident confirmed that the GP visited, and this was also recorded in entries in care plans and the visitors’ book. Surveys were sent to residents’ GPs but unfortunately they were not returned. The manager recognised the need to monitor the residents’ tissue viability; one resident was seen using a pressure-relieving cushion and being reminded to use it appropriately. The manager confirmed that no residents had pressure areas. All three residents now have mobility difficulties and staff explained how they were encouraged and supported to move around the home. Medication is kept in a locked cupboard. Medication is now provided in monitored dosage system. The manager confirmed that records are signed as soon as medication is given to service users and that service users are discreetly monitored to ensure that medication is taken. Care plans indicate when service users may feel less willing or able to take medication. The printed medicine administration record chart for residents was checked, and seen to be up to date. Two people now sign handwritten changes to the medication records. The registered manager told the inspector that there is currently no controlled drugs kept in the home. If this changes, the home would need to provide a metal cupboard, which complies with the Misuse of Drugs (Safe Custody) Regulations 1999 and keep the required records. The registered manager could give examples when the GP would be called. For example, if a change of medication might be linked to a negative change in the service user’s well-being. The home now has a written policy on the receipt, recording, storage, handling, administration and disposal of medicines. The manager confirmed she would return a prescription that was out of date. The registered manager and two staff have now attended training to update their basic knowledge of how drugs are used. The manager gave examples about respecting residents’ dignity with regards to personal care and privacy. For example, one resident confirmed that they had a key for their room to prevent unwanted intrusions. A resident spoke about being able to wear their own clothes and the manager was seen Highbray DS0000021947.V293646.R01.S.doc Version 5.2 Page 11 ensuring that residents’ clothes were well cared for. The manager gave an example of asking health staff to visit the home because of the distress it causes one resident to go to the surgery. A relative commented via a survey cared that ‘when I do make contact or visit I feel the care offered is of the highest standard’. However, one person had been given a clean incontinence pad to wear around their neck to protect their clothes from spillages, which seriously compromised their dignity. The manager said this practice would not continue. Highbray DS0000021947.V293646.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ need for contact with family is recognised and supported by staff but there is little social stimulation within the home. Staff support residents to maintain control over their lives but recognise when to intervene if a resident’s action potentially puts them at risk. The meals in this home are good, offering choice and variety, and cater for the changing needs of residents. EVIDENCE: All three residents’ mental or physical health has deteriorated since the last inspection, which has impacted on two of their chosen social routines which involved them going leaving the home, either for the pub, social club, shops or cinema. On the day of the inspection, all three residents were watching television in their individual rooms, and they all confirmed that this was how they spent their time. No activities are offered within the home. The registered manager said that visitors are encouraged to visit the home although due to residents’ circumstances this does not happen regularly. On Highbray DS0000021947.V293646.R01.S.doc Version 5.2 Page 13 the last inspection, a resident spoke about being able to maintain in contact with their family, and the manager explained how this is currently being managed in a supportive way. Two relatives said they felt welcomed, that they were kept informed of important matters affecting their relative and that that they were consulted. They both said they could visit their relative in private. Through records in a care plan and discussion with staff, it was evident that although residents’ independence was promoted steps were taken when their behaviour put them at risk. A resident confirmed that they had a choice of what they wore and whether they chose to lock their door. One resident currently has mobility problems and the manager was seen encouraging them to call staff using the call bell if they needed help down the stairs. Menus showed a varied range of meals and it is now documented that supper is available, which was seen being served on a previous inspection. Likes and dislikes are listed for each resident, and the manager recognised this sometimes varied due to changes in the mental or physical well-being of residents and she said that alternatives are offered. This was confirmed with a resident. Currently, all residents eat their meals in their rooms. Highbray DS0000021947.V293646.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear complaints procedure, which means that residents and relatives should know how to make a complaint. EVIDENCE: The pre-inspection report stated that there have been no complaints since the last inspection and none of the residents raised any concerns about the service. No complaints have been received by CSCI since the last inspection. There is now a 28 day response time included in the complaints policy. The home’s complaint procedure is outlined in the service user guide and each resident has a copy. The manager has obtained a copy of the multi-disciplinary Alerter’s guide to promote the protection of vulnerable adults within the home. Highbray DS0000021947.V293646.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,22,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the environment within the home is good and provides residents with clean and hygienic surroundings that are improved by safety features. EVIDENCE: The home was clean and odour free. The home now has one lounge, with the former second lounge now being used by the owners, who the manager said live on the premises. The one lounge still provides over the recommended communal space for each resident and is smoke free. The lounge has recently been redecorated and recarpeted making it an attractive room. However, none of the residents currently use this room, two people confirmed this was their choice and the third person’s recent mobility difficulties currently make accessing the lounge difficult. Their needs are currently being assessed by Highbray DS0000021947.V293646.R01.S.doc Version 5.2 Page 16 health professionals. A resident’s room has also been attractively decorated and recarpeted, which they appreciated. The three residents share one bathroom, which also contains the toilet, and is on the first floor close to all three single bedrooms. Equipment has been provided to help residents use the toilet more easily, and the home now has a wheelchair available to residents. Each bedroom has a call bell system, and a resident confirmed that they knew how to use it. All bedrooms have windows that are restricted for safety reasons. The home is currently being fitted with radiator covers, which is good practice. 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 service users’ 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. Highbray DS0000021947.V293646.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The procedure for obtaining CRBs is now robust and safeguards are in place to offer protection to people living at the home. Positive steps have been taken to begin to address staff training needs but this needs further development to ensure that residents can be assured that their changing needs can be met. There are sufficient staff on duty to meet the needs of residents but there is poor record keeping with regards to who is on duty each day. 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 residents. However, the staff duty rota did not reflect the staff on duty at the time of the inspection. The manager said that one member of the staff team mainly covers sickness and annual leave but agreed their name is regularly recorded as having worked. On the day of the inspection, another member of staff was on duty, whose name was not recorded on the rota. 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. Highbray DS0000021947.V293646.R01.S.doc Version 5.2 Page 18 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, despite the changing needs of residents. The staff team have not undertaken recent training linked to the client categories of the home. Highbray DS0000021947.V293646.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally well managed but there are some inadequate record keeping around safety checks. 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. The service users’ guide makes it clear that it is the home’s policy that service should manage his or her own affairs. Where this is not possible the home manages service users’ personal allowances. Appropriate records and receipts are maintained with resident signing for their personal allowances. Highbray DS0000021947.V293646.R01.S.doc Version 5.2 Page 20 Paperwork showed that the manager has contacted family and GPs to gather views on the service, which were positive. The manager now lists the names of people that attend fire drills. Records show that fire equipment is checked regularly and that thermostatic valves have been fitted to regulate water temperature within recommended guidelines and this was calibrated in 2004 but temperatures are not routinely checked. All fire checks take place at required intervals. The manager was unable to produce paper work to show that the gas boiler had been serviced recently (the last time was 21/12/04) and she is currently waiting for the work on the electrical wiring of the home to be completed so that the work can be signed off and then the paperwork can be sent to CSCI as confirmation. Portable appliance tests took place in September 2004. The manager said these would be carried out again when the re-wiring is signed off. Highbray DS0000021947.V293646.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 2 3 x x x 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x 3 x x x 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 2 Highbray DS0000021947.V293646.R01.S.doc Version 5.2 Page 22 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. Standard OP10 Regulation 12 (4) (a) Timescale for action The registered person shall make 31/07/06 suitable arrangements to ensure that the care home is conducted in a manner, which respects the privacy and dignity of service users. (Appropriate protective clothing must be provided to a resident and they must be consulted on its style). The registered person 31/08/06 shall…consult service users about the programme of activities arranged by or on behalf of the care home. (Residents must be consulted about activities within the home and supported to pursue interests inside and outside of the home). A copy of the duty roster of 31/07/06 persons working at the care home, and a record of whether the roster was actually worked. (The staff rota must reflect who actually worked each day). The registered person shall make 31/08/06 suitable arrangements to provide a safe system for moving and DS0000021947.V293646.R01.S.doc Version 5.2 Page 23 Requirement 2. OP12 16 (2) (n) 3. OP29 17 (2) Schedule 2 4. OP30 13 (5) Highbray 5. OP38 13 (4) handling service users. The registered person shall 31/08/06 ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. (A copy of the service paperwork for the gas boiler must be sent to CSCI to show that it is serviced annually.) (The electrical wiring and portable electrical appliances test certificates must be sent to CSCI.) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP1 OP31 OP38 Good Practice Recommendations The statement of purpose should reflect the changes to the communal space available to residents. The registered manager should make enquiries at a local college for a relevant NVQ to update her own knowledge. The temperature of the hot water should be monitored regularly. Highbray DS0000021947.V293646.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 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.V293646.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. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!