Inspection on 31/07/07 for Highbray

This inspection was carried out on 31st July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found 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 10/07/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Highbray 84 Mount Pleasant Road Exeter Devon EX4 7AE Lead Inspector Louise Delacroix Unannounced Inspection 31st July 2007 10:35 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.V338526.R02.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.V338526.R02.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.V338526.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd June 2006 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 noticeboard. Highbray DS0000021947.V338526.R02.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 two and a half hours and during this time the manager contributed with information and their views of the service. As part of the inspection, medication, peoples’ 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 a telephone message was left for a care management team; one GP responded. One survey was received from a relative. Only one person is currently living at the home, and their views were sought on the service, where possible. 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: What has improved since the last inspection? Previous requirements have been met as people are now consulted about activities inside and outside of the home, and paperwork has now been seen to confirm that maintenance checks have taken place. Water temperatures are also monitored now. The home has a statement of purpose/service user guide, although the manager plans further changes to the wording of the document. Highbray DS0000021947.V338526.R02.S.doc Version 5.2 Page 6 Bedrooms are being redecorated, including new flooring. 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.V338526.R02.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.V338526.R02.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 1,3,4 and 5. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Assessments take place as part of people’s admission to the home and people are provided with information about the service. However, 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: The manager told us that they had updated the service user guide/statement of purpose but that they currently did not have a copy of this document as it had been given to visitors viewing the home. A copy of the statement of purpose/service user guide has since been sent to CSCI. This is detailed but the manager plans to review the wording so that it appears less restrictive. A revised will be sent to CSCI. Highbray DS0000021947.V338526.R02.S.doc Version 5.2 Page 9 We looked at the plan of care for the person living at the home, and saw copies of a professional assessment outlining their care needs. The manager had also identified areas where the person would need support, although it would provide greater clarity if there were not incorporated into daily notes. 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 area, despite the manager recognising that the people they support have complex needs. Since the previous inspection, 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. A visitor felt that the service always met the needs of their relative and understood them well. The person living at the home did not wish to make changes to the service. The manager said the person had visited the home before moving in, but this was not documented. The home does not provide intermediate care. Highbray DS0000021947.V338526.R02.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. The quality of recording in care plans and medication records needs to improve, as does issues around confidentiality, in order to promote the safety, well being and privacy of people living at the home. EVIDENCE: A plan of care was looked at, which was generally clear and outlined the support the person needs. However, risks had been clearly identified in the assessment on file but there was no risk assessment as to how these were to be managed. The manager discussed a risk linked to scalding but again there was no risk assessment to show how this would be managed. Daily records made reference to one of these identified risks linked to finances, but it did not show that other professionals had been consulted in their view on how it was managed, which would be good practice, although the person living at the home had been involved as shown by their signature on the daily record entry. Daily records, which are detailed, are completed approximately every Highbray DS0000021947.V338526.R02.S.doc Version 5.2 Page 11 three days and are written by the manager but monthly reviews are not taking place. The last entry in the daily records was 20th July 2007 as the manager had been on holiday and other staff do not complete them. The care plan had not been signed by the person it referred to, despite them moving to the home eight months earlier. 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 peoples’ 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. Medication records showed that daytime administration is correctly recorded. However, medication records showed that one set of nighttime medication had been signed to say that the medication had been administered. However, the blister packs indicated that it had not; instead another day’s medication had been wrongly opened. This was the only mistake seen. The manager said that one of the night time medications had been increased in dosage but they were awaiting a change to the prescription. Changes were not recorded on the medication record sheet. The registered manager and two staff have attended training to update their basic knowledge of how drugs are used. The manager has stated in their AQAA that the home does not have controlled drugs on the premises. We looked at whether peoples’ dignity and respect is maintained. Little interaction was seen between the manager and the person living at the home as the person was sitting in the garden during the inspection, which they said they enjoyed, and the manager was assisting with the inspection as they were the only staff member on duty. However, respect is shown to peoples’ privacy and dignity by the bedrooms and the bathroom being lockable. The manager showed respect towards the person’s room and their belongings. Daily records show that the issue of privacy has come up around telephone calls for people living at the home and that this has been resolved. However, prior to the inspection, confidentiality was not upheld when there was poor practice during a telephone call. Highbray DS0000021947.V338526.R02.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 the person living at the home, and that they were supported to attend. The person living at the home confirmed that these had taken place but that some had finished for the summer. The manager spoke about how the home helped the person maintain contact with close friends, and supported them in keeping in contact with people important to them. This support is documented in daily records and was confirmed by a relative. They said that the manager was ‘brilliant’ and kept them up to date. Highbray DS0000021947.V338526.R02.S.doc Version 5.2 Page 13 We looked at how people are supported to make choices in the home. Through daily records in a care plan and discussion with the manager, it was evident that although peoples’ independence was promoted, steps were taken when their behaviour put them at risk. However, one example was found that did not show that other relevant professionals had been involved, which would have been good practice. (See standard 7) Daily records showed that the person living at the home had made choices over how they spent their time. Menus showed that the meals provided are varied and offer a good range, including breakfast. The person living at the home said the arrangements were satisfactory. Highbray DS0000021947.V338526.R02.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. EVIDENCE: The manager could not find a copy of the complaints procedure on the day of the inspection but said that it remained the same as on the previous inspection last year, apart from the CSCI contact address, which had been changed. On the previous inspection, the complaints procedure was clearly written. Health and social care professionals have visited the home since the last inspection, and discussed concerns raised by people living there. Discussion with these professionals, and from looking at records showed that the manager at the home was involved in these discussions and both issues were resolved and one allegation was not substantiated. The home has a copy of the Alerter’s guide, which provides guidance about safe-guarding issues. Highbray DS0000021947.V338526.R02.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): 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 and improvements are being made to reduce risks to people’s safety. EVIDENCE: The home is well maintained and clean with one bedroom having recently been decorated, which has included new flooring. 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. There is one bathroom, which also contains the toilet, and is on the first floor close to all three single bedrooms. Each bedroom has a call bell system, which was tested during the inspection. The manager said that first floor rooms have windows that are restricted for safety reasons. However, one unoccupied Highbray DS0000021947.V338526.R02.S.doc Version 5.2 Page 16 bedroom has a window that is not restricted, which the manager said they would address promptly. The home is currently being fitted with radiator covers, which is good practice. These were seen in two of the bedrooms, the bathroom and the lounge. 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 currently no issues of infection control linked to incontinence in the home but the AQAA states that the home has no infection control policy. Highbray DS0000021947.V338526.R02.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 there is poor record keeping as to who is on duty each day and 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. The manager agreed that their name is regularly recorded as having worked when this is not the case. 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 the new person living at the home did not need support in Highbray DS0000021947.V338526.R02.S.doc Version 5.2 Page 18 this area of care. The staff team have not undertaken recent training linked to the client categories of the home. ( See standard 4). Highbray DS0000021947.V338526.R02.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 31,33,35,37 and 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 people living at the home would benefit from the registered manager updating their training, and improvements in recording. 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. Highbray DS0000021947.V338526.R02.S.doc Version 5.2 Page 20 The manager said that the person living at the home managed their own money and daily records showed evidence that the person living at the home had access to their finances. 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. We looked at record keeping during the inspection and found that most had gaps of information such as the care plan, a lack of risk assessments and an incorrect medication chart, the staff rota is inaccurate, there is no policy in infection control and the accident book had not been completed after one incident. We looked at how safety issues were managed in the home. 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 and temperatures are now routinely checked. Food and fridge temperatures are also routinely monitored. The home has insurance in place. There is now documentation to show that gas appliances have been serviced and that the electrical re-wiring has now been signed off. The manager spoke of an incident relating where scalding was a risk. She said an appropriate risk assessment had been completed. Highbray DS0000021947.V338526.R02.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 3 x 3 2 2 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 3 3 x x x x x x 2 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 2 3 Highbray DS0000021947.V338526.R02.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 OP4 Regulation 18 (1) (a) Timescale for action Staff must undertake appropriate 01/12/07 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. Identified risks to people living 01/09/07 at the home must be documented in the care plan with a clear plan of action as to how the risk will be managed and reviewed to help keep people safe. Where appropriate, other professionals must be consulted about managing risk. Changes to medication must be 01/09/07 appropriately recorded to ensure the safety of people living at the home. The staff rota must reflect who 01/09/07 actually worked each day. Requirement 2. OP7 13 (4) 3. OP9 13 (2) 4. OP29 17 (2) Schedule2 Highbray DS0000021947.V338526.R02.S.doc Version 5.2 Page 23 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. 4. 5. 6. 7. 8. 9. Refer to Standard OP5 OP7 OP7 OP7 OP10 OP26 OP28 OP31 OP37 Good Practice Recommendations The home should record the visits of people planning to move to the home. 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. Daily records should be kept up to date, including when the manager is on holiday. Care should be taken to ensure that client confidentiality is maintained. 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 quality of recording issues relating to care and the running of the home should be improved. Highbray DS0000021947.V338526.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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.V338526.R02.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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