Inspection on 01/08/07 for Highermead

This inspection was carried out on 1st August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Highermead 13/02/08

Highermead 16/08/06

Highermead 05/10/05

Highermead 28/04/05

Highermead 20/10/04

Highermead 28/04/04

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

CARE HOMES FOR OLDER PEOPLE Highermead College Road Camelford Cornwall PL32 9TL Lead Inspector Mrs Kerensa Livingstone Key Unannounced Inspection 1st August 2007 09:30 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 Highermead DS0000009188.V346690.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. Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highermead Address College Road Camelford Cornwall PL32 9TL 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) 01840 212528 01840 211024 Ark Care Services Limited Mr Shaun Boundy Care Home 22 Category(ies) of Dementia - over 65 years of age (22), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (22) Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service users to include up to 22 adults aged over 65 years with a mental illness (MD(E)) Service users to include up to 22 adults aged over 65 years with dementia (DE(E)) Total number of service users not to exceed a maximum of 22 Date of last inspection Brief Description of the Service: Highermead is a privately run home, which provides twenty-four hour personal care and accommodation for up to twenty-two older people who suffer with a mental disorder or dementia. The home is owned by Mr and Mrs Ajisebutu, who also own a second home in the North of England. Accommodation is provided on two floors. With the exception of one double room, all accommodation is provided in single rooms in a large detached house in a quiet rural area in Camelford. There are a choice of lounge areas. Access between floors is restricted by stair gates. A passenger lift is available. In good weather there is a courtyard garden area available for use. There is good car parking by the home. Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place over one full day commencing at 09.30 and finishing at 6.30pm, it was conducted by two inspectors. During this time the inspectors used observation, reviewing of documentation and inspection of the environment. The inspectors met with staff and service users. The Registered Manager was present for the morning of the inspection. Relatives feedback has been incorporated into this report. As part of this inspection a case tracking exercise was carried out. This involved us looking closely at selected residents’ care from the point of their admission to the home. The current fees for this home are £335-£480. Hairdressing and chiropody are extra. What the service does well: What has improved since the last inspection? What they could do better: The Statement of Purpose and Service User’s Guide must include the required information, be up to date and circulated as required. The information provided would not enable service users to make an informed choice about where to live. A pre admission assessment must be completed prior to a service user moving into the home to ensure that their needs can be met. The staff are not provided with the training to ensure that they can meet the specialist needs of the service users. The service users’ plan of care is not adequate to direct and inform care. The level of need and interventions to meet the needs are not recorded. Healthcare Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 6 needs are not fully met. Risk assessments must include a risk management plan. Leadership is required to ensure that challenging situations are managed effectively and support the service user and staff. Procedures relating to the administration of medicines require improvement. Staff must receive instruction during induction on how to treat service user with respect at all times. The daily routines are inflexible and do not meet the individual needs of the service user. Service users have limited control or choice over their lives. Service users do not have an express choice of food that they eat. There is an unhealthy interval between teatime and breakfast, it is over fifteen hours. There are no regular structured activities in the home. One relative commented that they would like more activities and entertainment. Service users are not being protected from abuse, their safety and wellbeing is not safeguarded. Service users’ complaints are not dealt with using the home’s complaints procedures. The accommodation is homely and comfortable. There are areas of the home that need regular cleaning. The maintenance, laundry and cleaning staffing is inadequate to meet the home’s needs. Environmental risks are not being assessed and managed within the home. Specialist equipment must be provided to enable staff to meet individual service users’ needs. Lockable doors could provide service users with a higher level of privacy. The current staffing is not adequate to meet the needs of the service users. Managerial time has been eroded by the need to delivery a service and that has impacted on the smooth running of the home. Service users are not safeguarded by the home’s recruitment procedures. Staff are not being provided with the training to ensure that they have the skills to meet the service users’ needs. During the inspection the inspectors observed evidence of a lack of leadership and effective management. This is reflected in the number of statutory requirements. Staff are not provided with a structured induction or supervision. Service users and staff health and safety is not safeguarded. 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. Highermead DS0000009188.V346690.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 Highermead DS0000009188.V346690.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): 1, 3, 4 & 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose and Service User’s Guide must include the required information, be up to date and circulated as required. The information provided would not enable service user to make an informed choice about where to live. A pre admission assessment must be completed prior to a service user moving into the home to ensure that their needs can be met. The staff are not provided with the training to ensure that they can meet the specialist needs of the service users. EVIDENCE: The service users’ guide contains details of the previous manager and the environmental information does not include the extension. This document states that the home is registered with Cornwall County Council and that care plans are reviewed three monthly, this is not accurate. The inspector was informed by the Manager that this information is not provided to prospective Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 9 service users or their representative. A copy of the most recent report, contract and complaints procedure must be included. It is recommended that service users views are included. The Statement of Purpose must be updated and the information listed in Schedule 1 included. The organisational structure includes laundry and housekeeping staff. Pre admission assessments and care needs were observed to be left blank. There was no evidence of needs having been fully assessed prior to moving into the home. There is no structured training programme to ensure that the staff have the skills to deliver the care that the home offers to provide, individually or collectively. Staff stated that they would like to do some more training but instead, they were provided with leaflets to read. Intermediate care is not provided at this home, therefore this standard is not applicable. Highermead DS0000009188.V346690.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): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service users’ plan of care is not adequate to direct and inform care. Healthcare needs are not fully met. Risk assessments must include a risk management plan. Leadership is required to ensure that challenging situations are managed effectively, support the service user and staff. Procedures relating to the administration of medicines require improvement. Staff must receive instruction during induction on how to treat service user with respect at all times. EVIDENCE: There is no comprehensive assessment of need drawn up for each service user to base the plan of care upon. There was no evidence of family/service user involvement in the writing or reviewing of the plan of care. These documents had been reviewed within the last month, however they did not reflect the Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 11 complexity of need for the service users and interventions to meet service users’ needs were not identified. Social, spiritual and mental health needs were noted to be missing. In particular, there was very little or no information included in the care plans of service users who require extra support because of complex behaviours. It is important to have clear guidance in place in these circumstances so that staff can approach challenging situations confidently and consistently. Risk assessments are in place but in many cases have not been reviewed for long periods of time or following significant events. For example, one resident had been wandering into other service users’ rooms and another service user was exhibiting challenging behaviour. There was no evidence of any management review of the risk assessment. Strategies to de-escalate challenging situations and identify antecedents were not included in care planning. The chiropodist visits the homes six weekly. The inspectors were informed that there are no regular arrangements for dental and optical care. The inspectors were informed that a General Practitioner and Community Psychiatric Nurse had reviewed the (12) service users registered with that particular G.P. in the previous week. However there was no evidence recorded in individual records that this had taken place. There was evidence that staff are undertaking tasks for which they have not received any training. No individual continence assessments were observed in the records inspected. Communal continence products were located in the toilet. There was no evidence that continence is promoted. Bowel, weight, fluid and skin records are kept in one central folder. Weighing records were incomplete and no entries in bowel charts for 8-14 days. There are Policies and Procedures relating to the safe handling of medicines. Regular checks are important to ensure that staff are handling medicines in the right way. An inspection of the controlled drugs cupboard and register did not accurately reflect the medicines that were stored in the cupboard. The medication administration record did not identify the number tablets received into the home, this was recorded by a tick system in an additional record book. The tablets received into the home should be signed for by the person checking them in. There is a designated medicines trolley, however the inspector was informed that this is too small, it is anticipated that the pharmacy will replace this for the home. There is a designated fridge; fridge temperatures are not recorded. There is a list of staff signatures, this was completed by half of the staff. The Home Remedies procedure was not signed by the General practitioner. Regular checks (audits) on medicines records and stocks are not carried out. Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 12 The manager said that staff are provided with an internal medicines course. However, no formal assessment of competence is carried out and staff are not regularly supervised to ensure they are and remain competent. Staff were observed to call service users ‘my darling’, ‘my love’ and ‘bless her’, one service user was referred to by a shortening of their name. Preferred names were not recorded. Screening is provided in the double room. Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14 & 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The daily routines are inflexible and do not meet the individual needs of the service user. There are no regular activities or entertainment for the service users. Visitors are able to visit as they wish. Service users have limited control or choice over their lives. Service users do not have an express choice of food that they eat. There is an unhealthy interval between teatime and breakfast, it is over fifteen hours. EVIDENCE: The inspectors were informed that the staff knew what the service users preferences/choices were on numerous occasions during the inspection for example in relation to activities and food. Individual choices, likes/dislikes and preferred routines are not recorded. There is a document for recording the ‘Life Story’ of the service user, however on inspection the documents were blank. Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 14 On arrival at the home at 9:30, at least seventeen service users were observed to be up, dressed and seated in the lounges, the inspectors were informed that all service users except one were up and downstairs in the lounge at 09.45. The night book showed evidence that staff were assisting service users to get up, washed and dressed from 5.30am on a regular basis. On the 28/7/07 ten service users were identified as washed and dressed by 06.30. Individual preferred routines were not evident within the care plans or service users’ records. Personal profile information and Keyworker observations were noted to be incomplete. The service users were observed to spend the day in one of two lounges or the courtyard (this was for a short period). No service users went upstairs to their room on the day of the inspection. There are no structured activities provided and no record is kept centrally of activities that have taken place. One relative commented that they would like more activities and ‘my relative only goes out of the home if we take them’. Visitors are encouraged to visit the home at anytime. Written information is not being provided to relatives, friends and representatives when they move into the home. There is no information about advocacy services available in the home. Families and representatives are encouraged to be as involved as they wish. There is no evidence that service users are encouraged to exercise choice over their lives. Personal possessions are evident in service users’ rooms. Breakfast is served at 08.00, lunch at 12.00, tea at 16.00 and drinks with biscuits or cake are offered later. All three meals are provided within an eighthour period. Most of the dry stores were noted to be ‘economy’ produce e.g. biscuits, tinned foods, mousses. On the day of the inspection all service users had Beef casserole, Yorkshire pudding, boiled potatoes, carrots and sprouts followed by blancmange with cream. No choice was offered to service users. The menu written on the board in the dining room was not up to date. There is no rotational menu, the inspector was informed that it depended upon what food is available. There were no cleaning schedules, the inspectors were informed that there is not enough time to undertake regular daily cleaning apart from the work surface areas and the maintenance person does a ‘deep clean’ once a week. Limited food records are kept. Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 15 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): 16 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users are not being protected from abuse, their safety and wellbeing is not safeguarded. Service users’ complaints are not dealt with using the home’s complaints procedures. EVIDENCE: There is a complaints procedure; this needs to include the Department of Adult Social Care and CSCI contact details must be updated, removing a specific inspector’s name. The complaints log showed that nothing had been recorded since 2003. Throughout the inspection we found evidence that a number of service users or representatives had made complaints that do not appear to have been acted upon using the home’s complaints procedure. All concerns and complaints must be recorded. There are specific guidelines that must be followed in the event that an incident of abuse is reported or suspected which are provided by the Department of Health (No Secrets); these are generally referred to as Safeguarding Adult procedures. Staff have not been provided with Protection of Vulnerable Adults training. The Registered Manager stated that he and the Deputy Manager had received training. Staff should attend the Department of Adult Social Care facilitated training. There is no Protection of Vulnerable Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 16 Adults procedure and staff were not aware of the action they were required to take. Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 17 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): 19, 21, 22, 24 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The accommodation is homely and comfortable. There are areas of the home that need regular cleaning. The maintenance, laundry and cleaning staffing is inadequate to meet the home’s needs. Environmental risks are not being assessed and managed within the home. Specialist equipment must be provided to enable staff to meet individual service user’s needs. Lockable doors could provide service users with a higher level of privacy. Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 18 EVIDENCE: The building is located just outside the small town of Camelford. There is plenty of car parking and gardens. The gardens would benefit from the removal of equipment left outside and being made more attractive. The front door is locked, fire doors are alarmed and access to the courtyard is alarmed. There is no programme of routine maintenance, renewal of fabric and redecoration. There is a maintenance person who works approximately eight hours a week. This is a large three storey building, during this time they clean carpets and undertake the ‘deep cleaning’ of the kitchen. A conservatory had been proposed previously to increase the communal space, however this has not been provided yet. One bathroom had buckets soaking personal laundry and items soaking in the bath. One bathroom was being used for preparing and storing cat food, this bathroom smelt very strongly of urine. Another toilet is used as a staff changing room and cloakroom. Generally there was a lack of specialist equipment to assist more physically dependant service users e.g. bathing, moving and handling, weighing scales, raised toilet seats. There is a passenger lift, the door has been identified as needing repairing over a prolonged period of time. This is yet to be done. It was recommended at the previous inspection that grab rails be fitted in corridors, this has not been done. Service users’ accommodation was observed to be personalised and homely. However some rooms did not have any pictures on the wall. Two rooms were noted to have a facility to secure the door either on the outside or inside; these have been removed since the inspection. The assistant manager stated that these had been fitted at the request of the service users’ relatives. No rooms have a lockable door which is overrideable in the event of an emergency. Soiled doormats were observed next to service users’ beds. The inspectors were informed that all water is regulated and hot surfaces covered. Window latches are in place however they are detachable. No environmental risk assessments have been compiled. The ‘gate’ at the top of the stairs was observed to be unlocked during the inspection. There is adequate natural light and ventilation throughout the home. The laundry smelt strongly and there was a backlog of personal laundry. Bed linen is laundered externally. There are no designated housekeeping or laundry staff. There were areas of the home that required cleaning. Some chairs were soiled and needed cleaning. Generally there were odours in several areas of the home. Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 19 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): 27, 28, 29 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The current staffing is not adequate to meet the needs of the service users. Managerial time has been eroded by the needs of the service delivery and this has impacted on the smooth running of the home. Service users are not safeguarded by the home’s recruitment procedures. Staff are not being provided with the training to ensure that they have the skills to meet the service users’ needs. EVIDENCE: On the day of the unannounced inspection there were three carers and the Deputy manager on duty; this was one carer down and mid morning cover was found. In the afternoon there are four or five staff on duty and two waking staff at night. In January 2006 the previous inspector had been informed that the number of night staff would increase to 3 waking and an extra day carer when the new rooms were occupied. They were occupied on the day of the inspection. There is a cook on duty until 5.30pm. There are no designated housekeeping or cleaning staff; these tasks are undertaken by the care staff during their shift. Maintenance support is provided once a week. It was evident that the provision for cleaning, laundry and maintenance was inadequate. The duty rota must reflect the hours worked by all staff, on the day of the inspection the Registered Manager’s hours for the previous day did not reflect the hours worked. Staff stated that they enjoyed working at the home. Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 20 Seven carers have achieved their National Vocational Qualification; four in level 2, two in level 3 and one in level 4. The Manager informed the inspectors that three are currently studying for it. Seven out of twenty one carers equates to 33 . The inspectors were informed that no one under the age of twenty-one years of age is left in charge of the home. The recruitment procedure operating within the home requires the completion of an application form. Written references were noted to be missing from one staff file. None of the staff files examined had a POVA First or Criminal Records Bureau check. Gaps in employment are not explored as part of the recruitment procedure and references are not routinely sought from the last employer. There is no evidence that new staff are provided with the General Social Care Code of Conduct. A job interview assessment checklist is utilised. New staff are provided with an in house induction. There is no structured induction based upon the Skills for Care induction. Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 21 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): 31, 33, 34, 35, 36, 37 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. During the inspection the inspectors observed evidence of a lack of leadership and effective management. This is reflected in the number of statutory requirements. Staff are not provided with a structured induction or supervision. Service users and staff health and safety is not safeguarded. EVIDENCE: The registered manager informed the inspectors that they hold the National Vocational Qualifications level 4 in care & the registered manager’s award. Staff confirmed that they found the Registered Manager accessible. The inspectors were advised that staff meetings had ceased with the exception of the Senior Carers’ meeting, however the last one was held in August 2006. There is no evidence that staff, service users and stakeholders affect the way the service is delivered. The Registered Manager confirmed that monthly Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 22 unannounced visits were not being conducted by the Registered persons under Regulation 26 and they were not being provided with a report. The Commission has requested confirmation of these visits and this has not been provided. Incidents of events taking place in the home that adversely affects the well being and safety of the service user are not being reported to the Commission for Social Care Inspection. There is evidence that the Registered persons periodically gather quality assurance information centrally; the last information available in the home is dated December 2005, and the Manager must be instrumental in this process. There is no evidence in the home that regular auditing takes place. There is no evidence of a quality monitoring system as part of an annual development plan, based upon seeking views of the service users. Policies and Procedures have been reviewed recently, however there is no evidence that staff have read and understood them. The results of service user’s surveys detailing the actions taken should be published and made available to current and prospective service users, their representatives and the Commission. Views should be sought from stakeholders, families and friends. Employer’s Liability insurance is in place. The business and financial plan was not open to inspection. There is a Service Users’ Money and Property policy. Service users’ monies were not inspected at this inspection. Care staff do not receive regular supervision covering all aspects of practice, the philosophy of care and career development needs. Staff are seen for a one to one if there are any problems, however this had not taken place for a year. Informal supervision takes place on a day-to-day basis, the inspectors were informed. The home’s communication books, Senior Carer’s book and night book do not ensure that record keeping complies with data protection. Staff had been booked to undertake a First Aid training course, however the training provider cancelled this. The inspector was informed that ‘several have expired now’. Moving and handling training is provided for staff, however training records were not up to date, so it was unclear who had received this training. The servicing of fire extinguishers has been allowed to lapse, some were dated April 2005, none of them had been serviced in the last year. Fire drills and fire alarms, which are due to done weekly had been last done on 9/7/07. Fire drills were recorded to take place monthly. The Deputy Manager provided fire training to staff in May and June 07, the content of the questionnaires completed following this training raised concerns. Some bedroom doors could not automatically close in the event of a fire as the carpet was stopping the Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 23 door closing. Portable appliance, hardwiring and gas Landlord’s certification were not available for inspection. The Manager stated that the hoists are rented from a company who undertake their own servicing. Environmental risk assessments have not been undertaken for any risks within the home. Staff were observed having to lift a heavy wooden gate blocking access to the stairs or climb over it to go upstairs. The lift door, which is broken, has been identified at numerous services, this has not been repaired. There are detachable window latches, which are easily removable. A company had undertaken a Health and Safety inspection in July; the Manager stated that the report and action plan is due soon. There was no legionella risk assessment, however a water sample is sent away in December 2006 and found to be clear. Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 24 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 1 X 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 X 2 2 X 2 2 1 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 2 3 1 2 1 Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 25 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 OP1 Regulation 5 Requirement The registered person shall produce a written guide to the care home referred to as The Service User’s Guide, this shall be supplied to each service user and kept up to date. The Statement of Purpose must include the information detailed in Schedule 1. The registered person shall not provide accommodation until the needs of the service user have been assessed and the registered person has confirmed in writing that the care home is suitable to meet the service user’s needs in respect to his health and welfare. The registered person shall ensure that staff are provided with the training appropriate to the work they perform. Timescale for action 01/12/07 2. 3. OP1 OP3 4, Sch. 1 14 01/12/07 01/10/07 4. OP4 18(1c) 01/12/07 Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 26 5. OP7 15 6. OP8 12 7. OP9 13(2d) 8. OP12 16(2m&n) 9. OP14 12(2 &3) 10. OP15 16(2i) 11. OP15 17(2) Sch.4 12. OP16 17(2) Sch. 4 The registered person shall after consultation with the service user, or representative prepare a written plan as to how service user’s needs in respect of his health and welfare are to be met. This must be available to the service user. The registered person shall ensure that the home is conducted to promote and make proper provision for the health and welfare of the service users. The registered person shall make arrangements for the recording and safekeeping of medicines received into the home. The registered person shall consult service users about their social interests and provide a programme of activities that meets these needs. The registered person shall enable service users to make decisions with respect to the care they are to receive and their health and welfare, taking into account their wishes and feelings. The registered person shall provide adequate, wholesome and nutritious food which is varied and available at such time as may be required by service users. The registered person must ensure records of food provided are kept in sufficient detail to determine whether the diet is satisfactory in relation to nutrition and otherwise. The registered person must keep a record of all complaints and the action taken in respect of any such complaint. This must be available for inspection. 01/10/07 01/10/07 01/10/07 01/10/07 01/10/07 01/10/07 01/10/07 01/10/07 Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 27 13. OP18 13(6) 14. OP22 23(2n) 15. OP26 23(2d) The registered person shall make 01/12/07 arrangements by training staff to prevent service users being harmed or suffering abuse or being placed at risk of harm. The registered person shall 01/12/07 ensure that adequate adaptations, equipment and facilities are provided as required. The registered person shall 01/10/07 ensure that all parts of the care home are kept clean. The registered person must make adequate provision for the regular laundry of personal clothing. The registered person must ensure that there are adequate staff on duty with the skills and knowledge to meet the service user’s needs e.g. care staff, activities staff, maintenance, laundry, housekeeping. The rota must reflect the hours worked. The registered person shall not employ a person at the care home unless the employer has obtained the information and documents required. The registered person shall ensure that persons employed receive appropriate training e.g. induction. The registered person shall make arrangements to enable staff to contribute to the running of the home. The Registered person shall carry out monthly, unannounced visits and supply copies of the report as required by this regulation. 01/10/07 16. OP26 16(2e) 17. OP27 18(1a) 17(2) Sch. 4 01/10/07 18. OP29 19 Sch.2 01/08/07 19. OP30 18(1) 01/12/07 20. OP31 21 01/12/07 21. OP31 26 10/08/07 Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 28 22. OP31 37 23. OP33 24 24. 25. OP34 OP36 25 18(2) 26. OP38 23(4) 27. OP25 13(4) 28. OP38 13(4) The registered person shall give notice to the Commission without delay of any event, which adversely affects the wellbeing or safety of any service user. The registered person shall establish a system for reviewing the quality of care. The registered person shall supply the Commission a report in respect to any review conducted and make the report available to service users. The registered person shall provide the Commission with evidence of financial viability. The registered person shall ensure that persons working at the care home are appropriately supervised. The registered person shall after consultation with the fire authority take adequate precautions against the risk of fire. The registered person shall 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 e.g. door gates, window restrictors. The registered person shall 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 e.g. door gates, window restrictors. 01/10/07 01/12/07 01/12/07 01/12/07 01/08/07 01/08/07 01/08/07 Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 29 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. 10. 11. 12. 13. 14. Refer to Standard OP1 OP7 OP9 OP10 OP12 OP15 OP19 OP21 OP22 OP24 Good Practice Recommendations For service users’ views of the home to be included in the Service User’s Guide. For the service user and/or their representative to be involved in the drawing up, agreeing and signing of the plan of care. For drugs fridge temperatures to be monitored regularly. For service users’ preferred name to be recorded and used. For a centralised list of activities that have taken place to be kept. For service users to be offered a clear choice of food at meal times. A programme of routine maintenance and renewal of the fabric and decoration of the premises is produced and implemented with records kept. For bathrooms and toilets to be kept clean and accessible for the use of service users. For advice to be sought on the environment from an Occupational Therapist. Doors to service users accommodation to be fitted with locks accessible to staff in emergencies and provided with keys unless their risk assessment suggests otherwise. For fifty per cent of the care staff to have completed their NVQ Level 2. For all new staff to be provided with the General Social Care Council Code of Conduct. For there to be a staff training and development programme. For all staff to sign to say they have read and understood the Policies and Procedures of the home. OP28 OP29 OP30 OP33 Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton Devon 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 Highermead DS0000009188.V346690.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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