CARE HOME ADULTS 18-65
Highfield 50 Abington Avenue Northampton Northants NN1 4DA Lead Inspector
Mrs Moira Mosley Unannounced Inspection 20th October 2005 1:50 Highfield DS0000012810.V256700.R01.S.doc Version 5.0 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 Highfield DS0000012810.V256700.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Highfield DS0000012810.V256700.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Highfield Address 50 Abington Avenue Northampton Northants NN1 4DA 01604 632614 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) Mentaur Limited Lisa Joanne Galloway Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Highfield DS0000012810.V256700.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. To include two current named service users who have Sensory Impairments in additional to their Learning Difficulties It is a condition of this registration that the home is authorised to care for the named service user who has a mental health diagnosis in addition to a Learning Disability The home will limit its services to the following service user categories: No person falling within the category Learning Disabilities (LD) can be admitted where there are already six persons of category LD already in the home. The total number of Service Users in the home must not exceed six (6) 4. Date of last inspection 5th July 2005 Brief Description of the Service: Highfield is situated close to Northampton town centre in a large terraced house. It is convenient to local facilities including shops and leisure provision with good public transfer links. The home is a terraced property offering single accomodation over three floors, plus the laundry in the basement of the property. The home can accommodate six young adults with Learning Disabilities, currently three male and three females. In addition the home has conditions on its certificate to care for two service users who have additional Sensory disabilities, and one with an additional Mental health diagnosis. The home has a dining area, and small lounge, and a garden, which is used by the service users. The home is owned by Mentaur Ltd, who also own two other homes and a day centre in Northampton. Highfield DS0000012810.V256700.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a statutory unannounced inspection; 2 hours were spent gathering information and planning for the inspection and 3 hours were spent in the home. The care of two service users was reviewed to include their care plans and other records. One of the service users was in the home at the start of the inspection and three others returned to the home after their day placement and spoke with the inspector. Due to their learning disability some were unable to comment on their care however a period of observation and discussions with them and three members of staff was undertaken. What the service does well: What has improved since the last inspection?
All the requirements and recommendations made at the last inspection have been addressed: The Statement of Purpose was available in the home and contains the necessary information to ensure that the purpose of the home is clearly documented and all staff are now aware of this document. Highfield DS0000012810.V256700.R01.S.doc Version 5.0 Page 6 The insurance certificate is clearly displayed in the home to ensure that cover is in place in the event of any loss or damage and liabilities of the company. Maintenance records are now kept in the home to demonstrate that there is a programme of routine maintenance and that the health and safety of service users is not compromised. The recording of complaints has been reviewed to ensure that any issues raised by the service users is discussed and agreed with them, to ensure they are happy with the outcome. The fire door between the dining room and main house has been reviewed and it is recorded in the maintenance records that an automatic fire closure device will be fitted. 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. Highfield DS0000012810.V256700.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Highfield DS0000012810.V256700.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5 The statement of purpose and pre admission process is sufficiently detailed to ensure that any prospective service user would be suitably assessed and an appropriate placement made. EVIDENCE: The statement of purpose is available in the home and it contains the necessary information to ensure service users and their representatives have information about the home and the service it provides. All staff are aware of the document and have signed to say they have read it. There have been no new admissions to the home since 2003, prior to the appointment of the current registered manager. There is a pre admission assessment process available and the registered manager was clear about how she would ensure any assessment process would be completed. The service users files reviewed contained a contract with the home outlining the agreed terms and conditions and signed by the service user or their representative. Highfield DS0000012810.V256700.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9 Care plans and risk assessments identify service user needs and the overall care planning system provides a consistent approach. EVIDENCE: Service user plans are competed to a high standard with clear formats and regular reviews. Staff spoken to confirmed they use the care plans to direct care and they have a keyworker system to ensure individual needs are met. The service users sign their plans and are involved in developing plans to meet new goals and aims as discussed with their keyworkers. Risk assessments are available and cross-referenced to care plans with highlighted action to be taken by staff to minimise the risks identified. One service user had a detailed behaviour-recording system, with accompanying risk assessment and these formed part of the ongoing assessment with the involvement of the psychiatrist to review treatment and care practices to minimise distressing behaviours.
Highfield DS0000012810.V256700.R01.S.doc Version 5.0 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 Individual programmes are in place to ensure residents receive a varied opportunity to develop skills and experience a wide range of social opportunities. EVIDENCE: The service users spoken to confirmed they have their own daily timetable with activities planned to occupy their time. This is individual depending on level of need. The service users enjoy evening and weekend activities including pub visits, meals out, bingo at a local bingo hall and other outings along with in house activities and games. Three of the service users are currently attending college one day per week to develop new skills and all have access to day placements in a variety of settings. The service user who was in the home on the day of the inspection had been out that morning and spoke about the animals he had seen and had enjoyed a pottery session.
Highfield DS0000012810.V256700.R01.S.doc Version 5.0 Page 11 Highfield DS0000012810.V256700.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 21. There is an effective system in place to address the healthcare needs of the service users. EVIDENCE: Healthcare needs are being addressed and there is evidence of input from the multi disciplinary team including GP, psychiatrist, chiropody, dental and optical services. The service users records include a section about their wishes as they age and in the event of their death, this has been sympathetically addressed with keyworkers and demonstrates the level of choice and control the service users are supported to have in their life. Highfield DS0000012810.V256700.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 There is an effective system in place to respond appropriately to complaints made. EVIDENCE: The complaints process has been reviewed and the outcome of any complaint made by a service user is discussed and agreed with them to ensure they are happy with the findings. The registered manger discussed how to record any issues raised that the service user did not want to be recorded as a complaint and it was agreed that staff would make an entry to demonstrate what if any action is taken to remedy any concerns raised. Highfield DS0000012810.V256700.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 and 30. The home provides a safe and comfortable environment for the service users. The laundry facilities need reviewing to ensure service user needs can be met and infection control maintained. EVIDENCE: The home was clean and tidy and both the service users and staff spoken to were very happy with the environment. Maintenance records are maintained and show action taken in response to any environmental issues raised. The registered manager confirmed that records for health and safety including fire records and water temperature records are maintained. The fire doors between the dining room and main house are being costed to be fitted with fire closure devices in order for the doors to be kept open to allow free movement around the home and increase the monitoring of service users without compromising their safety in the event of a fire. A service user bedroom seen showed evidence of personalisation and the service users are involved in choosing décor and furnishings.
Highfield DS0000012810.V256700.R01.S.doc Version 5.0 Page 15 There are sufficient bathrooms and toilets to meet the needs of the current client group and risk assessments along with detailed individual care plans ensure that the risks are balanced safely with the service users rights to privacy and dignity. The laundry facilities are sited in the basement of the home and although risk assessments have been completed this has resulted in some service users being unable to assist with their own laundry due to the risk of the stairs. In addition the floor and walls are not impermeable and the finishes are not readily cleanable, this is a risk to any infection control issues. Highfield DS0000012810.V256700.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 34 and 35. There is an overall effective system to ensure that the staff team are recruited, supported and trained to meet the purpose of the home and the assessed needs of the service users. The uptake of staff training is being compromised by the uncertainty of the financial costs to the individual. EVIDENCE: There is an established and consistent staff team who work well together to provide care for the service users. The rotas confirm that staffing is calculated to meet service user needs and extra staff are supplied to support activities and outings as required. The staff spoken to said they felt very supported in their job and there were sufficient numbers of staff on duty to meet the service users needs. Discussions with staff identified concerns about the costs of training, as they have to agree as part of their contract to pay for training received in the past 24 months of employment on a sliding scale of costs. One staff had commenced NVQ training as it was free from the local college, but other staff have to agree a repayment plan. There was confusion between staff as to what they did have to pay for in training and although they accepted they needed to
Highfield DS0000012810.V256700.R01.S.doc Version 5.0 Page 17 be trained to meet service user needs they did have to consider the financial implications to them. Staff files are available in the home and the registered manager confirmed she is involved in the recruitment of staff. Highfield DS0000012810.V256700.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 43. There is an effective management system in place to give clear guidance and support to the staff team and to the service users. The Quality Assurance system could be improved to evidence action taken as a result of comments raise by staff, service users and their families. EVIDENCE: The manager has been successfully registered with the CSCI as the Registered Manager since the last inspection. There is a quality assurance system that includes questionnaires sent to staff, service users and their families, however these are issued from head Office and neither the manager, service users nor staff in the home receive any information about the feedback received. They are unaware of any positive comments made or of any action plans to address the issues raised. The service users have a weekly meeting in the home to discuss a wide range of topics including the menus, complaints, ideas for activities and to review the
Highfield DS0000012810.V256700.R01.S.doc Version 5.0 Page 19 past week. These are minuted and evidence of action taken as a result of suggestions and comments are available. There is also a forum meeting held three monthly where staff and service user representatives meet with the company director to discuss any issues about the homes and be updated on any future developments and plans. The insurance certificate for the home is on display and evidences current insurance cover in the home. Highfield DS0000012810.V256700.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X 3 Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X 3 X X 2 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 3 3 2 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Highfield Score X 3 X 3 Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X X 3 DS0000012810.V256700.R01.S.doc Version 5.0 Page 21 NO Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action 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 Refer to Standard YA30 YA30 YA39 YA35 Good Practice Recommendations
The laundry floor and walls should be washable to maintain effective infection control. The facilities for laundry should be reviewed to address the access problems for some service users and so restricting their independence skills. The results and development plan to address any issues identified from the service user, staff and family questionnaires should be available to the home and the service users. Staff should receive at least five paid training and development days (pro rata) per year. Highfield DS0000012810.V256700.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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