Inspection on 11/06/07 for Highfield Court

This inspection was carried out on 11th June 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Highfield Court 21/01/09

Highfield Court 21/01/08

Highfield Court 15/05/06

Highfield Court 21/11/05

Highfield Court 20/07/05

Highfield Court 15/11/04

Highfield Court 21/06/04

Highfield Court 04/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Highfield Court Stafford Road Uttoxeter Staffordshire ST14 8QA Lead Inspector Jane Capron Key Unannounced Inspection 11 and 12 June 2007 09:30 Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 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 Court DS0000004955.V338290.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 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 Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highfield Court Address Stafford Road Uttoxeter Staffordshire ST14 8QA 01889 568057 F/P 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) Moorcourt Developments Limited Della Ann Wright Care Service 59 Category(ies) of Learning disability (59), Learning disability over registration, with number 65 years of age (1), Mental disorder, excluding of places learning disability or dementia (9), Physical disability (5) Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That residents with physical disability or mental health needs relate to current residents only. 15th May 2006 Date of last inspection Brief Description of the Service: Highfield Court provides care for up to 59 adults with a learning disability but also provides care to some people with a mental disorder who have lived at the service for sometime. In December 2006 Rushcliffe Care, a company with its headquarters in Loughborough, bought the company. The accommodation is provided in bungalows for individual or small groups, (maximum six) of people. There are 10 staffed bungalows supporting 29 people. The other bungalows provide support flexibly according to the assessed needs of the service user although 24-hour staff support is provided to all residents and staff are available to support residents to attend to their personal care and health care needs. All bedrooms are for single occupancy. Many of the staffed bungalows run as independent units cooking their own meals, doing their shopping and their own laundry. Most of the other people have their meals in the main dining room. Several people in the unstaffed bungalows do their shopping, cooking and washing with staff support. There is a central laundry. The service has an activity centre although this is primarily used for the people with a learning disability. The service offers some trips out and a few people attend college. The service is situated in a rural location on the outskirts of Uttoxeter and is set in extensive grounds. The service has its own transport. The fees range from £450 - £950 per week (July 2007). People that live at the service also have to pay for transport at 30p a mile, for toiletries, some activities and for trips out and holidays. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We visited the service over a two day period spending over 14 hours there. They did not know we were visiting. During the time we were there we spoke to about fifteen of the people that lived there. We also spoke to staff and to a senior manager who was present in the absence of the Care Manager. We looked at the lifestyle of the people that lived there including the way the service arranged for people to move to the service, how people’s health and personal care needs were met and about their social and leisure activities. We also looked at how the service took account of people’s wishes and whether people were able to have the lifestyle they wanted and whether the service was safeguarding them. We looked at a range of documents including a sample of plans, health and safety records and personnel files to look at whether the service was make the proper checks before staff were started to work at the service. In addition to visiting the service we talked to social care and health care staff that supported people that lived there. We also did a pre inspection survey of people that lived there and we received 10 responses. A number of the people that responded had needed help of care staff to complete the surveys. We sent some surveys for relatives to complete but we did not receive any replies. Since the last key inspection in May 2006 we have visited the service 5 times. We visited to see how the service was addressing requirements we had made, to look whether the service was meeting people’s medication needs following concerns evident at the key inspection and to follow up on concerns brought to us about the care provided. What the service does well: We saw that the service had an admission procedure in place. People were assessed prior to a decision being made about whether the service was suitable to meet their needs. People were able to visit the service to decide if they liked it and wanted to move there. One person commented: ‘I was brought here to visit on lots of occasions to see my new service and visit other service users’. Everybody came to the service for a trial period and a placement was not made permanent until a review including the person took place. We found that the service had support plans in place that covered most of the areas. These were being reviewed and the people that lived there were included in the meeting and their views sought. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 6 The service had developed a range of individual risk assessments to ensure that plans were in place to protect people and to ensure that there were no unnecessary restrictions in place. We found that some people were able to go to college and a few people had jobs provided by the service, one person was gardening and another was doing some decorating. People told us they liked the meals provided in the main dining room. We saw that there was always a choice of main meal and sweet and that fruit was always available. Comments received about these meals included ‘lovely food’ and ‘always have a choice.’ What has improved since the last inspection? What they could do better: We found that the service needed to make improvements in a number of areas, as there were some outcome areas that were poor. We found that although everyone had a support plan these did not contain information about the support people with specialist communication needed and did not contain information about the support people needed to budget and manage their money. We also found that when plans were reviewed the changes were not always followed up. The service was supporting people to make decisions and choices about their lives but these choices were not always followed. We also found that although the arrangements for people getting their money had improved people were still not happy about having to wait if they wanted larger amounts of money. Also we found that some people had no idea how much of their money the company had. The service should review its procedures and put in place arrangements based on current good practices. Most people should be able to have their own bank account and be supported go to the bank to get their money. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 7 We found that the service needed to improve how it responded to people’s views. People were being consulted but they felt that if they raised an issue it was either not acted upon or that they did not get a satisfactory answer. This had led to some people buying items that the service should probably have bought. We also found that the service was not recording people’s concerns and showing how they were responded to. There was also scope for people to participate in running the service. People could be involved in recruiting staff, and in staff training and in helping to develop procedures about how the service was run. We found that although the service did provide opportunities to take part in social activities and to go out into the community some people were having few opportunities. We also felt that the service could look for more educational and fulfilling activities for the people to take part in. Some people wanted to go to church but the service was not supporting them to do this. The service was meeting most people’s health care needs but we did find that the service was not able to show that it was following up some health care issues. The last time we visited we found this to be the case and although there had been improvements there still were some areas that were not being followed up. We saw incidents where people’s privacy and dignity was not respected when having their personal care needs attended to. Although there had been improvements in the way the service administered medication there were still issues that were not fully safeguarding the people that lived there. The service had trained its staff in adult protection but we found that there had been a potential safeguarding matter that had not been looked at. When we looked round the service there were some areas that needed attention. One bungalow ‘the respite unit’ was particularly in need of decorating and some furniture repairing or replacing. There were also fridges that were dirty and needed to be defrosted and were not fully working effectively. The privacy of people living at the service would be increased through having suitable locks on doors. The service had a number of people that smoked and we saw people smoking in one part of the dining room when people were eating. When we visited we found that the service did not have enough staff on duty to meet the needs of the people that lived there. We saw this when we last visited in April and it was still occurring. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 8 We looked at a sample of staff files and found that the way that the service recruited staff was not safeguarding the people that lived there. The service was implementing the new company’s method for reviewing the service but when we visited there was little evidence to show that the service was being monitored and reviewed and there was no plan in place to show how the company was going to improve the service. Health and Safety procedures were in place but there were actions the service needed to do to make sure that people were fully protected. 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. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 9 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 Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service undertook assessments prior to admission and encouraged people to visit and trial the service before moving there permanently. However the service was not currently meeting the needs of all the people that lived there. EVIDENCE: Case tracking showed that there had been no recent admissions to the service. However the records showed that people were assessed prior to admission both by the service and by the placing authority. The service’s assessments contained the required information relating to health and personal care, social and family relationships. Placements were made on a trial basis and people were able to visit the service before making a decision to move there. In the survey prior to this inspection several people stated that they had visited a number of times before moving to the service. One commented ‘I was brought here to visit on lots of occasions to see my new service and visit other service users’ Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 11 Currently the service was not able to meet the needs of all the people that lived there. The rosters and discussions with staff and people that lived there showed that there were times when there were insufficient staff on duty to support people to have their full needs met. Also not all staff had the training to support people. Two care staff we spoke to reported they had not had training in working with people with challenging behaviour although they were expected to work with people with these needs. The service was not supporting people to have the social and spiritual needs met. A number of people that wanted to go to church were not supported to do so. One person had had few opportunities to leave their bungalow to take part in social activities. The service was not always following up health care issues and decisions agreed at people’s reviews. Two people that needed exercises to maintain mobility were not always receiving them. Concern was also expressed by a health professional that health issues were not always followed up. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The support planning process generally provides adequate information for staff to support people but there are gaps in certain areas and they are not in a person centred format. Risk assessments are in place and support people to undertake activities with risks at an acceptable level. People are supported to make decisions about their lives but the staffing levels are at times preventing them from enjoying their chosen lifestyle. People’s views were sought but they did not feel their views had much effect on the running of the service. EVIDENCE: We looked at a number of support plans during the inspection. This showed that every one had a plan in place although these were not in a person centred format. The plans were satisfactory and covered most areas of need. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 13 We saw that there were plans in place to respond to people that showed aggression but some plans did not contain information showing the support people needed to budget and manage their money. Plans contained a communication plan but for those that had specialist communication needs these needed to be more comprehensive. There was evidence that people had been involved in developing and reviewing their support plans but not all issues raised in reviews were followed up. One review stated that the service would look at the person’s accommodation with a view to it being improved and we were told of another when a specific activity had been requested. Neither of these issues had been followed up. The service had developed a range of individual risk assessments covering such areas as bathing, accessing the community, use of hoists and wheelchairs. These were generally kept up to date and reviewed. The service supported people to make decisions about their lives and there was evidence that the service had responded to one person’s wish to start food shopping and cooking their own breakfast and tea and another person’s decision to buy and cook their own meals. However there were instances when activities that people had chosen to do did not happen due to the absence of adequate staffing. One person reported that there had been times when they had not been able to get up at their usual time, another reported that they could not go to college because no one could drive the car and others had not been able to go to church. When people completed our surveys most said that they were listened to and most reported that staff took action on their views. However this was not what we found when we spoke to people. They told us that although the service consulted them through monthly meetings and individually they felt that they were not listened to. They said that they had raised the issue over access to their money but it was not responded to until we visited and required the service to change its practices. One person said they had raised the issue about the shortage of staff and had been told ‘ we can’t do anything about it’ and another person reported that they were buying their own toilet rolls because the service had changed the type they used without consulting them. Two other people said that the service had said they could have a new suite but because they wanted a different style they had needed to buy it themselves. When we spoke to the senior manager present he said the matter had not been brought to his attention and agreed to look into it. The service did speak to people about the meals and there were plans to expand this further by catering staff attending the monthly meeting of people that live at the service. We found that a number of people participated in a range of domestic tasks related to the running of the service, cooking their own meals, helping to do their laundry, shopping and cleaning their bungalows. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 14 The service had developed a pictorial service user guide to assist people to understand what the service offered. There was scope for further participation including for example being involved in staff selection and staff meetings and training. The last time we visited the service we found that the service was severely restricting people’s access to their money. This situation had improved and people were now able to get their money for half an hour twice a day. The service was keeping a relatively small amount of money for each person and if they wanted a larger amount they needed to give several days notice. Some people were unhappy about this feeling it was their money and they should be able to access it when they wanted. Also some people we spoke to had no idea how much of their money the service had. Although improved the service needed to review its current procedures and advocates could be used to assist where needed. Current good practice would support people to have their own bank account albeit with necessary safeguards in place to ensure people are protected. People told us that they had somewhere secure to look after money. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The service provided some opportunities for people to take part in meaningful activities and some people had a varied and active lifestyle however there were other people that had fewer opportunities and were not taking part in many social activities or accessing the community on a regular basis. The service was not supporting people to have their spiritual needs met. The service enabled people to maintain relationships with family and friends. The meals served in the main dining area were varied and provided people with a choice however the service needs to work with people to address issues relating to weight. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 16 EVIDENCE: We looked at the lifestyle that people that lived at the service enjoyed. The service was supporting some people to develop their independent living skills. Several people were being supported to do their own shopping, cook their meals and do their own laundry. We were told however that there had been times when people that were preparing their own meals had not been able to because of the staffing levels and had to eat in the main dining area. There was scope for further people to be involved in independent living activities. When we visited last time we found that people that wanted to go to church were not able to and we made a requirement that his should happen. This time we found that the service was still not supporting people to go to church. A small minority of people went to college to study subjects such as computers and beauty. Several people were working on the site – during the inspection one person was cutting the grass and another person told us that they had been doing some painting at the service. These people were receiving therapeutic earnings. The service should investigate whether there are further opportunities for more people to take part in educational and fulfilling activities. The support plans identified the social activities people enjoyed. The service provided opportunities for people to undertake a range of leisure and social activities. A number of people went to the Gateway club and a Friendship Club. People also went shopping to Uttoxeter and on occasional trips out. Some people went bowling and swimming. The service had its own activity centre on site and many activities centred on this. Most people spent some time there doing such activities as painting, sewing, beadwork and drawing. However whilst for some people there were sufficient activities, there were some people that were not well supported to take part in social activities and rarely went out into the community. One person’s record we looked at showed that they rarely left their bungalow and rarely went into the community although their support plan said they liked going for walks, to pubs and liked the company of others. There had also been times when activities could not occur due to staff shortages. We found that the situation about going on holiday was a mixed picture. Some people had the opportunity to go on holiday and several had made trips abroad and one person was at Paris Disneyland during the inspection. We saw that the service welcomed visitors and people told us that they kept in touch with relatives. Several people went to stay with their family regularly. People were supported to develop friendships. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 17 Due to the nature of the service the routines were generally flexible with those that were able getting up and going to bed when they wanted and making choices about their lifestyle. However for those that needed more support the staffing levels had affected them. People told us that there were times when they could not get up when they wanted and people’s prepared routines had been affected by several of the staffed bungalows not having the staffing they needed. The people at the service either ate in their bungalows or joined other residents in the main dining room. Those that eat in their bungalows generally planned their menus and the meals were made by themselves independently, with staff support or by the staff. However we noted there was one person whose meal was made by the main kitchen but was eaten in their bungalow. The reason for this was unclear as the person was not able to make this decision and their support plan stated that they liked the company of others. The service itself had some concerns over the menus and some of the quality of the meals provided by staff in bungalows and those people preparing their own meals and had plans to work with staff to improve the diets of these residents. The main kitchen prepared meals for many of the people that live there and there was always a choice of main meal and pudding although this is not always made known. There was fruit always available at meal times. The service provided a supper. People we spoke to said they liked the food from the main kitchen. The catering staff consulted with people over their likes and dislikes but there were plans to develop this consultation further. The support plans identified dietary needs but it was noticeable that there were a number of people that had weight problems and the service needs to work with people to address these. The service had plans in place to monitor people’s weight but one we saw showed no evidence that they had been weighed. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Personal care in this service is not always provided in such a way to promote and protect people’s privacy and dignity. The people that live at the service generally have their health care needs met although records do not always confirm the outcome of health issues and recommendations of health care staff are not always followed. Whilst the medication arrangements have improved and the service has auditing systems in place there remain areas to be addressed to ensure that the people’s medication needs are met in manner that safeguards them. EVIDENCE: The personal care and health care needs were identified in the support plans. Staff were ensuring that people were supported to get up and have personal care needs met although this was not always at a time that the person wanted and some people that were assessed as needing a staff member fulltime in their bungalow did not always have this level of support. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 19 We observed some staff that were demonstrating good care practices ensuring that they explained how and what they were going to do and seeking people’s agreement. These staff were respecting people’s rights to privacy and treating people with dignity. This was supported by people we spoke to who felt that most staff were treating them with respect. We also saw some poor practice where people’s rights were not promoted. We saw that one person being bathed with the door not properly closed and we saw a staff member agreeing to another person using the toilet in the bathroom at the same time. We also saw a staff member going into a bathroom and administering medication whilst one person was having a bath. We found that people’s hair and nail care needs were being met. There was evidence of people visiting GPs, opticians, the dentist and the chiropodist. People were also receiving psychiatric services where needed. There was however a need for the service to ensure that records always showed the reasons for appointments and their outcomes and that recommendations from health care professionals were always followed through. At the last inspection we found that exercises needed by two people were not being completed as recommended. At this inspection we found improvements but there were still times when the exercises were not being provided. There was no information to show outcomes following a person having medical tests. Although an Occupational Therapist had done an assessment this did not appear to have been followed up. We were also informed by health professionals of instances where staff were following their recommendations but they reported there were also issues not properly followed due to poor communication between staff and a lack of continuity due to staff changes. We looked at the service’s arrangements for administering medication. At a random inspection in August 2006 a pharmacy inspector found that the service’s arrangements for medication were poor and a lot of requirements were made. A further random inspection looked at how far the service had met those requirements and we found that there had been improvements in the arrangements. On this inspection we found that the service had a comprehensive procedure in place and staff that administered medication had been trained both in administering medication and in the procedures. The service had also put in place a medication auditing system. The service was generally storing medication correctly although the temperature of the medication fridge was working outside the accepted range of 2-9 degrees. When we looked at the medication administration records we found few gaps in the records however the service’s own auditing system had identified a significant number of errors where the amount of medication in stock did not tally when the amount administered was taken into account. This audit and information, provided from an incident report about an instance when medication had been wrongly administered, showed us that the service was following up on issues. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 20 When we checked the medication records of one person we saw that the support plan showed that their blood sugar levels should be taken four times a day however staff reported it should be three times a day. The records showed that the times it was taken varied from three times a day to occasions when it was not taken at all. We did identify that the service still needed to ensure that protocols for PRN were always in place and that people who were administering their own medication had a full assessment to confirm they could administer medication correctly. The service had not made sure that ‘as directed’ medication was confirmed by the prescriber but reported that they had written to the GP but to date had not received a reply. We also identified issues relating to staff’s knowledge of administration of medication when a staff member did not know how to respond when a pill fell onto the floor. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although a complaints procedure was in place and people knew how to complain people’s concerns were not being recorded and there was no information to show they were acted upon. There were safeguarding procedures in place and staff were being trained however evidence indicates that not all potential incidents are dealt with appropriately. EVIDENCE: The service had a complaints procedure and the surveys we received and people we spoke to knew how to raise issues. However when we spoke to people they told us that they had raised concerns but that they were not adequately dealt with and they had not received any outcome to issues they brought up. People felt as stated earlier in this report people that they were not listened to. One person said ‘ I don’t feel they listen to me’. The service had a record of complaints but there were none recently recorded. This indicated that the service was not recording issues as complaints and therefore could not demonstrate what action had been taken. Since the last key inspection we had received concerns about the care received by some people that lived at the service and a random inspection was undertaken that led to the service being required to undertake a number of actions. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 22 The service had procedures for safeguarding people that lived at the service. Staff we spoke to had received training in safeguarding issues and could identify signs and symptoms of abuse. However a potential safeguarding issue was raised by one of the people that lived there and when we looked at the records there was no information to indicate that any action had been taken even though the person was bruised and the bruising had been seen by staff and the doctor. A requirement was made that this matter be looked at urgently and a report sent to us and a referral made through the safeguarding procedures. The service had put in place plans to ensure staff were aware of how to respond to incidents of aggression by anyone that lived at the service. Not all staff were trained to work with challenging behaviour including diversion and distraction techniques. The service’s arrangements for managing people’s finances has been discussed in relation to standard 7. However we did a sample check on two people’s finances. This showed that the service was keeping records of expenditure and that receipts were kept of money spent. The records tallied with the amount of cash in the service. There were however indications that people had spent money on items that should be provided by the service including toilet rolls and a lounge suite. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The accommodation was generally satisfactory although there were some areas that needed to be addressed including decorating and upgrading certain rooms and providing locks on bedroom doors to ensure that all people had a pleasant environment to live in. The service is generally clean and has procedures in place to prevent the spread of infection but the service needs to ensure that refrigerators are kept clean and defrosted regularly. EVIDENCE: The service was provided in a number of bungalows set around a grassed area. Bungalows were occupied by between one and five people. All bedroom accommodation was for single occupancy. All bungalows had suitable communal areas- all having either a lounge and kitchen or a lounge with kitchen. All had a toilet and bathing facilities. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 24 The accommodation was of varying standards. Some were of good quality and others were less good. The ‘respite’ bungalow was particularly in need of decoration and some refurbishment, having stained carpets and some broken furniture. There were also some other bungalows that would benefit from redecoration and most of the bathrooms tended to be clinical. The service had responded to the requirement to ensure all bungalows had satisfactory TV reception but had not repaired the woodwork or repaired the double-glazing that had blown. A sample of bedrooms was looked at and these were generally satisfactory providing adequate storage space and being personalised. Bedrooms were not lockable. People cooked in some bungalows and in these units there were cooking facilities. All bungalows had fridges. It was also noted that although some people were doing their own shopping weekly they did not have freezers and were using the small freezer compartment at the top of the fridge in which to store frozen foods. One seen did not have a door. In addition to the bungalows the service had a large central kitchen and dining room. The dining room had been redecorated and new flooring since the last key inspection. This had improved this accommodation. It was however noted that part of the dining area was used as a social area. During the inspection smoking was taking place in this area when people were eating their lunch. The service reported it had plans to improve the accommodation and some decorating had taken place in vacant bungalows. The service did not have a planned renewal and maintenance plan to show their plans for the accommodation. Five of the people living at the service were wheelchair users and there were records to show that wheelchairs were being checked monthly. Wheelchairs had lap straps and staff were seen ensuring that footrests were used. The service had several hoists to aid with mobility. The service was generally clean but there were fridges that needed to be cleaned and defrosted. The service had infection control procedures in place and discussions with staff confirmed they were aware of good practices relating to preventing the spread of infections. The service had addressed the issue of protective clothing identified at the last random inspection. Staff reported that there were always gloves available. The service had a large laundry where most of the laundry was done. This was suitable to meet the needs of the people that lived at the service. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The service’s staffing levels were inadequate leaving some people without the support they need and adversely affecting people’s welfare and quality of life. The service had provided staff with training and many were qualified however there remained gaps in their knowledge that needed to be addressed to meet the needs of the people that lived there. The service’s recruitment and selection procedures are not safeguarding the people that live there. EVIDENCE: When we looked at the rosters and spoke to staff and people that live at the service we found that the service was on many occasions not providing adequate staffing levels to meet the needs of people. This was the case when we visited at a random inspection in April 2007 and we were then told by the Director that there was no reason for the service to be short staffed as the service could access additional staff. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 26 At this inspection we found that there were not enough staff on duty to cover the bungalows that needed to have staff throughout the day leaving people that had been assessed as needing support without it. The service provided two more staff but this was still below the level needed to support the people that live there. We found that one staff member was at times supporting 2 bungalows when each bungalow should have had a staff member present. This situation was found to be having adverse affects on many of the people that live at the service. People’s choices were affected, for example people could not get up when they wanted having to wait for a staff member to provide the support they needed and there were times when people were having to have their meals in the main dining room when their plan was to have staff support to cook and eat in their bungalow. We also felt that one person was not getting up until late morning and early afternoon because there was not always staff support to encourage them to get up and undertake daily living tasks. Their support plan stated that they needed staff to provide support and encouragement to help them to prepare snacks and help with domestic chores and needed to have meaningful activities during the day. We were told that this bungalow was always the first to have their staff removed if there were staff shortages. The inadequate staffing levels had meant that people that wanted to could not go to church and some people’s opportunities to undertake social activities were restricted. We were also told by a health professional that when working with one person she had found the staff supportive but that due to staff changes and communication issues, plans were not properly followed through. When we spoke to staff they knew what support people needed but did express concern over the staffing levels feeling that it was affecting their ability to support the people that lived there. One staff member commented: ‘we are rushed off our feet and have no time to talk to people’. As highlighted earlier in this report some staff were observed to be displaying good care practices whilst others were not promoting people’s rights. The service had sent us training records before the inspection and these showed that staff had received training in respect of most aspects of care practices but training was still required in communication skills and for some people in working with people with challenging behaviour. Staff had not yet received training in the mental capacity act. The service had a high number of staff qualified to at least NVQ level 2. We looked at a sample of staff personnel files to see whether the company had a robust recruitment and selection process. Of the four we looked at only one showed evidence that they had a satisfactory police and protection of vulnerable adults check. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 27 One did not have a recent photograph of the person and one did not contain the necessary references. Three files did not contain evidence that staff had been assessed as fit to undertake the work. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst the manager has the necessary skills and qualifications, the change of ownership had affected the service provided to the people that lived there. The service is not meeting the needs of all the people and is not complying with all of the Care Standard Regulations. The service’s quality assurance scheme is not yet assessing the service and taking account of the views of the people that live there. Health and Safety procedures are in place and staff have received most of the required training however there are issues that the service needs to address to ensure that the people that live there are fully protected. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 29 EVIDENCE: The manager has the necessary qualifications and experience to manage the unit. The service no longer has a deputy manager or training manager since being taken over by Rushcliffe Care in December 2007. A senior manager informed us that they were in the process of altering the management structure through the introduction of Team Leaders and a senior manager to oversee this and the other registered service on site. These changes and the introduction of new policies and procedures has affected the service and currently the service is not meeting the needs of all the people that live there. The service was not always sending us information relating to incidents. There had been some incidents of misconduct not reported and we had not been informed about the incident relating to a potential safeguarding issue discussed earlier in the report. Also the service is not complying with the Care Standards Regulations and requirements made at previous inspections have not been met. The service had the Quality Assurance system of the new company but there was little information available to show that it was assessing the service it provided and was listening to the people that lived there. The senior manager informed me that the scheme included surveys of people that lived there but this had not yet taken place. The service had no development plan in place. The service had Health and Safety procedures in place and staff received training in this field as part of their induction training. Staff had received training in food safety and first aid but it was not clear that all staff were up to date with their fire training and moving and handling training. The service was undertaking the required testing of equipment and had contracts in place for the servicing of lifting equipment. The fire records confirmed that the alarm was checked weekly and that the emergency lighting and doors were being checked. A copy of the service’s fire risk assessment and evacuation plan were not available during the inspection. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 30 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 SERVICE Standard No Score 1 X 2 3 3 1 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 3 28 2 29 2 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE SERVICE Standard No 37 38 39 40 41 42 43 Score 2 2 1 3 X LIFESTYLES Standard No Score 11 2 12 3 13 2 14 2 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 2 X 2 X 2 X X 2 X Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 31 YES 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 Services Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15(2) Requirement When support plans are reviewed the service must ensure that changes to plans are put into practice to make sure that people receive the support that has been agreed. The service must have plans in place for supporting people to manage their money that takes account of their wishes. (Previous timescale of 11/05/07 not met) People that use the service must be supported to attend religious services of their choice. (Previous timescale of 18/04/07 not met) To continue to work to provide residents with adequate opportunities undertake suitable activities including educational and vocational both in the service and in the community. (Previous timescales of 1/09/06, 1/01/07, 10/5/07 not met) Timescale for action 24/07/07 2. YA7 12(1)(a)(b), (2) &(4)(a) 24/07/07 3. YA11 16(3) 10/07/07 4. YA14 16(m)(n) 24/07/07 Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 32 5. YA17 12(1)(a) 6. YA18 12(a) 7. YA19 12(1)(a)&(b) 8. YA20 13(2) 9. YA20 13(2) 10. YA20 13(2) 11. YA22 22(1)(2)(3) People that live at the service must be supported to have healthy diets and those people with risk factors relating to weight must be supported to access healthcare support. People’s privacy must be respected and people treated with dignity when care tasks are undertaken. People’s health must be promoted through the service following the recommendations made by health care staff. (Previous requirement 18/4/07 not met). When people are selfmedicating a detailed assessment must be carried out and this must be able to support the service’s decision. (Previous timescale of 12/11/06,01/01/97 and 01/05/07 not met) Where PRN medication is prescribed there should always be a protocol in place to ensure staff are aware of when such medication should be administered. Where the service is storing medication in a fridge the temperature must be maintained between 2 and 9 degrees to ensure that medication remains effective. When people raise complaints about the service these must be fully investigated and people informed of the action that has been taken. DS0000004955.V338290.R01.S.doc 24/07/07 01/07/07 26/06/07 12/07/07 17/07/07 01/07/07 10/07/07 Highfield Court Version 5.2 Page 33 12. YA23 12(1)(a), 13(6) All potential safeguarding incidents must be responded to appropriately, to ensure that the people that live at the service are properly protected. 13/06/07 13. YA23 13(6) 14. YA24 15. YA33 16. YA34 17. YA37 18. YA42 The service must make sure that people are not buying goods that should properly be bought by the service. 16(2)(c)&23(2)(d) The accommodation provided to the people that live at the service must be of a satisfactory standard. 18(1)(a) There must be adequate staffing provided at all times to meet the needs of the people that live at the service. (Previous timescale 12/4/07 not met) 19 Schedule 2 All staff that work at the service must have the necessary employment checks to protect people from possible harm. 37(1)(e)&(g) A system to ensure untoward incidents are reported to the Commission should be implemented. This will ensure that the Commission is informed of serious incidents relating to the health and well being of people living in the service. 23(4) A fire risk assessment and evacuation plan that takes account of people’s need for support must be put in place to provide people with protection. 10/07/07 12/08/07 12/06/07 09/07/07 12/07/07 12/07/07 Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 34 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. Refer to Standard YA6 YA6 YA7 YA7 YA8 Good Practice Recommendations To develop person centred plans To ensure that support plans contain the information to support people with specialist communication needs. To support people to make choices and to ensure that their choices are respected To develop procedures to support people to manage and budget their money in line with current good practice To look at ways of increasing the level of residents’ participation in aspects of running the service including for example people that live at the service being involved in staff training, recruitment and policy making. To increase the opportunities for people to be involved in independent living activities. To provide more people with the opportunity to go on holiday To implement a system to regularly assess the competency of staff to administer medication To repair the exterior woodwork where needed and to ensure that any windows that do not give people a view due to the double-glazing being ineffective are changed. To promote people’s privacy by the fitting of suitable locks to bedrooms and providing those people that are able with keys to their front door. To provide freezers in accommodation where people are buying and cooking their own food in order that they have the proper facility to store frozen food and can take advantage of buying larger quantities. To look at ways to make the bathrooms more homely for the people that live at the service. To provide a separate area for smoking so that nonsmokers are no longer affected by people smoking in the dining area. To provide staff with training in Communication skills, Challenging behaviour, mental health and the Mental Capacity Act To further develop the system for reviewing and improving the service to the people that live there. DS0000004955.V338290.R01.S.doc Version 5.2 Page 35 6. 7. 8. 10. YA11 YA14 YA20 YA24 11. 12. YA24 YA24 13. 14. 15. 16. YA27 YA28 YA35 YA39 Highfield Court 17. 18. YA42 YA42 To provide staff with regular updates in moving and handling techniques to ensure the safety of themselves and the people that live at the service. To ensure an effective system is in place to ensure that all staff have regular fire training and that once a year fire training is provided by a fire specialist ensuring staff are up to date with current fire safety requirements. Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Stafford Local Office Commission for Social Care Inspection Dyson Court Staffordshire Technology Park Beaconside Stafford, ST18 0ES 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 Highfield Court DS0000004955.V338290.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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