Inspection on 15/05/06 for Highfield Court

This inspection was carried out on 15th May 2006.

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 15 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 11/06/07

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 Unannounced Key Inspection 15 May 2006 09:30 Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 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.V290236.R01.S.doc Version 5.1 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.V290236.R01.S.doc Version 5.1 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 Home 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.V290236.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. That residents with physical disability or mental health needs relate to current residents only. 21st November 2005 Date of last inspection Brief Description of the Service: Highfield Court provides care for up to 59 adults with a learning disability and/or mental disorder but in future is admitting only users with a learning disability. The home provides for a range of abilities. The accommodation is provided in bungalows for individual or small groups, (maximum six) of residents. There are ten staffed bungalows that cater for thirty residents. 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. Most of the staffed units run as independent units cooking their own meals, doing their shopping and their own laundry. Most of the other residents either have their meals in the main dining room or have meals cooked for them and brought to their bungalows. Several residents in the unstaffed bungalows do their shopping, cooking and washing. There is a central laundry. The home has an activity centre although this is primarily used for the service users with a learning disability. The home offers some trips out and a few residents attend college in Leek. The home is situated in a rural location on the outskirts of Uttoxeter and is set in extensive grounds. The home has its own transport. The fees range from £278 - £1200 per week (April 2006) Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over a two-day period and lasted seventeen hours in total. Sue Mullins, Regulation Inspector, accompanied the lead inspector on the first day of the inspection. The inspection included tracking six residents to understand their experiences of living at the home. This included discussions with these residents, examining their records and discussing their needs with staff and managers. In addition discussions were held with a number of other residents, a sample of the accommodation was looked at and a meal was taken with the residents. The staff rosters and a sample of staff personnel files were examined. A sample of Health and Safety records was examined and a discussion was held with the maintenance manager. The laundry was inspected and discussions were held with staff about the homes’ practices for the control of infection. The home’s menus were looked at and discussions held with the cook over food preparation and nutritional issues. A discussion was held with the Training Manager and the Training Co-ordinator and a sample of staff training records were examined. As part of the inspection process relatives’ views were canvassed both through a written survey and by personal contacts. Comments were also sought from the Community Nurse service and several Social Workers. Since the last inspection there has been four additional visits made to the home to follow up on previous requirements. What the service does well: The home was providing a good service to most of the residents in the staffed accommodation. The staff knew the residents well and responded to their needs. Residents reported that they liked the staff. These residents undertook a range of independent living tasks including cooking, shopping and doing their laundry. These residents accessed the community on a regular basis and enjoyed a range of social and leisure activities. Relatives of these residents reported that they were happy with the service. Residents liked living in these units. These residents had their health and personal care needs met. Social Workers reported that for these residents the home was providing a good service. All the residents at the home had the opportunity to have their views heard in residents meetings. Good practice was demonstrated by having a resident to chair this meeting. Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Whilst progress had been made there remained significant areas that needed to be improved. The information the home provided to prospective residents needed to be updated and to fully reflect the service and to be in a range of formats to provide them with the information to make an infirmed decision. Progress had been made on the support plans but some were inadequate and did not fully reflect the needs of the residents. In some cases there were significant omissions particularly in developing individual plans for residents that may display aggressive or violent behaviour. The home needed to address this and it is recommended that the home Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 7 develop person centred planning. Relatives and Social Workers confirmed that reviews were taking place but records did not confirm this. The home had developed a range of individual risk assessments but there remained some areas of risk for some residents that had not been assessed. These included smoking and the use of kitchen equipment. The home also needed to develop individual fire risk assessments. Residents were befitting from improved leisure and social activities and from increased access to the community. However for some residents there were not enough activities and chances to go into the community and there were only a small number accessing any educational opportunities. The home needs to look at developing opportunities for residents to take part in paid work, educational courses and voluntary work. The home needed to take action to ensure that the health needs of all residents were being met. Some residents’ weight was not being effectively monitored and in two cases it was noted that the home was not following health plans. There were healthcare assessments outstanding and the home was required to follow these up. Records relating to health care needed to be improved. It was also recommended that the home look at how it could work more effectively with the Community Nursing service. The current medication practices were not meeting the needs of all the residents and the home needed to address this as a matter of urgency. Whilst the home was providing a range of training staff there were areas where staff did not have the necessary knowledge to understand and work with a few residents. The home must provide training in these areas, which included challenging behaviour, mental health and issues relating to alcohol dependency. The home had made progress in respect of refurbishing the bungalows but some remain outstanding and there were a few maintenance tasks that needed to be attended to. Some recommendations were made that would lead to improvements in the service to the residents. These included looking at ways of increasing the participation of residents in areas of running the home, further developments in the review and monitoring of the service and ensuring that residents were aware of the menus and the choices available. 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 Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 8 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.V290236.R01.S.doc Version 5.1 Page 9 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): 1,2,3,4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides prospective residents with information but this needs to be further developed and to include information in user-friendly formats. The home undertakes assessments and introductory visits prior to a resident deciding to move into the home. Whilst the home is able to meet the needs of most residents it needs to ensure that staff have the skills and knowledge to respond to residents’ with more complex needs. EVIDENCE: The home had a Statement of Purpose and service user guide. These still needed further development to ensure that the documents were kept up to date and were presented in user-friendly formats. The home had undertaken an assessment of residents admitted over the last year. These covered the necessary areas and were the basis of support plans. Discussions with residents and with relatives confirmed that residents had the opportunity to visit the home before moving in and that they were involved in planning their move into the home. Placements were made on a trial basis and discussions with relatives and Social workers confirmed that a review was held prior to a placement being made permanent. Residents were involved in reviews and there views over the placement sought. Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 10 The home’s staff had the knowledge and skills to meet the needs of most residents but there were some gaps in knowledge in certain areas including mental health, alcoholism and challenging behaviour. The home worked with a number of professionals including District Nurses, psychiatrists, diabetic nurses and social workers but did need to look at how it could work more effectively with the Community Nursing service. Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 11 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): 6,7,8,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All the residents had support plans in place but the quality of these varied and in some cases there were omissions in key areas such as individualised procedures to respond to issues of aggression and/ or violence. The residents had the opportunity to make some choices over their lives and to participate in a range of issues. However there was scope for further developments in this area for a number of the residents in order to increase their quality of life. EVIDENCE: Case tracking showed that all residents had some level of support plan on their files. Many of the support plans were newly constructed but a few were not yet in this new format. In addition there were some important gaps in respect of a few residents that needed specific individualised plans relating to potential aggression or violence. There were no records seen that showed that support plans were being reviewed but comments from Social Workers and relatives did confirm that reviews were taking place. Risk assessments were on file. However there were a few omissions. Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 12 These related to risks specific to several individuals and included smoking in bungalows and the use of kitchen equipment. The home also needed to develop fire risk assessments for the residents. Discussions with residents confirmed that choices were being provided. These included what residents wore, times for getting up and going to bed, where to spend their time, access to activities and choice of decorations when rooms were being decorated. Those residents that moved to the home in October following the closure of another home were involved in planning their bungalows including the choice of furnishing. A number of residents were managing their own finances and medication. Residents confirmed that they participated in a range of independent living activities. A number were doing their own shopping and cooking, cleaning and doing their own laundry with the support of care staff. The home sought the views of residents through resident meetings. This was an example of good practice as one of the residents was chairing the meeting. There was scope for further participation for example in the recruitment process, menu planning and for residents to be involved in planning social and leisure activities. There was also scope for more residents to be involved in undertaking domestic tasks. Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 13 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): 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 level of access to the community and to educational, social and leisure activities had improved but for some residents this was not yet at a high enough level. Most relatives found the home welcoming and all could meet with their relative in private. The home provided a varied diet but residents need to be made aware of the menus and the choices in order to be able to make an informed choice. EVIDENCE: Residents in most of the staffed units have a full and varied lifestyle. They are engaged in a range of social, leisure and independent living activities. A few attended college in Leek. Some residents in unstaffed accommodation who do not need support to access the community did so on a regular basis going into Uttoxeter. The activity level for the other residents had increased through the hard work of the activity staff. Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 14 All residents have the opportunity to attend the on-site activity centre and to go shopping. They also had the opportunity to attend the Gateway club and go out to the pub and for trips out. Other activities included attending a coffee club, a friendship group, the gym, swimming and going to a gently exercise session. However due to staffing levels many of these activities had to be provided to residents on a roster basis and there was still scope for some residents’ access to activities both on site and in the community to be increased. The home also needed to seek specialist advice in order to provide appropriate equipment for stimulating residents with sensory needs. A number of residents were supported with cooking, doing their laundry and cleaning and there was scope for this to be further developed and to include more residents in these types of activities. A number of residents go on holiday funded by the residents. The home has its own transport, which residents contribute towards. A number of residents attended church weekly. Few of the residents engaged in educational and voluntary activities and this is an area that needed to be considered for development. Generally relatives felt welcomed and could see their relative in private. Staff were aware of residents’ rights to intimate relationships and supported residents to access sexual health services. Generally the routines at the home were relaxed with residents able to decide when and where to spend their time. They could choose to be alone or in the company of other residents and to choose whether to join in with activities. The home had started the process of putting locks on bedroom doors. Two residents spoken to stated they had keys and used them. The residents varied over where they had their meals. Most of the resident in the staffed units shopped and made their own meals. Some others had a meal made in the central kitchen but had it delivered to their bungalow. The others ate in the dining room. Residents liked the meals and there was always a choice although this was not always made known to the residents. Also the menu was not displayed. The main meal was at lunchtime. At teatime and breakfast there was also a choice of food. The home was in the process of looking at its menus to try and make them more nutritionally balanced. Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 15 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): 18,19,20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home was meeting the personal care needs of the residents and was promoting their privacy and dignity although record keeping did need to be addressed. The was not meeting the health care needs of all the residents and issues such as weight monitoring, follow up of health issues needed to be addressed. Medication administration throughout the service was inconsistent and demonstrated poor practice. EVIDENCE: Observation of practice and discussions with residents and staff showed that residents’ personal care needs were being met. Those that needed support to maintain their personal care were being provided it although the records did not always clearly evidence this. Hair care and nail care was seen to be provided. Residents felt that staff treated them with respect and they felt that privacy and dignity was promoted. Staff spoken to were aware of the individual personal care needs of residents. The home does have a key worker system and most of the residents were aware of their key worker. However the home was in the process of changing key workers. Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 16 There was evidence of residents visiting GPs, opticians, the dentist and the chiropodist. There was however a need for the home to follow up on requests for assessments and to ensure that records fully showed the reasons for appointments and the outcome and that residents healthcare treatments were always followed through. For example two residents’ files showed they should be doing exercises but the records did not show this was happening. The home had plans in place to provide training in ‘Reporting and Recording’ and in developing Health Action plans. Residents had a programme of weighing and in the main residents were being weighed and there was evidence that weight gain/ losses were being followed up. The home did need to ensure that residents are weighed as specified in their support plans. Residents who were wheelchair users were being referred for wheelchair assessments. As identified in the section relating to ‘Choices of Home’ the home does need to look at ways of working more effectively with the Community Nursing service. The medication system of storage and administration was inspected and this showed inconsistencies and demonstrated poor practice. Medication was seen in random envelopes with names and some dates on and these held unidentifiable drugs for administration. These were being stored in the door of the medication cabinet and should be disposed of as soon as possible. This method was unacceptable. Sampling of the medication administration records showed that for a specific resident who was insulin dependant there were gaps in the record and no code had been entered to explain the reason for non-administration. It appeared that the medication had been refused but there were no records in the main file either to indicate this or to alert staff to monitor the residents’ condition or detailing the consequences of not receiving the medication. The Care Manager stated that she intended to review practices around residents who refuse medication. The home also needed to contact the GP with regard to clarifying the frequency of determining blood sugar levels and to ascertain the precautions staff should take should the resident refuse this. The storage of some medication was not acceptable. The medication fridge was kept unlocked in an unlocked room. The temperature was too hot for storage of some medication. Within the fridge there was an excessive amount of insulin. The home should only stock adequate insulin for those who require it. The home had provided all senior staff with some training in medication and had plans in place for all senior staff to undertake a comprehensive distancelearning course in the ‘Safe Handling of Medication’. Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 17 At the current time all expect two had completed the training and these two were due to start the course in June 2006. Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 18 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): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The homes procedures for listening to residents were effective with residents being able to raise concerns and feeling that they are addressed. The home’s procedures and the staff training should protect residents from abuse and ensure that concerns are addressed however staff need to have more understanding of issues of violence and aggression and how to appropriately respond. EVIDENCE: This is an area that has shown improvement over recent months. The home had a complaints procedure that was in written and pictorial form. Copies had been provided to residents and relatives. Residents and relatives knew how to complain and felt that the home listened and responded to concerns. The home maintained a record of complaints and this showed that complaints were recorded to and responded to promptly. The manager was advised that it would be good practice to provide a written response to complaints rather than purely a verbal response. The home had procedures in place to respond to concerns about adult protection. Staff were aware of these and all staff had received training in adult protection over the last six months. The home had procedures in place for the management of residents’ finances but this was not able to be inspected due to absence of the relevant staff member and will be looked at the next inspection. Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 19 The home did need to ensure that staff were aware of issues relating to violence and aggression and had the necessary training in managing any such incidents. Discussion with staff and the manager confirmed that incidents of potential adult abuse were responded to and that the home liaised with the local authority over any concerns. Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 20 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): 24,26,28,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The overall accommodation for the residents was satisfactory with residents having ample communal and private accommodation. The home did need to continue its refurbishment and to undertake some maintenance tasks. The home’s procedures for the control of infection was satisfactory providing residents with a clean environment however this could be further improved through staff receiving comprehensive training in infection control. EVIDENCE: This outcome area has shown improvement over the last year. The home was in the process of upgrading the accommodation and those bungalows that have been completed were greatly improved providing good accommodation. Residents spoken to were pleased with their accommodation. Each bungalow provided single bedroom accommodation and either a lounge/ kitchenette or a separate lounge and kitchen. Each bungalow had its own bathroom with toilet and a separate toilet. Doors were of a suitable width to allow wheelchair access but the home needs to ensure that all doors that need it have door guards fitted. Radiators were guarded. Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 21 The home had domestic style lighting throughout most of the resident areas and emergency lighting was provided. Generally the home was being satisfactorily maintained having its own maintenance personnel on site. There were some areas that needed to be addressed in addition to the bungalows waiting upgrading. There was some exterior woodwork that needed attention and a few of the double glazed windows had their seal ‘blown’ and condensation was seeping in. The home had some problems with TV reception and this needed to be addressed. Residents’ accommodation was of a good size and those seen had in the main been well personalised. Residents were able to bring in furniture of their own. Bedrooms had suitable furniture including a wardrobe and chest of drawers. The accommodation provided suitable space for residents to have TVs, music equipment and video / DVD players. All bungalows were lockable and the home was making progress in providing locks for bedrooms for those residents that wanted them. The home provided the residents with sufficient bathing and toilet facilities although some of the bathrooms were quite clinical in appearance. The residents had ample communal space. In addition to their own lounge in their bungalows there was a large social area/ dining room. Currently this area is not homely and the home had plans in hand to address this issue. The home had a central laundry with staff working there seven days a week. This had the necessary washes and driers to ensure that laundry could be effectively washed up to disinfectant standards. Some residents had laundry facilities in their bungalows and did some of their own washing. Anything that needed a sluicing facility was taken to the central laundry. The home had COSHH procedures in place. Staff spoken to were aware of issues relating to the control of infection. Although infection control is covered in staff’s induction the home intends for staff to undertake a more comprehensive distance-learning course. Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 22 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): 32,33,34,35,36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is moving towards having the necessary permanent staff and the amount of staff that will meet the needs of the residents. The training and support provided to staff is leading to improvements in the service provided for the residents. The recruitment processes are now protecting the residents. EVIDENCE: The home has experienced some staffing difficulties over the past year but this now appears to be largely resolved. The use of agency staff has greatly reduced and six permanent staff have been appointed during 2006. The rosters were examined. The care staffing levels within the staffed units met the needs of the residents. The level of two staff and a senior has been too low to meet the needs of the residents in the unstaffed units. In response to this the home is to appoint another activity staff member as the unmet needs for these residents has tended to be for stimulation and for developing independent living skills. Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 23 This activity staff member will work along side the two current activity staff and this additional staffing should be able to improve the level of service to those residents in the unstaffed units. The residents were positive about the staff and most relatives found staff to be helpful and welcoming. Staff had the necessary knowledge and skills to respond to the needs of most of the residents but did need to have more knowledge and skills to fully respond to the specialist needs of some of the residents. (See section on Choice of home). Over the last eight months there has been a big improvement in the provision of training. The home has a Training Manager and Training Co-ordinator whose role is to develop staff training records, organise and provide training and to identify training needs. Each staff member now had a training file and the home had a profile of the training that each staff member needed to undertake. Training planned for the near future included, Reporting and Recording, Infection Control, Makaton, Autism, Supervision and Medication. The home was addressing the need to increase the number of staff qualified to NVQ 2 or above. Currently seven staff had this training, seven staff were close to completing NVQ 2 and a further ten were due to be registered on the course. One staff member had NVQ level 3 and a further eight were due to be registered. All new staff undertake induction training that included some basic training in infection control, adult protection and challenging behaviour. The home had addressed the previous concerns over its recruitment processes. The home was now undertaking all the required pre-employment checks, including CRB, POVA and obtaining 2 references. The home had followed up on all those that were outstanding for some considerable time. All staff received contracts and were provided with a copy of the General Social Care Council Code of Conduct. The home had implemented a supervision programme and staff confirmed that they were receiving individual supervision including one to one meetings and observed practice. The home had staff meetings both for day and night staff. Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 24 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): 37,38,39,42,43 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is benefiting from improved management and this is leading to improvements in the service provided to the residents. The home has some systems in place for reviewing and monitoring the quality of the service but there is scope for further development. The home’s health and safety procedures are protecting the staff and residents. The home’s external management structures are providing the support to enable the home to make the progress needed to improve the service to the residents. Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 25 EVIDENCE: The Care Manager has now been in post for approximately nine months and she has had a positive influence on the service. She has the necessary qualification, knowledge and skills to be an effective manager. She has undertaken training to keep her knowledge up to date. Staff reported that since the Care Manager started there had been a lot of changes resulting in improvements to the service. Resident reported that that the manager listens to them and acts on issues they raise. The home had both resident meetings and staff meetings providing opportunities for staff and residents to raise issues. The home had some system in place to review and monitor the service. This included gaining the views o professional visitors to the home. Additional systems included reviewing the accommodation. The home had plans to introduce systems for monitoring support plans and medication. The home had health and safety procedures in place. As part of the pre inspection questionnaire the home reported that it was undertaking the necessary health and safety checks. Sampling confirmed that checks were being completed on fire equipment, hoists and on the temperature of hot water. Precautions were in place for the legionella bacteria. The home has a current gas safety certificate. The home was undertaking the necessary fire precautions checks including checking the fire alarm and the emergency lighting. The home did have a policy for the storage and use of hazardous substances and data sheets and risk assessments were present in the laundry. The home needs to check that these are available to all the domestic staff. Training records show that there were programmes in place for health and safety training including fire, moving and handling, first aid and food hygiene. The home was being well supported by the companies Directors who were located on site. The Director of Care was in regular contact with the Care Manger and provided a good level of support. She was actively involved in developing new systems, updating documentation and in developing the quality assurance system. The home had effective controls in place for managing the financial side of the home and for human resource planning and personnel issues. The home had the necessary insurance cover. Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 26 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 Standard No Score 1 2 2 3 3 2 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 3 3 3 X X 3 3 Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 27 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 Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4&5 Requirement Timescale for action 01/09/06 2. YA6 3. 4. YA6 YA9 5. YA14 6. YA13 That the home provides information that fully describes the services provided and that information is provided in a range of formats. 15(2) That all residents have comprehensive support plans in place and that individual plans are in place to address issues of potential aggression/ violence, (Previous timescales not met) 15(2)(c) To demonstrate the involvement of residents in the care planning process. 13(4)(b)(c) To ensure that all areas of risk are assessed and plans put in place including use of kitchen equipment, smoking and the risk of fire. 16(m)(n) To provide all residents with adequate opportunities to undertake suitable activities both in the home and in the community. (Previous timescale not met) 16(m)(n) To provide all residents with adequate opportunities to undertake suitable activities both in the home and in the community. (Previous timescale DS0000004955.V290236.R01.S.doc 01/08/06 01/08/06 01/06/06 01/09/06 01/09/06 Highfield Court Version 5.1 Page 28 not met)0 7. YA12 12(1)(b) To look at opportunities available to residents to engage in educational, voluntary and fulfilling activities and to look at developing residents independent living skills. To ensure that health treatments are fully recorded and that health plans are always followed through. To follow up on specialist assessments (OT) and to seek advice re the provision of appropriate equipment for resident with sensory needs. To ensure that all resident’s weight is monitored in line with their individual support plans. That the home operates a safe system for the recording, handling, storage, safe administration and disposal of medication. That the fridge used for storing medication is suitable for the purpose. To undertake the following: • Address the issue over TV reception • To repair the windows where the double glazing has failed To ensure that the plans are put in place to provide staff with the necessary training and knowledge to be able to meet the needs of the residents: • Challenging behaviour • Mental health • Alcohol dependency To ensure that the extra staffing as discussed is implemented. 01/09/06 8. YA19 12(1)(b) 01/06/06 9. YA19 12(1)(b) 01/07/06 10. 11. YA19 YA20 12(1)(a) 13(2) 01/06/06 20/05/06 12. 13. YA20 YA24 13(2) 23 01/06/06 01/09/06 14. YA32 18 01/09/06 15. YA33 18 01/07/06 Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 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. Refer to Standard YA8 YA17 YA19 YA24 YA39 YA42. YA27 YA28 YA6 Good Practice Recommendations To look at ways of increasing the level of residents’ participation in aspects of running the home. To ensure that residents are made aware of the choices at mealtimes and that the menu is displayed. To look at developing better working relationships with the Community Nursing service. To repair the exterior woodwork where needed. To further develop the QA system. To provide fire training once a year from a fire specialist. To look at ways of making the bathrooms more homely To follow through on the plans to make the social area/ dining area more domestic in appearance. For the home to commence person centred planning with residents. Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Highfield Court DS0000004955.V290236.R01.S.doc Version 5.1 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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