Inspection on 21/01/08 for Highfield Court

This inspection was carried out on 21st January 2008.

CSCI found this care home to be providing an Adequate service.

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 6 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 11/06/07

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 Unannounced Inspection 21st January 2008 09:30 Highfield Court DS0000004955.V354376.R02.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.V354376.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V354376.R02.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) Rushcliffe Care T/A Moorcourt Developments Ltd 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.V354376.R02.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. 11th June 2007 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.V354376.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We undertook this inspection over one day. Two inspectors, Jane Capron and Wendy Jones, completed it. During the inspection we spoke to the manager, staff and people that lived at the service. We also looked at some of the accommodation including a sample of people’s bedroom accommodation. We also looked at a sample of support plans and information about complaints, staffing and training. We also looked at the meals the service provided. We also checked the service’s medication arrangements and how the service was supporting people to have their healthcare needs met. The inspection looked at how the service was checking the service it provided and its plans for improving the service. As part of this inspection we surveyed a sample of people that live at the service, their relatives and professional staff. We asked the service to complete a document about the service called an Annual Quality Assurance Assessment but this was not provided within the timescale. It is a legal requirement to complete this document. Since the last inspection the service has provided us with an improvement plan to show how they are addressing concerns raised. We also completed a random inspection in October 2007 to see how far the service had progressed in meeting the things it needed to do to improve the service to the people that lived there. What the service does well: An assessment of a person’s needs is undertaken before they are offered a place at the service. People have the chance to visit the service and spend time there before making the decision to move there. All placements are made on a trial basis and only made permanent when a review of the person has taken place. People that live at he service are generally having their health care needs met and the arrangements for administering medication is satisfactory. The service makes sure that all new staff have induction training. The service provides people with bungalow accommodation that gives them a good range of private and communal areas. Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There continue to be areas that can be improved to provide a better service to people that live at Highfield Court. The information provided to people needs to be improved and show people what they can expect if they live at the service. This needs to include what the fees cover. Information could also be provided in a range of formats. Although there are support plans in place they can be further developed in a person centred format and to include people’s hopes and wishes for the future. In respect of people with mental health needs plans should include information about the illness so that staff can know if changes indicate someone needs an early health care referral. The service also needs to develop individual Health Action Plans for people. The service needs to make sure that its risk assessments are kept under review. The service still needs to improve people’s opportunities to take part in activities, including educational, fulfilling and social and to give people more chance to be part of the wider community. People have a choice of meals and menus are varied but the service could review its menus to make sure that people are provided with healthy balanced Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 7 meals. There are areas of the medication arrangements that the service could improve that would lessen the chances of any errors occurring. Some people feel that the service does not deal with concerns and poor practice properly and therefore we recommend that the service looks at whether the way it does this encourages people to feel able to bring issues to their attention. Although there are improvements in the overall accommodation one bungalow needs to be urgently upgraded and another needs some repair work to be undertaken. The service needs to also make sure that it always confirms who people are before they start work at the service. There continue to be areas where we could not confirm that staff had received the necessary health and safety training and other training to meet people’s needs. The service still needs to make sure that the plans to evacuate people have the information about the support each person needs. A new manager started work in October and is not registered with the Commission. 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.V354376.R02.S.doc Version 5.2 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.V354376.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People are provided with information about the service but this needs to be more specific about the service and give people clear and full information about what they can expect should they live there. The service had an admissions procedure in place that included prospective residents and that took account of their needs EVIDENCE: The service provides people with a Statement of Purpose and a Residents’ Guide. There is also a summary in words and symbols. These documents contain most of the information but were not sufficiently service specific. For example the information did not describe the type of care needs it can meet and does not show how it was going to meet the needs of people with a learning disability in line with current good practice. It did not identify that the service provides support to people to do shopping, cooking and their own laundry. The information about the management structure was also not accurate. In addition it did not include any views of people that live there. The service user guide states that staff wear uniforms but this was not the case when we visited although the manager subsequently told us that this was the intention. The service user guide provides information about fees but it did show that people would need to pay in addition for certain items. It did not include transport although we know that people pay for this. Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 10 We would recommend that the information be provided in a more accessible and user-friendly format for example through audio means and through the use of pictures. The service has an admission procedure that ensures that people are not admitted without an assessment being completed. The admission procedure included one completed by the placing authority and one by the service. People told us that they were involved in the arrangements to move to the service and one person told us that they requested to move there having lived at the service previously. People thinking of moving to the service are able to visit beforehand and all placements are made on a trial basis. Placements are not made permanent until a full review including the person and relevant people has taken place. Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The service’s care planning process identifies people’s needs but now needs to develop them in a person centred format and include people’s hopes, wishes and goals for the future. People make decisions about their life but there is scope for choice and decision-making to be further promoted within the service. EVIDENCE: We looked at a sample of support plans. There are support plans in place for all the people living at the service. They cover the necessary areas although some need to be further developed and be in a person centred format. Plans cover areas including health, personal care, communication, mobility, social care needs including spiritual needs. Care plans now cover the support people need to manage their money. We did not see any plans that contained people’s hopes and wishes and did not see that any goals for the future had been developed with people. Care plans are being reviewed and there is evidence that people are involved in the reviewing process. One person told us that they helped to develop their plan and was able to talk about its Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 12 contents. The manager did tell us that they were liaising with the Local Authority to make sure that everyone had a multi agency review. Risk assessments are developed and cover such areas as bathing, mobility, community access, manual handling and smoking where appropriate but there is evidence that they are not all being reviewed in line with the agreed reviewing schedule. People living at the service tell us that they have choices over their lifestyle although some areas of choice are necessarily restricted due to staffing constraints. People that wanted to make their own meals were able to do so and those that needed support were provided with it. There is always a choice over meals and over times for getting up and going to bed. People have some choices over taking part in activities. More independent people who can access the community have nearly complete choice over their lives deciding where and how to spend their time. The service is managing and safeguarding many people’s money and there is further scope for more people to have their own bank accounts and to be more involved in activities such as withdrawing money from the bank and paying their fees. Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The service provides people with some activities and opportunities to access the community but this remains an area to be developed to improve the lifestyle of people that live at the service. People are able to have a choice of meals and a varied menu but the menus could be reviewed to ensure they always provide people with a balanced and healthy diet. EVIDENCE: We looked at the lifestyle available to people living at the service. A few people go to college several days a week. There were no people with paid or unpaid employment working in the community and this is an area that the service could look at to develop. The service employs two activity staff members but unfortunately one was not at work due to ill health. The manager did tell us that the service is to recruit Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 14 another staff member whose role will be to support people with activities and independent living skills. She also stated that there were plans to develop the social opportunities for people and they had completed a survey of the activities people wanted to do. We spoke to the activity staff member and she is well motivated and identified a number of areas for development including supporting people to cook and taking part in more activities in the community such as using the library. The service has an activity centre that provides a range of craft activities for people living at the service. People attend on a roster system due to the size of the centre. This centre tends to provide services to people with learning disability rather than people with mental health needs. The activity staff also provide opportunities for some people to take part in swimming and a Friendship group although this is also provided on a roster due to the number of people wanting to attend and the staffing levels. Two people also go horse riding at a local centre. People go shopping but again due to the number of people and staffing levels the amount of times for people is limited. The activity staff also provide a number of trips out. A few people are supported to go on holiday. The service still needs to look at how it can provide more opportunities for people to take part in activities both in and out in the community and for more people to have the chance to go on holiday. The service has its own transport and people pay per mile for its use. Within each bungalow there is a TV and most have video/ DVD facilities. The service also arranges a weekly coffee club that meets in the communal dining room. This area is also used for organised activities such as the Xmas party and the forthcoming Valentine’s Day disco and bingo sessions. The service is supporting people to develop and maintain relationships between people living at the service. Several people visit their family on a regular basis and family members visit the service. The response to our relatives survey was mixed with some people feeling that the service could improve how it supported people to keep in contact with family members and to keep them informed of important issues. One person said that the service could improve ‘by keeping family up to date’. People are having their privacy respected with staff making sure they knock on people’s doors before entering. The service is also moving forward in making sure that people that are able have keys to their properties and bedrooms. People that smoke in their bungalows have a risk assessment in place. The service is looking to provide a communal area where smoking can take place. As part of the inspection process the provision of meals is looked at. A number of people are cooking their own meals and those in bungalows with a number of people are cooking and eating their meals together in their bungalow. The people in one bungalow have their meal brought from the main kitchen and it is unclear why one person who is said to enjoy company is not having their meals in the communal dining room. We raised this issue with the manager to look into it, to make sure it was not related to staff preference rather than the Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 15 needs of the person concerned. A lot of people are having some or all of their meals in the communal dining room. People tell us they like the food and the menus show us that there is always a choice available. However when the choice is a salad there is no choice of a hot meal. We feel that the menus could be reviewed to ensure that they provide healthy meal options. On some days it is difficult to differentiate between meals as they seem to be main meals provided at lunch and teatime. Also although fruit is provided at all meals people seemed to prefer the alternatives of a hot pudding or ice cream. The breakfasts are quite substantial having cereals, a hot choice such as beans on toast and toast and marmalade. The type of food and variety provided may not be appropriate for many of the people that live quite a sedentary lifestyle. Meals are a social occasion and staff and people that live at the service got on well in a relaxed and friendly manner. People that need support with eating are given it and people are aware of the choices available. The service is able to provide people with specialist diets including diabetic and low fat. Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 16 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 adequate This judgement has been made using available evidence including a visit to this service. The service provides people with the support to have their health care needs met. The medication practices are generally satisfactory to meet people’s medication needs but there are areas that could be improved to lessen the possibility of errors occurring. EVIDENCE: We looked at a sample of 5 case files. We saw that generally the health care and personal care needs of people are identified although the service has yet to make sure Health Action Plans are in place. We feel that there is an improvement since our last key inspection in the way staff show people respect and promote their privacy. Staff were observed treating people with respect. We saw and people told us that staff knock on doors before entering someone’s bungalow or bedroom. We also saw that the process of providing people with keys to bungalows and locks on bedroom doors is being further developed. We are pleased to see that the service was writing to people to arrange to meet with them to discuss aspects of their care. We are also told that the service intends to provide each bungalow with its own Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 17 front door bell and number. We did however see one person being fed his meal whilst sitting on the floor and felt that the service should look at providing this person with suitable seating. People we spoke to told us that they have a key worker and they know who they are. Records show us that people have access to health services and have support to attend appointments for regular routine preventative checks and with specialist health care professionals. This includes seeing the GP, the dentist, the chiropodist and the optician. However in one record the last recorded weight was in February 2007 although when asked staff said this was not accurate and that monthly checks were carried out and more frequently if needed. The manager did retain a list of weights separate from the care files. Some people are actively involved in weight reducing programmes. The service is making sure that where specialist health care is needed it is making the necessary referrals. We saw information that people are referred for dietetic support and nutritional advice. However the manager told us GP practices do not always have the funding to support individuals with this. We would recommend that the manager monitor these referrals and take further advice over this issue. We saw that the service refers people for behavioural support from Learning Disability Nurses and for psychiatric support when necessary. One file relating to a person with mental health needs did not provide information for staff about triggers or signs that may indicate a deterioration in their mental health necessitating an early referral to a health professional. Therefore it is recommended that such information be provided. As part of this inspection the way the service manages people’s medication was looked at. Since the last key inspection the service has changed the way it stores medication. Medication is now stored in people’s bungalows. There is a small lockable storage cabinet in each bedroom unless there are recorded reasons why this may pose a risk. This has led to a change in the way medication is dispensed by the pharmacist. Medication is now received in its original packaging known as a ‘bottle to person’ method. Procedures for the administration, storage and recording of medication are in place. All but one of the staff responsible for medication has been trained in medication. This person did state that he had been assessed as competent to administer medication by his previous employment. The manager is to follow this up to make sure that this person is competent to administer medication. Two people were self-administering and records show that this is monitored on a weekly basis. Samples of the medication storage facilities and the medication administration records (MAR) were seen during this visit. Some issues were identified regarding staff not recording appropriate codes on the MAR and in one example the instructions for the administration of medication had not been followed. This was discussed with the manager who felt that she needed to Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 18 discuss the prescription with the GP for clarification. The home has some controlled medication that needs to be stored as controlled but need not be administered as controlled medication. This medication is stored securely. The service records it as a controlled medication but the records show that on three occasions this did not happen. The manager said she intends to introduce a different recording system that is more appropriate. She was advised that whatever system is adopted it is important that staff understand it and that there is regular monitoring of staff practise. The service has a medication auditing system in place and this did show that there had been some errors but when these occurred the service took action to address them. At the last visit there was a problem identified with the medication fridge temperature, efforts have been made to rectify this but it was noted that the service is not recording the lowest and highest temperature range as per good practice guidance. Advice was given about this, as staff did not understand what was expected of them. Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 19 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 adequate This judgement has been made using available evidence including a visit to this service. Although the records showed that the service was responding to people’s concerns information received from staff and relatives did raise concerns over the way the service manages complaints and concerns. The improved safeguarding practices should improve the protection of people living at the service. EVIDENCE: A complaints procedure is displayed in each of the bungalows we visited. People living at the service confirmed that they know how to complain and who to go to if they have any concerns. This was borne out by the responses we had to our survey of a sample of people that live at the service. The service keeps a record of complaints and this shows how each complaint had been responded to and managed by the service, including written acknowledgment and written information of the investigation and outcome. The records show that all recent complaints have been responded to in a timely manner and in keeping with the policy. People that live at the service are consulted about the service through home meetings. The last one was held in October 2007 and we would recommend that these are held more regularly. We would also recommend that the service consider how to ensure that the views of those people with specialist communication needs are heard. The responses to our relative survey gives a mixed picture. Of the four surveys we received, two people say they do not know the complaints Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 20 procedure and two say that the service did not always respond appropriately when a concern is raised. However another relative said that when she had raised issues the manager had positively responded to them and she was happy with the outcome. In the light of this the service needs to review the way it deals with concerns particularly from relatives. The service should also make sure that all relatives are aware of the complaints procedure. The service has whistle blowing and safeguarding procedures in place and we have seen improvements in the service’s practice since our last key inspection. The service has responded to our previous requirement to refer potential safeguarding issues to the local authority for consideration. We spoke to some staff about their knowledge of safeguarding issues. They are aware of signs of potential abuse including emotional abuse and most said they would refer incidents to senior staff. One person said they would start to investigate issues and were not aware of the multi-agency procedures. The service is making sure that people have training in safeguarding issues but would recommend that all of the staff are aware of the safeguarding procedures. Since the last key inspection we have received information about the care provided to people. It is an issue for the service that the Commission is receiving this information rather than the service. This may indicate issues over the procedures in place to respond to concerns. We would therefore recommend that the service review its practices to make sure that there is an ‘open culture’ where people feel safe to raise issues. The service has procedures in place to safeguard people’s money. An administrator is employed to manage the finances of the service. She confirmed that usually people’s money is paid into a communal account that has been set up for the purpose. There are a few people who have their money paid directly to them. Money is requested on a weekly basis and is then passed to people to use for bills, shopping and toiletries etc. The administrator was able to demonstrate that accurate records of financial transactions are maintained and checks were undertaken during this visit to confirm this. Most people had building society accounts, some people managing these independently and others requiring support. The support people need is recorded in their support plan. The manager is asked to ensure that that the service’s insurance policy regarding cash held in the home is sufficient for their needs. Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 21 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): 24,25,26,28,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the service has made progress in upgrading the accommodation and there is a schedule of improvements in place there remain areas to be addressed to ensure that all people are provided with a good standard of accommodation. The service has made improvements in their infection control practices but further changes are recommended to further lessen the chance of the spread of infections. EVIDENCE: The service is in the process of upgrading all the accommodation and has provided us with a schedule of improvements as part of their improvement plan. New UPVC windows and doors have been fitted to bungalows and this has greatly improved the exteriors. The fitting of front door bells and numbers is still to be completed. A number of bungalows have been upgraded and one person told us they are now pleased happy with their accommodation after it Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 22 had been refurbished. This person told us on a previous visit that they were consulted about the colour scheme. We saw four individual bungalows and these are of varying standards. Two were two bedded units that have separate lounge and kitchen area and have bathing and toilet facilities. These bungalows are adequately equipped, decorated and maintained. People have their own key to the front door and bedrooms. The people in one unit are waiting to have a new freezer delivered and they are concerned that this meant they could not use their tumble drier, as there is no socket available. This was mentioned to the manager to address. We are advised that all bungalows where people cook are to have a freezer installed. Bedrooms are well personalised. The other two bungalows seen are of a lesser standard. These had not been upgraded. One had badly marked paintwork, water damaged woodwork and the automatic ventilation in the bathroom was not working. This bungalow has adapted bathing facilities for people with mobility problems. Another bungalow we looked at is in a very poor state of décor, cleanliness and maintenance, with evidence of very heavy damage due to smoking. The ventilation also appeared to be inadequate. This unit must be refurbished as soon as practicable. We advised the manager of our concerns. All bungalows have fridges provided and there is evidence from the ones we saw that they are cleaned and maintained. The service has a nurse call system that was not working when we visited last. People confirmed that the system is now working. The service has a main dining room where many of the people eat their meals and is used for social activities. This was suitable for people and was clean. On our last visit we recommended that the service provide people that wanted it with a smoking area. This has not yet been provided although the manager said that they are considering having designated smoking areas. The service has an activity room but this would benefit from upgrading. The service has procedures in place to control the spread of infections. Staff have adequate supplies of aprons and gloves and during the inspection one bungalow needed additional supplies and these were provided promptly. The service has a central laundry although a few people do their own washing in their bungalow. The central laundry was sufficiently equipped to meet the laundry needs of the service. There is a washing machine that has a sluicing facility for soiled laundry. It is concerning however to note that foul laundry is transported to the laundry in black plastic bags and then sorted by the laundry staff who wear non-disposable gloves to do this. The manager was reminded of the need to ensure adequate standards relating to infection control. We would recommend that disposable gloves be provided and alginate bags used for foul laundry as these can be put directly into the washing machine. Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 23 Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 24 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 adequate This judgement has been made using available evidence including a visit to this service. Although the staffing levels are generally improved there still remain times when additional staffing is needed to meet the holistic needs of people that live there. There remains scope for further training to make sure that people’s needs are fully met. The service’s recruitment procedures generally protect the people living there. EVIDENCE: As part of the inspection we looked at the staffing levels. The rosters confirm that there is an overall improvement in the staffing levels although there are days when the service is managing with 12 staff that allows for only basic support to be provided to people. The service has people living in 10 units that require continual staff support during the day and a further 20 people that needed support over a 24 hour period including at least two that had mobility and personal care needs. The roster did show us that there had been times when the service had more staff - 14/15 which will provide better support for people and provide people with more opportunities to take part in activities and to develop their skills. The service was providing adequate staffing levels at night. On the day of the inspection adequate staff were on duty as 2 people that need 24 continual support were away from the service. Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 25 We did receive concerns over staffing from relatives that responded to our surveys. One commented: ‘ The home could improve if they had staff that’s more settled instead of being there a few months, then moving on as it upsets the people living there’. The service did tell us that they had recruited 8 new staff. As well as care staff there are 2 activity staff although 1 is not currently available. The activity staff member spoken to is well motivated and keen to develop this part of the service. She is also involved in working with people in their bungalows to develop their independent living skills. In addition there are domestic, catering and maintenance staff provided. Staff we spoke to are aware of people’s individual health and personal care needs and we observed staff having a friendly and relaxed relationship with people over lunchtime. Staff we spoke to seemed quite motivated and wanted to provide a good service to people. People told us that the new manager was giving them support and there are records relating to a staff meeting and a seniors meeting. The number of staff that are qualified to at least NVQ level 2 is unclear however the manager said that 10 staff are starting the qualification in the near future. The service is providing new staff with induction training that includes care practices, safeguarding and the basic mandatory training. However we are unable to confirm the training of other staff as the current records are not comprehensive. The manager stated that she is to develop a better system for recording training. However the staff we spoke to say they have received some additional training. Personnel files did show that some people had training in epilepsy, medication and diabetes. Some external training has been provided in autism and de-escalation techniques but it is unclear how many staff have attended these. The manager states that there is training about the Mental Capacity Act, sexuality and mental health planned and that the mandatory training is to be provided approximately every quarter. We did feel that all staff needed to have a range of training including person centred practice, mental health, learning disability, Health Action Planning and Challenging Behaviour. The service’s recruitment process is generally making sure that the proper checks are completed. Although we did not see any original CRB documentation all records had a CRB number present. We also spoke to other Inspectors that have access to the company’s head office and they report that they have no concerns over the service seeking POVA and CRB checks. All files confirm that 2 references are sought. We did however see that 2 files did not did not have confirmation of people’s identity on them and did not have a recent photograph of the person. We raised this issue with the Senior Manager present. Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 26 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. The manager is suitably qualified to manage the service for the people that live there although she is not yet registered with the Commission. A system for monitoring and reviewing the service is in place but can be further developed to ensure that the service is achieving its objectives in improving the service for the people that live there. The Health and Safety procedures are generally protecting the people that live there although there are some areas that still need to be addressed. EVIDENCE: Since the last key inspection a new manager is in place. She is a qualified nurse and has a necessary management qualification. She has previous experience of working in the care services and of managing care units. Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 27 Currently she is not registered with the Commission and is due to submit an application once she has received the necessary Criminal Records Disclosure. Monitoring and reviewing of the service is taking place although this is not yet co-ordinated. The current system includes checks on the environment, audits of the medication practices and an analysis of complaints and accidents. The service is also seeking the views of people through surveys of issues such as menus and activities. The service also seeks people’s views through meetings although we would recommend that meetings are held more regularly. The system would also benefit from regular audits of care plans and of seeking the views of relatives and other significant professionals. There is an improvement plan in place to work towards developing and improving the service for the people that live there. The service has Health and Safety procedures in place and staff received training in this field as part of their induction training. Training in food safety, moving and handling, first aid and fire training takes place but the current records are not sufficient to confirm that all staff were up to date with their mandatory 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 was not available during the inspection and this needs to be seen at the next inspection. There is an evacuation procedure but this does not contain the information relating to the support each person needs to evacuate the premises. The service is having regular fire drills but needs to make sure that all staff take part in drills. A fire authority inspection has taken place since we last visited and the manager stated that there are plans in place to address the issues it identified. Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 28 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 Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 29 CHOICE OF HOME Standard No Score 1 2 2 3 3 X 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 X 26 2 27 3 28 2 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 2 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 3 X X 2 X Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 30 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 5 Requirement Timescale for action 01/05/08 2. YA9 3. YA24 The information about the service must be accurate and reflect the service offered including what needs to be paid in addition to the fees. This will make sure that people are fully aware of what the service is like before they move there. 13(4) Risk assessments must be 01/05/08 reviewed. This will make sure that information is kept up to date and that the risk management process ensures that people are not subjected to any unnecessary risks. 16(2)(c)&23(2)(d) The bungalows identified as 01/06/08 being in a poor state of repair, maintenance or cleanliness must be upgraded. This will make sure that people have satisfactory accommodation. 19 Schedule 2 As part of the recruitment DS0000004955.V354376.R02.S.doc 4. YA34 01/03/08 Page 31 Highfield Court Version 5.2 5. YA42 23(4) process the service must make sure that they confirm prospective staff’s identities. This will make sure that the process is protecting people. An evacuation plan that takes account of people’s need for support must be put in place to provide people with protection. (Timescale of 12/7/07 and 25/10/08 not met) The service must make sure that all staff have had the required training in Health and Safety practices. This will make sure that people are protected. 01/05/08 6. YA42 18(1) & 13(5) 01/05/08 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. Refer to Standard YA1 YA6 Good Practice Recommendations Information should be provided in a range of formats. This will make information more accessible for people that may wish to move to the service. Support plans should be developed in a person centred format. This will make sure that people individual wishes, aspirations and goals for the future are identified and plans are in a more accessible format. To further promote people to make decisions over their lives for example in managing their money. This will promote people’s independence and increase the control over their lives. To work to increase the opportunities for people to take part in education, occupational and fulfilling activities. This will promote people’s feeling of worth and will help them to develop their skills. DS0000004955.V354376.R02.S.doc Version 5.2 Page 32 3. YA7 4. YA12 Highfield Court 5. YA13 To provide people with more opportunities to access and take part in activities in the community. This will enable people to be more a part of the local community. To provide people with more opportunities to take part in social activities of their choice. People will then have a fuller and more varied lifestyle of their choosing. To provide more people with the opportunity to go on holiday To consider if the practise of keeping in touch with relatives needs improving. This will ensure that appropriate people are aware of important issues concerning their relatives To review the current menu and make any necessary changes to ensure that people are provided with a healthy and well balanced diet. To increase the choice of meals to provide an additional choice as well as a salad. In the case of the person being fed whilst on the floor the service to investigate appropriate seating. This will ensure that the person’s dignity is promoted when having meals. To develop individual health action plans. This will ensure that people’s individual health care needs are fully identified and they always receive the care they need. That plans for people with mental health needs identify individual triggers and symptoms. This will give staff indicators of early mental health changes that could indicate that health intervention is needed. Where health referrals are made this should be followed up regularly. This will make sure that people receive the health care services they need. To implement a system to regularly assess the competency of staff to administer medication and to ensure that all people that administer medication are trained. That staff are made aware of the need to ensure that medication is administered as the Medication Administration Record and that where medication is stored as a controlled medication accurate records are maintained. This will reduce the likelihood of errors being made. Where the service is storing medication in a fridge the temperature must be maintained between 2 and 9 degrees. This will make sure that medication remains effective. 6. 7. 8. YA14 YA14 YA15 9. 8. 10. 11. 12. YA17 YA17 YA18 YA19 YA19 13. 14. YA19 YA20 15. YA20 16. YA20 Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 33 17. YA22 18. YA23 19. 20. 21. YA23 YA24 YA24 22. 23. 24. YA27 YA28 YA29 To increase the regularity of meetings with people living at the service and to look at ways of making sure people with specialist communication have their voices heard. This will give people a greater opportunity to have their views heard and to be consulted about the service. All staff need to be made aware of the local interagency safeguarding procedures. This will make sure that they take the appropriate action if any safeguarding concerns are raised. In order the people are fully protected the service should look at how it can ensure that people feel confident to raise issues with the managers of the service. To continue with the process of fitting locks to bedrooms and providing people with keys to their front door. This will promote their privacy and independence. To continue 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 suitable communal place for smoking. Disposable gloves should be provided in the laundry and alginate bags used for foul laundry as these can be put directly into the washing machine. This will reduce the likelihood of the spread of infections. Staffing levels should be maintained at a level that will meet the holistic needs of the people that live at the service. Staff receive training in Communication skills, Challenging behaviour, mental health and the Mental Capacity Act. This will make sure people have the skills to be better able to meet the needs of people living at the service. To further develop the system for reviewing and improving the service to the people that live there. 25. 26. YA33 YA35 27. YA39 Highfield Court DS0000004955.V354376.R02.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Aylesbury Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury Buckinghamshire HP19 8JR 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.V354376.R02.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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