Inspection on 21/01/09 for Highfield Court

This inspection was carried out on 21st January 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Highfield Court 21/01/08

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Highfield Court Stafford Road Uttoxeter Staffordshire ST14 8QA     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Wendy Jones     Date: 2 1 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Highfield Court Stafford Road Uttoxeter Staffordshire ST14 8QA 01889568057 F/P Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Rushcliffe Care T/A Moorcourt Developments Ltd Name of registered manager (if applicable) Jayne Elizabeth Wood Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia physical disability Additional conditions: That residents with physical disability or mental health needs relate to current residents only. Date of last inspection Brief description of the care home 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 upto 29 people. The other bungalows provide support flexibly according to the assessed needs of the individual although 24-hour staff support is provided to all, Care Homes for Adults (18-65 years) Page 4 of 33 care home 59 Over 65 1 0 0 59 9 5 Brief description of the care home and staff are available to support people who use the service 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 with people 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 500 - 1000 pound per week. People who live at the service also have to pay for transport at 30p a mile, for toiletries, some activities and for trips out and holidays. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection site visit of this service undertaken between 21 and 23 January 2009 and included formal feedback to the manager. The visit was undertaken by four inspectors and an expert by experience and his mentor. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. The purpose of this visit was to assess the services performance and to establish if it provides positive outcomes for the people who live there. The visit included checking that any requirements and recommendations of the previous inspection 21 January 2008 have been acted upon; looking at information the Care Homes for Adults (18-65 years) Page 6 of 33 service provides for prospective people, their carers and any professionals; looking at information that the service provides to people who use the service to ensure that they understand the terms and conditions under which they have agreed to live at the home and the fees they should pay. Other information checked included assessments and care records, health and medication records; activity and records relating to the menus, finances, staff training and recruitment, complaints and compliments, fire safety and health and safety checks. The manager, staff and people who use the service were spoken to during the site visit and we also visited the various bungalows. Before the visit began, the service provided its own assessment of its performance, in the form of an Annual Quality Assurance Assessment AQAA. Surveys for people who use the service, relatives, staff and any professional that has involvement in the service were sent to the manager for distribution, we received 16 from people living at Highfield Court, 13 from relatives and one from a health professional. We spoke to staff about surveys and were told that they hadnt been given one, we spoke to the manager who said, that she hadnt been asked to distribute surveys to professionals or staff. To fulfil our intention to include views of all relevant people, we have sent 10 surveys to named staff following this inspection site visit. But we have not received a completed survey at the time of writing this report. What the care home does well: What has improved since the last inspection? What they could do better: The service must ensure that the conditions of registration for the service are adhered Care Homes for Adults (18-65 years) Page 8 of 33 to ensure that no one is admitted to the home if the service hasnt got the skills and registration to provide care. The systems for the safe administration of medication should be reviewed to ensure that instructions for the administration of as required medication are retained at the point where medication is administered. Records should be accurately maintained, to ensure that staff have up to date information, so that they can deliver appropriate care. The organisation should look at the recruitment and retention of staff to the service to reduce the currently high turnover of staff. The recruitment procedures should be reviewed to ensure that all pre employment checks are carried out and are on file. The bungalow we saw in an extremely dirty condition must be maintained in a clean and hygienic state for the benefit of the person who lives there. People using the service need to be confident that they have access to a varied range of activities both on the site and in the local community. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service can be sure that they receive information about the service and it is up to date. But there is a need to ensure that the service only admits within the registration categories that have been agreed. Evidence: The service told us in the AQAA that, We have now produced a revised Statement of Purpose and Service User Guide. We have been provided with copies of both documents and understand that alternative formats of the guide are in the process of being produced. The manager has also shown us a list of dates when each bungalow wasprovided with a copy of the guide. The stated aims of the service are, We aim to create a friendly home with a family atmosphere and to enhance and promote the quality of life of our residents. The Statement of Purpose states, Prior to admission the Registered Manager from the Care Homes for Adults (18-65 years) Page 11 of 33 Evidence: home will carry out an Assessment of Need. A prospective resident will only be accepted if the manager feels confident that the home can adequately meet those needs. We looked at the pre admission information of the person most recently admitted to the service and are concerned about the circumstances of his admission. The manager said that the senior manager and the care manager from Highfield Hall carried out the assessment. We could not be sure that the service has admitted within our registration categories and conditions of registration agreed. We received 16 surveys from people who use the service, 13 said they received enough information about the service prior to moving into the home, three said that they hadnt. 10 said they were asked if they wanted to move in six said they werent. We have 10 surveys returned from relatives, nine were satisfied with the amount of information they receive, one said they didnt receive enough information. One relative said, My relative is very happy there, far happier than he has been in other care homes he has lived at. People who use the service said, I like living here. My sister helped me choose where I wanted to live and we visited here before we decided it was the right place to come to. The expert by experience said, On arriving at the home today it felt very strange as the home was located off a busy main road with a sign saying Highfield Court, then I saw lots of buildings off a long drive with a signpost pointing to reception. Straight away I didnt feel this was a very homely place for people to live, it felt very secluded. I would like to think in todays society people with learning disabilities are living in the local community with everyone, next door to everyone else. Looking at the sign I tried to figure out which direction the reception was but the sign was difficult to understand and we ended up wandering in the wrong place but a gentleman pointed us in the right direction for the reception. We recommend that the service improves its signage. Care Homes for Adults (18-65 years) Page 12 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service cannot be confident that their care plans are up to date to ensure the information in them accurately reflects their current circumstances. People cannot be sure that they can access their own money if they need to. Evidence: We looked at care plans in the bungalows we visited. In total we saw eight sets of records. Of these two sets of care plans are kept in the central office due to risk assesssments around security and confidentiality. We saw evidence that improvements in care planning has taken place since the last key inspection visit, but further work is need to improve the record keeping. We found examples where records were not up to date and evidence that evaluations of care havent always been carried out as often as the records say they should. We saw evidence of good personal profiles in four examples and inspectors looked at four care plans with the people who use the service. These people said that they knew what was Care Homes for Adults (18-65 years) Page 13 of 33 Evidence: in their care plans and that they talked to staff about them. In three examples we noted that the care plans contained old and new documentation, and in two examples some information is kept in the bungalow of the person and some in the central office. We noted that this means the records are not easy to follow and in two examples we saw that there is a difference in the information kept. This is specifically around the reporting of accidents and incidents. We saw that the service has started to implement person centered planning and the records show that some staff have received this training. We recommend that all staff receive this training. We have been told that 90 of the people who live at the service have had a formal social work review in the last year. We looked at a sample of six financial records with the administrator for the service, we saw that a record is kept for each person that shows the balance of their accounts and any transactions. We have been told that, and saw evidence that, a number of people have their own bank and savings acounts, some access these independently some have to be signed on their behalf. We looked at one set of finances where the individual signs for herself but were concerned about this because we saw in the records that she is assessed as not having capacity to make decisions. In the relatives surveys, one person said, My relative is always being asked for money, and I have been asked to provide arbitrary amounts. We spoke to the manager about this who confirmed that she had contacted a relative for money prior to christmas as the person using the service had stated that she wanted to make a large purchase. We recommend that access to finances are discussed at each persons review where there is a potential issue. If necessary advice from independent advocacy services should be sought. We have been told that people using the service can only access their money kept at the service on their behalf at a specific time during the day, this is reported to create some problems. We recommend that the service reviews the current arrangements so that people using the service have easier access to their money. Care Homes for Adults (18-65 years) Page 14 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are not offered enough real choices in relation to their day to day activity and their food. Evidence: The service told us in the AQAA that, We create a lifestyle that meets the needs of individual residents through the provision of on-site activities and local community participation. Improvement is on going in line with CSCI requirements and recommendations. We spoke to nine people who use the service during this visit, we received comments from 16 people and 10 relatives in surveys. A relative said, They could provide a club or something to help pass time when chores and the usual thing are done. I think in the evenings to help pass the time instead of just watching telly or staying in their own Care Homes for Adults (18-65 years) Page 15 of 33 Evidence: space, another said, They are not being taken on holiday. Another said, They provide a lovely setting for the people who live there, but totally neglects the community and the need to get people together, they need a tea room where they can meet to talk and socialize and form a community. Another relative commented, There are times when I think they could give them more choice, and They are very good in telling my relative to phone me and keep in touch, nothing has cropped up yet but I feel they would get in touch if so. Another relative said, We have found this year contact with my daughter has been hit and miss regarding her sending birthday cards to immediate family. They could improve by better contact with family and friends, ie news letters on events etc. I think they need more staff, and to take them on holiday. A person has said in a survey, I would like to go to church more often and would like to visit my family sometimes. More outings, more staff, more activities, more choice of food. We saw that efforts are being made by the service to improve the opportunities available to people living at the home. An on site activities facility provides individual activity sessions, dedicated staff are employed to do this. People are involved in a friendship club in Rocester Village. During our visit a group of people went out on a shopping trip and we spoke to another person who said he didnt want to be involved in the activities available on the site. In one example we saw that no activities had been recorded in one persons records. A member of staff said that the person does go out shopping. We have been told that changes to the mini bus insurance has reduced the number of staff now available to drive it and that this has affected the opportunities people have to go out of the home. A person using the service said, I enjoy sewing and do my own ironing, cooking, cleaning, I also have a part time job. Another person told us, I go out regularly to visit my relatives and they visit me here. Another person said, I attend church and go to the hairdressers in Uttoxeter. I also go to college and would like to get a job. We talked to people who use the service about the food, one person said, I go to the canteen for my meals, the food is okay and I can have as much as I want. We visited the canteen on the 2nd day of the visit and saw that there isnt a menu on display. The catering staff told us that they have tried putting a menu up but it was destroyed. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: The expert by experience said, The manager offered me lunch, which was a choice of either sausage and mash or vegetable cheese-bake. I didnt think much of the menu and asked for a sandwich, which they kindly said yes to. The staff member then said he would show me around to the first bungalow. On the way to the bungalow we popped into the main kitchen where I was introduced to the cook. The kitchen was quite big and like a kitchen you would find in a hotel, not in peoples home. In one bungalow staff said they cook the hot meals at lunchtime. I do think people should be supported to cook their own meals but the kitchen is so small it is probably not practical. Which doesnt give the men the opportunity to develop their skills in the kitchen. Staff did say some people do help with chores after the mealtime. But again I think people should be supported to be as independent as possible for themselves and be involved in cooking. One member of staff said, I used to do menu planning with one person but we have both become somewhat disillusioned as other staff do not stick to the menu. The person using the service said, they do whatever is easy. The last record of food consumed was dated 13/01/09. We recommend that records of food are up to date. We saw one person helping to prepare her meal, staff said they are trying to follow a healthy living plan but this isnt followed consistently by staff. A member of staff said, Since the rules have changed about smoking staff cant now smoke on site, but people using the service are able to smoke in their own bungalow or have a cigarette in the grounds. A number sit outside the main dining room, this area is unprotected from the weather. Also I feel that those people with mental health needs and who are smokers now miss out on the discussions and interactions they had with staff when staff could smoke in the grounds. I feel that this potentially has an affect on their well being. One person who uses the service gave an account of an interaction with a member of staff that we dont feel is appropriate, we shared this information with the manager of the home for her action. Care Homes for Adults (18-65 years) Page 17 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service cannot be confident that their medication is properly managed to ensure they receive the medication they are prescribed. Evidence: The service has told us in the AQAA that, All major health care problems have been addressed and promptly acted on. There are no people currently exhibiting major health care problems that are not been assessed or treated. Staff have been fully involved with residents in respect of health care issues on an educational basis, and this has resulted in a more proactive approach to the identification of individuals problems. Consequently this has enabled staff to prevent further deterioration of health of residents. We have seen a greater and improved involvement of staff in the production of more professional care plans. Staff training relevant to the area of work is in place and ongoing. We have not received any concerns from health professionals or social workers and none of the relatives who have returned surveys have raised health issues as concerns. One relative said, The service has been extremely supportive while my Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: relative has been unwell and kept in close contact with me. A health professional said, The manager always follows through my medical recommendations. Individuals health needs are usually met and the service always respects the privacy and dignity of individuals. The expert by experience said, During our visit a lady walked in the lounge and said she was giving one gentleman his medication who happened to be out the room at the time. I found it quite disrespectful this person did not knock on the persons front door before walking in. In one bungalow we saw there was a Health Care Action Plan (HAP). (A Health Action Plan is an individual plan, belonging to a particular person, that explains the persons health needs. It also describes what has to happen for those needs to be met.) That was not completed. In one example behavioural issues had been identified for one person using the service. We spoke to staff about the difficulties and have been told that problems have occurred when the person using the service has not been able to relate to specific members of the staff team. We saw records relating to two incidents and have been told that the management for the service have taken action to ensure that the person living in this bungalow receives support from staff she is confident with, where possible. In another bungalow we looked at how the service monitored and supported people who have epilepsy and we spoke to one person who said, I havent had any problems with my epilepsy since I moved in here. In another bungalow we spoke to a person using the service about his health needs, he told us that he very often refuses to have or give himself his Insulin injection. We talked to the manager about this and the support that is being offered to this individual, we saw there is a support plan in place which is reviewed regularly 3 monthly. The service has close links with psychiatric services who hold a surgery on site. A health professional said, Due to the complex needs of some people there is heavy involvement of health community nurses, speech and language, psychology and psychiatry. Qualified staff would ease this as well as improve the service. We looked at the records of another person who is reported to refuse assistance with his personal and healthcare needs. We asked the manager to make a referral to the Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: GP to ensure that his health wasnt being compromised because of this. We looked at medication records and storage, and talked to people who use the service and staff. In one bungalow we noted that it was not clear from the care record what medication the individuals needed. On checking the current Medication Administration Record (MAR) for this person it was noted that they are prescribed Lorazepam as required (PRN). We asked senior staff for a record of the instructions or Protocol that gives advice when this medication is to be given. This was not available in the bungalow. We also tried to complete an audit trail of the medication (Lorazepam) but because the MAR did not provide information about the number of tablets carried over from the previous MAR we were not able to do this. In another bungalow we saw that, the protocol for PRN Diazepam has not been not signed as agreed by the GP or dated. We also saw that the MAR sheet says repeat up to 4 times daily but this isnt what the protocol states. We are concerned that medication practice potentially places people at risk. In another bungalow the person living there said, seniors give me my medication. A health professional said, They always support individuals to administer there ownmedication and to live the life they choose. In one bungalow we were told that one individual is prescribed PRN medication for epilepsy, Rectal Diazepam, we saw that there are clear instructions available for when the medication is to be administered and have been told that staff are trained to administer it. But we saw that on the epilepsy monitoring chart an individual had a seizure that is recorded as lasting eight minutes. There was no record of the circumstances of the seizure and its duration in the care records. We are also concerned that the protocol for administering PRN medication states it should be given after three minutes. The training records confirm 32 staff have received training in Epilepsy and nine staff have received recent training in adminstering this medication, the records also show that seven other staff received this training in November 2005, but we understand that this training is now out of date. We have been provided with training records that show 17 staff have received training about diabetes, seven have received training relating to mental health awareness, and 18 have received training about the management of Challenging Behaviour. It is recommended that all staff have the opportunity to receive this training. Care Homes for Adults (18-65 years) Page 20 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that they have access to the information they need to make a complaint. But must be confident that suspected abuse is properly reported. Evidence: The service told us in the AQAA that, We act promptly to acknowledge all complaints and provide responses where necessary. At all times we ensure that policies and procedures are followed. We have ensured that staff listen to and respond to all complaints and that appropriate action has been taken and response provided within identified time scales to concerns raised. The service has a complaints procedure, the manager told us she is planning to produce the procedure in alternative formats to be sure that people using the service can more easily understand and access it. People we spoke to said they knew how to make a complaint if they need to. A relative said that when he had made a complaint to the service he was listened to and it was managed well. Another relative said they were not sure how to make a complaint. One relative said in a survey that her relative had sustained an injury resulting in going to hospital. We looked at this during this visit and noted that the incidents had been reported to us on 22.7.08. An injury had been sustained during an epileptic Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: seizure, and the individual attended A& E to receive treatment. But when we tried to track the information from the record held in the home we established that an accident form had not been completed and the daily notes on 22.7.08 did not record this incident. We spoke to staff who remembered the incident but they could not locate the records. One member of staff said he phoned the personsmother and told her, but we could not find a record of this. We were ultimately unable to establish the date it happened from the record in the home. The need to ensure records are properly maintained is essential. We looked at the complaints record the service is asked to maintain. We saw that complaints received have been properly managed and responded to within the timescales the service has agreed to. We havent received any complaints about the service since the last key inspection visit. We are aware that a safeguarding referral has been made since the last key visit and has been investigated, the conclusion of that referal indicates the allegations were not up-held. We have been told that the service co-operated fully throughout that period of investigation. We saw that 35 staff have received training in recognising and reporting abuse. The manager was able to evidence that other staff are being nominated for the training. The staff we spoke to showed a good understanding of safeguarding. We looked at the number of accidents and incidents reported to us and the record maintained at the home, we are concerned that some incidents/accidents have not been properly reported, we spoke to the manager about this. We noted in the staff recruitment records that there are elements of the the organisations practice that require improvement. We looked at five recruitment records; in one file we found one written reference, when there should be two, in another a reference was not appropriate. We discussed this with the manager for action as this potentially puts people at risk. Care Homes for Adults (18-65 years) Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service should be confident that the place they live in is maintained in a clean state to ensure that their health and well being is not compromised. Evidence: The service told us in the AQAA that, We provide and maintain to a good standard small group living environments that meet the residents needs. We continue to attempt to keep these as homely as possible whilst providing opportunity and encouragement to the residents to be involved in this process. We have provided a programme of redecoration and refurbishment of the complex which is an ongoing work in progress. The manager provided us with a record of the work completed and planned. It is evident that the organisation has made a lot of improvements in this area. We spoke to people using the service, one said, I have been able to choose the colours in my bedroom. We visited eight bungalows during this visit, of these six were in a good state of repair and decor. People told us they had been included in making decisions about the colour Care Homes for Adults (18-65 years) Page 23 of 33 Evidence: schemes and decoration in their homes. One of the bungalows we visited was in a very poor state of cleanliness, we saw pools of brown liquid on the floor in the lounge, which staff said was a combination of urine and human excrement. There was also a strong unpleasant odour and staining on the walls and doors. We spoke to the manager and staff about this and made an immediate requirement that the bungalow be cleaned and maintained in a hygienic state. The manager addressed this straightaway and confirmed that a schedule of maintaining the cleanliness of this bungalow has now been put in place. A second bungalow was noted to be shabby and in need of redecoration and a carpet badly ruffled presenting a potential trip hazard, we again made an immediate requirement that the service take action to remove any hazard. The manager stated that she is in discussion with the person living in this bungalow and has agreed a plan with him to redecorate and re furbish his home. The ruffled carpet has been removed and is to be replaced. The expert by experience said, My first impression when I sat in the lounge was how small the room was, it was open plan with a very small dining table that barely fits the four men around and also a small kitchen. When I was in one bungalow a member of staff came in without knocking. I felt that this was disrespectful to the people living in the bungalow. In another bungalow one person showed us her bedroom, which has been recently redecorated in colours and fabrics she has helped to choose. This is a cosy bedroom with evidence of personalisation. The service has separate laundry facilities on site, we talked to the manager of this service. He commented that although the service has a stock of alginate bag for laundering foul linen hygienically, they are not always being used, presenting a hygiene risk for laundry staff. We spoke to the manager of the service about this, she confirmed that she would inform staff of the importance of promoting good standards of hygiene and infection control and ensure that they are aware of the availability of the bags. We saw that 22 staff have received training in infection control. The service has a central kitchen where meals are prepared not only for people living at Highfield Court but at another service on the same site. A canteen/dining room is attached to the kitchen and would benefit from some redecoration and refurbishment. Care Homes for Adults (18-65 years) Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be sure that staff receive opportunities for training and receive the supervision and support they need. But the high turnover of staff and the shift patterns can impact on the quality of care provided. Evidence: The service told us in the AQAA that, We make all effort to ensure that our staff are provided with the knowledge and skills necessary to provide care that meets the identified needs of our residents. We continue to select and recruit, using an improved and robust system of recruitment. Information provided demonstrates that the service has a rolling programme of training, we saw evidence of generally good levels of mandatory training and evidence that some staff have attended other training sessions relevant to the needs of the people who live at the home. One member of staff said, I was given induction and that have received regular supervision and appraisal. I would like to undertake more training. The last team meeting I attended was about 12 months ago. Another said, When I come back on shift and attend the handover I only receive information from the last shift. I would Care Homes for Adults (18-65 years) Page 25 of 33 Evidence: like to have an overview about what had happened during the three or four days I was off. The staff rotas show that staff work 14 hour shifts. The expert by experience said, I asked staff about the shifts they work and was told they do 14 hour shifts. I was horrified that staff work for 14 hours in one day! I feel quite strongly staff are unable to truly give people 100 of their time for 14 hours, which would impact on the people in the home. We spoke to staff about the shift patterns and received feedback as follows, I feel that the shift patterns offer better consitency, when we used to work short shifts it created problems particularly at handover times. We can usually work really well with a person for the three or four days when we are on duty, but then were off for three or four days and sometimes have to start all over again. We discussed the issue of consistency with the manager and the importance of passing on information between shifts. We looked at a sample of five recruitement files that the organisation provided for us, and found some areas that need to be improved. In one file we found one written reference, when there should be two, in another a reference was not appropriate and in another we saw that the individual had a student visa, we were not sure the terms of the visa were being applied. We spoke to the Human Resources Director of the organisation about this, and also said we would seek further clarification. We have done this and have been told that and have received an assurance that the terms and conditions of the student visa have been properly applied. The manager told us that meetings are planned monthly with staff, but the records show that they have not happened this frequently. A member of staff said, We havent had a meeting for long time. We spoke to seven staff about NVQ training, three told us they have received the training, another said, Id really like to do my NVQ training, one other said, Im being nominated for the training. In the AQAA we have been informed that 32 of the current 54 staff have been trained to NVQ 2 this exceeds the minimum recommendation of 50 of the workforce. But the training matrix we have been provided with states that 22 staff have NVQ level 2 or above and 24 have or are being enrolled on the training course. Care Homes for Adults (18-65 years) Page 26 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be sure that the manager is qualified to manage the service but must have confidence that the service is developing and constantly improving. Evidence: The service told us in the AQAA that We provide an open management structure that is staffed to by qualified and competent individuals who work well as a team. We adhere to all policies and procedures that are designed to ensure that the service provided operates smoothly for the benefit and protection of the residents at all times. Since the last key inspection site visit the manager of the service has been approved by us and is now registered as the care manager. She has satisfied us that she has the skills and experience required. We received the AQAA when we asked for it and can confirm that is contains sufficient detail. Care Homes for Adults (18-65 years) Page 27 of 33 Evidence: We looked at records available to us relating to risk assessment, quality monitoring, and other relevant documentation. We saw that the service audits the views of relatives about the quality of service it provides. We also saw that the organisation has completed monthly reports on the conduct of the service. We understand that this information is being used to produce a development plan which will demonstrate how the service intends to continually improve. We looked at the registration certificate of the service to confirm that it is correct. We have spoke to the manager about the registration categories for the service and have now confirmed that one person has been admitted outside the agreed conditions of registration. We looked at records relating to fire safety and have asked the manager to ensure that all staff are involved in fire drills. We have referred this matter to the Fire Safety Service. We saw that a fire safety risk assessment has been produced and an evacuation plan is in place. Care Homes for Adults (18-65 years) Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 30 13 To extablish a robust regme to ensure that the environment in B2 is clean. To ensure that the person living in the bungalow benefits from a clean and hygenic environment. 23/01/2009 2 30 13 Take immediate action to 23/02/2009 ensure the carpet in A1 is clean and does not present a trip hazard. To ensure that the person living in the bungalow has a clean carpet and is not at risk. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 43 The provider must ensure that the service admits within the registraion categories we have agreed. To ensure the service has the skills to meet the needs of people admited. 12/06/2009 2 20 13 That quantities of medication that are carried over should be recorded on the MAR chart. 21/06/2009 Care Homes for Adults (18-65 years) Page 30 of 33 To ensure that an accurate audit trail can be established. 3 23 13 The provider must ensure that recruitment procedures are robust. To ensure that people who use the service are not put at risk. 4 32 13 The provider must ensure 30/06/2009 that all staff have received training specific to the needs of the people who use the service. To ensure that staff have the skills to meet the needs of people living at the home. 30/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 4 5 6 6 7 9 12 All staff should receive training in the implementation of Person Centered Plans The service should ensure that peoples care plans are up to date, to ensure that they meet their needs. People who use the service should be supported to access their own money. Risk assessments should be subject to regular review to ensure that they are up to date. The service needs to ensure that person centered principles are applied when providing people who use the service with opportunities for activities and outings. People who use the service should be supported to access local community facilities to improve their community participation and presence. People who use the service should have opportunities to go Page 31 of 33 6 12 7 14 Care Homes for Adults (18-65 years) on holiday. 8 9 10 15 15 17 The service should ensure that staff are consistent in their approach, this eliminates any potenial problems or conficts. People who use the service should be supported to maintain close contact with relatives and friends. People who use the service and the main dining room should be provided with a menu to ensure they are offered a choice of main meal. All staff should receive epilepsy training to be certain that they have the skills and knowledge to meet the needs of people with epilepsy. That a protocol for administration of prn medication should be readily available for staff to refer to. The service should ensure that the records kept in the service are accurately maintained. The service should ensure that incidents and accidents are properly reported. The service should continue with the planned development of the environment to ensure that people using the service have a pleasant and save place in which to live. The service should ensure that staff have the opportunity to receive a more comprehensive handover if it is necessary. Staffing levels and deployment should remain under review, to ensure that the service can respond at all times to peoples needs. The service should ensure that staff meetings are held regularly. The service should produce an annual development so that people using the service know how it intends to continually improve. The service should ensure that all staff are involved in regular fire drills. 11 19 12 13 14 15 20 23 23 30 16 31 17 33 18 19 36 39 20 42 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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