CARE HOME ADULTS 18-65
Highfield Hall Highfield Hall Stafford Road Uttoxeter Staffordshire ST14 8QA Lead Inspector
Jane Capron Key Unannounced Inspection 10 , 11 June and 2nd July 2008 11:30
th th Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Highfield Hall Address Highfield Hall Stafford Road Uttoxeter Staffordshire ST14 8QA 01889 563780 01889 566902 info@moorcare.co.uk 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 Mr Lee John Bentley Care Service 21 Category(ies) of Learning disability (21), Physical disability (2) registration, with number of places Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Kingston View - Six beds - Learning Disability (LD) Abbey View - Six beds - Learning Disability (LD) Highfield Hall - Nine beds - Learning Disability (LD) and Two beds Physical Disability 30th April 2007 Date of last inspection Brief Description of the Service: Highfield Hall is a service for people with a learning disability. The service is located on an eight acre site just outside of Uttoxeter. The accommodation is provided in three adjoining units that make up two sides of a courtyard. Opposite the service is an activity centre used by the people living at Highfield Hall and Highfield Court, another service on the same site. The Hall itself provides accommodation for nine people with a learning disability. The service is on two levels with four bedrooms downstairs and five upstairs. The service has all single bedroom accommodation which are of a good size and all have ensuite facilities. The service has a lounge with attached dining area, a small industrial style kitchen and a laundry. The service has a vertical lift. The people at the Hall have ranging abilities but a number have high dependency care needs. Abbey View provides accommodation for six people. The accommodation provides single bedrooms with ensuite facilities. The service has a large lounge, a domestic style kitchen with a dining room adjoining it. The people that live there assist in running the service undertaking a range of daily living tasks including assisting with meal preparation. Kingstone View provides accommodation for six people with varying dependency levels but all need regular supervision and support to undertake tasks. The service provides single bedroom accommodation, a lounge and a domestic kitchen come dining area. All units have laundry facilities. There are grassed areas to the rear of all the units and all units share the services of an activity staff member. The service has the use of a mini bus. Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 5 The aim of all the units is to encourage people to be as independent as possible and to provide them with a full and varied lifestyle. Each unit has its own staff but all staff may work in each unit from time to time. There is one senior that is responsible for all the units on each shift. The information provided by the service does not give the fee levels and therefore people need to contact the service to get up to date information. Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service 1 star. This means the people who use this service experience adequate quality outcomes.
This visit lasted approximately nine hours over two days. The service did not know we were visiting. During the inspection we spoke to people who live there, some staff, the Care Manager and the senior manager responsible for the service. Our visit looked at the lifestyle people experience, whether the service was promoting people’s choices and whether the service was meeting people’s health and personal care needs. We also looked at whether the service was safeguarding people including how it recruits its staff. As part of the inspection we had information from one relative and from a health care professional. The service provided us with an Annual Quality Assurance Assessment. This was provided late and followed us sending the service a reminder letter. This document gives the service the opportunity to tell us about the service including what they do well, areas they have developed and areas that they can improve in the future. Since we visited last we have received no complaints although the service reported it had received four all of which it upheld. What the service does well:
People like living at the service. Comments from people living there include: included: - I’m happy here’. I can do what I like and when I like,’ and ‘It’s good here’. We have lots of things to do’. A relative told us that the service ‘has a good homely atmosphere and the residents have a reasonably good social life’. The service treats people as individuals and provides people with a varied lifestyle based on what they want to do. Some people choose to go to college and one person works as a volunteer at a charity shop. People can do lots of activities such as swimming, horse riding, keep fit, playing football on the grass outside, going out for meals, shopping and taking part in arts and crafts. People go out often and use local resources such as the shops, pubs, church, and the leisure centre as well as using local health care resources. The service arranges day trips and holidays. Some people had been on holiday to Wales and one person said he had ‘ a beautiful time’. Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 7 The service listens to what people say and consults them on running the service. There are regular unit meetings, people fill in surveys once a year and a representative from each unit meets with the manager and sits on the service’s ‘Friends’ group. People have good accommodation. All bedrooms are single and all except one have ensuite facilities. People can make their bedroom their own with, for example, pictures and photos. The communal areas meet people’s needs. Outside there is a large grassed area with a vegetable garden and hens that the people that live there look after with staff support. The service is supporting people to look after their health and personal care. People go to the doctor, the dentist, optician and the chiropodist. Links with health care staff such as Community Nurses are good and they feel that they work well with the staff. The staff know the people that live there well and know about the things they like to do and about the support they need. There is a good relationship between staff and the people that live there. A high number of staff are qualified and the service provides additional training. The service makes sure that there are enough staff on duty to give people the support they need. The service’s manager is very experienced and knows all about the people that live there. He is well regarded by staff and by other professionals. What has improved since the last inspection? What they could do better:
People living at the service experience some good outcomes however there are some areas that need to be improved. The service’s recruitment procedures are not always protecting people. When we visited initially there was no evidence to show that one person working at the service had a satisfactory Criminal Records Bureau (CRB) or Protection of Vulnerable Adults (POVA) check. There was also no evidence that two
Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 8 references had been obtained. We issued an immediate requirement and when we visited subsequently a CRB was in place for this person but we were told that one written reference had been sent for but not received. The service is not providing accurate information about the service. This would mean that people are not able to make an informed decision about whether the service could meet their needs. Part of the information did not relate to the service and the information did not accurately describe what the service offers. It also did not identify the level of fees and specify fully what people would need to pay in addition to the fees. In addition to the above requirements we made a number of recommendations that will improve the service provided to people. 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 Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The information provided by the service does not accurately reflect the service provided thereby not giving people suitable information about what they can expect if they move to the service. The service’s admissions process ensures that they only admit people whose needs they can meet and enables people to try the service before moving in. EVIDENCE: The service has developed a Statement of Purpose which was updated in October 2007, and service user guide, the latter in pictorial format. On examination we found that the information provided is inaccurate. The document wrongly states the service is registered for 59 people and the accommodation identified is not that provided by Highfield Hall. This information appears to relate to the other service on the same site. In addition the document states that the Care Manager has a nurse qualification, which the manager confirmed to us is incorrect. The information did not accurately reflect the service provided. It did not mention the service’s emphasis on developing and promoting people’s independent living skills for example; there is no mention that in one unit people do their own food shopping and take part in domestic activities such as cleaning their own rooms.
Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 11 The information about fees is not provided and additional costs such transport costs, and paying for holidays are not specified. Examination of records and talking to people confirms that people have an assessment before moving to the service. This assessment covers such areas as their health and personal care, activities, family contact and spiritual needs. The manager also confirms that they complete an assessment and had recently completed one in respect of someone looking to move to the service. As well as completing their own assessments the service obtains ones form the local authority. The service’s AQAA tells us that people have the chance to visit before moving in and one person said that they visited several times and helped to choose the decorations for their bedroom. Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service’s care planning process identifies peoples’ needs and describes how these are to be met. People living at the service are supported to make decisions about their lives. The service seeks people’s views and encourages them to be involved in aspects of running the service. EVIDENCE: Three people’s files, one person from each unit, were examined in detail and these show us that the service is completing support plans. Plans include people’s health and personal care needs, any communication needs, social needs and spiritual needs if appropriate. Plans did not contain information about the support people need to manage their money. Plans include the way needs are to be met. For example; a file of a person with specialist communication needs shows how the person communicates through facial expressions and using pictures and photographs. Another file contains a plan to respond to a person’s behavioural needs. This includes the need to complete
Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 13 reports on antecedent and consequences of specific behaviour and informs staff how to respond including the use of distraction techniques. The service is also completing person centred plans. These are full of pictures showing people doing activities and include people’s likes and dislikes. One file identifies that one person does not like getting up early or cold weather. When we spoke to this person they told us this was correct. Person centred plans also identify people’s goals and wishes for the next 12 months. Plans are reviewed with the person concerned. Risk management strategies are in place to support people. The service’s Annual Quality Assurance Assessment (AQAA) states; ‘all service users need to take risks in order for them to make progress, this is done with the support of all staff. Each risk is assessed on the basis of the individuals needs. The aim is not to minimise the activity but to provide opportunity for progress safely’. Evidence of risk assessments is in support plans. These include accessing the community, mobility, use of transport, behavioural issues, and health related issues such as epilepsy. One person spends long periods out of the unit in the gardens and the risk assessment identifies that staff check him every hour. Staff we spoke to are aware of this and records confirm these checks are being completed. Risk assessments are reviewed. The service is promoting people’s choices. We saw this by the range of different activities people are undertaking and by people spending time where they wanted. For example; one person told us that they choose to spend time in their bedroom watching their TV, another person told us they have chosen to go horse riding and go to college. He also said that he chooses his meals. Staff we spoke to know how to support people with communication needs to make choices. They told us that they help one person to choose what to wear by giving them a small selection of clothes to choose from. For another person they use photographs and catalogues to help them choose items to buy. A staff member also told us of an occasion when she supported a person to buy some new shoes. She knew what he wanted through his facial expressions. This person now wants to wear the shoes all the time. One staff member said to help people choose the ‘best thing is to know the person’. People are participating in aspects of running the service and have the chance to influence the service. People tell us that unit meetings are held where they discuss such issues as future plans and activities, holidays and menus. We also saw that the service is getting people’s views about the service through yearly surveys. One person also told us that he is his unit’s representative and meets with the manager and also sits on the service’s ‘Friends’ group, a group of friends and relatives that provides financial support to the service. This confirms what the service told us in their AQAA. ‘ We promote selfadvocacy by the use of questionnaires to service users. Three service users sit on a committee for the Comfort Fund. There are in-house meetings held on a regular basis.’
Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 14 Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 15 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People are supported to live the lifestyle of their choice with the chance to take part in a range of activities and to regularly access the community to use local resources. The service promotes people to develop and maintain important relationships. Meals are varied and provide people with choice. EVIDENCE: The service’s AQAA states that it ‘provide the opportunity [for people] to take part in a range of activities both in the Home and the community’ and that ‘people access the community; shops, library, pubs, places of worship. A group of service users attend Leek College. [They] have own garden and vegetable patch. ‘ Our observation of files and talking to staff and people that live at the service show that people enjoy a varied lifestyle that includes activities both in the service and in the community. Some people attend college. One person told
Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 16 us that he goes to college once a week to do a pottery and arts and crafts course. Examples of his pottery are seen in the unit. Another person said that he works voluntarily at a charity shop two days a week. He commented on how much he enjoys it. Most of the people take part in the service’s gardening project. At the rear of the service there is a vegetable garden growing a range of vegetables. The staff and people living at the service have developed this garden. In addition to the garden there are hens that people feed and keep clean. The money that is raised from the eggs is used to fund the feed for the hens. People access the community on a regular basis to take part in social activities and to access local resources. People we spoke to tell us they go shopping regularly both for personal items and to do the food shopping. One person’s file shows he goes to a local hairdressers and another file showed us that they went to the leisure centre to go swimming. People attend the local doctors’ surgery. The service is aware of people’s different ages and disabilities and interests and looks to provide activities related to their specific interests and to overcome issues relating to any disability. For example one person has a motorised scooter to help them get around the site. The service’s AQAA acknowledges that there are some difficulties for people with mobility needs to access the garden and is looking at how this can be overcome. We saw that people enjoy a range of social activities of their choice. Activities out of the service include going to the Gateway club, going horse riding, going on day trips, swimming, out for lunch and going out for a drink. The service has a person doing ‘keep fit visiting’ once a week. One person told us that he chooses not to take part in many activities but has his own motor scooter and enjoys travelling round the grounds on it. The service employs a fulltime staff member to promote activities. She told us that she supports people with the gardening project, encourages people to undertake with a range of arts and crafts and supports people to go shopping. We saw evidence of people’s craftwork throughout the service. In Abbey View we saw people’s work on the corridor walls and on people’s bedroom doors. The activities provided by the service are paid for by the people living there and through fundraising efforts of the staff. The service organises holidays for people. One person said he had recently been to Wales and said he had ‘a beautiful time’. Another person said she was going on holiday soon. Walls in units and in people’s person centred files contain photos of people on holiday. People pay for their own holidays. The service has its own minibus. People pay per mile to use this transport. We saw that people are supported to take part in activities related to running the service. This is particularly evident in Abbey View where people are more able to undertake such tasks. One person told us that they help in the garden, do the food shopping, choose the menus, help prepare meals and help with cleaning their bedroom. Another person also told us they did these things. We
Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 17 also saw a roster confirming these activities. We also saw that the service’s routines are flexible with people getting up when they want and spending time where they wanted. People are supported to maintain and develop relationships with family and friends. We saw one person visiting friends during the inspection. One person we spoke to told us that they regularly went to their family for weekends. Another person told us that the service as recently organised for him to visits the place where he used to live with his family. This has led to him meeting up with a number of cousins. He said: ‘this has made a big difference to my life.’ We looked at the meals people are provided with. Each unit has a different menu. Kingstone Unit and Abbey View plan their own menus and do their own shopping and cooking. At the Hall there is a four weekly menu based on healthy eating and on what people like to eat. Also at the Hall there is a cook employed. When we spoke to people they said they liked the meals and a choice was provided. Although some people could not verbalise their wishes the staff use methods such as showing people food to help them make a choice. Staff are also aware of what food people like and dislike. Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The service supports people to have their health and personal care needs met in a flexible and responsive manner. People are having their medication needs met but improvements could be made to reduce the likelihood of errors occurring. EVIDENCE: Examination of files, talking with people and with staff shows that the service is promoting people’s personal and health care needs. Plans identify people’s health care needs and good records of health care appointments are kept. We saw in the files that people are having health checks, including having eye and dental checks and having regular nail care support. Staff are aware of people’s health care needs and aware of the support they need. One person at the service had been ill recently and staff could tell us about the symptoms and about the treatment he is receiving. While we were at the service a staff member took him to attend a further doctor’s appointment. Another file told
Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 19 us that one person had previous had a collapse and needed health intervention. The person concerned said that this had happened and staff had taken him to the doctors where he had some tests. We also saw that the service is monitoring people’s weight on a regular basis. The service is responding to people with needs relating to behaviour. They have good relationships with specialist health professionals including Community Nurses. We spoke to two health care professionals that work in the field of learning disability and they gave us positive comments about the service. One said that they feel that the service has done very well with responding to people’s needs and that staff act on advice provided. Another stated that following training in autism the ability to meet a specific person’s needs had improved. The service operates a monitored dosage medication system for the administration of medication expect in the case of one person that had difficulties in swallowing medication. Medication is stored in each unit although is administered to all units by the senior care staff member on duty. In the Hall there is a secure medication cabinet containing a controlled drugs cabinet secured inside. The service records the medication received and that returned to the pharmacist. Since the last time we visited the service has updated its procedures and includes procedures for homely remedies and a home leave record form. Records and discussions with staff confirm that they are trained in medication practices. The service undertakes a monthly audit of medication and in addition a local pharmacist visits to undertake an audit on the storage and administration of medication. A copy of the last visit shows no errors and no recommendations. Examination of the medication administration records shows that staff are completing these accurately and people are receiving their medication. We did notice when we audited a sample of medication this did not tally with the amount in stock and that used. It seems likely that there was an error when transferring amounts of medication in stock from one Medication Administration Record (MAR) sheet to the next. We also noticed that when a handwritten entry for Zotin was made on the MAR sheet it did not describe the method of administration. When we spoke to staff about this they described different ways they administered the medication. Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 20 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 good This judgement has been made using available evidence including a visit to this service. When people raise complaints these are acted upon. People are being protected by the staff’s knowledge and understanding of safeguarding issues. EVIDENCE: Information about how to make a complaint is displayed in all the units. These are in a pictorial format. Basic records are being kept of complaints made and these confirm that they are being acted upon. The Commission has received no complaints since the last inspection. The service’s AQAA reports that four complaints have been made and all have been upheld. One person we spoke to told us that they were satisfied with the way the service responded to a complaint they raised. This related to the food served and as a result of their complaint had a meeting with the catering manager. The relative that responded to our survey said that they know how to make complaint and that the service always responds if they raise anything. The service has procedures in place to safeguard the people living there. Examination of training records shows us that the service is training staff in safeguarding issues. Staff we spoke to are aware of the categories of abuse and how any concerns should be reported. One person told us that if they have any concerns they would ‘tell care team leader and if nothing happened tell the manager’. Another staff member said ‘I am here for the residents’ and ‘I put them first’.
Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 21 One person told us of an incident she witnessed and confirms that the manager had taken action. We have received two safeguarding alerts in respect of the service. No evidence of safeguarding has been found in either although one led to disciplinary action by the service. The service is looking after money for people with the company receiving people’s personal and mobility allowances. We would recommend that the service looks to support people where appropriate to open their own accounts and to have more involvement in managing their money. A check on a sample of records shows that the service is keeping accurate records and is keeping receipts of money spent. Sampling confirmed that the cash held corresponded with the records Information from staff and other significant people and a discussion with the manager leaves us confident that he will act on any issues affecting the welfare of the people that live at the service. Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 22 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): 24,26,27,28,30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The service provides people with accommodation that is homely and domestic in style. People enjoy a service that is clean and tidy. EVIDENCE: The service is located on the outskirts of Uttoxeter and it is a 20 minute walk to the town centre therefore most people are reliant on transport to access local facilities. The service is provided in three separate units each with their own front and back door. All units back onto a large grassed area providing seating and a place to walk and do activities outside. The service has developed a vegetable garden that people help to maintain, there is a sensory garden, a small wildlife pond and an enclosed area where hens are kept. The service tells us that it is looking at ways to make the garden more accessible for people that use wheelchairs. Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 23 All units are well maintained and provide people with good accommodation. The service undertakes regular audits of the accommodation and identifies areas to be addressed. The service’s AQAA tells us that over the last 12 months they have updated the accommodation by redecoration of some bedrooms, new carpets and a non-slip floor in Kingstone unit, new tables and chairs and a new television at the Hall. A new assisted bath had been provided at the Hall. All units are decorated and furnished in a domestic style. Each unit has suitable communal areas. The Hall provides a range of seating to meet the needs of the people that live there. All units have single bedrooms and all except one have ensuite facilities. Some bedrooms within the Hall are especially large with ensuites having their own bath. Bedrooms are personalised and contain suitable furniture. All were lockable and some people are choosing to keep them locked. One bedroom in Kingstone is quite stark. Staff told us that this person exhibited some behavioural issues that resulted in some items being kept elsewhere. We saw that this is recorded in his records. All units have their kitchens. In Abbey View and Kingstone where people living there are involved in meal preparation the kitchens are domestic in style. At the Hall there is a small industrial style kitchen. Each unit has laundry facilities. Currently the washing machine in Kingstone was broken and washing is done at the main laundry used by the other service on the site. The service is clean and tidy throughout and staff are aware of infection control procedures. The service’s AQAA tells us that most staff have completed infection control training. Highfield Hall DS0000065382.V365879.R01.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 poor. This judgement has been made using available evidence including a visit to this service. Staff are trained and qualified and are provided in sufficient numbers to support the people living at the service. The service’s recruitment procedures are not robust and are not providing people with adequate protection. EVIDENCE: Comments from people using the service include: ‘staff are good’ and ‘ I like the staff’. The relative that responded to our survey said ‘as far as I can tell most staff been very caring and friendly’. The service’s AQAA states: ‘The service users are supported by staff who are well motivated and knowledgeable about residents needs they are trained and qualified appropriately.’ From our observation and discussions with staff we feel that this is accurate. Staff spoken to are aware of people’s needs and the type of support they need. They are aware of how to communicate with people with specialist communication ends, although we would recommend that people have training in makaton that is used by some people living at the service. Observation shows that they have relaxed, friendly relationships with people and treat them with respect.
Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 25 The service is providing staff with training to undertake their role. The service’s AQAA tells us that 75 of staff are qualified to at least NVQ level two. Staff are receiving training to undertake their role. People tell us and records confirm training is provided in Health and Safety issues and challenging behaviour, person centred planning, medication and communication. Two health professionals tell us that they have provided training for staff relating to specific people and that these sessions are well attended and have led to an improved level of care for these people. We looked at staff rosters to check that there are sufficient staff on duty to support people. Currently there are seven care staff on duty throughout the day made up of three in the Hall and two in each of the other units. The manager’s role is supernumery although he does on occasions work as a care staff member when there are staff absences. Currently the service has three staff vacancies and in the day of the inspection an interview took place. The staff vacancies are covered by existing staff and staff that usually work at the other service on the same site. This means that the people living at the service know the people supporting them. At night there are four staff on duty. In addition to care staff there is a fulltime activity staff member and a part time cook that works in the Hall. We feel that this level of staffing is sufficient to support the people currently living at the service. We examined a sample of three personnel files to check the service’s recruitment processes. As personnel files are not kept on site these were brought from the company’s headquarters in Loughborough. The company was unable to provide one file reporting that it was currently with their training department located at any venue. The company did provide us with a Criminal Records Bureau (CRB) number to confirm that this check had been completed. In the second file two references were present and there was confirmation that a CRB check had been completed. The records did indicate that information was present on the CRB and that a meeting had been held. The records did not clarify the purpose or outcome of the meeting. This CRB had been completed in 2005 before this company purchased the service. We would therefore recommend that a further CRB is sought so that the current responsible people are aware of the issues and be confident that people are safeguarded. The third file looked at contained no references and there was no evidence that a satisfactory CRB had been received. We raised this issue with both the Care Manager and the senior manager of the company present. At our request the personnel department was contacted to seek if there was any further information and if so to fax the information to the service. We left the service an immediate requirement in relation to this issue. At the time of writing this report a further visit has been made to the service and we have been satisfied that this person now has CRB clearance. A senior manager also confirmed that one written reference and a verbal reference has been obtained. Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 26 At our last key inspection on 30 April 2007 we also found that that the recruitment process was not robust. That report stated: ‘two files did not contain confirmation that a satisfactory CRB had been obtained and that staff were fit to undertake the work.’ Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 27 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): 37,38,39,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service is being well led in many areas and is providing people with some good outcomes however there are issues relating to recruitment that are leaving people at risk. EVIDENCE: The manager is suitably experienced and qualified to manage the service. He has worked for many years with people with a learning disability. We feel that the manager is very user focussed and generally puts the welfare of the people that live at the service first. We saw that he has positive and relaxed relationships with staff and people that live there. Health care staff we spoke to are positive about the manager’s abilities and they report a good working relationship. Comments include: ‘I am impressed with the manager’ and ‘he has done well with the people we work with’. We also saw a letter from a
Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 28 relative to the service that said: ‘He is very conscientious and very much has the good of each people that live at the home at heart’. The service is well led with good outcomes in areas related to people’s lifestyle and health and personal care. However, issues relating to the information available to people about the service is inaccurate. There are also omissions in the service’s staff recruitment process that is leaving people at risk. Although the company’s personnel department completes pre employment checks, as registered manager there is a responsibility to ensure that these areas meet the required legislation and standards. We would therefore recommend that a system is in place for the manager to be able to confirm that the necessary pre employment checks have been made. The service provided us with an Annual Quality Assurance Assessment. This was provided to us late and we had to send the service a reminder before it arrived. The AQAA did provide some good information about what the service provides and its plans for the future. Monitoring systems to check the quality of service are in place. These include surveys by people living at the service, relatives and visitors to the service. We saw copies of these and saw that the service uses them to identify issues to improve and develop the service. Other information that the service uses to assess the service includes environmental audits completed by the catering manager and the care manager, information from the fire authority and the environmental health departments’ inspections. The Care Manager also said that he visits the service at the weekend and at night to monitor the service provided. The service maintains Health and Safety issues. The service’s AQAA confirms that it undertakes checks on fire equipment, electrical appliances and has procedures in place for the safe handing and storage of hazardous substances. The AQAA also confirms that staff receive Health and Safety training and our examination of training records and discussions with staff confirms this. Records relating to checks on fire issues show that the service is undertaking regular checks on the fire alarms and emergency lighting. We did notice that the records show that the fire alarm is checked fortnightly although when we spoke to the manager and another staff member they confirm that it is completed weekly. It appears that one staff member was not completing the records. Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF SERVICE Standard No Score 1 1 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 4 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 1 35 3 36 X CONDUCT AND MANAGEMENT OF THE SERVICE Standard No 37 38 39 40 41 42 43 Score 3 3 4 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 4 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 4 3 X X 2 X Highfield Hall DS0000065382.V365879.R01.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 Services Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA34 Regulation 19 Schedule 2 Requirement The service’s recruitment procedures must ensure all staff have a satisfactory CRB check and that two references are obtained in order to protect people. Previous timescale of 08/05/07 not met. Timescale for action 12/06/08 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. Refer to Standard YA1 Good Practice Recommendations A service user guide and Statement of Purpose that are accurate and comprehensive, and contain information about the fees and costs paid in addition such as transport fees must be provided. This will make sure that people who are considering moving to the service have all the information to make an informed decision. The support people need to budget and manage their money should be recorded in their support plan. This will make sure that staff know the nature of the support needed for each person. The service should have a robust medication auditing
DS0000065382.V365879.R01.S.doc Version 5.2 Page 31 2. YA6 3. YA20 Highfield Hall 4. YA20 5. 6. 7. YA23 YA22 YA32 8. 9. YA34 YA34 9. YA42 system. This will ensure that systems are in place to confirm that people have their medication as prescribed When writing entries on Medication Administration Records these must include the method of administration. This will make sure that people receive their medication in the most effective manner. Where appropriate people should have their money paid into their own bank account. This will enable them to be more involved in managing their own money. To provide more details in relation to responding to complaints. This will more clearly show the actions taken by the service when responding to complaints. Staff should receive the necessary training to undertake their role in supporting the people. This to include such areas as challenging behaviour and communication skills including makaton To ensure people are protected records relating to the staff employed at the service must be available for inspection. Where CRB checks indicate areas of concern records should be kept of meetings held and of any reasons for decisions made. This will make sure that people are protected. Records relating to fire equipment testing should be completed. This will confirm that the necessary checks are taking place. Highfield Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Hall DS0000065382.V365879.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!