Inspection on 30/04/07 for Highfield Hall

This inspection was carried out on 30th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Highfield Hall 01/12/08

Highfield Hall 10/06/08

Highfield Hall 07/06/06

Highfield Hall 30/01/06

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Highfield Hall Highfield Hall Stafford Road Uttoxeter Staffordshire ST14 8QA Lead Inspector Jane Capron Key Unannounced Inspection 30th April 2007 09:30 Highfield Hall DS0000065382.V338296.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.V338296.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.V338296.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 admin@rushcliffecare.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) Moorcourt Developments Limited Mr Lee John Bentley Care Home 21 Category(ies) of Learning disability (21), Physical disability (2) registration, with number of places Highfield Hall DS0000065382.V338296.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 7th June 2006 Date of last inspection Brief Description of the Service: Highfield Hall is a care home for residents with a learning disability. The company Moorcourt Developments was bought by Rushcliffe Care Ltd a company with Head Office based in Loughborough in December 2006 The home is located on An 8 acre site just outside of Uttoxeter. The accommodation is provided in three adjoining units that make up two sides of a courtyard that provides parking. Opposite the home is an activity centre used by the residents at Highfield Hall and Highfield Court, another home on the same site. The Hall itself provides accommodation for nine residents with a learning disability although two also have a physical disability. The home is on two levels with four bedrooms downstairs and five upstairs. The home has all single bedroom accommodation which are of a good size and all have ensuite facilities. The home has a lounge with attached dining area, a small industrial style kitchen and a laundry. The home has a vertical lift. The residents in the Hall have ranging abilities but a number have high dependency care needs. They all moved together from a home owned by the previous company that was closing. Abbey View provides accommodation for six residents. The accommodation provides single bedrooms with ensuite facilities. The home has a large lounge, a domestic style kitchen with a dining room adjoining it. The residents assist in running the home undertaking a range of daily living tasks including assisting with meal preparation. Kingstone View provides accommodation for six residents with varying dependency levels but all need regular supervision and support to undertake tasks. The home provides single bedroom accommodation, a lounge and a domestic kitchen/dining area. Highfield Hall DS0000065382.V338296.R01.S.doc Version 5.2 Page 5 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 home has the use of a mini bus. The aim of all the units is to encourage residents 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 level of fees range between £489 and £1300 per week (May 2007). The fees cover a number of in house activities but do not cover transport costs, holidays, toiletries and activities such as swimming and horse riding. Highfield Hall DS0000065382.V338296.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that lasted around 7 hours. During the inspection we spoke to some of the residents, some staff and the manager. We also observed staff working residents. We spoke to some relatives that were visiting and to a Social Worker that was at the home attending a review. Before we went to the home we sent the home a questionnaire and we used information from that. We also sent out some resident and relative questionnaires but we did not receive any responses. During the inspection we looked at a sample of residents’ support plans and documents about the service they were getting. We looked at residents’ opportunities to take part in activities and participate in tasks around the unit. We also looked at a sample of staff files to look at how the company recruited staff. We looked at how the home was meeting residents’ health and personal care needs and the arrangements for administering medication. We also looked at how the home responded to any complaints. During the inspection we looked at how the home looked after people’s health and safety. We particularly looked at whether the home had fire precautions in place and whether they were doing the checks that were needed. We went round all the units and looked at the communal areas and some of the residents’ bedrooms. Since the last inspection we had received one complaint. This was looked at by the home and we felt it was satisfactorily dealt with. What the service does well: Relatives and residents we spoke to were happy about the service the home provided. One relative said her relative was ‘very happy’ and that the unit she lived in was ‘like a family’. Another commented that their relative ‘liked to come home but also was very happy to come back to Highfield Hall’. Residents in Abbey View said that they enjoyed living at the home. Comments included: ‘We are all friends’ and ‘I like the staff’. We saw that residents had lots of opportunities to take part in activities both at the home and in the community. They did things like going shopping, out for trips, to the pub, swimming and horse riding, to the Gateway club and to Keep Highfield Hall DS0000065382.V338296.R01.S.doc Version 5.2 Page 7 Fit classes. Some people also went to college to learn subjects like art and pottery. All people particularly in Abbey View and Kingstone View were involved in aspects of running the home. They did things like deciding the food they ate, helping to keep their bedroom clean and tidy and helping with making meals and setting and clearing the table. Abbey View and Kingstone View had vegetable gardens and some people told us that they had eaten food they had grown for lunch. The home listened to what residents thought about the home and asked them about what they wanted to do. Staff had meetings with residents and each unit had a resident who was house leader that met with the manager to give them the views of all the people that lived in the unit and to tell them of any problems. The staff we spoke to were very keen and knew about what the residents needed. We saw that staff got on well with residents and that the home felt relaxed. The people were having their health looked after. They were seeing the doctor when they were ill and having check ups, they were having their eyes checked and going to the dentist. Also if a resident needed some special help the home was arranging this. What has improved since the last inspection? What they could do better: There were still things that the home needed to do to improve the service for the residents. We saw that some support plans needed more information in them about what help people needed to manage their money and about how their spiritual needs were to be met. Highfield Hall DS0000065382.V338296.R01.S.doc Version 5.2 Page 8 Residents felt they were listened to but the way the home was recording complaints did not make it clear what the complaint was and what they had done about it. The home’s rules about how medication was kept and administered was not suitable and was not fully protecting the residents. The home’s rules about managing residents’ money was not properly safeguarding them When we looked at the records about the way staff were employed we found that they did not show that everybody had a satisfactory police check and that the home had got two references. If the proper checks are not done residents cannot be properly protected. We could not confirm that staff had received the training needed to make sure that residents were kept safe and we did not know how many staff had completed the training and qualifications they needed to provide residents with a good service. By talking to some staff and looking at support plans we found that some staff needed more training in working with people with special communication needs and challenging behaviour. Some residents used makaton signing but staff had not been trained in this. The home had not made sure that all the emergency lights were working. We found records that some had not been working since January. 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.V338296.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.V338296.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): 1,2,3,4 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The information provided by the home along with their admission procedures ensures that the home provides a service to those residents whose needs they can meet and who are fully aware of what the home offers. EVIDENCE: The home had a Statement of Purpose and a service user guide, the latter being in a user friendly format. Discussion with a relative confirmed that they enough information to make a decision over whether the home could meet their relative’s needs. Prior to anyone coming to the home an assessment was undertaken by the local authority and by the home. They had a suitable admission procedure in place. Information obtained included about a prospective resident’s health and personal care, social and family contacts, educational needs and methods of communication. A discussion with a relative during the inspection confirmed that they had been involved in the assessment process and been provided with the opportunity to visit the home before making a decision about their relative moving to the home. Residents spoken to also said that they had visited the home and had been involved in planning Highfield Hall DS0000065382.V338296.R01.S.doc Version 5.2 Page 11 their move to the home visiting several times and choosing furniture and decor. Examination of plans and discussions with staff, residents and relatives showed that the home was able to meet residents’ needs. Staff were able to describe residents’ individual’s health care needs and personal care needs and their likes and dislikes. Progress had been made over meeting behavioural and communication needs and there was some good use of pictures and symbols to aid one resident’s communication needs. There was evidence of positive working relationships with primary health care services. One relative spoken to stated that she was ‘very happy with the care provided’ and that the unit her relative lived in was ‘like a family and the best she had ever seen’. A social worker present at the home reported that the home was meeting the needs of her client and that he had made progress in developing his skills. Highfield Hall DS0000065382.V338296.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Whilst all residents had support plans and risk assessments in place there were areas of the plans that needed to be further developed to ensure that all staff had the necessary knowledge to fully support the residents. Plans about spiritual and financial needs needed to be developed. It is also recommended that plans about communication and challenging behaviour be further developed. Residents were supported to make decisions and choices and had the opportunity to take part in activities relating to the running of the home although there was scope for this to be further developed. EVIDENCE: A sample of files was looked at covering residents from each unit. All residents had a care plan that identified their health and personal care needs, their educational and domestic needs as well as their social needs. These plans Highfield Hall DS0000065382.V338296.R01.S.doc Version 5.2 Page 13 identified how staff could meet these needs. There was evidence of internal reviews and some multi agency reviews taking place. Plans contained behavioural and communication plans but there was scope for some of these to be further developed. In respect of behavioural plans these tended to be reactive rather than looking at ways of working with residents to reduce the behaviour. Some plans could be clearer over the methods of communication and include the way residents expressed likes and dislikes. Some plans for residents that had spiritual needs were not identifying them and how they were being met, although staff were aware of these needs. Plans were not in a person centred format although the manager reported that this process had started. The home had developed a range of individual risk assessments covering such areas as accessing the community, bathing, household tasks and risks associated with specific behaviours. These were being reviewed and kept up to date. Residents were supported to make decisions about their lives. A group of residents spoken to in Abbey View stated that they helped to choose meals and decide where they went out to. They went shopping to choose clothes and decided on where to go on holiday. Discussions with staff and observation showed that the staff provided residents that had non-verbal and limited verbal skills with choice. One resident was supported to use a picture board to identify what they wanted to do during the day and another was seen to lead a staff member to show something that he wanted. Observation showed staff offering residents’ choices about food, activities and where to spend their time. A relative spoken to said that the residents and relatives were involved in choosing their bedroom decorations prior to moving into the home. She also said that the home promoted residents’ choices over their lifestyle. Several staff members spoken to were able to identify how residents with specialist communication needs were able to express preferences and methods they used to assist residents to make decisions. There was however scope for further development in this area to include the increased use of specialist communication methods including makaton and pictures and symbols both to aid residents with decision making and participation. The home was the appointee for 15 residents and looked after some money for the others. Records confirmed that the home discussed with third parties when large amounts of money was to be spent. The home did not have a financial plan/ risk assessment in place for each resident that showed the amount of support needed to manage their finances. All units had resident meetings and this was confirmed by records and discussions with a group of residents in Abbey Unit. They felt listened to by the staff. They were involved in the day to day running of the home undertaking a range of activities including shopping, planning meals, deciding on social Highfield Hall DS0000065382.V338296.R01.S.doc Version 5.2 Page 14 activities and doing a range of domestic tasks. Residents within Kingstone Unit also took part in a range of household activities including some meal preparation, cleaning, gardening and doing their laundry. Residents in the Hall were involved to a lesser extent both due to their specific conditions and needs and because the home had its own cook. The home’s current quality procedures included the use of service user questionnaires. The home also has some procedures, for example complaints and fire, in a pictorial format to aid residents’ understanding. This area could be further developed through for example more involvement in the Hall of residents in menu planning and for all residents to be more involved in recruitment and selection of staff. Highfield Hall DS0000065382.V338296.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home provides residents with the opportunity to take part in a range of activities both in the home and in the community providing them with a varied lifestyle. Residents are supported to develop and maintain relationships with friends and family. Residents have meals that are varied and are based on their choices and preferences. EVIDENCE: Residents in all units were provided with support to have a varied lifestyle that took account of their choices over how they lived their life. Each unit tended to independently arrange their activities and routines. All residents had the opportunity to access the community and go out on trips. On the day of the inspection a number of residents from all the units went to a keep fit session in the morning, residents from Abbey View went to Uttoxeter food shopping in the early afternoon and residents from Kingstone View were going for a walk Highfield Hall DS0000065382.V338296.R01.S.doc Version 5.2 Page 16 on Cannock Chase later in the day. At night some residents were going to a disco at the Gateway Club. Trips were also arranged for individual residents or for one of two to go out together. The residents regularly accessed the community using local health care resources and going to the library, shopping, the gym, swimming, horse riding, meals out and to the pub. Residents paid for these activities themselves. The home also arranged holidays funded by the resident. A range of photographs of residents at Abbey View in Wales were seen. Residents all stated that they had a good time and were looking forward to going on holiday this year. A number of residents attended Leek College taking course such as art, crafts and pottery. One resident went every day to the central kitchen (of another home on the same site) to get bread and milk for their unit. Two units had set up their own vegetable gardens that the residents looked after. Residents from one unit reported that they had eaten some of the produce at lunchtime and a resident said that he watered the garden every night. Within the home residents took part in a range of leisure and household activities. These included watching TV and videos, board games, drawing and arts and crafts and spending time outside sitting or playing games in the grounds. During the inspection two residents had been drawing and one resident spent time outside on a motorised scooter. This resident enjoyed the freedom and the chance to talk to other residents and visitors to the home. Routines within each unit were relaxed but took into account individual resident’s needs. Residents had choice about when they went to bed and got up and could spend time in their bedrooms or in the communal areas. All bedrooms were lockable and a number of residents chose to lock their room either all the time or when they went out. Times for meals in Abbey View and Kingstone were flexible and depended on the days’ activities. Meals times were less flexible in the Hall as they had a cook employed there. All the residents had some opportunity to take part in a range of independent living activities including keeping their bedroom tidying, vacuuming, laying and clearing the table, baking and helping with preparing the meals and assisting with their laundry. These activities were less evident in the Hall and there was scope for development. The home supported residents to develop and maintain friendships and relationships with family members. On the day of the inspection one resident returned from being home for the weekend and several relatives were visiting residents following a meeting of the home’s relatives and friends trust. Residents were provided with a varied menu and staff were aware of the need to monitor residents’ weight and diet. Breakfast was usually taken when residents got up and took account of individual residents activities for the day. Other meals were taken as a group in each unit’s dining room or kitchen/ Highfield Hall DS0000065382.V338296.R01.S.doc Version 5.2 Page 17 diner. In both Kingstone View and Abbey View staff cooked the meals and residents were more involved in choosing and planning the meals than in the Hall. In these units meals were planned on the day with the involvement of residents. In the Hall there was a planned menu and a choice was always available. Meals were a chance for residents to get together with staff and in all units staff sat with residents during mealtimes. Residents that needed assistance were provided with it and the home provided equipment to assist residents to be as independent as possible when having a meal. All residents had the chance to go out for meals. Highfield Hall DS0000065382.V338296.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 adequate This judgement has been made using available evidence including a visit to this service. The personal care of residents was being provided in a way that met their needs and promoted their privacy and dignity. Residents’ health care needs were being met. The home’s medication procedures did not satisfactorily cover the required areas and was potentially placing residents at risk. EVIDENCE: Sampling of residents’ files showed that the support plans identified residents’ health care and personal care needs. Observation showed and residents confirmed that they received nail care- the chiropodist visited the home regularly and hair care – either by attending the hairdressers or from the staff at the home. Support plans showed the level of personal care support needed and daily records and discussions with staff showed that this was being provided. Staff were able to describe the needs of individual residents and could state what actions they took to ensure needs were met, They were also aware of how residents liked their personal care attending to. Residents had a key worker and when spoken to, residents could say who this was and what Highfield Hall DS0000065382.V338296.R01.S.doc Version 5.2 Page 19 support they provided. They said that the key worker would go shopping with them and support them to buy clothes and toiletries. Health care needs were attended to. Records showed residents were having eye and dental checks and that weight was being monitored. One resident had regular contact with a District nurse. This resident also had bedrails fitted and there was an assessment in place. Residents retained choice over where health care checks were done with one resident reporting that he still attended the services near his home. The home worked in partnership with families to make sure residents’ health care needs were being met with some families being involved in health appointments. Records showed that the home involved specialist health care resources including the speech and language therapist and the psychiatrist services. The arrangements for the administration of medication were looked at during the inspection. Each unit kept their own medication although the Hall stored stock medication. The home operated a nomad system for the administration of medication and examination of the records showed that all medication that had been administered had been signed for and there were no gaps. The home did have a medication procedure but this did not cover all the necessary areas. Correct procedures were not in place for storage, periods of home leave and homely remedies. In addition although there was a system in place for auditing and checking the amount of medication this was not effective and did not provide an adequate auditing system. The home was writing its own MAR sheets and there was no system in place for checking these to ensure they were correct. A discussion with a senior support worker on duty showed that he was aware of the correct method to administer medication. The home had provided training in the safe administration of medication to a number of staff. Highfield Hall DS0000065382.V338296.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 adequate This judgement has been made using available evidence including a visit to this service. The home’ listened to the views of residents and relatives and responded to complaints although the details of complaints were not adequately recorded. Residents were safeguarded by the staff’s knowledge and understanding of adult protection but the home needed to ensure that it’s procedures for managing resident’s finances were robust enough to provide the necessary protection. EVIDENCE: The home had a complaints procedure in place that was displayed around the home. The procedure was in a pictorial format. A relative spoken to said that she was aware of the procedures and that she would raise any concerns directly with the manager. Residents felt they were listened to and could raise any concerns they had. Discussions with staff showed that they were aware of how residents without verbal skills showed distress or unhappiness. One resident was encouraged to use pictures to describe the reasons for distress or dissatisfaction. The home had received two complaints and these had been responded to appropriately. The home maintained a record of complaints but this did not clearly identify the complaint or the actions taken to respond to it. All staff spoken to had received training in safeguarding adults and were able to describe the signs and symptoms that could indicate abuse. They were also Highfield Hall DS0000065382.V338296.R01.S.doc Version 5.2 Page 21 aware of how to respond should they have any concerns over possible abuse. Staff were aware of issues of abuse/ bullying between residents. The manager was aware of how to respond and report allegations of potential abuse under the multi agency procedures. The home had procedures in place to manage residents’ finances. Residents could access their money throughout the week and the home was keeping individual records for each resident. Money was kept individually and was kept locked away. Expenditure was supported by receipts. The current method of record keeping was not providing a clear audit trail and sampling of residents; finances did show one error. A senior manager did report that they were aware that the current system was not satisfactory and was looking to bring in a more robust system that whilst enabling residents to have their money provided the necessary safeguards. Highfield Hall DS0000065382.V338296.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 home provided residents with good private and communal accommodation both internally and externally. The accommodation was clean and tidy throughout and procedures were in place to control the spread of infection. EVIDENCE: The inspection included looking at all the units. The units were adjoining but had separate front and back door entrances. They were set around two sides of a courtyard. The units backed on to a large grassed area with trees. Each unit had its own seating area and two units had their own vegetable garden. The home was satisfactorily maintained. The Hall had a new hallway carpet All communal rooms were looked at as well as a sample of bedroom accommodation. Overall the home provided residents with good accommodation. Abbey View and the Hall provided an excellent standard of Highfield Hall DS0000065382.V338296.R01.S.doc Version 5.2 Page 23 accommodation. The accommodation of Kingstone View was satisfactory but the accommodation including some bedrooms would benefit from some decorating. All units had sufficient communal areas each having a separate lounge. All accommodation was decorated in a domestic style apart from the kitchen in the Hall . Bedrooms were all single and most had ensuite facilities. Residents in the Hall and Abbey View had provided much of their own furniture. All bedrooms at the home were lockable. Bedrooms had been personalised with different styles and colours and with the residents’ ornaments, pictures and certificates on the walls. The home provided suitable bathing and shower facilities that were all lockable. The manager reported that the home was getting two new assisted baths. Two bathrooms seen tended to be a bit sparse and clinical in appearance. Each unit had laundry facilities that were suitable to meet the laundry needs of the residents. The home had cleaning schedules in place and a number of staff had received training in infection control. The home had procedures in place to control the spread of infection. Highfield Hall DS0000065382.V338296.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. The residents were supported by staff in adequate numbers and who were well motivated and knowledgeable about residents’ needs. We could not confirm that residents were being supported by staff that were trained and qualified. The recruitment process was not fully safeguarding residents. EVIDENCE: The home had eight staff on duty during the day– two staff in Abbey View, and three staff in both the Hall and Kingstone View. At night there were four waking night staff with two working at the Hall and one in each of the other units. This level of staffing was sufficient to ensure that the needs of the residents were met. The three staff during the day in Kingstone View included one staff member that was providing 1:1 support for one resident. Examination of the rosters confirmed that this level was provided consistently although there were periods when the manager was working as a support worker and this could detract from his role as manager. The home also had a fulltime activity staff member that provided group and individual support to all Highfield Hall DS0000065382.V338296.R01.S.doc Version 5.2 Page 25 the residents. However all staff were also responsible for arranging activities for the residents. Additional staff included a domestic staff member at the Hall although she had oversight of the cleaning at the other units. The Hall had a cook. Maintenance was provided by staff employed to work both at Highfield Hall and the other home on the same site. During the inspection discussions were held with four staff. These staff were aware of their role in supporting the residents. They were well motivated and had developed positive relationships with the residents. Although working mainly in one unit they were aware of the needs of all the residents. Discussions confirmed that they were aware of conditions such as autism and epilepsy having received training in these areas. They were aware of issues relating to communicating with residents and further training in this field to would help to ensure that the progress in developing strategies for communication with residents was continued. Some residents records showed that they used makaton signing but staff had not received training in this although one staff reported that they were learning at home. Several had received some training in Challenging Behaviour but discussions showed that this was also an area that staff needed to develop. Staff responses tended to look at how to react to incidents of challenging behaviour rather than having a proactive plan in place to understand and work with the residents. Several of the staff reported that they were doing NVQ 2 but the number of staff doing and having completed the qualification could not be confirmed as no training records were available. Similarly no records were available to confirm the other training that staff had undertaken. We were told that records of these were kept at the company’s head office and not at the home. The home did not currently have a training plan although we were informed that the new company was due to develop this in the near future. The home recruitment and selection procedures were looked at. The staffs personnel files were kept at the company’s headquarters in Loughborough. A sample of staff files were brought to the home and the examination of these files confirmed that the home was confirming staff’s identity. Two files did not contain confirmation that a satisfactory CRB had been obtained and that staff were fit to undertake the work. One file had references that appeared not to have been sought by the company i.e. were headed ‘to whom it may concern’. Highfield Hall DS0000065382.V338296.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41,42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home’s manager is knowledgeable and has the necessary skills to effectively manage the service. The home had procedures in place to review, monitor and improve the service provided to residents. Currently the home could not confirm that residents’ Health and Safety was being safeguarded. EVIDENCE: The manager has been at the home since it opened. He was in the process of doing the NVQ level 4. He was well liked and respected by the staff and relatives and was felt to stand up for residents’ rights. He knew all of the residents and their individual needs. Highfield Hall DS0000065382.V338296.R01.S.doc Version 5.2 Page 27 The home was operating some systems for monitoring and reviewing the service although the home was due to implement a new system used by Rushcliffe Care. Currently the home was checking a range of records including medication; support plans and records relating to the environment. The home also sent relatives and health professionals surveys to gain their views. Residents meetings were held to gain their views. The home maintained a range of records at the home but did not have staff files on the premises hence staff’s training was not able to be confirmed and personnel files had to brought from the company’s head office for inspection. The home had health and safety procedures in place. Checking of sample of records showed them to be up to date and those due e.g. fire equipment were planned. The home was doing the necessary fire checks including the fire alarm, emergency doors and lights. It was noted that the records showed that several emergency lights in one unit had not been working since January. Staff spoken to said they had completed Health and Safety training but due to the absence of records at the home this could not be confirmed. Highfield Hall DS0000065382.V338296.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X 2 2 X Highfield Hall DS0000065382.V338296.R01.S.doc Version 5.2 Page 29 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement All residents must have a detailed care plan that covers all the necessary areas in full including financial and spiritual needs. This will ensure that staff have the necessary information to fully support the residents Timescale for action 01/08/07 2. YA20 13(2) 3. YA20 13(2) 4. YA20 13(2) 01/08/07 The home must develop a comprehensive policy and procedure for the handling of medication within the home, which depicts all of the procedures that are and need to be carried out by the care staff. This will ensure that all staff have the necessary information in order to ensure that the residents’ medication needs are fully met. All handwritten entries on MAR 01/06/07 sheets must be signed and double-checked by another member of staff. This will ensure that no errors are made when transcribing information from the pharmacy label. A procedure for homely remedies 01/08/07 must be put in place that includes the agreement of the DS0000065382.V338296.R01.S.doc Version 5.2 Page 30 Highfield Hall GP. This will protect residents from any problems with combining medications. (Previous timescale of 1/7/06 not met) 5. YA22 22 Accurate records of complaints must be kept including the nature of complaints and the action taken in response. This will show that any complaints had been properly dealt with. The procedure for managing residents’ expenditure must provide a clear audit trail and all records must be correctly completed. This will safeguard residents. (Previous timescale not met of 1/6/06 not met) Sufficent numbers of qualified staff must be provided in order to provide better outcomes for residents. The home’s recruitment procedures must ensure all staff have a satisfactory CRB check and that two references are obtained in order to protect the residents. To ensure residents are protected records relating to the staff employed at the home must be kept at the home and are at all times available for inspection. Emergency lights should be kept in working order ti ensure that proper arrangements are in place to support the residents to evacuate of the home. Staff must have training in Health and Safety issues, including food hygiene, first aid, moving and handling and fire. This will ensure that staff are able to provide residents with a safe environment. DS0000065382.V338296.R01.S.doc 01/07/07 6. YA23 13(6) 01/07/07 7. YA32 18(1) 01/08/07 8. YA34 19 Schedule 2 08/05/07 9. YA41 17(2)&(3) 01/07/07 10. YA42 23(4) 04/05/07 11. YA42 18(1)(a) 01/08/07 Highfield Hall Version 5.2 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA5 YA5 YA8 Good Practice Recommendations To develop the plans in relation to communication and challenging behaviour. To provide support plans in a person centred format To look at methods of increased decision making and participation of residents including those with specialist communication needs. To assess whether residents would be able to mange a front door key. To look ay ways of making the environment in Kingstone View more homely To look at ways making the bathrooms more domestic and homely Staff should receive the necessary training to undertake their role in supporting the residents. This to include such areas as challenging behaviour and communication skills including makaton To develop a training plan for the home 4. YA16 5. 6. 7. YA24 YA27 YA32 8. YA35 Highfield Hall DS0000065382.V338296.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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.V338296.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. 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