Inspection on 15/12/05 for Highfield House

This inspection was carried out on 15th December 2005.

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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Highfield House 24/01/09

Highfield House 25/02/08

Highfield House 26/04/06

Highfield House 22/04/05

Highfield House 07/09/04

Highfield House 05/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Highfield House London Road Stroud Glos GL5 2AJ Lead Inspector Peter Still Unannounced Inspection 15th December 2005 09:45 Highfield House DS0000016465.V271117.R01.S.doc Version 5.0 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 House DS0000016465.V271117.R01.S.doc Version 5.0 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 House DS0000016465.V271117.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Highfield House Address London Road Stroud Glos GL5 2AJ 01453 758618 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) Stroud Care Homes Limited Mr David Donald Harley Care Home 7 Category(ies) of Learning disability (7), Mental disorder, registration, with number excluding learning disability or dementia (3) of places Highfield House DS0000016465.V271117.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd April 2005 Brief Description of the Service: Highfield House is a detached house with accommodation for seven adults with a learning disability or mental health need who may display behaviour that challenges the service. The home is situated close to the centre of Stroud and residents are able to access public transport easily. Highfield House is one of three homes owned and managed by Stroud Care Homes. The home is staffed 24 hours a day, seven days a week. Family and friends are welcome to visit the home at any time and service users can meet them in private if they wish to. Residents have single rooms and access to two a large communal lounge, a smaller lounge and a kitchen/diner. There are substantial gardens to the rear of the home. The service users attend a local day centre, a nearby college and work experience placements. Highfield House DS0000016465.V271117.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over five hours and the manager supported the process. There were no vacancies and three residents and three staff were specifically spoken with. A tour of the home was carried out and records were reviewed, including the files for two residents for the purpose of case tracking. The atmosphere at the home was busy with residents involved with their planned arrangements and general daily activity. One resident was well supported by staff to ensure potentially challenging behaviour was channelled. Residents gave high praise for the way staff support them. What the service does well: What has improved since the last inspection? Care planning systems have improved. Comprehensive risk assessments for residents, including specific care strategies, were being reviewed monthly and the manager had clearly worked hard since the last inspection to make further progress with these. The responsible individual had supported the manager to engage a named psychologist on a regular monthly basis to support staff on a one to one and group basis. This included work on preventative and coping strategies, which was highly valued by staff. Highfield House DS0000016465.V271117.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Highfield House DS0000016465.V271117.R01.S.doc Version 5.0 Page 7 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 House DS0000016465.V271117.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Prior to residents moving into the home, detailed information and assessment was undertaken to ensure appropriate admission. EVIDENCE: Two care plans were reviewed and comprehensive documentation was seen, which enabled the home to consider the needs and past history of residents. One file had a good index but the index was missing on another. It was possible that a member of staff had been using it for their NVQ work at the time of inspection and the manager said he would investigate and ensure it was replaced. The manager was working through the general filing system, replacing care plans file holders with new ones of excellent construction. This was considered to be a good investment for files that have high usage. Prior to admission a trial visit was provided and staff discuss new residents to consider their suitability. Current residents views were also sought. Parents were involved in a pre admission meeting in one case reviewed. One care plan was not signed or dated and the two contracts reviewed were not fully complete. A requirement will be made that they meet the standard. All contracts must include the bedroom to be used; the fee payable and contracts must be signed and dated. Highfield House DS0000016465.V271117.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Comprehensive care plans and risk assessments, which include resident input, protect and help residents to make progress. An annual survey and regular resident meetings and communication with key workers ensure residents are consulted and participate in the life of the home. EVIDENCE: The manager has worked hard since the last inspection to make further progress in the care planning arrangements at the home. Care plans and risk assessments were seen to be comprehensive. Two care plans were reviewed and the risk assessments were seen to be detailed, covering a number of key risk areas. Recording was thorough and up to date. Daily recording was reviewed monthly by key workers to support a monthly report, which included input from residents. Two residents said they were well supported by their key workers and were involved with their care plans. They praised staff for the way they provided support and felt they were making progress. One resident, talking about their key worker was pleased that “if I step off base line, he will put me straight back on”. This concerned the care plan. The resident whilst not happy at the time said that the key worker was acting properly and for their benefit, which was appreciated. Three staff and the resident were involved in monthly care plan reviews. The key worker follows up the review Highfield House DS0000016465.V271117.R01.S.doc Version 5.0 Page 10 with a draft, which is typed and discussed with the resident, being signed when the resident is happy with it. The manager had produced clear and detailed individual strategies to ensure consistent care was provided and for staff to use for quick reference. These were held on resident’s files and posted up in the office in large print, with emergency phone numbers in red. Staff said they felt confident with the support and information available. Two residents confirmed they were consulted about the running of the home and find the regular house meetings valuable. They said they can raise issues, are listened to and action was taken, though they both said that there were current difficulties with one resident, whom they felt should be in hospital, when the person was unwell. The home had a policy of locking the front door of the home and using an alarm if the door were opened. A key was provided within a ‘break glass’ box by the front door. Following the inspection, the inspector considered this with the fire officer, who said there should be thorough risk assessment regarding the procedure and specific staff training. At the time of inspection the inspector did not ask to see the work place risk assessment concerning the front door and is not able to make a comment. Clearly the provider has responsibility to ensure the procedure is only used following risk assessment, which is judged to ensure safety of residents, staff and others who visit the home. If the provider needs more guidance, the fire safety officer would be happy to be consulted. Highfield House DS0000016465.V271117.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14, 17 Residents have opportunity for a range of social, recreational and educational activities but are restricted due to lack of appropriate transport. Residents have choice and control over the menu. EVIDENCE: The last inspection made a requirement that will be repeated that there must be review of the transport system available at the home to ensure it met resident’s needs. Two residents raised concern about the lack of suitable transport and the negative effect for residents in that they could not always go out when they wished or needed or as a larger group. The current vehicle enables two staff and two resident to go out, causing staffing restriction. Resident’s behaviour can challenge the service and cause stress and unrest amongst residents. It was considered that the ability of residents to have more choice about going out would reduce tension and promote contentment and the goals residents work towards. Residents said they enjoy the wide range of activity available to them, which includes: College; work experience with Smartworks; shopping; bowling; holidays; pubs and swimming. One residents said they were saving money to go to the USA next year and a resident enjoys cooking, sharing a very tasty Highfield House DS0000016465.V271117.R01.S.doc Version 5.0 Page 12 Christmas cake he/she had made with the inspector. Records were maintained about resident’s activity, which was recorded for each individual. The location of the home ensures good contact within the community and the local CAB was supporting a resident with an issue concerning a local company. Each resident has a day when they choose the menu and help with the cooking. Staff record the menu plan and check to ensure it is balanced. Residents also had choice where requested. A resident said that they go shopping and help to buy the food and other household items. The home has a checklist sheet for shopping to help remember the essential items required. Some £600 was available each week to cover the needs for the home and found to be adequate. Highfield House DS0000016465.V271117.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 Comprehensive recording demonstrates that resident’s physical and emotional needs are met or that staff work hard to support progress. Good administration of medication protects residents. EVIDENCE: Detailed healthcare records for two residents reviewed were maintained within care files and showed appointments and contact with agencies and key professionals. Significant and consistent external support was provided by the CLDT/CMHT and by a psychologist, who visits monthly to provided staff with one to one and group support. The last inspection raised concerns that support from the CLDT had not been put in place and the manager has responded well to this since the last inspection. Also the manager ensures staff have a group debriefing session at the end of every work shift and that if staff need further individual support, it can be provided. The protocols and guidance for staff as they work with residents and at times of stressful situations was very detailed. No residents held their own medication. The system was looked at, and found to be organised, the records for two residents were correct and up to date. Staff receive annual training in the administration of medication and the manager completes a monthly audit. Highfield House DS0000016465.V271117.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Residents are protected by staff that listen and act on concerns. The complaints process needs further review and staff need training concerning the protection of vulnerable adults. EVIDENCE: One resident said that the best thing about the home was the staff and the support they give. Whilst there was an understanding that residents felt safe and protected by staff, two residents talked of concerns they had about a resident and one said she/he had made a complaint to a member of staff. This was confirmed with the member of staff and was being addressed. One resident said “you need to be able to switch off from it”, referring to difficulties when a resident was “unwell”. A resident said it would be helpful if the home had a People Carrier so that residents could get out more and when there were difficulties. The manager said residents would need help to be more understanding and to use parts of the building, which were quiet. Apart from bedrooms, residents have some four areas they can use. During the inspection, staff were observed to be highly aware of residents needs and able to channel and diffuse challenging behaviour. Complaints were recorded under the regulation 37 reporting procedure, which concerns any event, adversely affecting the well being or safety of any resident. Incidents were properly recorded and submitted to the CSCI, however complaints need to be kept separate. It was understood there had been no recent complaints apart from the one the inspector was made aware Highfield House DS0000016465.V271117.R01.S.doc Version 5.0 Page 15 of at the inspection. Whilst a complaint may lead to a regulation 37 report, it may not and the complaints process must be reviewed to ensure clarity of process and separation from the reporting of incidents. Standard 22 will be helpful to consider and provision of a complaints file, which includes the policy and procedure will be recommended. Staff read the policy and procedures about vulnerable adults when they are inducted, however the full policy was not easily available at the inspection. Where policies and procedures are held, their labelling and indexing should be reviewed. A young volunteer member of staff was questioned about their understanding of adult protection and of steps to take. An excellent response was given, however there was no evidence of recent training concerning adult protection and another member of staff could not recall having had training. The manager said he had taken steps to provide training, through the social services adult protection coordinator and a requirement will be made for this to take place. Highfield House DS0000016465.V271117.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 Residents live in a comfortable home. Some environmental issues should be addressed to provide residents with a good quality environment. EVIDENCE: The manager had addressed a number of points from the last inspection. The kitchen and dining area was homely and a good focal point for the home. A requirement will be repeated to provide paper towels near the washbasin in the kitchen. A file wedged the fire door to the 2nd floor landing open and the manager immediately removed it; when staff use the office near this door, they cannot support staff immediately when needed if the door is closed. Clearly it is essential for staff to be able to hear the mood of the home and a requirement will be made for the issue to be reviewed. If it is decided that the fire door should be held open, there must be consultation with the fire and rescue service to ensure they are content with any equipment being installed. The shower/WC on the top floor needs refurbishment and it was understood that this would take place from January of 2006. A call pad to alert night staff of a resident leaving their room at night was not working properly and the manager said he would ensure it was resolved on the day of inspection to support night staff. Highfield House DS0000016465.V271117.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35, 36 The manager will be supported by two senior staff from the beginning of the New Year. Staff recruitment and supervision protects residents, however they are not protected by a qualified staff team. EVIDENCE: Two files were reviewed for staff recently appointed and the recruitment process was satisfactory. Evidence of staff identification was also seen. Their supervision records were reviewed, showing good records had been maintained with six weekly supervision and dates for these were posted up in the office. The manager, a qualified nurse, was completing the manager’s award. No other staff held an NVQ certificates. The manager has ensured that all but two new staff were undertaking their qualification at level 3. The expectation was that 50 of staff would be qualified by September 2006. Two valued senior staff had recently gained promotion and due to be replaced on 3rd of January. This will provide the manager and staff team with essential support and a full staff team. The company was recruiting a new staff-training officer and this person will ensure the training standard is met. Highfield House DS0000016465.V271117.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39, 43 Resident’s views are listened to in the development of the home and the responsible individual supports decision-making and accountability. Policies and procedures were in place but need to be more easily available. EVIDENCE: Two residents said they were listened to and other residents indicated they were consulted. The resident survey, which was about to be repeated and house meetings provide residents with opportunities for involvement and discussion. The manager and key workers also meet with residents individually. Residents had been involved in staff recruitment, where their views had been taken into account. The manager values the support of the responsible individual and the regulation 26 visits. The manager has worked hard during the last two years to develop the home and has made very good progress. Documentation and information systems were held in four places on the premises, including the company headquarters. Space for documentation, Highfield House DS0000016465.V271117.R01.S.doc Version 5.0 Page 19 policy and procedures is often a difficult compromise for homes and the reasons are understood. Substantial shelving had recently been provided in the second floor office to ease the difficulty. There will be a recommendation for review to see if further ideas could lead to improvements to the general filing system. The inspector would like to see clearly labelled files in logical order, which are easy for staff to locate and use. The use of new top quality files should also be continued where possible. Highfield House DS0000016465.V271117.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 2 X X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 2 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Highfield House Score X 3 3 X Standard No 37 38 39 40 41 42 43 Score X X 3 X X X 2 DS0000016465.V271117.R01.S.doc Version 5.0 Page 21 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 YA13 Regulation 16(2)(m) (n) Requirement Review the transport systems available to the home and ensure it meets the needs of residents. (Previous timescale of 31 July 2005 not met) A paper towel dispenser must be provided near the hand washbasin in the kitchen. (Previous timescale of 31 May 2005 not met) Support staff with their NVQ training. Review support arrangements so that staff can be assisted when needed. This concerns the 2nd floor-landing door and need for staff to hear staff & residents. Provided staff with training concerning the protection of vulnerable adults. Ensure the complaints procedure fully complies with the standard. Ensure contracts are fully completed Timescale for action 31/03/06 2. YA30 13(3) 28/02/06 3 4 YA32 YA42 18 13 (4)(c) 30/04/06 28/02/06 5 6 7 YA23 YA22 YA5 13 (6) 22 5 28/04/06 28/02/06 28/02/06 Highfield House DS0000016465.V271117.R01.S.doc Version 5.0 Page 22 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 YA41 Good Practice Recommendations Review the storage of files to see if improvements can be made to provide easier access for staff. Highfield House DS0000016465.V271117.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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