Inspection on 29/06/06 for Highfield Road

This inspection was carried out on 29th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Highfield Road 11/05/07

Highfield Road 26/01/06

Highfield Road 16/08/05

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Highfield Road 29 Highfield Road Dartford Kent DA1 2JS Lead Inspector Helen Martin Unannounced Inspection 29th June 2006 2:30 Highfield Road DS0000064649.V296041.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 Road DS0000064649.V296041.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 Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highfield Road Address 29 Highfield Road Dartford Kent DA1 2JS 01322 229600 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) DGSM Limited Miss Theresa Chambers Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26/01/06 Brief Description of the Service: The home provides accommodation and residential care for up to 8 people with learning disabilities. Twenty-four hour supervision is provided. Each service user has a single bedroom (bedrooms are arranged over 3 floors). The premises are close to local facilities and to public transport. There is a car park at the rear. The house is owned by Hyde Housing and leased to DGSMencap Ltd. The premises has a small patio area at the rear. The manager advises potential service users and their supporters that the premises are only suitable for service users with good mobility. Current fees for the home were requested at the time of inspection but not received. Full information about the fees payable and the service the home provides, including inspection reports by the CSCI, are available from the manager. Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on 29th June 2006 between 14.30 and 18.00. The visit included talking with the manager, support workers and residents. Some judgements about the quality of life within the home were taken from observation and conversations. Some records were looked at. A tour of the home and patio area was undertaken. Residents were happy to talk with the inspector about their life within the home. In addition one comment card was received as part of the inspection process from a social care professional. Highfield Road currently has eight residents with no vacancies. What the service does well: What has improved since the last inspection? What they could do better: Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 6 Residents could be better protected by improvements in some health and safety procedures and the administration of medication. They would benefit from some additional facilities and refurbishment. Residents’ changing needs could be better reflected by some improvements to the systems for record keeping, including contracts, risk assessments and care plans. They would benefit from care plans that they could easily understand. Residents could be better protected from potential abuse by some changes to the financial procedures of the home. Their interests could be better promoted by a review of quality assurance, record keeping and written policies and procedures. They would benefit from the full cost of a holiday included in the contract price. Although requested, not all records were available for inspection. It was not possible to fully assess whether residents benefit from comprehensive, easily understandable information before they decide to move in or whether they are fully protected by the systems for staff recruitment and training. 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 Road DS0000064649.V296041.R01.S.doc Version 5.2 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 Road DS0000064649.V296041.R01.S.doc Version 5.2 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): 1, 2, 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents know that the home will meet their needs. It was not possible to assess whether they benefit from comprehensive, easily understandable information before they decide to move in. EVIDENCE: Previous inspection identified that pre-admission information available for prospective residents was contained within one document, designed to include the combined required details of the statement of purpose and service users’ guide; all the information was present with the exception of a copy of a standard contract including terms and conditions of accommodation, the complaints procedure and contact details of the CSCI; the information was not available in a format that would be easy for residents to understand. Updated information was requested at the time of this inspection but not received. Residents benefit from an assessment prior to their admission to the home, to ensure that their needs can be met. The manager explained that although this was generally undertaken by the funding authorities, they would also assess a prospective resident before they moved in. Since the last inspection, the manager’s assessment is recorded. Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 9 Previous inspection identified shortfalls in the personal contract for residents; the manager undertook to review this and to have a revised contract available for any new residents. At the time of this inspection, the manager explained that although the contract had been revised and approved by the head office of DGSM, confirmation was awaited from individual resident’s care managers. Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 10 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, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported to make their own choices and decisions about their lives. Their changing needs could be better reflected in care plans and risk assessments that they could easily understand. EVIDENCE: A written plan of care for each resident is prepared from a pre-admission assessment. Care plans include information regarding residents’ health and social care and likes and dislikes. Documentation seen was not sufficiently holistic and did not fully reflect all of a resident’s changing needs and goals. One care plan contained little information about a resident’s activities. Some records seen were out of date and in need of review. Daily notes are recorded in individual books, although not all accidents and incidents were included. Care planning information continues not to be available to residents in a format that is easy for them to understand. Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 11 Residents are supported to take risks as part of maximising their independence and this is documented; some records are up to date whilst others are not. Residents are encouraged to make choices. They receive continuity of care by having individual key workers. There is evidence that considerable attention is given to helping residents to make decisions about how to spend their time and to avoid the development of very rigid routines. Residents are involved as far as possible in decisions regarding the running of the home. They are involved in some cleaning, cooking and menu planning. A weekly meeting is held about choice of meals. Regular residents meetings are undertaken. Some residents described aspects of their aspirations and goals. These were very diverse as the group of residents have widely differing support needs. Information regarding residents is dealt with appropriately and documents are kept securely. Staff demonstrated an understanding of confidentiality issues. Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 12 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): 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. Residents enjoy individual lifestyles, which include opportunities for social, educational and recreational experiences. They would benefit from the full cost of a holiday included in the contract price. EVIDENCE: Residents are supported towards independent living skills, dependant on their capacity, and also have the opportunity for personal, emotional and social development. Residents are treated as individuals who have different interests and aspirations. Activities and development opportunities are provided accordingly. Residents are part of the local community. Some residents are able to go out independently whilst some need support to do so. During weekdays residents enjoy attending day centres, participating in social events, activities that personally interest them or to further develop their life skills. Transport is Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 13 provided. Activities available include drama, athletics, keep fit, art and craft, cooking, music, swimming and snooker. Four residents are involved in a drama production and one in a local band. Residents regularly enjoy attending nightclubs. Two individuals attend church on a regular basis. Residents spend time at the home in the evening, weekends and on the days when they do not attend day centres or work. They are able to relax watching television and videos or doing puzzles. One resident grows plants in tubs and residents use the patio for barbeques. Residents’ individual interests are encouraged. Support workers support residents with one-to-one time and trips out locally including shopping, meals and coffee out, pubs and live music. They are able to assist residents to continue their education or training and to continue taking part in planned activities. Residents are supported to go to college and work experience. Opportunities are available for residents to undertake paid or voluntary work, including catering, furniture making and gardening. Residents are encouraged and supported with shopping, cooking, cleaning and laundry tasks wherever possible. Laundry and kitchen facilities are domestic in nature. Residents have access to the home’s patio area. Residents are able to see their family and friends as often as they wish. Individuals can visit the home at any reasonable time and can be received in private, either in residents’ rooms or the quiet room. Some residents have very close connections with members of their families who visit regularly and take a close interest in their progress and wellbeing. Some visit their families on occasions. Residents have been able to maintain friendships outside of the home. All residents currently have the opportunity to go on holiday. The organisation pays for staffing and food costs but does not pay for accommodation. Residents enjoy privacy in their rooms and staff respect this. Staff talk to residents in a friendly and polite way. Residents are able to receive phone calls and visitors in private. Residents have meals in accordance with agreed menus, known choices and nutritional needs or preferences. Residents are supported in cooking and menu planning. Two residents were enjoying cooking a meal at the time of this visit. A weekly meeting is held about choice of food and each resident can choose a meal. A written menu is developed from this. The manager, staff and residents demonstrated a good understanding of individuals’ likes and dislikes. The home provides special diets including diabetic. Information, specialist cook books and records are kept regarding Phenyllketonuria (PKU). Staff support all residents that need it with special diets. Residents have access to food and drink whenever they wish. Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 14 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): 18, 19, 20, 21 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from support which meets their individual needs. They would be better protected by improvement to the system for the administration of medication. EVIDENCE: Residents are given the personal support they need to maximise their independence, while respecting their dignity and privacy. Residents are able to exercise choice and they have individual clothing and hairstyles. Staff have an understanding of the preferred routines of each resident. Residents have access to social and health care professionals. They are supported with any specialist appointments. Residents’ nutrition and weight is monitored and recorded and dieticians are accessed if necessary. It was said that a medication review had improved one individual’s epilepsy. Residents with mental health difficulties in addition to learning disabilities are supported with issues and access to psychiatrists, although some information regarding this in care plans was out of date. Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 15 No residents currently keep their own medication. One resident administers one of their medications under supervision from staff and has done for some time, although no appropriate documentation, GP approval or risk assessment were in place to support this. The manager said that a specialist nurse had assessed the resident as able to self-medicate in this respect, although a GP letter was seen stating that they were not suitable. Arrangements are in place for the storage and administration of medication by the home. Storage is secure, although a designated controlled drugs cabinet is not used. Since the last inspection, the home has obtained a designated logbook for the recording of controlled drugs. MAR (medication administration record) sheets seen were completed appropriately, with the exception of some handwritten entries; these were not countersigned as accurate or supported by written confirmation from the prescribing GP. Records are kept with photographs of residents and a staff signature list, although this was in need of updating. The manager said that the home no longer used any homely remedies. The manager demonstrated a good understanding of the challenges faced by residents regarding the death of a person close to them. Residents have been supported to come to terms with their loss according to their individual capacity. Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ views and concerns are listened to, which receive appropriate consideration. They could be better protected from potential abuse by some changes to the financial procedures of the home. EVIDENCE: Residents are at ease and confident talking with the manager and support workers who listen to their views and concerns; they know who to complain to if they need to. The home provides a written complaints procedure, a précis of which is displayed within the home. Residents have access to this in a format that they can easily understand. A record of all complaints is kept; currently one is in the process of investigation. Previous inspection identified that residents are protected from potential abuse by the procedures in place within the home. The home follows the Kent & Medway Policy for Adult Protection. Since the last inspection, the organisation has reviewed the home’s adult protection and whistleblowing policies, which are available for staff. The manager demonstrated a good understanding of the procedures involved. The home has a system in place, which aims to protect the financial interests of residents and holds small amounts of cash on the behalf of some. This is kept securely. All money is stored individually and transaction records are maintained. Cash checked tallied with accounts seen. Receipts are kept for purchases made. Previous inspection identified that the financial system is Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 17 audited regularly by the home and by the head office of DGSM; DGSM has held appointeeship for one resident for some time, as no other options are viable. Previous inspection identified that residents’ personal possessions and valuables are documented, although records are not signed or dated by the resident and/or their representative or staff. During this inspection it was noted that items kept secure by the home on behalf of one resident were not documented. Discussion took place regarding items that residents paid for. It was evident from discussion with the manager that residents had paid for pillowslips, duvet covers and towels. It was agreed at the time of inspection that the home should provide the items listed in Standard 26 and that residents should not pay for them. It was agreed that if residents wished to purchase any additional items over and above those provided by the home then they should be enabled to do so. All residents who have purchased items listed in Standard 26, that were not additional to those provided by the home, should receive a full refund by 18th August 2006. Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 18 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, 25, 26, 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a clean, comfortable and homely environment, however this would be enhanced by some additional facilities and refurbishment. The premises are best suited for people with few mobility difficulties. EVIDENCE: The building fits in with the local community and has a style and atmosphere that meets individuals’ needs. Residents have unrestricted access in the house and to the patio area. Residents benefit from living in a clean and comfortable accommodation. The premises are generally suitable for their current needs. Previous inspection identified long term plans for the future of the home; it is planned that a local purpose built premises will replace the current building. The house is maintained and decorated by ‘In Touch’, a representative of which meets with the home on a regular basis. The manager said that any repair or maintenance required was undertaken in good time. Since the last inspection some shower and bathroom facilities have been refurbished and an Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 19 additional toilet provided. A fly tipped bed has now been removed from the patio and this has been improved, however further development is necessary as this is the only outside area available for residents at the home. The manager said that works were due to commence shortly. The manager is currently in the process of arranging for all carpets, bedheads and upholstered chairs to be cleaned; it was mentioned that this would be undertaken shortly. Previous inspection identified that a potentially dangerous wall at the rear of the premises had been identified as belonging to a neighbouring property; a fence had been erected in front of the wall to avoid any potential risk to residents. It was stated that the kitchen would be refurbished. Adequate recreational, dining, toilet, bathing and individual accommodation are available to residents. The home provides a lounge, dining area and a quiet room. All residents have their own rooms, arranged over three floors. Residents clearly like their rooms, which are all individual and highly personalised. They are able to choose the colour schemes and how their furniture should be arranged. Bedrooms meet service user’s needs and are well furnished. Issues regarding the payment for the provision of pillowslips, duvet covers and towels have been mentioned previously within this report. There are no lifts, specific environmental adaptations or disability equipment within the home. The manager indicated that some equipment would be provided if a resident’s review determined a need. Current residents have few mobility problems. Previous inspection identified that the new planned premises would have environmental adaptations. Discussion took place regarding the staff call system; currently call points are in bathrooms and toilets only. Previous inspection identified that the system should be extended to residents’ rooms. The manager said that currently residents continue to make their way to the locked door of the staff sleep-in room if they need assistance at night. It was said that the Board of DGSM is currently considering an extension to the existing system. The premises are clean and hygienic. There is a laundry room used by residents with support from staff. Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 20 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): 31, 32, 33, 34, 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a sufficient number of qualified staff who have a good understanding of their needs. It was not possible to assess whether residents are fully protected by the systems for staff recruitment and training. EVIDENCE: Staff showed a good understanding of residents’ needs and the homes philosophy and values. Residents benefit from good support and interaction. Staff communicate well with each other. The home has a stable staff team. The manager explained that since the last inspection the home has reviewed the induction training offered to new staff. It was mentioned that both induction and foundation training were now linked to LDAF, although no documentation was available at the time of inspection. Current evidence of induction training consists of a tick list with brief detail, one of which was not completed. Training certificates are kept in staff files. It was mentioned that the restraint policy was presently under review and would change together with staff training. The manager explained that most staff had received training in Epilepsy. Previous inspection identified that although most core courses had been undertaken, there were some gaps. As part of this Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 21 inspection, the staff training matrix was requested but not received. The manager stated that six out of seven permanent staff members have obtained an NVQ qualification. Staffing hours are flexible dependant on the needs of residents. Staff support residents with cooking, cleaning and laundry tasks wherever possible. No ancillary staff are employed by the home. Staffing hours are recorded on a roster and since the last inspection individuals’ full names have been recorded. The manager explained that although they were short staffed at the moment, they were in the process of recruitment and gaps should be filled shortly. It was said that the home used little agency workers and had bank staff to cover any absences. A procedure is in place that aims to appoint suitable staff who can support the needs of residents. Staff files evidenced that some pre-employment checks had been undertaken, although they continued not to include proof of identity. The manager said that questions asked and the answers given at interview would include a record of any employment gaps. It was stated that this, together with proof of identity and evidence of a POVA first check continued to be kept at the head office of DGSM, and therefore continued not to be available for inspection. Previous inspection identified that the home’s application form did not contain the facility for the self-disclosure of any cautions. A copy of this was requested as part of this inspection but not received. Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 22 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): 37, 38, 39, 40, 41, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a well run home, although their interests would be better promoted by a review of quality assurance, record keeping and written policies and procedures. Residents’ welfare is promoted, although they could be better protected by improvements in some health and safety procedures. EVIDENCE: The registered manager is a registered nurse with experience in the care of people with learning and physical disabilities in residential and clinical settings. She has achieved a DMS (Diploma in Management Studies). There is an open and inclusive atmosphere in the home. Residents were comfortable chatting and spending time with staff. Residents’ meetings are held regularly. Residents were happy to speak with the inspector about life within the home. Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 23 The quality assurance system for the home was discussed. It was said that although questionnaires were used internally they were not sent to relatives of residents or relevant health and social care professionals. The manager explained that the home also uses an internal auditing system and changes could be made dependant on the results. Previous inspection identified that although the home receives some feedback from the head office of DGSM, a full system of formal analysis and feedback had not yet been developed. The home has comprehensive recorded policies and procedures that are available for staff. Since the last inspection the majority of these have been updated by DGSM with the remaining few currently in the process of review. It was mentioned that the restraint policy was presently under review and would change together with staff training. A number of records have been looked at as part of the inspection process. These have been mentioned within this report where appropriate. Accidents and incidents are recorded appropriately, although recent documentation did not include details of the investigation or any action taken. Records and certificates indicated the regular testing and maintenance of systems and equipment within the home. The staff call system is tested internally on a regular basis, although there is no external maintenance contract with a specialist company. Window restrictors are fitted upstairs, although previous inspection identified that these would be replaced by a type that were not easily removed. The manager stated that this would be undertaken at the same time as maintenance of the windows. The kitchen was maintained in a clean and hygienic manner. The manager explained that although hot food temperature was tested, this was not recorded. Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 24 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 2 2 3 3 X 4 X 5 2 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 2 25 3 26 3 27 3 28 3 29 2 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 3 2 2 2 2 X Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4&5 Requirement The registered person shall produce a written guide to the care home. In that, the reviewed combined statement of purpose and service users’ guide must include a copy of a standard contract including terms and conditions of accommodation, the complaints procedure and contact details of the CSCI. Updated information was requested at the time of this inspection but not received. This requirement has been repeated from inspection dated 16th August 2005 and 26th January 2006. 2 YA1 YA34 YA35 YA41 Highfield Road Timescale for action 20/08/06 17(3)(b) Sch 46(f) The registered person shall ensure that the records referred to in Schedule 4 are at all times available for inspection in the home by any person authorised by the Commission to enter and DS0000064649.V296041.R01.S.doc 20/08/06 Version 5.2 Page 26 inspect the care home. In that, proof of identity, POVA First checks and records of any gaps in employment continue not to be available for inspection and therefore it is not possible to evidence a thorough recruitment procedure. Not all staff training records were available for inspection and therefore it is not possible to fully evidence thorough training procedures. A copy of the updated statement of purpose/service users’ guide was requested at the time of this inspection, but not received. All records must be made available for inspection at any time; potential further action may be taken by the CSCI should this timescale not be met. Issues regarding recruitment records have been repeated from inspection dated 26th January 2006. 3 YA6 YA9 15 ‘…the registered person shall…prepare a written care plan as to how the service users needs in respect of health and welfare are to be met’ In that, care plans and risk assessments must fully reflect all of resident’s changing needs and goals and be kept up to date. Daily notes must Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 27 20/08/06 include all accidents and incidents. 4 YA20 13 (2) The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. In that, documentation and risk assessments must evidence that residents are suitable to self-medicate; handwritten entries in medication administration record sheets must be countersigned as accurate and supported by written confirmation from the prescribing GP; the signature list for trained staff assessed as competent to administer medication must be kept up to date. 5 YA23 13 (6) The registered person shall make arrangements, by training staff and by other means, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. In that, it was agreed at the time of inspection that the home should provide the items listed in Standard 26 and that residents must not pay for them; it was agreed that if residents wished to purchase any additional items over and above those provided by the home then they should be enabled to do so; all residents who have Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 28 20/08/06 18/08/06 purchased items listed in Standard 26, that were not additional to those provided by the home, must receive a full refund by 18th August 2006. 6 YA35 18(1)(c)(i) The registered person shall ensure that staff working at the home receive training appropriate to the work they are to perform. In that, the staff training documentation available for inspection did not fully evidence thorough procedures. This requirement has been repeated from inspection dated 26th January 2006. 20/08/06 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 It is recommended that the information contained within the combined statement of purpose and service users’ guide should be available in a format that is easily understood by service users. In that, a copy of the statement of purpose/service users’ guide was requested as part of this inspection but not received. This recommendation has been repeated from inspection dated 26th January 2006. 2 YA5 Revised personal contracts should contain more specific information regarding the service provision for individual DS0000064649.V296041.R01.S.doc Version 5.2 Page 29 Highfield Road service users. In that, the manager explained that although the contract had been revised and approved by the head office of DGSM, confirmation was awaited from individual resident’s care managers. This recommendation has been repeated from inspection dated 16th August 2005 and 26th January 2006. 3 YA6 It is recommended that care planning information is available to residents in a format that is easy for them to understand. In that, care planning information continues not to be available to residents in a format that is easy for them to understand. This recommendation has been repeated from previous inspection dated 26th January 2006. 4 YA9 It is strongly recommended that the manager complete their stated intention to update and review all recorded risk assessments. In that, it continues to be the case that not all recorded risk assessments are up to date. This recommendation has been repeated from inspection dated 26th January 2006. 5 YA14 It is recommended that the cost of residents’ accommodation when on holiday should be included in the basic contract price. In that, although currently all residents have the opportunity to go away, the organisation continues to pay for staffing and food costs only and not for accommodation. This recommendation has been repeated from inspection dated 26th January 2006. 6 YA20 It is strongly recommended that, with regard to medication: A designated controlled drugs cabinet and logbook should Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 30 be used. GPs’ approval of the use of some homely remedies should be evidenced in documentation. In that, since the last inspection a designated controlled drugs book has been used and the home no longer uses any homely remedies. However controlled drugs continue not to be stored within a designated cabinet. This recommendation has been repeated from inspection dated 26th January 2006. 7 YA23 It is recommended that records of residents’ personal possessions and valuables should be signed and dated by the resident and/or their representative and staff. In that, previous inspection identified that residents’ personal possessions and valuables are documented, although records are not signed or dated by the resident and/or their representative or staff. During this inspection it was noted that items kept secure by the home on behalf of one resident were not documented. This recommendation has been repeated from inspection dated 26th January 2006. 8 YA24 The rear patio area should be developed as a safe and useful amenity for service users. This is particularly important in the absence of a garden at the premises. In that, although the patio area has been improved, the home continues to await further developments. The manager said that works would commence shortly. This recommendation has been repeated from inspection dated 16th August 2005 and 26th January 2006. 9 YA24 It is recommended that, as service users on the 3 floors must make their way to the locked door of the room where the (sleeping) support worker is based at night, the call bell system should be extended to all bedrooms. In that, it was said that the Board of DGSM is currently considering an extension to the existing system. This recommendation has been repeated from Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 31 inspection dated 16th August 2005 and 26th January 2006. 10 YA24 It is recommended that the manager should complete their stated intention to clean the downstairs corridor carpet as soon as possible. It is strongly recommended that, with regard to staff recruitment files: Records regarding questions asked and answers given at interview should be kept within the home. The application form should contain the facility for the selfdisclosure of any police cautions. In that, records of questions asked and answers given at interview continue not to be kept within the home; a copy of the revised application form was requested as part of this inspection but not received. This recommendation has been repeated from inspection dated 26th January 2006. 12 YA39 It is strongly recommended that with regard to quality assurance, a system of formal analysis and feedback should be developed. In that, although some quality assurance takes place, systems are not fully developed. They do not include feedback from relatives of residents or health and social care professionals and the home does not receive regular formal feedback from head office. This recommendation has been repeated from inspection dated 26th January 2006. 13 YA40 It is recommended that DGSM complete the review of policies and procedures to ensure that they are up to date and specific to the home. In that, since the last inspection the majority of these have been updated by DGSM with the remaining few currently in the process of review. This recommendation has been repeated from inspection dated 26th January 2006. 11 YA34 Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 32 14 YA41 It is strongly recommended that the manager complete their stated intention to update and review all recorded risk assessments. In that, it continues to be the case that not all recorded risk assessments are up to date. This recommendation has been repeated from inspection dated 26th January 2006. 15 YA41 It is strongly recommended that all accident and incident records should be kept up to date to include details of the investigation and any action taken. It is recommended that the manager complete their stated intention to replace existing window restrictors with a type that is not easily removed. In that, the manager stated that this would be undertaken at the same time as maintenance of the windows. This recommendation has been repeated from inspection dated 26th January 2006. 16 YA42 17 YA42 It is strongly recommended that, in the absence of an external maintenance contract with a specialist company, a review should be undertaken to ensure that prompt and adequate repair and maintenance to the staff call system could be undertaken if necessary. It is strongly recommended that hot food temperatures should be recorded in order to evidence that these are being tested where necessary. 18 YA42 Highfield Road DS0000064649.V296041.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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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