Inspection on 19/12/05 for Highfield Road (5)

This inspection was carried out on 19th 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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Highfield Road (5) 11/06/07

Highfield Road (5) 15/08/06

Highfield Road (5) 23/11/04

Highfield Road (5) 10/05/04

Similar services:

Foxley Lane (121a)

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

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

CARE HOME ADULTS 18-65 Highfield Road (5) 5 Highfield Road Purley Surrey CR5 2JJ Lead Inspector James O`Hara Unannounced Inspection 19th December 2005 08:30 Highfield Road (5) DS0000028115.V271440.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 Road (5) DS0000028115.V271440.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 Road (5) DS0000028115.V271440.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Highfield Road (5) Address 5 Highfield Road Purley Surrey CR5 2JJ 020 8660 6676 020 8660 1547 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) Surrey Oaklands NHS Trust Ms Jeanette Campbell Care Home 11 Category(ies) of Learning disability (11) registration, with number of places Highfield Road (5) DS0000028115.V271440.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th April 2005 Brief Description of the Service: 5 Highfield Road is a residential home for adults with physical and learning disabilities, it is owned, managed, and staffed by the Surrey and Borders Partnership NHS Trust, a specialist health provider for people with learning disabilities. There are ten residential places at the home and one respite bed. Highfield Road is a large detached house located in a quite residential road in a quiet area of Purley and is well placed for access to Croydon and Purley town centres. The home has a large lounge, separate dining room, kitchen and laundry room. There is also a sensory room attached to the lounge. To the rear of the home is a large, well-maintained private garden, which is very popular with the service users in the summer months. Highfield Road (5) DS0000028115.V271440.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second inspection at the home this year the first took place in April. The inspection began at 8.30 am and finished at 10.30 am on a Monday morning. Methods of inspection included previous inspection experience of the home, observation of contact between staff and service users and discussion with staff on shift. Records examined included Person Centred Plans, care plans and the homes record of maintenance. The home manager is presently on Maternity Leave, in the mean time the deputy manager is acting as the home manager. The acting home manager was not present and the service manager was not available on the day of the inspection so the senior member of staff on shift ably supported with the inspection process, she provided evidence where she could regarding requirements and recommendations set at the last inspection. What the service does well: What has improved since the last inspection? What they could do better: There were six requirements and six recommendations set at the last inspection. The senior member of staff provided evidence that three requirements and four recommendations had been met however requirements set in the staffing standards could not be inspected as she could not access staffing information. As a result of this inspection the two requirements under the staffing standards have been amended. A requirement and a recommendation have been reviewed and amended into one requirement. Highfield Road (5) DS0000028115.V271440.R01.S.doc Version 5.0 Page 6 The recommendation that the home manager consider other options for storage of the hoist has been removed as the member of staff on shift explained that there were no other places in the home where it could be kept. The overall impression when visiting the home is that it is well organised however some service users still need to have their care plans/placements reviewed by their care managers and requirements in the staffing standards need to be inspected. The inspector would like to thank the service users, the senior member of staff on shift and all other staff for their support on the day of the inspection. 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 (5) DS0000028115.V271440.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 Road (5) DS0000028115.V271440.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): 0. Standards 1, 2 and 5 were assessed as met at the last inspection. EVIDENCE: At the last inspection it was noted that the quality of information provided for prospective service users was good. The homes Statement of Purpose and Service User Guide had been reviewed a given to service users. No new service user has moved into the home since the last inspection. Highfield Road (5) DS0000028115.V271440.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. Standards 7 and 9 were assessed as met at the last inspection. All service users have a My Plan in place, however some service users have yet to have their care plan/placement reviewed by their care managers. If this is not rectified it could lead to service users not receiving the services they need. EVIDENCE: A requirement was set at the last inspection that the home manager ensures that all service users have their needs assessed by their care manager. Three service users files were examined there was evidence that service users care managers attended Person Centred Planning reviews however the service users care plans had not yet been reviewed. A recommendation was set at the last inspection that the home manager arranged a meeting with service users, relatives and the care managers to address a previous recommendation in relation to phasing out the homes only shared room by 1st April 2004, unless it can be demonstrated that the two service users currently occupying the double room choose to share. Highfield Road (5) DS0000028115.V271440.R01.S.doc Version 5.0 Page 10 In order that the previous requirement and recommendation can be fully addressed a requirement is set that the home manager ensures that all service users have their care plans reviewed by their care manager and that the issue of the two service users sharing a bedroom is discussed as part of their review. It was identified at the last inspection that service user files were heavy and cumbersome some of the information was old and should be archived. The service users files have been reviewed and old information has been archived. Highfield Road (5) DS0000028115.V271440.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): 0. Standards 12, 13, 14, 15, 16 and 17 were assessed as met at the last inspection. Service users at Highfield Road have severe learning disabilities the home offers plenty of activities both in the home and in the community. Through discussions with relatives at the last inspection there was evidence of a strong relationship with service users relatives and staff at the home. EVIDENCE: Highfield Road (5) DS0000028115.V271440.R01.S.doc Version 5.0 Page 12 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): 20. Standards 18, 19 and 20 were assessed as met at the last inspection. EVIDENCE: A recommendation was set at the last inspection that medication stored in the homes fridge is kept on a separate shelf so as to reduce the risk of contamination. It was observed that this medication is stored in a locked tin in a separate shelf in the fridge. Highfield Road (5) DS0000028115.V271440.R01.S.doc Version 5.0 Page 13 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. Standards 22 and 23 were assessed as met at the last inspection. EVIDENCE: The member of staff on shift stated that there had been no complaints made to the home since the last inspection. Highfield Road (5) DS0000028115.V271440.R01.S.doc Version 5.0 Page 14 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): 25, 26, 28 and 30. There have been some improvements to the homes décor since the last inspection and an effort has been made to ensure that service users live in a more homely and comfortable environment. EVIDENCE: Light shades have been replaced in the living room as required at the last inspection. The living room has been redecorated as recommended at the last inspection. A requirement was set at the last inspection that the home manager must ensure that the cabinet in the living room is repaired. The cabinet in the living room has been removed however appropriate furnishing is in place. The member of staff on shift stated that service users have chosen new furniture for the living room as recommended at the last inspection. This furniture has yet to be received at the home. On the day of the inspection the home was comfortable, clean and hygienic. Highfield Road (5) DS0000028115.V271440.R01.S.doc Version 5.0 Page 15 It was noted that the wall above the respite room door was damp. The member of staff on shift contacted the works department so that they could come to the home and investigate the cause. Highfield Road (5) DS0000028115.V271440.R01.S.doc Version 5.0 Page 16 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): 32 and 34. Standards 33, 35 and 36 were assessed as met at the last inspection. As stated in the last inspection the home has an experienced well established staff team who have had relevant support and training enabling them to meet the needs of the service users living at the home however some staff completed this training some years ago and are in need of refresher training. EVIDENCE: The acting home manager was not present on the day of the inspection and the service manager was not available. The member of staff on shift could not access staffing information. Requirements set at the last inspection that the home manager ensures that staff has their training needs assessed, that staff receive training on Adult Protection and that the home manager inform the Commission when staff Criminal Records Bureau Checks are available in the home for inspection could not be fully inspected. Therefore the acting home manager must send evidence to the Commission that all staff have had their training needs assessed and that all staff has received training on Adult Protection. Highfield Road (5) DS0000028115.V271440.R01.S.doc Version 5.0 Page 17 The acting home manager must make arrangements with the Commission for staff Criminal Records Bureau Checks to be examined. . Highfield Road (5) DS0000028115.V271440.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): 37 and 42. Standard 39 was assessed as met at the last inspection. The home manager is presently on maternity leave however the deputy manager (acting as the home manager) and most of the staff have worked in the home for a number of years thus ensuring stability and familiarity for the service users. EVIDENCE: The home manager Elizabeth Mahdi is presently on Maternity Leave the member of staff on shift stated that she might return back to work around March 2006. Elizabeth Mahdi has applied to the Commission to be the registered manager for the home. In the mean time Sue Johnson the deputy manager is acting as the home manager. Evidence was provided for a Portable Appliance Test 02/02/05. The test had been requested from the trusts works department by the home on this date however the test was completed some time afterwards and the receipt had been signed by a member of staff that the work had been carried out. Highfield Road (5) DS0000028115.V271440.R01.S.doc Version 5.0 Page 19 It is recommended that staff date the receipts when the works department carry out testing or other maintenance work at the home. The University of Surrey and the Trust is carrying out research at the home around the person centred approach. A social psychologist explained that the aim of the research was to find out how the service users choice and communication is managed on a day-to-day basis. It was noted that daily and weekly hot water temperatures are recorded at the home. Highfield Road (5) DS0000028115.V271440.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 X X X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X X X Standard No 24 25 26 27 28 29 30 STAFFING Score X 3 3 X 3 X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 X 2 X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Highfield Road (5) Score X X 3 X Standard No 37 38 39 40 41 42 43 Score 3 X X X X 3 X DS0000028115.V271440.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 YA6 Regulation 14 (2) a Requirement Timescale for action 31/03/06 2. YA32 18 (1) c. 3. YA34 19 (1). The acting home manager must ensure that all service users have their care plans reviewed by their care manager and that the issue of the two service users sharing a bedroom is discussed as part of their review. Amended requirement/recommendation. The acting home manager must 31/01/06 send evidence to the Commission that all staff have had their training needs assessed and that all staff has receive training on Adult Protection. This requirement is unmet from previous inspection 25th April 2005. Amended requirement. The acting home manager must 31/01/06 make arrangements with the Commission for staff Criminal Records Bureau Checks to be examined. This requirement is unmet from previous inspection 25th April 2005. Amended requirement. Highfield Road (5) DS0000028115.V271440.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 YA42. Good Practice Recommendations It is recommended that staff date the receipts when the works department carry out testing or other maintenance work at the home. Highfield Road (5) DS0000028115.V271440.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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. Extracts may not be used or reproduced without the express permission of CSCI Highfield Road (5) DS0000028115.V271440.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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