CARE HOME ADULTS 18-65
Highfields Care Home Highfield Road Swadlincote Derbyshire DE11 9AS Lead Inspector
Brian Marks Unannounced Inspection 7th February 2006 09:30 Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 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 Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 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. Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Highfields Care Home Address Highfield Road Swadlincote Derbyshire DE11 9AS 01283 224658 NOT GIVEN highfields@unitedhealth.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) United Health Limited Hazel Elizabeth Ashmore Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th August 2005 Brief Description of the Service: Highfields is a purpose built single storey building offering 5 places for adults with severe learning disabilities, and physical disabilities; its design specification had been set at a high standard, as has the quality of equipment, furniture and fittings. This includes special beds, baths, hoists and other equipment specific to individuals and all bedrooms have access to en-suite bathrooms with integral overhead tracking to access between the two areas. Corridors and communal areas are extensive to allow for comfortable access for service users and staff. The home benefits from good support from outside professionals who advise the homes staff on a variety of care issues. Highfields was registered on the 24th September 2003, and is owned by United Health, a company based in Lincoln that specialises in the operation of care homes for people with severe learning disabilities. Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced visit that took place at the home over a morning. Additionally, time was spent in preparation for the visit, looking at previous reports and other documents. At the home, apart from examining documents, care files and records, time was spent looking around the building and speaking to the manager and staff on duty. Because all of residents have a lot of difficulties expressing themselves in words, they were not able to contribute directly to the inspection process, but they were observed throughout the visit working with and being cared for by staff. The aim of inspection activity during the current inspection year is to assess a service against the ‘key’ National Minimum Standards and these are identified at the beginning of each section of the report. The majority of these keys standards were examined at the last inspection so, for a more complete picture of this service, this report should be read in conjunction with the report dated 15th August 2005. What the service does well:
Highfields provides a specialised service to people with complex learning and physical disabilities, and does so successfully, using staffing levels that are set very high allowing for good levels of individual care. Although the home is a very large bungalow with wide corridors and doorways to allow for easy movement, it has been fitted out in a domestic style and staff have worked hard to create a family atmosphere. Staff work in very flexible ways and activities take place both inside and outside the home with each individual’s needs in mind. The home was purpose built with this type of resident in mind and, as noted above, the physical layout of the home has been designed to make their lives as easy as possible. Furniture, fittings and decoration are to a high standard, and additional specialist equipment has been provided, which helps the residents to be cared for safely and in comfort. All of the residents are wheelchair users and these have been supplied to suit their individual requirements. Staff at the home are very alert to any problems that occur with the equipment within the home and are supported by a good service company. During the visit staff were observed caring for the residents; they did this with sensitivity and a relaxed style, constantly using verbal prompts and encouraging responses from the person they were supporting. Staff have developed ways of understanding what the residents are wanting and help them to make choices about their lives. The staff group are committed to the job of resident care and the manager reported that although there have been
Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 Page 6 vacancies recently, consistency in resident care has been maintained and outside agency staff are no longer used. Staff receive good levels of support from both their colleagues and the home’s managers and they are committed to the home and its residents. General management and administration are well organised and the home benefits from the services and advantages of a larger organisation that takes care to make sure its homes are running properly. What has improved since the last inspection? 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. Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 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 Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 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): EVIDENCE: These standards were not specifically looked at this inspection, other than as part of a general examination of care at the home. For the full assessment of the key standards see the inspection report dated 15 August 2005. Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 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): EVIDENCE: These standards were not specifically looked at this inspection, other than as part of a general examination of care at the home. For the full assessment of the key standards see the inspection report dated 15 August 2005. Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 Page 10 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): 17 Residents are assisted to enjoy a varied and healthy diet that is based on their preferences and individual needs. EVIDENCE: The manager and staff at the home work to a 4-week menu that has been developed with the support of an NHS dietician, in order to make sure that meals are balanced and nutritious. All of the residents have special arrangements for eating because of their difficulties, with fully softened diets needed for 3 and the other two having a liquid diet through an inserted tube (PEG). ‘Build-up’ supplements are also added to food because of eating difficulties, although 1 resident has a very healthy appetite and his weight is very carefully monitored because of this. In spite of these difficulties staff take care to present meals in as pleasant a form as possible, and all the residents spend mealtimes together in the dining room with the staff in constant attendance, giving direct assistance. Additionally cooking is used as a therapeutic exercise and the residents are involved in cooking as a sensory experience with full staff support; the layout of the kitchen is domestic in style and supports this activity. They are also involved in food shopping at local supermarkets and shops, that is apart of the wider programme community experiences they enjoy. Individual records
Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 Page 11 indicate how the assessment of nutritional needs is kept under review and the staff have used ‘trial and error’ to make sure that mealtimes are as stimulating as possible. Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 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): EVIDENCE: These standards were not specifically looked at this inspection, other than as part of a general examination of care at the home. For the full assessment of the key standards see the inspection report dated 15 August 2005. Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 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 and 23 The home has comprehensive policies and procedures in relation to making complaints and the protection of vulnerable people, and staff are made aware of their responsibilities in these areas. EVIDENCE: The home has a comprehensive complaints policy and procedure, a copy of which is included in the Service Users Guide, which is given to residents and their representatives, and is also on display at the home. The procedure includes details about the CSCI and about how people can contact the Commission if they wish to complain further. The written record indicated that there had been one concern expressed by a resident’s parent within the past 12 months and this had been dealt with satisfactorily. The manager’s style is very open with residents and their families and there is an annual barbeque and family meeting when they formally meet to discuss issues of concern they may have about the home. In this way issues are dealt with as they arise. The home has a detailed policy and procedure in relation to the protection of vulnerable adults, and this links to the local statutory procedure to be followed. Staff are given periodic instruction on their responsibilities in this matter, and all but those newly appointed had received this training in 2005. Further training is to be given to make sure the whole staff group is safe in this issue. There were no incidents reported during the past 12 months but the manager had previous experience of being involved with an investigation, an indication that things will be dealt with properly. Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 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): EVIDENCE: These standards were not specifically looked at this inspection, other than to note that the high standards of the home’s environment had been maintained and that new equipment was being provided to meet the specilaised needs of the newly arrived resident. For the full assessment of the key standards see the inspection report dated 15 August 2005. Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 Page 15 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): 32,34 and 35 The home is well staffed with experienced, skilled and knowledgeable people who are supported to work effectively by management and their colleagues. Systems at the home ensure that only the right people for the job are employed at the home. EVIDENCE: Records on staff files showed that 7 care staff had completed or were completing an NVQ qualification at a minimum of level 2, which is in line with the required target of 50 of staff; the manager and staff are to be commended for this achievement. The membership of the staff group has stabilised following a period of staff leaving during the latter part of 2005; new staff have started and one spoken to described how she had been introduced to the home and that this had been a positive experience. Staff were observed with the residents during the inspection and interactions were seen to be warm and professional, with constant verbal prompts being an important feature of how they work. Records on file indicate that staff have enjoyed regular access to training and development opportunities, although those that were newly appointed had missed some key health and safety subjects. The home’s main diary indicated that updates on infection control and emergency first aid were planned. New staff receive adequate preparation through induction training, and a number of additional subjects are regularly covered through links with the Social Services Department and Skills for Care – a national training organisation. Because of
Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 Page 16 the special nature of the problems faced by the residents of this home, ‘on the job’ training is particularly important, in order for staff to learn about their particular needs. Communication techniques and safe moving and handling were discussed to illuminate how formal training has limited application to their circumstances. Examination of the procedure manuals and staff files indicated that a company’s recruitment process is followed at the home and that only the right people for the job are employed. However, a number of items, required by law, were not present in the files examined and this could affect the overall safety of the system. Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 Page 17 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, 39 and 42 The home is well managed with a good set of administrative arrangements, and the company and its staff ensure that a good standard of service is maintained and that it is a safe place for people to live in. EVIDENCE: The manager is a qualified nurse and has extensive experience of working with people with physical and learning disability. She has completed an Open University management course that is the equivalent of NVQ4, and has maintained her development standards, currently studying for a teacher’s certificate applicable to a care setting. She is also responsible for much of the internal training and instruction to the staff group. The manager encourages feedback about the running of the home and the annual family meeting, mentioned previously, contributes to this process. Relative and staff surveys have been carried out in the past and these are due to be repeated; the home’s line manager carries out a monthly audit of services as part of her visit also. A detailed annual plan has been prepared for the home each year and the one for 2006 was seen in draft form. All of these
Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 Page 18 activities indicate that the company and home’s management reflect upon the service provide at the home and are committed to its improvement. Staff records indicated that staff training in relation to key health and safety subjects had been carried out in 2005 but not all staff, particularly those recently appointed, had received this. As indicated previously, refresher courses were planned for later in the year. A full examination of records indicated a good standard of health and safety activity at the home and this protects the residents; the maintenance man carries out an extensive range of routine activities and the last inspections of the Environmental Health and Fire Officers were satisfactory. The documentation related to gas servicing was not at the home. Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 Page 19 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 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X 3 X 3 X X 2 X Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? No 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 YA23 Regulation 13(6) Requirement Timescale for action 30/06/06 2. YA34 19(1) Sched. 2 3. YA42 13(3), 18(1) 13(4), 23(2) 4. YA42 The registered person must ensure that all staff receive training in Adult Protection, and are aware of Derbyshires statutory, multi-agency policy and procedures. The registered person must 30/06/06 ensure that documents indicating proof of identity and 2 written references are obtained and placed on staff files during the recruitment process. All staff at the home must 30/06/06 receive training or instruction in infection control and emergency first aid. The registered person must 31/03/06 ensure that all gas equipment is serviced and a copy of the safety certificate forwarded to CSCI for examination. Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA35 YA37 Good Practice Recommendations The registered person should ensure that training is provided for staff that links in with the Learning Disability Award Framework (LDAF). The registered person should carry out regular surveys of key groups involved with the home to establish their opinion about the care provided by the home. Highfields Care Home DS0000051271.V282448.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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