Inspection on 11/01/07 for Highland Mist

This inspection was carried out on 11th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 27 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Highland Mist 06/06/08

Highland Mist 03/12/07

Highland Mist 15/05/07

Highland Mist 19/06/06

Highland Mist 21/02/06

Highland Mist 02/08/05

Highland Mist 09/03/05

Highland Mist 16/06/04

Highland Mist 26/03/04

Highland Mist 09/03/04

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

CARE HOME ADULTS 18-65 Highland Mist Highland Mist Bronshill Road Torquay Devon TQ1 3HA Lead Inspector Sam Sly Unannounced Inspection 11th January 2007 10.00 Highland Mist DS0000018370.V318247.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 Highland Mist DS0000018370.V318247.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. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highland Mist Address Highland Mist Bronshill Road Torquay Devon TQ1 3HA 01803 328156 01803 328156 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) Mrs Susan Irene Ann Hill Vacant Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8) of places Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd October 2006 Brief Description of the Service: Highland Mist provides care for up to 8 adults with mental health needs. The premises are in a residential area of Torquay within walking distance of shops, and the town centre. There is parking to the front of the home, and a grassed and patioed front garden. There is also a shed at the bottom of the garden for smokers. Entrance to the house is up several steps into the conservatory, which is also used for meals. The ground floor also has a shower room with toilet, four bedrooms, kitchen and laundry facilities, which are outside in the yard. Stairs lead to the first floor, which has a bathroom with toilet, and four bedrooms one of which is en-suite. Also the office is located on the first floor. Residents should be aware that a staff member sometimes sleeps in the lounge at night. An up-to-date Statement of Purpose could not be located at Highland Mist. The Owner Mrs Hill did not provide the Commission with the range of fees charged when requested. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Home visit was unannounced and took place over six hours on a weekday in January. Two Inspectors Sam Sly and Clare Medlock made the visit due to continued concerns about non-compliance with regulations. The visit to the Home included discussion with four of the residents, and the one staff member of duty. Three resident’s care was looked at in detail. The Owner/Manager Mrs Hill was not at the Home during the Inspection so it was agreed with Mrs Hill by telephone after the Inspection on January 12th that she would bring the required evidence, and be given feedback at the Commission’s Ashburton office on 15th January 2007. The Inspection process also included a review of contact the Commission has had with Highland Mist over the past year. Mrs Hill did not send the Commission the required pre-inspection data and information despite several letters and phone calls. The action plan Mrs Hill sent the Commission was for an Inspection on 19th June 2006, despite there having been three reports requiring improvement plans since then. What the service does well: What has improved since the last inspection? The Owner Mrs Hill has been working towards meeting the Commission’s requirements regarding staffing recruitment and care planning. There are now assessments, risk assessments, care plans, daily records and activity records for each resident. Staff files now contain the majority of documents and information required to prove their fitness and competencies. The appropriate checks against lists and criminal data bases (CRB checks) to make sure staff are safe to work with residents have been sent off, but not yet received back by the Owner Mrs Hill. The heating in the lounge is now mended and the house was warm throughout. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 6 The staff rota is now kept at Highland Mist so that staffing numbers can be checked. What they could do better: The safety and quality of life of residents continues to be put at risk by the failure of Mrs Hill to fully engage with the Commission, and the continued noncompliance with requirements to improve the service. Twenty-one requirements were made at this visit, ten of which have not been acted on despite extended timescales. It is concerning to the Commission that despite warning letters, written reminders and random inspections Mrs Hill has not been able to comply with these requirements. There is an assessment, risk assessment and care planning system now in place, however to make sure residents are safe and leading fulfilling lives, and staff know how to support them, assessments, risk assessments and care plans must be updated when circumstances and risks change, and care planning records must record how needs are to be met. Arrangements must be made to meet the needs identified in the care plans, particularly the social interests, community activities, training, recreational activities and needs relating to risk. The Owner Mrs Hill must keep financial records at Highland Mist of the dealings she and staff have with resident’s finances so that their money can be accounted for at all times. There must be adequate quantities of suitable, nutritious food for residents at Highland Mist and food must be properly prepared so that residents are not at risk of food poisoning. There must be arrangements in place to make sure the environment at Highland Mist is hygienic so that residents are safe and not at risk of becoming ill this includes staff undertaking necessary training. The procedures for medication administered to residents by staff must protect residents, so records must be correct and unused medication must be returned to the Pharmacy promptly. During the Inspection it was required that one resident’s medication was urgently reviewed due to an unaccounted discrepancy in the records. All complaints must be investigated promptly with records kept so that people know that their views are listened to and acted on. So that residents have a comfortable, safe, pleasant environment to live in Highland Mist must be kept in a good state of repair internally and externally with all parts of the house kept clean and reasonably decorated. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 7 Fire precautions, which have been identified in Highland Mist’s risk assessment and the fire risk assessment commissioned by the Home must be implemented. Fire doors must not be wedged open to protect residents from the risk of fire. There must be sufficient numbers of staff on duty to make sure that residents are safe and that they are supported to meet their needs identified in care plans. Staff files must include all the necessary information and documents to demonstrate they are fit to work with residents, and are gaining the appropriate training and support. The Owner Mrs Hill must produce a report based on the information collected through the Quality Assurance system to demonstrate that monitoring is taking place and steps are being taken to improve the service. To ensure toxic chemicals are handled safely and are not hazardous to staff or residents the required handling documents must be available, and products must be safely locked away when not in use. The Commission must be notified of any event that adversely affects the well being or safety of residents so that assurance can be gained that the Owner Mrs Hill is taking appropriate action. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 8 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 Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Insufficiently reviewed and updated assessments mean that resident’s needs are not always identified. EVIDENCE: Three resident’s care planning including their assessments, daily records and activities were examined in detail, and other assessments were referred to in conversation with residents. The care planning with regard to a person who had stayed for respite before Christmas was also examined. Improvement had been made to the assessment format and the content of the long-term resident assessments with more needs being identified including strengths. Assessments however, had not been updated when resident’s needs had changed or incidents affecting the well-being of residents had occurred. There had been no assessment carried out by the Home, or care plan written for the respite resident, although the local authority care plan had been obtained and daily records were being kept. Highland Mist DS0000018370.V318247.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Action is not being taken by staff to implement risk assessments and care plans and residents decision-making to enable residents to keep safe, as well as gaining independence and reaching their goals. The Owner is not managing resident’s finances in safe accountable way. EVIDENCE: Three residents care planning files were examined including care plans, risk assessments, daily records and activities records. Improvement had been made to the care planning format and the content of care plans and risk assessments, which were now written with aims, goals and actions however, there was some contradiction in risk plans, care plans and recording and some needs were not met at all or had not been reviewed and updated. For example several resident’s plans stated they needed their time filled and to be encouraged to be busy. Plans stated this need would be met partly through a Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 11 day service, but the staff member and residents informed the Inspectors that this facility was no longer in existence. Plans had not been updated. Activities records for these residents also showed that over the past month one of the residents had spent a lot of their time in the home with entries such as ‘slept, ate lunch’, ‘played pool in the lounge’, ‘sat in room’ and occasional trips to the pub, shops and to football with a support worker from the local Mental Health Team. The other resident had spent a lot of time out, sometimes not returning overnight. This did not demonstrate that these residents had a structured plan to support them to fill their time and remain busy. Another recorded that the plan was to achieve ‘avoidance of excessive alcohol’ yet the resident was being given a small glass of whiskey a day at the Home, and the records showed they had visited the pub unescorted and on another occasion arrived back at the home intoxicated. Review dates were set, and there was no evidence that changes in resident’s needs triggered a review of the care plan. The reviews that had taken place did not cover the whole care plan but just a particular issue for example dental care. Several risk plans stated that a good, varied diet must be provided. On the day of the visit, the quantity, quality and variety of food available and the menu did not support this. Several risk assessments stated that residents required structured day activity including excursions, to steer clear of alcohol, the monitoring of alcohol intake, and fire risks around residents smoking in the home. There was little evidence of any structured day activity or excursions, alcohol was being consumed and there was evidence of cigarette burn marks on furniture and carpets throughout the home. There has been an outstanding requirement regarding a detailed risk assessment, reviewed and updated after incidents affecting resident’s well-being since 21st October 2006. There is also an outstanding requirement regarding a care plan for each resident with timescales for compliance dating back to 2nd August 2005. The medication records showed that one resident’s medication had suddenly stopped, and there were no records in any of the care planning to show the reasons why and who had agreed this. A very recent residents meeting on 9th January 2007 recorded that the Owner had been talking to residents about arranging more activities inside and out of the home. On the day of the visit the procedures for the Owners and staff involvement in the handling of resident’s money were only partially examined, as there were no records available of residents finances other than their personal allowance. Access could also not be gained to resident’s personal cash tins, and the Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 12 records examined did not give an audit trail of resident’s money handled by the Owner Mrs Hill. Mrs Hill has previously informed CSCI that she is not Department of Work & Pensions appointee for any residents at Highland Mist, however information was received by the Commission that she is appointee for one resident and therefore responsible for paying the residential fees contribution to Torbay Council on behalf of this resident. This contribution has not been paid and the resident has incurred a significant debt to the Council. There has been an outstanding requirement with regard to Mrs Hill keeping all resident’s financial records and an audit trail of any involvement that she or staff have with resident’s money with an original timescale for compliance on 30th April 2006. Information was also received by the Commission that a resident whom had left Highland Mist several months previously did so with scant information about their finances. Mrs Hill was required to bring evidence of these financial issues to the Commission’s Ashburton office on 15th January 2006 but did not. Daily records showed that residents were able to make decisions about what they wanted to do if they were able to do the activity themselves. There was no recorded evidence that staff gave residents the assistance to make informed decisions and there was no information available at Highland Mist about educational, employment and leisure activities to help them make informed decisions. Some decisions residents had made about what they wanted to do, for example one resident wanted to join a boxing club had not been achieved. Residents had also recently had a meeting with the Owner to look at activities inside and out of the Home that they may wish to participate in. There was a poor use of terminology within the care planning records, which would not help maintain a positive view of residents. Terms like: ‘Storming around the home’, ‘kicking off’, ‘Going off on one’ and ‘Try to avoid undesirables’ were noted. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Steps have been made to identify resident’s social and leisure needs but staff are not consistently supporting them to lead active interesting lives. The meals at Highland Mist are not healthy and the quality and variety of food is poor. Food storage, handling and preparation are putting residents at risk. EVIDENCE: Residents had little structured to the activities they did. The care plans examined detailed what residents liked doing or wanted to do. Of the plans examined this included amateur boxing, shopping, speaking to relatives, watching T.V, music, watching boxing videos, walks, cooking, walks to pub, Town Hall club, football. Some of these activities were happening, especially those organised by an outside Agency like the football with a supporter from the mental health team and Town Hall Club. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 14 At the last Inspection residents had said they wanted to ‘go out in the community more’ and have ‘people take them out a couple more times a week’, there was no evidence that this had been acted on. The Owner had set up a day service for residents last year and several care plans recorded that residents were attending. However, the staff member on duty and residents said the service had been closed several months before. No residents attended any work or employment activities. There was no evidence of information on activities, education or work available at the home. It had come to the attention of the Commission that one resident who recently moved out of Highland Mist lost one of his Department of Work and Pensions benefit entitlement due to staff not supporting him to fill in renewal forms. Food stocks were low with the only fresh fruit and vegetables being 2 tomatoes, a box of parsnips and some swedes. The Commission had received a complaint regarding the lack of food at Highland Mist on 21st October 2006; at this time food stocks were again found to be low with no fresh fruit or vegetables. Mrs Hill said that a Tesco food order was being delivered that afternoon. She was asked to send the Commission receipts to verify this. This never happened. At this visit boxes of cakes with soon to expire eat-by dates were found and the majority of food seen was of the basic/value range offered by supermarkets. The food seen did not represent a varied balanced diet. The lunch provided to residents that day was a pasty and cakes, this was not the meal indicated on the menu. The fridges and freezers contained unlabelled and undated food products. A tuna mayonnaise in one bowl in the fridge was discoloured, had slightly liquefied and smelt off. Fridge and freezer temperatures are being recorded regularly. The member of staff was asked if they had undertaken food hygiene training, they had but thought it was a long time ago. The training some staff were recorded to have received was more of a food handlers checklist than actual training. Several residents missed meals on a regular basis, and there was no procedure in place to ensure this did not affect resident’s nutritional needs. A resident said that they enjoyed the meals at Highland Mist and that the food was good. The care plans examined recorded the contact resident’s wanted with family and friends. One resident spoke to their mother on the phone during the Inspection. For another resident contact with their family had risks, however the risk assessment and care plan contradicted one another about what contact was required. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 15 Staff had supported one resident to get a bus pass, so that they could use the bus independently. Several of the residents have friends that they visit, or who visit them at Highland Mist. Residents all have keys to their bedroom doors. The member of staff, on the day of the Inspection was observed to spend the majority of her time cleaning the premises and cooking the lunch. The rota showed that staff member was the only person on duty that day from 8am – 4pm. There was no one on the rota on duty from 4pm onwards or during the night. A second staff member of staff took some of the residents to medical appointments in the morning; this staff member was not recorded on the duty rota as working. As was evident at the Inspections on 2nd March and 19th June 2006 residents were smoking throughout the house leaving burn marks on carpets, this is breaking the contractual agreement Highland Mist has with all residents and is putting residents at risk. Mrs Hill has still not resolved this issue. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s health and personal needs are identified, and on the whole met; however shortfalls in the medication procedures at Highland Mist put residents at risk. EVIDENCE: Residents health personal and mental health needs were recorded in the care plans and risk assessments examined. Medical records showed that residents attended Community Nurse, Doctor, Psychiatrist, optician, and dental appointments. One resident had red sore-looking marks on their face where their glasses sat, no records were found that a doctor had been contacted to alleviate the problem, although this resident said they were going to the optician the following day. There was evidence that a resident with persistent toothache had been treated appropriately by the emergency dental service. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 17 The medication procedures were poorly managed and an immediate requirement was issued for the Owner to ensure medication administered by staff was recorded correctly, to make sure the stocks of unused medication were returned to the Pharmacy and to urgently review one resident whose records showed that medication had been stopped without explanation. Some residents were self-medicating some of their medicines. Records did not show that one resident had received an assessment to show they were safe doing this. The resident said that they were not sure whether they had been assessed and if they did it would have been done along time ago. Observation confirmed that medication was not stored in a lockable space in the resident’s room, but keys were used to lock bedroom doors. No consents for medication were seen in the care plans. Care plans did not accurately list the medications and changes in medications were not explained in the care plan. One medication administration record (MAR) sheet showed that medications had not been dispensed. The resident was unable to explain this, and said they had not seen their Community Nurse, GP or psychiatrist recently. The resident’s care plan also did not state why this medication was no longer being given. Observation confirmed records are kept for the receipt of medicines to the home but not the disposal or returns. A returns folder was located but had been completed last in October 2005. MAR sheets were seen for each resident. Each sheet had a photograph and list of any allergies. Inspection confirmed that these MAR sheets were incorrectly completed with omitted medications being signed for in more than one instance. Medications for a resident that had been out of the home overnight and during the visit were also signed for. Medications that are needed every now and again (Pain killers) were not noted to be prescribed by the GP. No policy for homely remedies was seen and this administration was not recorded on the MAR sheet, but was on a separate document. A pharmacy inspection took place in October 2006 where action was recommended by the Pharmacist but had not been taken by the Owner and staff. There were no prescribed controlled drugs at the home but inspection of the lockable cupboard where medicines are stored revealed 5 diazepam tablets, which were lying loose in the cabinet and not labelled for any particular resident. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 18 A repeat prescription form, and other medicines in tablet and liquid form were found for residents who were no longer living at the home. Some of these residents had not been at the Highland Mist since October 2006. One resident did not live at the home at all. Loose unknown tablets were found and paracetamol prescribed for one resident was being used for other residents in the home. Some staff training certificates were seen in respect for medication administration but it was not clear that all staff administering medication had received this training. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s views are listened to, however complaints are not investigated appropriately, and the procedures in place to safeguard resident’s finances are poor. EVIDENCE: Staff have either done or are booked to attend the Local Authority protection of vulnerable adults training very soon. There was a copy of the local authority Alerter’s guidance in the office. There was a complaints book kept in the hallway at Highland Mist; it was empty. As the book was kept in a public place it meant it could not be used to record complaint investigations. There was no evidence that the complaint that was identified in the communication book at the Inspection on 3rd March 2006 had been investigated with records kept, despite this having been made a requirement with timescales for compliance dating back to 30th April 2006. Residents who were asked said that staff listened to them. The procedures in place for accounting for resident’s finances handled by the Owner Mrs Hill or staff did not enable financial transactions to be audited. The only records found at Highland Mist regarding resident’s money were records of personal allowances given to residents by staff. There were no records of bank statements, benefit entitlement or money handled by staff despite the Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 20 Commission making it a requirement to have this information in the Home since the Inspection on 3rd March 2006. The Commission was informed prior to the Inspection that the Owner is Department of Work & Pensions appointee for one resident, that that this resident’s financial contribution had not been paid to Torbay Council for a considerable time, building up a large debt. The Commission had also been made aware on 22nd December 2006 and 11th January 2007 that a resident that had left Highland Mist before Christmas arrived at their new home with scant financial information and without their benefit entitlement, which at the time of Inspection they had still not received from the Owner Mrs Hill. The Owner Mrs Hill had recently reapplied for new Protection of Vulnerable Adult (POVA First) and Criminal Record Bureau (CRB) checks for all staff. Records of these checks being applied for were seen, however the checks had not yet been returned. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Highland Mist is not sufficiently maintained, safe and hygienic to ensure residents live in a comfortable environment. EVIDENCE: A tour of the building at Highland Mist showed it was unclean, damp in places, not sufficiently maintained and not sufficiently furnished. Outside several tiles had fallen off the roof, several fence panels had blown down and there was cardboard, an old chair and a broken TV in the front garden. Inside several carpets were well worn and many had cigarette burns, there was also evidence of cigarettes being put out on the lounge walls and lots of the furniture in communal areas and bedrooms had cigarette burns. The fire door to the lounge was propped open with a wedge, and the environmental risk assessment stated that the self closer had been broken on the door since November 2006. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 22 There were holes in some of the bedroom walls, and damp patches on walls and ceilings. Two bedrooms smelled strongly of damp but were not in use on the day of the visit. Some furniture was broken. Two bedrooms were particularly untidy and dirty on arrival with a discarded take-away all over the floor and burn marks on carpets and furniture, however the staff member had cleaned one of these rooms by the time the Inspectors left. At the inspection on 2nd October it was noted that the hot water tank lagging was torn and ineffectual and that the door that had a sign to say it had to be locked was open. This was still the case. The staff sleep-in room did not have a bed in it. The member of staff said that she did not sleep-in now, but that staff tended to sleep on the sofa in the lounge, she used to sleep in the office. The upstairs bathroom had no plug to the basin or the bath. The kitchen was not clean and cupboards were worn and dirty, the doors under the sink were loose and if the door was opened it also opened the oven door, which could cause a hazard if the cooker was on. The maintenance book could not be located and Mrs Hill was requested to bring it to the Commission’s Ashburton office on 15th January 2007. This did not happen. There is an outstanding requirement regarding having an up-todate maintenance and renewal programme including any issues identified in the Home’s risk assessment, by the Commission, by the Fire and by the Environmental health department. This requirement has timescales for compliance dating back to 31st October 2005. The Commission had received a complaint on 21st October 2006 that there was no heating in the lounge as the gas fire had been broken for over six months. This was found to be true then, however the fire was now working and the parts of the home toured were warm. There were very few cleaning products. The cupboard cleaning products were kept in was the secure location for toxic chemicals. No COSHH information (safety information required to be kept in the Home about dangerous and toxic chemicals included in cleaning products) could be found and the padlock for the cupboard was stiff and difficult to secure. There was no evidence that infection control procedures were in place or that the home had sufficient products to maintain a clean and hygienic environment. Also food hygiene standards were poor with food kept in the freezer and fridge that was unlabelled and undated. There was undated tuna mayonnaise in one bowl in the fridge that had discoloured and slightly liquefied and smelt off. The staff member on duty said she had done food hygiene training, but it was a long time ago. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been improvements to staff recruitment and training practices, however residents are not yet fully supported by a competent, supervised, qualified staff team. EVIDENCE: The staff member on duty during the Inspection was approachable, comfortable with the residents, and friendly. Residents spoken with were happy with the staff support they received. One resident said the staff are ‘wonderful’. The Commission had received a complaint on 21st October 2006 that the staff rota shown to the Commission was false, and that only one member of staff is on duty at the weekend including at night, and that staff do not sleep in a staff room but all over the house. This complaint was upheld at the time due to evidence from a visit, staff feedback and resident feedback that confirmed this was the case. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 24 There are currently five residents at Highland Mist and the rotas examined for the week starting 8th January 2007 showed that one care staff member is on duty 8am – 4pm and 4pm – 8pm and one staff sleeping in at night. Mrs Hill stated during a phone call after the Inspection on 12th January 2007 that she was on duty too each weekday, although on the rota she was recorded to be working only an 8am-4pm shift on 13th January 2007. It had been recommended to Mrs Hill at the Inspection on 2nd October 2006 that all her care hours be recorded on the duty rota. On the day of the visit the staff member spoken with was working 8am-4pm, but there was no one recorded as working the shift 4pm-8pm and the staff member had not been informed who was on duty and had to phone up the Owner to find out. When the Inspectors left at 4pm the staff member still did not know who was coming on duty. The staff on duty did the cooking and cleaning as well as supporting residents and although staff accompany residents to appointments, activity and daily records did not show that staff did much else with residents outside of the home. There have been requirements made regarding shortfalls in staff recruitment procedures affecting the safety of residents dating back to 2nd March 2006 and 2nd August 2005. At this Inspection there was evidence that the Owner Mrs Hill has taken action to rectify these shortfalls. Staff recruitment information was located in several places. The recording of information appeared disorganised and chaotic, however the Commission is aware that the Owner is working hard at present to improve the staff recruitment files, which would account for this. A lockable filing cabinet contained files for staff (up to three in some cases). Four staff files were examined at this inspection. None of the files contained evidence that a POVA First (Protection of Vulnerable Adults) check had been performed. Three files contained evidence that a CRB (Criminal Records Bureau-Police check) check had been undertaken but close inspection confirmed that previous employers had undertaken all three of these checks. There was evidence that the Owner had sent off repeat POVA First and CRB checks for all current staff. Four of the files contained an application form. One application form was inadequately completed and did not show employment history. Three files contained two written references, but four of these references were not addressed to the Owner or were from unsuitable sources. One file contained no references. Only two files contained evidence that staff had received a contract or terms and conditions. Only one file contained evidence that staff had received a copy of the General Social Care Council Code of Practice. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 25 There was no evidence to show that any of the staff had been recruited with the involvement of the residents. There was no evidence to show that an employment risk assessment had been performed on a staff member who are pregnant and working alone with residents. All staff had some evidence of some staff training. One file contained six training certificates, others had just one. There were no training assessments for staff seen. Two of the four files seen contained evidence of induction but the quality of this must be questioned as many subjects were covered on one day. Two of the four staff had received POVA training. Two of the staff had received fire training. There was no up-to-date overall staff training assessment and plan. Training records were disorganised and did not clearly show what training had been received and what was needed. Other evidence within the office showed that free training in infection control and POVA were being arranged. The Commission is aware that the Owner is working to improve the staff training files at Highland Mist. A file within the office showed that training leaflets and questionnaires were available for staff training purposes. Evidence was seen within the office that supervision had taken place for three of the four staff, however these records were all out-of-date. A communication books are used to communicate messages to staff. A staff meeting had been held on 7th January 2006. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 & 43 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Highland Mist is not a well run home and residents are potentially at risk from the lack of effectiveness and accountability of the management. EVIDENCE: There have been persistent breaches of regulations over the past two years and this has led to a warning letter about enforcement action being sent to the Owner Mrs Hill on 21st November 2006 by the Commission. An improvement plan was received by the Commission on the 22nd December 2006 but did not refer to the warning letter, requirements made on visits to the Home on 2nd October 2006 and 21st October 2006 just the last Key Inspection on 19th June 2006. This is the first action plan the Commission has received since the beginning of 2005. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 27 The Owner was requested, before the visit, to provide the Commission with information about Highland Mist (as with all establishments), and to give the Commission information on relatives and stakeholders so that questionnaires could be sent out. This did not happen despite follow up phone calls and letters. The Commission’s records show that the Owner Mrs Hill has not returned this information before Inspections dating back to the beginning of 2005. There are outstanding fees owed to the Commission by the Owner of Highland Mist Mrs Hill. Evidence was found in the communication book and in daily records that three residents had been involved with incidents that could potentially affect their welfare and the Commission had not been made aware of these incidents, and care plans had not been updated. The Owner was found not to have informed the Commission of similar incidents at Inspections on 21st February 2006 and 9th June 2006 and requirements were made to do so in the future. During the visit it was discovered that one resident had been out all night and had not returned to the Home before the Inspectors left at 4pm. The staff member said this was a usual occurrence and daily records confirmed this, however there was nothing in the residents care plan about this, or the procedure staff should follow to confirm their safety. When the staff member tried to contact the resident they could not. The Owner stated she knew where the resident was. An immediate requirement was made to inform the Commission of the resident’s safe return and to put in place procedures to be able to account for resident’s whereabouts. There was a resident’s signing in and out book, but it was not always filled in, and further evidence of a lack of procedure for accounting for residents whereabouts was found in daily recording for a resident having respite on 13th October, when the staff member had written ‘went out did not say where he was going’. The low food stocks, which were also found on 21st October 2006, poorly maintained environment, minimal staffing levels and outstanding fees to the Commission raises concerns about the financial viability of Highland Mist. Mrs Hill was requested to bring evidence of the Home’s financial viability to the Commission’s Ashburton office on 15th January 2007. This did not happen. Insurance certificates were displayed within the entrance hall and covered employer’s liability until June 2007. The Owner Mrs Hill is also the registered manager. She was unable to attend the Inspection as she was doing the Registered Manager Award at College. Mrs Hill has been undertaking this qualification since 2004 and at the Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 28 Inspection on 21st February 2006 had said it would be completed by June 2006. . The book kept to show that fire precaution checks had been carried out was not up-to-date. Checks on the fire alarm stopped on 12th December 2006, however a fire drill had been carried out with residents on 5th January. Staff had all had fire instruction. The fire risk assessment showed that fire risks associated with resident’s smoking had been acknowledged, however the action recorded to alleviate the risks: ‘only smoking in designated areas’, ‘handing in cigarettes at night’ were not being followed, as evidence of cigarette burned furniture and carpeting was found in communal areas and bedrooms and daily records confirmed this: ‘X smoking everywhere, fag butts everywhere’. The lounge door was being propped open with a wedge as the self-closer was broken and the environmental risk assessment recorded it had been broken since November 2006. A fire risk assessment carried out by an Independent company and seen at the last visit could not be located, so it could not be evidenced that appropriate action had been taken with regard to the recommendations. Mrs Hill was requested to bring evidence that the recommendations had been acted on to the Commission’s Ashburton office on 15th January 2007. This did not happen. Staff had not all received the required health & safety training, although the Owner Mrs Hill was working on this. The servicing records for the electrics, gas and wiring could not be located. Mrs Hill stated in her action plan that ‘gas checks completed. Wiring awaiting appointment from contractor.’ An environmental risk assessment is regularly carried out, however the broken fire door self-closer had been identified in November 2006 and not acted on. The Quality Assurance system audits had been added to since the last visit, however no annual development plan had been developed. Developing a Quality Assurance system annual report based on the analysis of the Quality Assurance system has been an outstanding requirement since 2nd August 2005. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 29 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 2 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 2 23 1 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 2 X LIFESTYLES Standard No Score 11 X 12 1 13 1 14 1 15 2 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 1 X 2 X X 1 1 Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 30 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 YA2 Regulation 14(2) Requirement Resident’s assessments must be reviewed and updated after any change of circumstance, to make sure the care plan can be updated to reflect the current action required by the resident and staff Arrangements must be made to meet the social interests, community activities, recreational activities, fitness, training and other needs identified in residents care plans so that residents lead fulfilling lives. Each resident’s entire care plan must be reviewed regularly, or after a change in circumstance, so that the resident and staff are clear of the action required. Timescale for action 22/02/07 2. YA6 16 (2)(m)(n) 22/03/07 3. YA6 15 (2) 22/02/07 4. YA7 YA23 YA43 20 17(2) Sch. 4 (9) The Owner must keep all the 22/02/07 resident’s financial records at Highland Mist, with audit trails for any involvement of herself or staff so that resident’s money can be accounted for at all times. (Previous timescale DS0000018370.V318247.R01.S.doc Version 5.2 Page 31 Highland Mist 30/04/06, 20/09/06 & 31/12/06 - not met) 5. YA9 13(4)(c) Action recorded to eliminate risks identified in resident’s risk assessments must be carried out to protect residents. Risk assessments must be reviewed and updated after incidents that affect the well being of residents. Arrangements must be made to meet the social interests, community activities, recreational activities, fitness, training and other needs identified in residents care plans so that residents lead fulfilling lives. (Previous timescale 30/05/06, 20/09/06 & 31/12/06 - not met). There must be adequate quantities of suitable, nutritious food and properly prepared for residents. The food handling, preparation and storage of food must be carried out safely so that residents do not catch food poisoning. There must be suitable arrangements for maintaining satisfactory standards of hygiene so that residents are safe and do not become ill. All care staff must have training in First Aid, food hygiene and infection control (Previous timescale 31/10/05, 30/04/06, 20/09/06 & 31/12/06- not met). Medication given by staff to DS0000018370.V318247.R01.S.doc 22/02/07 6. YA14 YA12 YA13 12(1) 16 (2)(m)(n) 22/03/07 7. YA17 16(2)(i) 22/02/07 8. YA17 16(2)(g) 22/02/07 9. YA17 16(2)(j) 22/02/07 10. YA17 YA42 YA30 18(c) 22/02/07 11. YA20 13(2) 11/01/07 Version 5.2 Page 32 Highland Mist 12. YA22 22 residents must be recorded correctly, unused medication must be returned to the Pharmacy promptly, and the identified resident’s medication must be reviewed urgently to ensure the safety of all residents. All complaints must be 22/02/07 investigated with records kept (Previous timescale 30/04/06, 20/09/06 & 31/12/06 - not met. 22/03/07 13. YA24 14. YA24 23(2)(b)(d) The environment at Highland Mist must be safe, kept in a good state of repair internally and externally and all parts of the home must be kept clean and reasonably decorated. . 23(4)(a) The action recorded to eliminate the fire risks associated with smoking identified in the Home’s fire risk assessment must be implemented to protect residents from fire. Fire doors must not be wedged open so that they work effectively should there be a fire. Staff must receive training on the areas of mental health that are required to meet the needs of residents (Previous timescale 20/09/06 & 31/12/06 - not met). Sufficient staff must be on duty to make sure that residents are not only safe but also able to participate in their chosen activities (timescale 31/10/07 – not met). 22/02/07 15. YA32 18(c) 22/02/07 16. YA33 18(1)(a) 22/02/07 17. YA34 19(1)(b) The required information and 22/02/07 documents must be kept at Highland Mist to demonstrate the fitness of each staff member DS0000018370.V318247.R01.S.doc Version 5.2 Page 33 Highland Mist to make sure residents are supported by appropriate staff. (Previous timescale 02/03/06, 20/09/06 & 31/12/06 - not met) 18. YA39 24(2) An annual report based on the analysis of the Quality Assurance system must be produced, with a copy available for CSCI and other interested parties to demonstrate that the service provided is being monitored and improved. (Previous timescale 02/08/05, 31/10/05, 30/04/06, 20/09/06 & 31/12/06 - not met) The COSHH policy must be fully implemented and toxic materials kept locked away so that staff and residents are protected from poisoning and harm. (Previous timescale 20/09/06 & 31/12/06 - not met). 22/02/07 19. YA42 13(3) 22/02/07 20. YA42 37 21. YA42 23(4) The Commission must be 22/02/07 notified of any event that affect which adversely affects the well being or safety of any resident. The findings of the fire risk 22/02/07 assessment commissioned by the Owner must be acted on to protect residents from the risk of fire. (Previous timescales 20/09/06 & 31/12/-6 – not met) 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 YA6 Good Practice Recommendations Staff records of residents activity programmes, medical DS0000018370.V318247.R01.S.doc Version 5.2 Page 34 Highland Mist meetings and general daily recording should be reviewed regularly and changes should inform their care plans. 2. YA7 There should be information available at Highland Mist about leisure, work, fitness, training, and other opportunities to help residents make decisions about what they want to do with their time. Staff should use terminology in written communication that helps maintains a positive view of residents. Residents drinking and smoking habits should adhere to the contractual agreement made with the home. There should be procedures in place to ensure if residents miss meals regularly this does not affect their nutritional needs. All concerns as well as complaints should be investigated with records kept of action taken. Adult protection training should include evidence that the staff member has read and understood the complaints procedure, the whistle blowing procedure and the Local Authority Alerter’s Guidance. There should be sufficient accommodation for staff to sleep at night. There should be an up-to-date maintenance plan, which records short and long-term maintenance jobs. At least 50 of care staff should have NVQ 2. Residents should be involved in the recruitment process. Staff should have specific training on the areas of equality and diversity and demonstrate how resident’s rights are being supported. The rota should include Mrs Hill’s hours of work and the waking hours of the night staff. The waking hours of night staff should be set out in their job description. 13. 14. YA33 YA34 A risk assessment should be carried out on the staff member who is pregnant. Disciplinary action taken against staff should be recorded. DS0000018370.V318247.R01.S.doc Version 5.2 Page 35 3. 4. 5. YA7 YA16 YA17 6. 7. YA22 YA23 8. 9. 10. 11. YA24 YA24 YA32 YA32 12. YA33 Highland Mist 15. 16. 17. YA35 YA36 YA37 The staff training plan should indicate the training required and completed by staff members. Staff should receive regular supervision. Mrs Hill should have gained NVQ 4 and the Registered Manager Award. Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Highland Mist DS0000018370.V318247.R01.S.doc Version 5.2 Page 37 - 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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