Inspection on 14/03/08 for New Hope Specialist Care Limited

This inspection was carried out on 14th March 2008.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

New Hope Specialist Care Limited 05/03/09

New Hope Specialist Care Limited 18/09/08

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Highpoint Care 32 Church Lane Handsworth Wood Birmingham B20 2EP Lead Inspector Sara Gibson Key Unannounced Inspection 14th March 2008 11.10 Highpoint Care DS0000070244.V356395.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 Highpoint Care DS0000070244.V356395.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. Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highpoint Care Address 32 Church Lane Handsworth Wood Birmingham B20 2EP 0121 241 3839 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) Highpoint Care Ltd vacant post Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC. To service users of the following gender Both. Whose primary care needs on admission to the home are within the following categories - Learning disability - code LD. The maximum number of service users to be accommodated is: 5 2. Date of last inspection First Inspection Brief Description of the Service: The service is registered with the Commission for Social Care Inspection to provide residential care for up to 5 persons with learning disabilities aged between 18-65. The service is set in a detached house in a residential street in Handsworth Wood, Birmingham. There are local facilities nearby such as shops, a library, and a leisure centre. Transport links are good, with various bus routes close to the home. The home is set over two floors and provides spacious accommodation for up to five occupants plus the care staff. The home has a number of communal areas, a kitchen, the house bathroom, five large bedrooms all en-suite, laundry, staffroom and office. There is also a large back garden with disabled ramp access. Fees charged start from £850 per week depending on the person’s needs and the level of support required. The fee information given applied at the time of the inspection; persons may wish to obtain more up to date information from the service. Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality rating for this service is 0 star. This means that the people who use this service experience poor quality outcomes. This is a new service registered with the Commission for Social Care Inspection. Prior to our site visit, the service returned an Annual Quality Assurance Assessment (AQAA) that contained no information as the service stated they had no people using the service, and no staff were employed. Birmingham, Sandwell and Dudley Councils’ confirmed at that time that they had not placed anybody with the service. On the day of our unannounced site visit, one person was using the service. The site visit took place over 5 hours and was carried out by two inspectors. At present the home does not have a Registered Manager, the Registered Individual Davis Veremu (referred to as DV in the report) was interviewed at length. The care staff on duty were also spoken with throughout the day. We looked at staff recruitment files, information on the person using the service, policies and procedures and other relevant documentation. A tour of the premises was undertaken, and an audit of the medication took place. During the time of the site visit the person using the service was out at college. The person did return shortly before the site visit concluded which meant we were fortunate to meet him. What the service does well: The staff present on the day of inspection was friendly, keen and enthusiastic. The management and staff gave full co-operation during the inspection process. Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Prospective users of the service must have the information they need to make an informed choice about where to live. The information must include fees and the method of payment, terms & conditions of their stay. People should only be admitted to the home following a full needs assessment, carried out by trained staff, to involve the prospective user, using an appropriate communication method, and with an independent advocate if appropriate. To ensure they are safe the service must demonstrate it can meet the complex needs of the people who use the service. The service must develop with the person an agreed individual care plan that covers all aspects of personal and social support, and healthcare needs. The physical and emotional needs of each person must be assessed and recognised, and procedures put in place to address them. All medication must to be stored in a suitable lockable space to which only suitably trained, designated staff have access. Records of all medication received and administered must be maintained to ensure that there is no mishandling. All medications must to be administered by designated and appropriately trained staff to protect people from harm. The premises must be sufficiently heated at all times. The service must implement systems to prevent the spread of any infection. Staff within the home must have the competencies and qualities required to meet the complex needs of those using the service There must be an effective staff team in sufficient numbers and with the required skill mix to meet the needs of the persons using the service on duty at all times. The home must ensure their recruitment procedure protects the safety and welfare of those using the service. The home needs to have a training and development programme in place for all staff. The home must have a registered manager who is qualified, competent and has the experience to run the home to effectively meet the needs of the persons using the home. The health, safety and welfare of people using the service and the staff must be promoted and protected at all times. Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 7 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. Highpoint Care DS0000070244.V356395.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 Highpoint Care DS0000070244.V356395.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): 1,2,3. Quality in this outcome area is adequate. People who use the service do not have comprehensive information to allow them to make an informed choice as to whether the service can meet their complex needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The information available for prospective users of the service does not give clear relevant information about the service. Written policies and procedures do not refer to giving information or the importance of informing people of what they can expect from the service. Prospective users of the service and their families have insufficient information on which to make a considered decision about whether the service will be suitable for them. The Registered Individual Davis Veremu informed us that one person was using the service who was taken as an emergency placement two days prior to our inspection. The service had completed an assessment tool on the day of admission. We saw that this assessment tool was very basic, with hardly any detail listed. It covered: • General details/NOK/GP/Other professionals involved. • Health needs Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 10 • • • • • • • • Mobility/aids used/oral health/vision/hearing Current medication – name & dose Personal care needs – not completed Continence – not completed Behaviour – known to abscond – no mention of sexual behaviour Religious/Cultural needs – not completed Educational/Occupational needs – attends school Psychological needs/Communication – not completed Information we saw provided by external agencies stated that the person has severe learning disabilities, autism and epilepsy. It also stated that the person poses a risk to others by showing physical and verbal aggression towards others and other challenging behaviours. From talking to the registered person DV admission to the service was agreed without any reference to a full needs assessment, consideration of the specialist care the person requires, or the skills, ability or knowledge of the staff caring for him. Care staff did not fully understand the particular needs of the person they were caring for and training had not been provided to enable care staff to develop and be aware of current good practice. These shortfalls in practice may result in the person’s needs not being met or him being placed at risk. Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 11 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. Evidence was lacking to confirm that people using the service are actively involved in planning their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The only information the service had available on the person living there was provided by the person’s last placement. The registered person DV told us that as the person had only been with them for 48hrs, they are still in the process of observing and working with him to gain an understanding of his complex needs and how best they can support him to meet those needs. DV told us that he plans to start completing the homes own documentation such as care plans, risk assessments and strategies to manage this person’s needs within the next week. Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 12 From written evidence we learnt that the person who uses the service is able to make his own decisions with little support. This we witnessed as the person decided he wanted to go to bed, and he also decided what he wanted for his evening meal after being given a choice by care staff. The registered person DV informed us that for the first four weeks of the new person’s placement there will be two care staff with him at all times to get to know him and assess his behaviours. The care staff we spoke to had an understanding of the risks associated with the person’s behaviour for example; two care staff told us that they were aware that the person could abscond from the building. Since the person’s arrival locks have been fitted on the front door to prevent the person from absconding. Staff also told us that they were aware that the person has other behaviours which may challenge the service. The staff had read the documentation provided by external agencies about the person living in the service and were beginning to understand how the person communicates his needs. We saw risk assessments provided by external agencies, which stated that the person is at risk due to behaviours and epilepsy. We did not see, and the registered person was not able to provide us with any risk assessments the service had produced themselves do date. Highpoint Care DS0000070244.V356395.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 adequate. The person who uses the service is supported to develop his life skills. The person is following educational pathways and is being actively supported and encouraged to do so. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The person who uses the service attends college Monday to Friday 9.30am – 3.30pm. Care staff support him to prepare for college and a staff member from the college collects and accompanies him to college and returns with him in the afternoon. A staff member told us that these arrangements have been made to make the settling in time easier by ensuring that the person has a familiar face around. These arrangements also allow the care staff to gain knowledge about the person from the college carer. Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 14 A staff member told us that the care staff and the college carer are working well together to ensure that minimal disruption is caused as the person settles into the service. We heard staff discussing the new person’s likes and dislikes. The college carer asked the service staff to provide photos of them for the person to keep at college, so the college team can remind the person whom he is going home to. For a short time we observed the person who uses the service. He was calm. We observed staff encouraging him to do some colouring and had put some music on for him to listen to. For a short time staff took the person into the garden for a walk. The registered person told us that the new person in his care has family in the area and that he sometimes visits them. Care staff told us that they are keen to ensure that the person maintains his family links, by organising visits and maintaining contact. Care staff spoken to were aware of the person who uses the service daily routine. They had gained information from the documentation that came with the person from his previous placement. Staff told us that the person has a set routine in the morning; he baths, then has his breakfast, and then gets dressed. He then likes to watch television until he leaves for college. Entries in the daily progress sheets made by the day staff were well written, detailed and contained information on the person’s mood, behaviour, actions, diet, personal care needs and waking and sleeping times. Entries were signed, dated and timed. Entries made by the night staff were very basic and require further input. For example, day staff told us that on waking that morning the person was upset and pulled his bedroom curtains off the rails. The night progress sheet did not mention this incident. Day staff told us that they will support the person to go shopping and to prepare their own meals. As the person is new to the home, staff are at present preparing his meals for him. The previous night staff had cooked chicken, rice and peas (a traditional West Indian dish), which the person who used the service refused and asked for pizza instead. The registered person told us that he is aware that more work needs to be done to meet the persons dietary needs. Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 15 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 poor. The health and personal care a person using the service receives is based on their individual needs. We found that medication practices were unsafe potentially placing the person who uses the service at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care staff are using information from the person’s previous placement until they complete their own assessments. We spoke to staff and found they were aware of the persons personal care needs. They were able to tell us how they support the person whilst maintaining his independence. Local services such as the GP and dentist are available. The care staff works in partnership with specialist services such as the Child & Adolescent Mental Health Team (CAMHS), Community Psychiatric Nurses (CPN) and social Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 16 workers to ensure that the complex needs of the people using the service can be continued to be met now he is in their care. Medication practices are unsafe, placing people who use the service at risk. Although the medication policy at the home is satisfactory, the practices within the home do not follow the policy leading to unsafe outcomes for the users of the service. Storage of the medication is poor. We saw medication kept in a drawer in the manager’s office rather than a suitable lockable cabinet to increase safety. The registered person DV told us that he was in the process of purchasing a suitable cabinet. We asked to see the person who uses the service medication to enable us to do an audit. We counted the medication and checked against the medication administration record (MAR) chart. 18 Paracetamol tablets were missing, as were a box of Risperidone tablets. The box of Risperidone was found at the back of the drawer, and the Paracetamol was found in the bottom of a person’s (prospective managers handbag). This person is not yet employed by Highpoint but told us she was taking the medication to the chemist for it to be blister packed. Further, we were concerned to find that the prospective manager who the registered person told us was not yet employed by the service had signed the medication record during the two previous days. These practices do not meet safe handling and storage of medication requirements and place people at risk We looked at the medication administration record (MAR) chart for the period 10/03/08 to 06/04/08. In the two days the person had been at the home, medication had been given and the MAR chart signed, apart from the morning of 14.3.08. The registered person told us that he had given the medication but had not signed the medication record. This practice is unsafe as staff may think the medication had not been given and administer a further dose. Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 17 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 poor. People who use the service do not have access to the complaints procedure in a format suitable to meet their needs. Suitable safeguards were not in place to protect the person using the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaints have been received to date about this service. The complaints procedure is not displayed in the home, and the person using the service does not have a copy which prevents him from knowing how to raise a concern if he had need to. The service has an abuse policy in place. The policy is not accurate in terms of safeguarding. It states that if there is an allegation the home manager will investigate. When what should happen is that any allegation should be referred to the Vulnerable Adults Team as per the Birmingham Multi Agency Guidelines for the Protection of Vulnerable Adults. At present the person’s’ safety is compromised due to lack of or unsafe practices as follows; Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 18 • • • • • • Assessment and Care Planning practices Recruitment practices Medication practices Lack of staff induction/training Lack of staff experience in challenging behaviours Health & Safety issues These issues have been explored in greater detail throughout the body of this report, and were discussed with the registered person DV at the time of inspection. We were also concerned to be told by day staff that the person who uses the service had demonstrated challenging behaviour that morning early when the night staff were still on duty. Yet this incident had not been recorded in the night notes. We asked if we could check any money belonging to the person who uses the service. We were told by the registered person ‘DV’ that the service at the present did not have any money for this person. Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 19 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): 24,25,26,27,28. Quality in this outcome area is adequate. The environment is light, spacious and neutral in décor. Heating is intermittent not allowing adequate warmth at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We undertook a tour of the premises. We saw that all rooms were light, spacious airy, and neutral with regard to décor. We saw that the front door has a keypad in place. The door was locked securely to prevent the person using the service absconding and preventing harm. Smoke alarms and fire extinguishers were present as was a fire blanket in the kitchen. To increase safety, restrictors have been fitted on all windows to prevent them opening too far. Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 20 We found the premises could be made to feel more homely for example; lighting was institutional rather than domestic. We saw that all five bedrooms have en-suite facilities, which is good as this promotes privacy and dignity. We were concerned to see that the bedroom occupied by the person being cared for had the door propped open with a piece of folded cardboard which could increase risk if a fire were to occur. The room occupied by the person who uses the service contained only a single bed, as all the other furniture had been removed. The person had previously pulled a wardrobe over. We suggested that fitted furniture would be better terms of safety and comfort. The person when upset that morning had pulled half the curtain rail off the wall, we saw it was hanging down over his bed. From reading the documentation from the person’s previous placement, it told us that the person has a tendency to pull his curtains down, to avoid this they had attached the curtains to the rail with Velcro, so no further damage was caused. To promote safety the service should have done the same before the person was admitted. We were further concerned as although it was midday, nothing had been done to repair the damage, and make it safe for the person on his return from college. We saw that the bedroom was very impersonal there were no personal possessions or homely touches present to make the room comfortable however, we do acknowledge that the person had only been living at the service for two days. We noticed that none of the en-suites had lids on the toilets. The registered person DV told us this was to allow the future occupants of the rooms to choose which toilet lid they wanted, plastic or wood. We noticed that there was no call bell to summon help if needed. The water from the tap was cold and there was an unpleasant stale odour in the en-suite. We saw the main bathroom in the home was large with an adapted bath to aid persons getting into the bath. We noticed that there was no heating on in the bathroom and it was quite bare and institutional in design. We saw that the kitchen was small but domestic in design. Fridge and freezer temperatures were within normal ranges, but food within the fridge was uncovered and undated which could lead to contamination and risk to the person using the service. A very strong, unpleasant odour was present in the kitchen, similar to the odour in the en-suite we suggested to the registered person there may be a problem with the drainage system that needs checking. We were concerned that the staff toilet cistern was leaking water onto the floor and required some maintenance. Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 21 We were concerned to see a pile of wet; soiled linen on top of the washing machine in the laundry room. When we asked a member of staff who does the washing, we were told; “the night staff does it”. When asked if that that meant that the soiled washing will stay there all day, no answer was given. We informed the registered person about this concern. We saw that all areas where hand washing takes place liquid soap was available, but there were no facilities for drying hands or disposing of rubbish, which could place people at risk from infection transmission. The home was cold, as was the water from the hot taps. Care staff told us that the boiler is turned off during the day whilst the person who uses the service is at college but turned on an hour before he returns. The registered person DV told us that this practice was to ‘cut costs’. When the person returned early from college it was to a cold home. We highlighted our concern to the registered person in that the welfare of the person and staff in the service during the day needs to be considered. The practice of turning the boiler of to ‘cut costs’ could have a detrimental effect on both staff and the person who uses the service. We saw that there were no call points in any rooms including the bathroom. Which means there is no way for the person who uses the service or staff to summon assistance if needed. We asked the registered person why there was no call system, he told us that a call point system was being fitted the following week by AYA Systems. Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 22 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): 31,32,33,34,35. Quality in this outcome area is poor. Staff, do not have the experience or training to meet the challenging needs of the person in their care. Recruitment practice is poor placing the person who uses the service at risk. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When we arrived at the service we asked who was in charge and were told; “ The manager is not here at the moment”. We asked to see the staff rota and were told by one staff member; “ The manager has taken it to work on”. Eventually, on arrival at the service the registered person DV gave us a piece of lined paper, which had handwriting on it. When we asked, DV confirmed that this was the staff rota for this week. We saw that DV’s name was only on the rota once (for Sunday night) but he had told us that he had been on site since the new person had been admitted. Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 23 It was not clear from the rota who was in charge of the service for any shift which may place the person at risk as no staff member is officially delegated as being in charge, responsible or accountable. During the inspection DV started work to produce new electronic rotas. We looked at six staff files in total, three for day staff and three for night staff. We were concerned to identify that staff do not have training and experience to enable them to look after people with challenging and complex needs, which means that the person in their care could be placed at risk or their needs not fully met. For the same six staff we looked at recruitment practices and were extremely concerned to discover that none of the staff had the full checks carried out to ensure that the vulnerable person in their care is being properly protected. For three staff there were no documents to confirm that they had a Criminal Records Bureau (CRB) check or even a Protection Of Vulnerable Adults (POVA) list check. Further, there were no written references for these staff. For another staff member there was documentary evidence of a CRB but no written references. We asked one staff member if he had been in the home with other staff and the person being cared for without the manager being there. He told us; “ Sometimes but only for about an hour”. This concerned us more as not only had staff not been subject to the required checks, at times they were being left with the vulnerable person in their care without any supervision. We raised our concerns with the Registered Person DV who could not provide the recruitment documents. DV told us; “ Things had been done in a rush and not done properly. I take responsibility. You have caught us out. I will take it on the chin”. Because of our concern we issued an immediate requirement. On receipt of the immediate requirement the registered person DV told us; “ I have block booked some agency staff and will stay on site myself. In an hour or two when the person has got used to the agency staff I will send the others home”. Before we left the service two, agency staff had arrived to start duty. Our observations showed us that all staff on duty were black, the person who uses the service white. In terms of meeting needs and diversity the registered person should ensure that the staff mix is correct. From looking at the rotas and observing we saw that the service provides both male and female staff, which is good as this gives the person who uses the service a choice of who provides his personal care in terms of gender. Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 24 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 Quality in this outcome area is poor. Staff recruitment and medication management and safety are poor placing the person who uses the service at risk and does not demonstrate that the service is being run in the interests of the person who lives there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We have described the concerns we identified regarding care planning, medication management and storage, protection and staff recruitment. The registered person has responsibility to safeguard the person in their care and they had not. Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 25 The person who was registered as manager for the service when the service was registered with us is no longer in the country. A new manager has been identified who DV told us has applied for registration with us. We were told by DV that this person is not yet employed by the service but is spending time in the service as part of her induction. We did not look at quality assurance processes or check service documents as the service had only been functioning for two days and these areas would have been assessed before the service was registered. Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 2 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 2 25 2 26 2 27 2 28 x 29 x 30 2 STAFFING Standard No Score 31 2 32 2 33 2 34 1 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 2 14 x 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 x 1 x 2 x x 2 x Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 27 No 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 YA20 Regulation Reg13,17 Requirement All medication is to be stored in a suitable lockable space to which only suitably trained, designated staff has access. Records of all medication received, administered, leaving the home or disposed of must be kept to ensure that there is no mishandling. All medications are to be administered by designated and appropriately trained staff. Medication in the custody of the home are handled according to the requirements of the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society of Great Britain, the requirements of the Misuse of Drugs Act 1971, and nursing staff abide by the Nursing and Midwifery Council Standards for the Administration of Medicines. Immediate requirement issued. Timescale for action 24/03/08 Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 28 2 YA34 Reg 19(1)(11) The home must ensure their recruitment procedure is based on equal opportunities, and protects the safety and welfare of those using the service. Immediate requirement issued during the inspection. 14/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations Prospective users of the service must have the information they need to make an informed choice about where to live. The information must include fees and the method of payment, terms & conditions of their stay including accommodation, food and personal care. People should only be admitted to the home following a full needs assessment, carried out by trained staff, to involve the prospective user, using an appropriate communication method, and with an independent advocate if appropriate. The home must demonstrate it can meet the complex needs of the users of the service. The service develops with the person an agreed individual care plan that covers all aspects of personal and social support, and healthcare needs. The plan is to be reviewed with the person every six months to reflect changing needs. Suitable menus that meet the dietary and cultural needs of the person must be devised, that take into account their individual preferences and tastes. The homes complaints procedure needs to be given or explained to each person using the service in an appropriate language/format. Suitable processes must be in place to ensure that people using the service are protected from abuse, neglect, and self-harm or poor treatment. Premises must be free from offensive odours, and provide sufficient and suitable heating and hot water. 2 YA2 3 4 YA3 YA6 5 6 7 8 YA17 YA22 YA23 YA24 Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 29 9 10 YA26 YA30 Furniture in the bedrooms must be appropriate for the person occupying that room. The home is to be clean and hygienic, with systems in place to control the spread of infection. This to include where hand-washing facilities are sited that paper towels to dry hands, and pedal bins to dispose of rubbish to prevent the risk of cross infection. Staff within the home must have the competencies and qualities required to meet the complex needs of those using the service. There must be an effective staff team in sufficient numbers and with the required skill mix to meet the needs of the persons using the service on duty at all times. The home needs to have a training and development programme in place for all staff. The home must have a registered manager who is qualified, competent and has the experience to run the home to effectively meet the needs of the persons using the home. An effective quality assurance system needs to be implemented to gain the views of all interested parties. 11 12 13 14 YA32 YA33 YA35 YA37 15 YA39 Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Highpoint Care DS0000070244.V356395.R01.S.doc Version 5.2 Page 31 - 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. 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