Inspection on 18/09/08 for New Hope Specialist Care Limited

This inspection was carried out on 18th September 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 11 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 14/03/08

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 05/12/2008.

CARE HOME ADULTS 18-65 Highpoint Care 32 Church Lane Handsworth Wood Birmingham B20 2EP Lead Inspector Donna Ahern Unannounced Inspection 18 and 19 September 2008 11:00 th th Highpoint Care DS0000070244.V368816.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.V368816.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.V368816.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 Berry Choga (Waiting registration with CSCI, application is being processed) Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Highpoint Care DS0000070244.V368816.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 14th March 2008 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 years. The service is provided from a detached house in a residential street in Handsworth Wood, Birmingham that is in keeping with other properties in the street. 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 people. The home has a combined lounge and dining room, a kitchen, ground floor bathroom, five large bedrooms one on the ground floor, all ensuite, laundry, staffroom and office. An activity room was under development at the time of writing this report. There is also a large back garden with ramped access for people with mobility difficulties. 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.V368816.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 no star. This means the people who use this service experience Poor quality outcomes. This inspection was carried out over two days; the home did not know we were going to visit on the first day. This was the homes key inspection for the inspection year 2008 to 2009. Because of concerns at the Home following a key inspection in March 2008 a Random inspection took place in April 2008. The outcome of this visit was some improvement had been made with medication management, however there still remained concerns with a number of areas including. We also tried to carry out an unannounced inspection on two occasions in July 2008, but we were unable to gain access as no one was at home. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. At the time of this visit three people were living at the home. All these people have a learning disability and have some behaviors that challenge the service. We case tracked all three people this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Some of the people who live at the home were not able to tell us their views because of their communication needs. Time was spent observing care practices, interaction and support from staff. The manager and three staff on duty were spoken to. A partial tour of the premises took place. A sample of care, staff and health and safety records were looked at. The manager assisted us with the inspection process and was on duty throughout the two-day visit and provided us with all the information we asked to see. He had only been in post for just over 6 weeks. The findings of the visit was we had significant concern about peoples welfare and safety because of shortfalls and failures in the running of the home. As a result of this we contacted Birmingham Social Services and told them about our concerns. We also met with the Directors of the company on 26th September 2008 so they could tell us what they were going to do to make sure the home is safe for people to live in. Highpoint Care DS0000070244.V368816.R01.S.doc Version 5.2 Page 6 A change of Directors took place on 13th October 2008. The new Directors have committed to address the shortfalls identified in this report. Further visits will take place to monitor compliance with requirements made. What the service does well: What has improved since the last inspection? What they could do better: Peoples needs should be assessed before they move in so that they can be confident their needs will be met and staff have the information they need so they can meet their needs and keep them safe. The care plan does not detail how staff can support people to make individual choices and express their preferences and make sure that they receive the care they require in a way they prefer. Decisions made by staff on behalf of residents should be recorded so that they can show how decisions were made and that it was in their best interest. There is little information about the activities that people like to do and how activities are planned this should be improved so that individual needs and preferences are met. Where there are restrictions in place the reasons for these must be recorded and the impact on people living in the home must be considered so their rights are not denied. It is not evident that people living at the home receive a varied, healthy nutritious diet, so dietary needs are not met and they are supported to stay healthy. Highpoint Care DS0000070244.V368816.R01.S.doc Version 5.2 Page 7 Staff do not have the information they need to meet peoples health care needs so that they are not placed at risk of harm. Peoples health care needs are not fully explained on their care plan and there is no information for staff to follow so these health care needs are met. This places people at risk of harm. Information telling staff how and when to give residents medication should be improved so that people are only given the medication they need at times they need it. The homes procedure for managing complaints does not ensure that matters are dealt with or people listened to. Staff do not have the information they need to support people with managing their behaviour so that the person and the other people living in the home are safe. The home does not inform the commission of incidents that occur in the home so that legal requirements are met. People do not get the help they need to manage their money in a safe way. Staff do not have the skills or training to support people safely. There is not always enough staff on duty to support people and keep them safe. The Home is not always a safe place for people in live in so they are placed at risk of harm. 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.V368816.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.V368816.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 and 3 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Arrangements are not in place to assess fully whether the care home can meet peoples support and accommodation needs prior to them moving in so they cannot be confident that their needs will be met upon admission. Prospective residents do not have all of the information they need to make a choice of whether or not they want to live there. EVIDENCE: The previous inspection report raised concern about the quality of the information available for prospective users of the service, as it did not give clear relevant information about the service. Without this information people cannot be clear about what they can expect from the service. The manager stated that all documentation is currently under review and the home has employed the service of a consultancy to help develop the homes documentation. It was agreed that when the statement of purpose, service user guide and admission policy is reviewed these will be forward to the Commission. Highpoint Care DS0000070244.V368816.R01.S.doc Version 5.2 Page 10 The previous inspection report raised concern about the homes admission procedures and needs assessment. The home now has three people living there and has continued to admit new service users before fully addressing the shortfalls that were highlighted in March 2008. The assessment tool in place is very basic, with hardly any detail listed and incomplete sections. A risk assessment checklist had been completed and identified such risk as physical and verbal aggression towards others and challenging behaviours however there was no assessment detailing how these risks should be managed. This means that staff do not have the information they need to be able to meet peoples needs in a way that meets their needs and expectations safely. There was no evidence that potential restrictions on choice, freedom and services had been discussed and agreed with the individual as part of the assessment process. The people living there have complex needs and challenging behaviour. People have been admitted to the home without consideration of the specific needs of individuals and the skills, ability and knowledge of the staff that are caring for them. The home does not demonstrate that it has the capacity to meet people assessed needs and the current arrangements places people at risk of harm. Highpoint Care DS0000070244.V368816.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, 8 and 9 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. People are not supported to take risks in a way that promotes their independence and keeps them safe. People are not supported to make decisions about their life and their rights and choices are not promoted. EVIDENCE: The care provided to all three people living at the home was looked at this included looking at their care records. A care plan was in place for each person and covered a range of areas including family contact, leisure, general health and behaviour and daytime occupation. However these documents contained very limited information and because the Home has no full and up to date comprehensive assessment it lacked any detail about the individuals assessed needs and how to meet them. It could not be used as a working tool for staff to follow, as it did not provide them with the information they need to meet peoples needs. There was no evidence of any involvement with the resident so Highpoint Care DS0000070244.V368816.R01.S.doc Version 5.2 Page 12 that they did not have an opportunity to say how they wanted their needs met. The document had not been kept under review and review dates had been set and nothing recorded so that changing needs had not been monitored. The manager had very recently implemented new care plans called Individual Service plans for each person. However again these only contained brief information and did not provide the required information so that staff know how to meet the individual needs of people. A document called a “ Service User Risk Assessment” had been completed for each person. This was not detailed enough to enable staff to keep people safe. For example this consists of a tick box format with some added comments which identified such risks as “can assault staff and adults” “threatens people both young and adults” “verbal abuse” “self neglect” “risks from others” “sexual exploitation” “risk of absconding”. However no comprehensive information had been included so that staff would know how the risk would present and what should be done by staff to manage these risks. No risk management strategies had been developed or guidelines implemented so that people receive the support they require to manage the known risk appropriately. Despite that many of these behaviours were known as they had occurred in the peoples previous placements. Discussions with the manager, staff and from looking at records confirms that incidents have taken place in the home and community including residents physically attacking members of the public on a bus, scratching other residents and assaults on staff. This places people at serious risk of harm. The commission has not been informed of these incidents. There is a legal requirement to notify the commission of these. Some of the people living in the home have specific communication needs however it is unclear how the staff team will support and enable the individuals to express their views and to take part in the day to day running of the Home as there is no details about how staff can support them effectively with their communication needs. We saw people make some limited choices during the visit including asking for a drink, choosing where to sit and asking to go out in the car. It is positive that staff responded to these choices. There is much scope for people to be supported to make decisions about their day-to-day life and this should be recorded in their daily notes. Where people living in the home lack capacity to make decisions this should also be documented and include whom, why and what decisions have been made on service users behalf. Highpoint Care DS0000070244.V368816.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 and 17 Quality in this outcome area is adequate. Opportunities for people to develop and enhance their independent living skills are inadequate, which limits people’s personal development. The arrangements in place for meal planning do not ensure that people receive a healthy diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two of the people living at the home attend full time day care. The manager said that he was in the process of supporting one of the residents who currently has no structured day care to obtain a suitable daytime placement and this was in the process of being explored with the person and other relevant people. Highpoint Care DS0000070244.V368816.R01.S.doc Version 5.2 Page 14 Activity plans were on peoples care plans but when we explored these in more detail the daily records and information from staff and the manager indicated that what was recorded on the plans had not actually occurred. The manager said that how activities are planned would be improved so there is involvement from the residents about what they want to do and when. One of the people said, “I like to go out, I like the cinema and I have a drink”. And “I like going out in the car”. Residents do go out in the car, on the bus and for walks as seen at the time of the visit. Some of the residents spend the majority of the day out of the Home at day care. Information on peoples files from their previous homes identified risks around accessing the community and travelling on transport. Incidents have also been logged whilst living at Highpoint including an incident when a resident physically attacked members of the public. There is a lack of information to support how the decisions to go out are made, and no evidence of planning around where people go and what they do. There were no risk assessments in place to ensure that these activities away from the home are carried out safely with planned strategies to manage known behaviours. This lack of planning and risk assessments has the potential to put people at risk. There is no information on peoples care plans about how they will be supported by staff to maintain their independent living skills and promote their independence within the Home. There are imposed restrictions which impacts on people’s rights and freedom of movement throughout the Home. This includes, locked kitchen, pad locks on kitchen cupboards, locked laundry, locked bedroom doors, front door key pad entry system, and furniture removed from some peoples bedrooms. Peoples individual care plans do not detail why these restrictions are in place, what the risks are and there is no comprehensive risk assessments in place to support this practice or that they were agreed as part of a multidisciplinary team. People have been supported to maintain links with their family and visit their family. For some people there are restrictions in place surrounding family contact however there were no guidelines or risk assessments about this in place. This information should be documented in peoples care plan so staff can make sure that people get the support they need. One of the residents said when asked, “I like the food”. We observed the evening meal being served. The meal, which was a chicken curry, was served up in the kitchen and brought through to the dining room. During the visit residents did ask for drinks and staff responded to these requests. There are no snacks left out for people to help themselves to. Staff said some of the residents go shopping with staff to the supermarket to buy the groceries. Food stocks looked at were adequate but only very few snacks were available including a few plain biscuits in a tin, and a few pieces of fresh fruit. Menus were looked at and are on a four-week rotating menu. The menus were Highpoint Care DS0000070244.V368816.R01.S.doc Version 5.2 Page 15 repetitive with the same food served every Wednesday, Thursday and Saturday. There were chips served for 5 out of 7 days. Tea for three consecutive days was “Tea and jam doughnuts or macaroni. The manager explained that the main meal is served at lunchtime when two of the three people are out at day services. We were told that residents have a cooked meal at their day centre or school and tea in the evening is mainly a sandwich. The records of food for residents had several gaps with no food recorded so it was not possible to ascertain if people are getting a healthy diet, which is essential to maintain people’s health and wellbeing. Highpoint Care DS0000070244.V368816.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 and 20 Quality in this outcome area is Poor This judgement has been made using available evidence including a visit to this service. Arrangements in place do not ensure that the health and personal care needs of individuals are met, which impacts on their well being and safety. The arrangements for medication administration do not fully ensure that people receive their medication in a safe way. EVIDENCE: Care plans had very limited information about how people should be supported with meeting their personal care needs so that they can not be confident that their needs will be met in a way that meets their expectations. For example; there were no guidelines or risk assessments in place regarding the support and supervision people require from staff during the night so they are supported in a way that they prefer. Highpoint Care DS0000070244.V368816.R01.S.doc Version 5.2 Page 17 All of the current residents are fully mobile, however one of the residents had a fall recently getting into the bath. Moving and handling risk assessment required implementing so people are supported safely. The “service user risk assessment” for one of the residents states that there is a risk of choking if they are not monitored with their meals. Information on file from where the person lived previously stated that the person will overfill their mouth, not chew and self induce vomiting. This information had not been fully transferred into the homes documentation so staff knew how to support the person safely at mealtimes. There were no risk assessments in place or guidelines to inform staff how they should support, monitor and act in the event of the person choking. There were no risk assessments guidelines or details on their care plan for a person with epilepsy. The manager did not know how the epilepsy presented but said there had been no seizures since they lived at the Home. If the person had a seizure they may not get the support they require. The manager had recently implemented recording sheets for medical and health care appointments to improve how people’s health care is monitored by staff as this practice has just commenced it was not possible to assess the quality. The manager had also just started weighing the residents, which is positive as weight gain, and loss is an indicator for possible health problems. There are no health action plans in place. This is a personal plan about what support the individual needs to meet their health needs and what healthcare services they need to access. There were no behaviour management plans, which should detail possible triggers and how to manage behaviours and inform staff how to work with the person in a positive way that can reduce the likelihood of the person displaying these behaviours so that the person and the other people living there are safe. Some of the people have input from other health care professionals including consultant psychiatrists and community nurses. The manager said that he is keen to ensure that residents get the support they require from other health care professionals and will be making further referrals for their input. The Random inspection in April 2008l found that the arrangements for managing peoples medication had improved. Medication was being stored in a secured cupboard, which is located on the first floor. During this visit we found that there is no protocols in place for medication given on an as required basis. Therefore staff do not have the information they need to know when to give the medication and how often. This may result in people receiving medication when they do not need it. There were some gaps on the medication record sheets, with no explanation given of why the medication was not given. There were records of medication returns to the pharmacy when they were no longer required but no record of incoming medication. There were no audits of non Highpoint Care DS0000070244.V368816.R01.S.doc Version 5.2 Page 18 blister pack medication, which meant proper audits checks could not be completed. There were no records of staff signing against the initials they use on the medication record sheet so there is a system for checking who has administered medication and this will enable audits to be completed. There was no information on peoples care plans about how they like to take their medication. The medication storage, which is on the first floor inside a small walk in cupboard, could be problematic from a health and safety point of view. There was no shelf to lean or work from and no hand washing facility near by making the task of administering medication from this location difficult. Highpoint Care DS0000070244.V368816.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 and 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The arrangements in place for the protection of people living in the home do not safe guard people and put them at serious risk of harm. EVIDENCE: The complaints procedure is not displayed in the home, and the people using the service do not have a copy, which prevents them from knowing how to raise a concern if they need to. No complaints to date have been received by CSCI about this service. The manager said that no complaints had been received directly to the Home. However when looking in the communications book two complaints from neighbours had been recorded but there was no evidence that these had been investigated and had not been logged in the complaint book. One of the complaints was about residents throwing clothes over the neighbour’s fence and the other was about staff parking cars outside the neighbours house limiting access to their property. The Home has a safeguarding policy in place. The previous inspections findings were that the policy is not accurate in terms of safeguarding. It states that if there is an allegation the 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. We were told during this visit that these documents were in the process of being reviewed so they meet the required standard. This means Highpoint Care DS0000070244.V368816.R01.S.doc Version 5.2 Page 20 that staff currently do not have any appropriate information to guide them in the event allegation is made. Staff spoken with during the visit did have some knowledge of safeguarding procedures, which had been gained from their experience in previous employment. During the visit one of the residents made an allegation to the inspector about the use of restraint by staff in the home. Incidents and accidents reports were looked at and indicate a number of incidents of physical behaviour have taken place which have caused injury to residents and staff. There was also an entry in the daily records, which stated that a resident was restrained on the sofa by four staff following an incident. A staff member spoken with confirmed that the incident took place however this incident was not logged on the homes incident reporting form. The manager said he was not aware of the incident. None of the incidents had been reported to us or to Birmingham Social Services who are the placing authority and the lead agency on protection matters. As previously stated there are no strategies or guidelines in place to specify the circumstances when restraint should take place and inform staff how to work with the person in a positive way. Restraint of a resident unless it can be demonstrated that for an individual in particular circumstances not being restrained would conflict with the duty of care of the person and this is agreed within the multi disciplinary team should not occur as it can be construed as assault upon the person. Staff received a one-day workshop on managing challenging behaviour on the day that the inspection took place. The training was called “managing violence and aggression and breakaway training” although the homes training record says it is “restraining technique training”. Prior to this there is evidence of only minimal training on challenging behaviour for some of the staff on an induction-training day that covered several other topics. Staff spoken with demonstrated limited knowledge of challenging behaviour and behaviour management strategies. The Homes restraint policy is also under review so has not been implemented. This report already highlights serious concern about the safety of residents due to the poor assessment process, poor care planning and lack of staff training and experience in managing challenging behaviour. Due to these significant concerns we made a safeguarding referral to Birmingham Social Services following the key inspection. As a result of the referral safeguarding meeting are currently being held. The finance records of three of the people living there were checked briefly. We saw that one of the people was paying for their meals at their day care out of their personal allowance, which is not acceptable as this is already covered in the fees they are paying. Another person does not have full access to their own money. Their finances are still being dealt with by their previous home Highpoint Care DS0000070244.V368816.R01.S.doc Version 5.2 Page 21 although they moved four months ago; cash is delivered to Highpoint from the previous home periodically so they have some money to use. This arrangement is unacceptable and must be reviewed in conjunction with the persons social worker so that the person has full access to their money. There were no financial risk assessments in place saying how the individual residents should be supported with their money. The manager said the practice of staff borrowing money from residents personal money to buy food items for the home when there was no petty cash available has now ceased. Highpoint Care DS0000070244.V368816.R01.S.doc Version 5.2 Page 22 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 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People do not live in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. EVIDENCE: We looked at some parts of the home. We saw that the front door has a keypad in place. The manager informed us that the door was locked securely to prevent residents absconding and preventing harm. We found the premises could be made to feel more homely for example; walls were mainly white washed and there were no pictures or finishing touches throughout the home. We saw that all five bedrooms have en-suite facilities, which are wet room design with very limited space and the practicalities of this design with the Highpoint Care DS0000070244.V368816.R01.S.doc Version 5.2 Page 23 client group seems problematic. When we were testing the water temperatures we saw that the whole en-suite facility gets soaked when in use. We discussed this with the manager as this would presents difficulties if the person needs some supervision from staff and wets any personal toiletries kept in the shower room. One of the en-suites was out of use as it had flooded the bathroom below and had triggered the fire alarm system. One of the occupied bedrooms contained only a bed and another bedroom contained only a bed and cupboard and chair. The manager told us that all the other furniture had been removed as the residents had previously damaged their furniture. He said that there are plans to install fitted furniture for safety. As this information about the persons behaviours and preferences was known prior to admission suitable arrangements should have been made prior to them moving in. One of the unoccupied bedrooms was looked at and residents furniture was seen stored in this room. Most items were damaged as a result of peoples behaviours. We saw some copper piping protruding from the floorboards in a person’s bedroom, which could be a safety hazard. There were no curtains in two peoples bedrooms and on the landing. The manager said that the curtains were in the wash. On the second day of the visit curtains has been replaced in the two bedrooms but not on the landing. Which would effect peoples privacy from passers by on the main road that the home is located on. We saw that the three occupied bedroom had no personal possessions or homely touches present to make the room comfortable. The manager said that there are plans to make peoples bedrooms more comfortable and residents will be involved in choosing colour schemes for their bedrooms. We saw the main bathroom located on the ground floor was large with an adapted bath to aid persons getting into the bath. The bathroom was quite bare and institutional in design and does not provide a relaxing space for people to attend to their personal hygiene. We saw that the kitchen was small and domestic in design. Fridge and freezer temperatures were within normal ranges so food is stored safely. One of the sofas in the lounge required replacement as it was soiled. Carpets were soiled in the hallway. The television had been broken and the manager said the replacement television was not suitable. There was no tumble drier for drying peoples clothes and the manager had requested one so that peoples clothes can be dried. There was a strong odour at the bottom of the stairs, on the landing and in one of the bedrooms, the odour was strong and there were flies in the person’s bedroom. The manager said that the carpet was due to be replaced. Highpoint Care DS0000070244.V368816.R01.S.doc Version 5.2 Page 24 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, 33, 34, 35 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Arrangements do not ensure that there is enough competent, qualified staff on duty at all times to keep people safe. EVIDENCE: The Random inspection in April raised concern about the Homes staff recruitment procedures. We looked at eight staff files and Criminal Record Bureau (CRB) checks were available for all staff confirming their suitability to work with vulnerable people. Two references were also on file for the staff files looked at. The manager confirmed that he had reviewed all the staff files and it was pleasing that robust system are now in the process of being implemented. We looked at the duty rotas, which consisted of handwritten names written in and cossed out. We were not able to confirm what staff had worked on several days before and our visit. We could not confirm that minimum staffing levels had been on duty, rotas seen indicated levels of well below minimum staffing levels. On the day of the visit several staff were in as staff training was taking Highpoint Care DS0000070244.V368816.R01.S.doc Version 5.2 Page 25 place so we were unable to accurately access staffing levels on this day. The manager said that at least two agency staff work in the home on a daily basis. Their names were not on the rota. Therefore it was not possible to confirm who was working in the home at any one time. The manager had obtained from the agency details of peoples training, expererience and CRB details so he could use this information to ensure that only suitable people worked in the home. The details of thirteen agency staff were seen. The manager said that minimum staffing levels consisted of three staff in the morning and five staff on an afternoon shift and one person on duty at night with one person sleeping in on call. The manager said that all people require a minimum of one to one staff in the home and two residents require two staff to access the community, to keep them safe. A number of care hours are vacant which the manager said they are recruiting to. The Homes statement of purpose states that the management structure will include two senior support workers. There are currently no senior staff in post and these positions will need to be appointed to so there is an effective staff team in place who can respond to the challenging needs of the residents. Staff spoken with were friendly and were caring towards residents but had a lack of training and experience of working with people with challenging behaviour. When asked about dealing with difficult situations they said they have their own way of trying to settle residents when they are agitated. One staff member said that staff sometimes would ring them when they are off duty to speak to residents on the telephone to try and get them to settle down. Another staff member said they use the ring tone on their mobile phone and pass this to a resident to listen too and this seems to calm them. There are no risk assessments in place for staff supporting people out in the community, lone working or escorting people in the homes transport. Which places them at risk of harm. Induction and supervision sessions have been implemented in the last six weeks since the new manager started. He had just completed a staff training plan which identifies that staff require training in fire safety, understanding challenging behaviour and autism health & safety, infection control, medication administration, 1st aid and adult protection and dates have been scheduled for the next three months. The specialist needs of the person using the service will also impact on the training required by staff and in addition to what the manager has planned training is also required in strategies to manage behaviours safely, autism and epilepsy to ensure the safety and well being of the people using the service. The manager was in the process of issuing staff with job descriptions and contracts so they know their roles and responsibilities. It is of concern that the owners had failed to issues these prior to now. Highpoint Care DS0000070244.V368816.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 and 42 Quality in this outcome area is Poor This judgement has been made using available evidence including a visit to this service. The home is not run and managed appropriately. Arrangements are not in place to make sure people are safe. EVIDENCE: The manager said he had been working at the home for about six weeks. He has made an application to the commission to be the registered manager and we were processing this application at the time of compiling this report. This report highlights signifanct shortfalls that have the potential to put people at serious risk of harm. People living there do not experience good outcomes or benefit from a well managed home. Highpoint Care DS0000070244.V368816.R01.S.doc Version 5.2 Page 27 We looked at the water temperatures recordings of water outlets and these showed excessively hot temperature readings of over 60 degrees. This was discussed with the manager who thought that this is what the temperature should be. Whilst the boiler should be of this temperature water out lets that residents have access to should be controlled at a temperature of no higher than 43 degrees to prevent the risk of scalding to people. We did some further testing of temperatures and found temperatures in the high 40,s but not as high as 60 degrees. An immediate requirement was made to urgently check all the water outlets that residents have access to and to take appropriate action so that people are safeguarded from the risk of scalding. When looking around the home we saw window restrictors in two of the first floor bedrooms at the rear of the home had been overridden and were in a fully open position presenting a possible risk to peoples safety. The manager was unsure why this had happened. An immediate requirement to review this practice was made. There was no work place fire risk assessment for us to look at the manager said that an independent person from GS fire protection will be completing the assessment on 19th September 2008. This is of serious concern, as staff have no guidance about how to keep people safe in the event of a fire. This information was passed onto West Midland Fire Service as the statutory agency responsible for fire safety. All the evidence available to us indicates that working practices in the home are not safe. There is no proper monitoring of incident and accidents. We saw that no entries had been made into the accident record book for staff members although incident reports state that staff had been assaulted. Policies and procedures are not fully implemented to protect residents or employees health and safety. Staffs lack experience, knowledge and skills in supporting people with challenging behaviour. The home has failed to comply with statutory reporting requirements and there is a poor understanding of risk assessment processes. We took a number of steps to address some of the shortfalls and this included meeting formally with the Directors. They agreed to admit no more people to the home until things have improved and the home is safe and comfortable for people to live in. They also agreed to improve all areas of the home so that it is safe and comfortable for the three people who live there now. We confirmed that we will be doing further visits to the home to make sure that the Directors comply with requirements. If they do not then the Commission will consider what further action it will need to take so the home is safe for people to live in. Highpoint Care DS0000070244.V368816.R01.S.doc Version 5.2 Page 28 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 1 2 1 3 1 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 1 25 X 26 1 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 1 33 1 34 2 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 X 1 1 X LIFESTYLES Standard No Score 11 X 12 2 13 X 14 X 15 2 16 1 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 1 2 X 1 X 1 1 1 1 X Highpoint Care DS0000070244.V368816.R01.S.doc Version 5.2 Page 29 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 YA2 Regulation 14 (1) Requirement Pre admission information must be collected so that people know their needs can be met. People must have risk assessments in place where they are identified as being at risk of harm so that they are protected. Proper provision must be made for the care, treatment and supervision of people so that their health and well-being is promoted. Protocols for medication given on a required basis must be in place so that people receive their medication in a safe manner. Incidents of physical restraint must be documented in full and reported to the relevant authorities so peoples well being is promoted. Staff must have knowledge of the appropriate action to DS0000070244.V368816.R01.S.doc Timescale for action 15/11/08 2 YA9 13 (4) a, b, c 29/10/08 3 YA19 12 (1)(b) 29/10/08 4 YA20 13 (1) b 29/10/08 5 YA23 13(7) and (8) 22/10/08 6 YA23 13(6) 29/10/08 Highpoint Care Version 5.2 Page 30 7 YA23 12 (1) a, b 8 YA33 18 (1) a 9 YA35 18 (1) c 10 YA42 13 (4) take in the event of an allegation of harm to ensure that people are safe from harm. Arrangements must be in place so that staff can support people with the Challenging behaviour consistently so that they know how to protects their health and well being, and reduce risk to them and other people living there. People must be supported by an effective staff team in sufficient numbers and with the required skill mix to meet their needs at all times. Staff must receive training on the specific and complex needs of residents so they have the required skills and knowledge to meet their needs. (Including challenging behaviour, epilepsy and autism). Arrangements must be in place to ensure that the water temperature available at outlets accessible to residents does not place them at risk of harm. 15/11/08 22/10/08 15/12/08 22/09/08 11 YA42 13 (4) Immediate requirement was made to action within 48 hours and confirm action in writing by 29th September. Arrangements must be in 22/09/08 place to ensure that people are not at risk of falling from windows. Immediate requirement was made to action within 48 hours and confirm action in writing by 29th September. Highpoint Care DS0000070244.V368816.R01.S.doc Version 5.2 Page 31 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. The service develops with the person an agreed individual care plan that covers all aspects of personal and social support, and healthcare needs. How and why choices have been made on peoples behalf should be recorded Peoples individual communication needs should be documented so that people are encouraged by staff to express themselves. People should be supported by staff to maintain their independent living skills and promote their independence within the Home. Restriction in place should be fully explained as to the reasons why and kept under review so peoples rights and freedom of movement is not exploited. People must be offered suitable, wholesome and nutritionally balanced food so that their health and welfare is promoted. Moving and handling assessment should be in place stating how people should be supported and moved safely. A record of in coming medication and non blister pack medication must be kept to ensure there is no mishandling of medication. There should be details on peoples care plans about how they like to be supported to take their medication. The support people receive to manage their finances must be reviewed so they are protected from the risk of financial abuse. Staff duty rotas should be an accurate reflection of the people working so that there is enough staff to meet peoples needs. The homes complaints procedure needs to be given or explained to each person using the service in an appropriate language/format. DS0000070244.V368816.R01.S.doc Version 5.2 Page 32 2 3 4 5 6 7 8 9 10 11 12 13 YA6 YA8 YA8 YA12 YA16 YA17 YA18 YA20 YA20 YA23 YA33 YA22 Highpoint Care 14 15 16 YA24 YA24 YA26 The premises must be free from offensive odours. A carpet in a bedroom required replacing so that the room would be free from offensive odour. Furniture in the bedrooms must be appropriate for the person occupying that room. And damaged furniture repaired. The home is to be clean and hygienic, with systems in place to control the spread of infection including an infection control policy and facilities to dry hands in the laundry to prevent the risk of cross infection. Facilities must be in place so that residents can dry there clothing. Staff must have job descriptions and contracts so they know their roles and responsibilities. Staff within the home must have the competencies and qualities required to meet the complex needs of those using the service. An effective quality assurance system needs to be implemented to gain the views of all interested parties. Peoples health and safety must be promoted and protected with the implementation of relevant policies and procedures. Accident/incident records must be completed so that there is an audit trail of information. The homes record keeping must safeguard peoples rights and interests. Arrangements must be in place to ensure residents are protected from the risk of fire. 17 YA30 18 19 20 21 22 23 24 25 YA30 YA31 YA32 YA39 YA40 YA40 YA41 YA42 Highpoint Care DS0000070244.V368816.R01.S.doc Version 5.2 Page 33 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.V368816.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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