Inspection on 05/03/09 for New Hope Specialist Care Limited

This inspection was carried out on 5th March 2009.

CSCI found this care home to be providing an Adequate 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 18/09/08

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 19/06/2009.

CARE HOME ADULTS 18-65 Highpoint Care 32 Church Lane Handsworth Wood Birmingham B20 2EP Lead Inspector Donna Ahern Unannounced Inspection 5th March 2009 09:30 Highpoint Care DS0000070244.V374497.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.V374497.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.V374497.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 Manager post vacant Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Highpoint Care DS0000070244.V374497.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 18th September 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. A passenger lift ensures access to the first floor for people with limited mobility. An activity room was under development at the time of writing this report. There is also a back garden with ramped access for people with mobility difficulties. The statement of purpose seen did not contain details of fees. Up to date information can be sought from the Home. Previous inspection reports were available in the hall for people to read. The dates of the previous inspections were Key inspection 18th September and Random inspection 2nd and 17th October 2008. Highpoint Care DS0000070244.V374497.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 one star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out over one day; the home did not know we were going to visit. This was the homes second key inspection for the inspection year 2008 to 2009. 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. Following concerns identified at a Key inspection on 18th September 2008 and at a Random inspection on 2nd October 2008 we were in the process of preparing Statutory Requirement Notices for failing to comply with the Care Standards Act 2000 and the Care Homes Regulations 2001. We were informed on 13th October of a change in Directorship of Highpoint Care. For this reason we made the decision to not serve the notices at this time but to allow the new Director time to address the shortfalls in the Home. We carried out another Random inspection on 17th October and the new director had already started to make improvements to the service. 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 owner, deputy manager and three staff on duty were spoken to. We looked around some parts of the Home to make sure it was warm, clean and comfortable. We looked at a sample of care, staff and health and safety records. We were sent an Annual Quality Assurance Assessment (AQAA) by the home. This tells us about what the home think they are doing well and where they need to improve. It also gives us some numerical information about staff and people living at the home. We also looked at notifications received from the Highpoint Care DS0000070244.V374497.R01.S.doc Version 5.2 Page 6 home. These are reports about things that have happened in the home that the must tell us about. No immediate requirements were made on the day of this visit, which means that there was nothing urgent for the home to put right to ensure people were safe. The deputy manager and responsible individual assisted us with the inspection. The manager is not yet registered with CSCI she was present at the end of the inspection for feedback. The responsible individual informed us on 24th February 2009 that the name of the home would be changing to Brighthouse. As this change had not yet formally taken place with CSCI registration team this report has been published in the name of Highpoint Care. We sent out 3 surveys to people living in the Home to seek their views and opinions, 10 to staff and 6 to professionals. We received 2 completed surveys from people living at Highpoint care, 7 from staff and 2 from professionals. People living in the Home received help from their advocate or friends to complete their questionnaires. Comments received are contained in the main body of the report. What the service does well: What has improved since the last inspection? Robust recruitment procedures are now in place so only staff suitable to work in the home are employed. Highpoint Care DS0000070244.V374497.R01.S.doc Version 5.2 Page 7 Policies and procedures have been put in place to promote and protect peoples well being. Care plans have improved so staff have most of the information they need to meet peoples personal and health care needs. People are supported by staff who have been trained and understand their needs. The Home has been made comfortable, safe and homely for people to relax in. Choices of meals are offered and a range of food is available which means people should receive food they like. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Highpoint Care DS0000070244.V374497.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.V374497.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 and 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents and their relatives have most of the information that they need to know so they could make an informed choice about whether they wanted to live at the home. EVIDENCE: Since our last inspection two people had moved from the Home and two new people had been admitted. There were three people living there when the inspection took place. We saw an admission process that would be implemented in the event of a vacancy occurring and we spoke to staff about the two people who have recently been admitted to the Home. Staff confirmed that before admission people had the opportunity to visit Highpoint, meet staff and the other people who live there. Staff said, We were well prepared to meet peoples needs We looked at the pre-admission assessment information and saw that new assessment paper work has been put in place since the last visit. However we Highpoint Care DS0000070244.V374497.R01.S.doc Version 5.2 Page 10 saw that not all the information about a persons individual needs had been recorded, which could result in people needs not being planned for and met. The service user guide and statement of purpose require some amendments. The range of fee levels and any additional charges should be made available so people know what the fee includes. The owner told us that he has applied to increase the registered numbers from 5 to 6. This application is still in process and not yet approved. The statement of purpose gives conflicting information about the current registered numbers, registered bedrooms and arrangements for waking night staff. This should be clarified so that this information accurately reflects the current service at Highpoint. Highpoint Care DS0000070244.V374497.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 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements have improved so that staff have most of the information they need and have a good understanding of the people they support, which should ensure their need are met. EVIDENCE: We looked at three care plans. Care plans explain what each person needs are and the care and support they require to make sure these needs are met. We found that the files looked at gave information about how staff should support the person in order to meet their individual needs in relation to personal care, communication health care, and social activities. We saw that improvements had been made so that peoples needs are recorded and planned for so staff have the information they need to support people. However the care plans are still very much being developed as people have not lived in the home for very long and staff are still getting to know what there preferences are. Highpoint Care DS0000070244.V374497.R01.S.doc Version 5.2 Page 12 We spoke to members of staff who support each of the people and we also observed people being supported by staff. The staff demonstrated knowledge of peoples individual needs which was consistent with the information on peoples file. This indicates that staff know how to provide care and support to people so their needs are understood. We looked at risk assessments for activities, using the house vehicle, bathing. We saw that some risk assessments are detailed and gave clear information for staff to follow so people are supported safely. Some assessments lacked detail and could result in people not getting the support they need to be safe. The owner told us that the risk assessments will be kept under review and improved as the Home gets to know peoples needs better. This should then ensure that people could take responsible risks according to their individual needs. Staff spoken with told us they knew what they must do so people are not put at risk of harm. Some of the people who live there due to their communication needs were not able to tell us about how they are supported to make choices and decisions about their lifestyles. We saw people receiving good support from staff and people were encouraged to communicate their needs by using what limited verbal communication they have or by using gesture and body language to communicate. Staff offered different choices of drinks and food and supported people to relax in the lounge and later to go out shopping. We spoke to staff about how they had supported people to make decisions. We saw some recordings had been made where decisions had been made in the best interest of a person, including buying items for their bedroom from personal money. Highpoint Care DS0000070244.V374497.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): 12,13,14,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported to take part in activities that promotes their independence and are reflective of individual needs. People enjoy a varied diet that meets their cultural dietary needs and preference. EVIDENCE: We looked at care plans and daily records to establish that people are leading meaningful lifestyles and taking part in activities that they enjoy. We also spoke to three staff members and observed care and support on the day. Care plans detail what people like to do. We looked at the daily records across the previous weeks. The records showed that people had been involved in trips out including cinema, shopping, lunch out and walk. Staff explained that activities plans are in place but are being kept under review and will be Highpoint Care DS0000070244.V374497.R01.S.doc Version 5.2 Page 14 developed with people as they become more settled in the Home. It would be positive and informative if more detailed information was kept on how people were involved in choosing activities and how they responded to activities so that this can be used for future planning. There is an activity room, which is in the process of being developed so that the people living there can take part in home-based activities. This is an enclosed room off the lounge area with no natural light or ventilation. This will need to be considered so that the room is comfortable for people to use. All three people went out shopping on the day of the visit and one person went on to see a film at the cinema returning home early evening. The care plans and daily records that we looked at showed that where possible people are encouraged to take part in day-to-day routines of the home such as clearing away after meals and taking their clothes to the laundry so they can develop their independent living skills. We saw that this is more limited for some individuals due to their needs. We saw that there are some environmental restrictions in place including a locked front door and storage room containing cleaning products and were told that these restrictions protect people from the risk of harm. Guidelines and risk assessments should be in place and kept under review to support the practice of the locking of the front door and to ensure this does not restrict peoples rights. Staffs spoken with said peoples family and friends are encouraged to keep in touch and visit the home and some people visit their relatives so relationships important to people are maintained. This was confirmed by looking at the care records. It was really positive to hear fro staff that people will be offered access to specialist guidance about issues such as personal relationships and sexuality. A weekend break to Blackpool had been arranged for all three people living there. Staff had researched a hotel catering for the needs of people with learning disabilities so that people needs are met whilst away. On the day of the visit we saw that people were supported to buy new clothes for their holiday. The daily records we looked at indicated that peoples food and drink intake is recorded daily and regular meals and drinks are offered. We could not determine if people are offered five portions of fruit and vegetables a day as this information was not recorded but plenty of fruit and vegetables were available. We saw staff asking people if they would like a drink. We saw a range of tinned, frozen and fresh food in the kitchen and store cupboards. Menus seen showed that culturally appropriate food is available. We saw that risk assessment were in place regarding the risk of choking. These needed Highpoint Care DS0000070244.V374497.R01.S.doc Version 5.2 Page 15 some additional information recorded so they are consistent with peoples care plans so people receive the support they need to be safe. Highpoint Care DS0000070244.V374497.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 adequate. This judgement has been made using available evidence including a visit to this service. Arrangements in place ensure that peoples personal and health care needs are met. EVIDENCE: Care plans that we looked at had some detail about how to meet peoples personal care needs. The owner told us that these would be further developed when staff have got to know peoples individual preferences. We saw that people were dressed in age appropriate clothing and people were well groomed, this indicates that people are supported to maintain a good selfimage. We met all of the people who live in the home and saw that staff were prompt to offer personal care as needed throughout the day promoting their dignity. At night there is two waking night staff on duty. Care plans we looked at need to detail how people would like to be supported throughout the night by staff Highpoint Care DS0000070244.V374497.R01.S.doc Version 5.2 Page 17 so their care needs are met in a way they prefer. Any night checks completed by staff should be supported by a risk assessment so people are supported safely and in a way that respects that privacy and dignity. The use of a listening monitor has recently been introduced for one of the people. This should be supported with guidelines so it is only used in the best interest of the person and its use should be kept under review. The epilepsy management plan in place for one of the peoples required clarification so that people receive the support they require. The plan gave information about using rescue medication. However, we spoke to staff who said they are not trained to administer the rescue medication and the emergency service would be called if the person had a seizure. The protocol must reflect what support the person needs and arrangements must be in place to ensure that staff are suitably trained and confident to support the person. We were told that the persons epilepsy is well managed with medication and they have had no seizures since living at Highpoint. Care plans looked at indicated that people are being provided with support to access healthcare professionals to meet their assessed needs. A number of referrals have recently been made to other health care professionals for people so they can get the help and support that they need to promote their health and well being. One of the people had recently been provided with a new wheelchair, which had improved their comfort and a referral for alternative comfortable seating for the person had also been actioned. We talked to the owner about developing Health action plans so peoples health care needs can be fully planned for. Surveys completed and returned to us from health professionals made the following comments; The provider has discussed with social workers about health related issues The home manager is always responsive to advice which indicates a positive value base Medication is stored in a separate locked storage area off the landing on the first floor. The cupboard was found to be clean, tidy and well ordered. The medication administration Records (MARS) looked at were signed indicating medication had been given as required. Copies of prescriptions are retained so that staff can check the right medication has been received from the chemist. The people who live in the home cannot self-administer their own medication due to their complex needs. It is recommended that information should be recorded on peoples care records informing staff of how people like their medication to be given. Highpoint Care DS0000070244.V374497.R01.S.doc Version 5.2 Page 18 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 Good. This judgement has been made using available evidence including a visit to this service. Arrangements are now in place so people are listened to and protected from the risk of harm. EVIDENCE: The previous report highlighted serious concern about the safety of people 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 in September 2008. As a result of the referral safeguarding meetings were held and two people were moved to other Homes. The safeguarding concerns have now been closed. The new provider has implemented new policies and procedures including complaints, concerns and safeguarding. We looked at the complaints procedure, which states that CSCI will investigate complaints that cant be resolved by the provider. This is not the role of CSCI and this need to be made clear so that anyone complaining to the provider is clear what the Homes procedure is. The complaints procedure was also available in an easy read version so it was easier for people to understand. However it refers people to the complaint department it must be made clear who people can complain to and the response they should expect. Highpoint Care DS0000070244.V374497.R01.S.doc Version 5.2 Page 19 The commission has received no complaints about this Home since the transfer change of owner. We saw that one complaint had been made directly to the Home, which was about care and supervision of one of the people living there. Paper work seen indicated that this had been fully investigated. Some people who live there demonstrate behaviour that determines staff must work with them in a particular way to help keep them safe and well. We saw guidelines on peoples care plans, which explain how staff should support people with these needs. We looked at some of the recordings that staff had completed following an incident involving people living in the Home and spoke to staff about what and where they record this information. We found that staff were not always consistent with the forms they complete following an incident. We found that some behaviour management guidelines were more detailed than others. The owner told us that they are in the process of working with other professionals to improve behaviour management plans for people so the staff team supports people safely and consistently. A system for analysing incidents should be developed so that the Home is proactive in meeting peoples needs and to prevent further occurrence of the risk of harm. Some of the people living in the Home would require significant support to raise their concerns about something due to their communication needs. We spoke to staff who said they would recognise when people are not happy about something. Staff said they monitor people behaviour and changes in behaviour for possible signs that they are unhappy about something. Staff we spoke to demonstrated a general understanding of their duty to safeguard people and how to report concerns on too senior managers. We looked at training records to determine that training in safeguarding vulnerable adults had been provided. Highpoint Care DS0000070244.V374497.R01.S.doc Version 5.2 Page 20 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 Good. This judgement has been made using available evidence including a visit to this service. People live in a safe and comfortable home that meets their individual needs. EVIDENCE: Highpoint care is located near to local shops with public transport routes close by. There is limited off road parking to the front of the house. To the rear of the Home there is a garden that people have direct access to. There is ramped access to the rear of the building for people who use a wheelchair this ensure there are no restrictions in entry to the building. Aids and adaptations include grab rails in bathrooms where required and a large assisted bathroom on the ground floor that was under refurbishment. Highpoint Care DS0000070244.V374497.R01.S.doc Version 5.2 Page 21 We looked at the shared areas of the Home and the bedrooms of the people whose care we had case tracked. There were no unpleasant odours, which would indicate good standards of hygiene practice are in place. Improvements have been made to the physical standards of the Home since the last visit and the owner has plans for further improvements. The lounge was welcoming and homely with leather sofas providing a range of seating for people and a comfortable and welcoming area for people to relax in. The kitchen is compact with some storage space and worktop space for preparing meals. The kitchen was clean and equipped with adequate space to store fresh, frozen dried and tinned food. There is a separate laundry room, which was clean and organised. We saw substances such as cleaning products that could cause harm to people had been locked safely away. All bedrooms have ensuite bathrooms, which ensures that personal care can be provided in a way that promotes peoples privacy. One of the ensuites was in the process of being repaired and made safe. We were informed that the person was using an ensuite in one of the unoccupied rooms, whilst the work takes place. Two peoples bedrooms are located on the ground floor and four on the first floor. The use and registration of rooms is currently under discussion as previously highlighted. The bedrooms we looked at had recently been painted in fresh bright colours. We were told that people were supported to choose colours were possible. We saw that some of the bedrooms had the furniture secured to the wall so that it was safe for people. Some of the people choose to only have limited items in their room and this and the reasons why had been recorded in their care plan. Staff were very positive about the progress people had made with making their rooms more personal and there are plans to continue with this work as people become more settled in their new home. Highpoint Care DS0000070244.V374497.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): 32,33,34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported by a team of staff who have a good understanding of their needs. The Home operates a robust system of recruitment for the protection of the people who live there. EVIDENCE: Some peoples communication needs made it difficult for us to talk to them so we watched the way that they interacted with staff on duty. When we first arrived at the home staff were engaging on a one to one with people and the atmosphere in the home was comfortable and welcoming. Staff were seen to try and communicate with people using verbal communication and gestures and encouraged people living there to communicate back. It was evident from what we saw that people seemed comfortable and relaxed with the staff on duty. At the previous Key inspection we were concerned about staffing levels and recruitment practice and felt that people were being put at risk. We looked at the staffing rota for the week of the visit and the previous week. These showed Highpoint Care DS0000070244.V374497.R01.S.doc Version 5.2 Page 23 that there is four or five staff on duty to care for the people living there during the day and two staff at night. A number of staff had been recruited and some staff transferred over from the previous provider. The deputy manager informed us that further staff appointments were being made. The provider told us he is keen to employ a staff team that is reflective of the gender and culture of the people living there but had encountered some difficulty attracting white staff to work in the Home. We looked at staff recruitment records for the three most recently employed people. Criminal Records Bureau checks (CRB) had been made and written references received before the employee began work so that people were protected from the risk of having unsuitable staff work in the Home with them. We spoke to three staff during this visit who demonstrated that they had a good understanding of peoples individual needs and had read peoples care plan. We spoke to staff about the training they had received and they said that they had completed induction training and in house training including challenging behaviour, autism, safeguarding, medication, health and safety, and fire. The owner told us he is currently looking at further training around supporting people with behaviours that can be challenging and he had approached The British Institute of Learning Disability (BILD) for advice on this. Only two staff had completed first aid training. Staff told us: I have regular supervision and the owner is very good I had induction for 3 days and shadowed staff on the 4th day Good staff and management team treats each client as a person I have regular supervision with my manager and if I have any problems I can contact my manager at any time. There is always enough staff on duty and there are members of staff to cover is someone is off sick (not agency). My manager is excellent also updates us with any changes at work and communicates it in a proper manner. Went through everything on my induction and felt confident when I started engaging with service users and other staff. Highpoint Care DS0000070244.V374497.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 and 42 Quality in this outcome area is adequate. Arrangements are now in place to promote the health, safety and well being of people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This is the homes first inspection since the change in provider. We were told a manager has been appointed and is in the process of putting forward an application to register as the manager with CSCI. The provider was able to demonstrate that he has reviewed a number of systems since taking over responsibility for the home in October 2008. Improvements have bee made to staffing arrangements, care planning, meeting peoples health care needs, Highpoint Care DS0000070244.V374497.R01.S.doc Version 5.2 Page 25 implementing policy and procedures for staff to follow and providing a safe and comfortable environment which ensures better outcomes for people. There is a quality assurance system in place which includes health and safety audits. The owner told us that the quality assurance system is still not fully implemented yet but when the home is more established and people settled the views of people and their representatives will be sought. This should ensure the home is run in the best interest of the people living there and to measure if the Home is meeting its aims. We looked at records to see that peoples health and safety is being promoted. The fire alarm system had been tested and serviced on a regular basis. Individual fire risk assessments should be developed for each person so staff know how to support people safely in the event of the firm alarm being activated. Only two staff had completed first aid training. We asked that a risk assessment be completed to assess the level of first aid training that the Home needs. The assessment should include the needs of the people living in the home, their likely needs and the kind of first aid training that might be required. We found that accident reporting was not always thorough and detailed and a couple of serious incidents had not been reported to us but had been reported to Social Services. We were able to clarify what needs to be reported at the time of the visit. A thorough system for analysis of accidents and incidents should be developed to promote the health and safety of people living there. The AQAA was completed to a good standard. However we saw from reading this that arrangements need to be made for the testing of electrical appliances so that equipment in the Home is safe for people to use. Highpoint Care DS0000070244.V374497.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 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 2 X 2 X X 2 X Highpoint Care DS0000070244.V374497.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 YA42 Regulation 18 (1) c Requirement A risk assessment should be completed to assess the level of first aid training the home needs to meet peoples needs and keep them safe. Arrangement must be in place so people receive the support they need to manage their epilepsy. Timescale for action 16/04/09 2 YA19 12 1 (a) 16/04/09 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 The statement of purpose should be amended to include the level of fees, additional charges, registered rooms and staffing arrangements. So people have all of all the information they need to know to make an informed decision about whether they want to live there and how much it is going to cost them. Pre admission assessments should contain enough detail so people know their assessed needs can be met. Care plans should continue to be improved so they reflect the persons needs and preference. DS0000070244.V374497.R01.S.doc Version 5.2 Page 28 2 3 YA2 YA6 Highpoint Care 4 5 6 7 8 9 10 11 12 13 14 15 16 YA9 YA12 YA17 YA16 YA18 YA20 YA22 YA24 YA35 YA37 YA39 YA42 YA42 Some risk assessment must be improved so staff have the information they need to keep people safe. The process for involving people in the choosing and evaluating of activities should be developed so that people are fully involved in making choices about their lifestyle. Food records should include fruit and vegetables served so accurate monitoring of a healthy diet can take place. Guidelines should be in place for the use of any restrictions in the environment so peoples rights are safeguarded. Peoples night time needs and support should be recorded so they receive the support they need from staff Consideration should be given to recording on care plans how people like their medication to be given to them. The Complaints procedure needs some clarifying so people are clear about how and who will deal with complaints. Repairs to bathrooms should be completed so people have safe access to their own bathroom. Further training should be provided so staff have the specific skills and knowledge to meet people assessed needs. A manager should be registered with CSCI so people can benefit from a well run Home. The quality assurance system should be developed to include the views of people living in the Home and their representatives. Arrangements must be in place so that incidents and accidents are analysed and steps taken to prevent further occurrence so people are protected. Arrangements should be made to ensure electrical equipment in the Home is safe for people to use. Highpoint Care DS0000070244.V374497.R01.S.doc Version 5.2 Page 29 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.V374497.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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