Care Home: Highbray

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What the care home does well Highbray is a small family-run home, which is domestic in scale. This means that although the home may not be suitable for people who require a high level of care, it is well suited for people who are relatively physically able and who need support to enable them to retain their independence. The home has good systems for identifying the needs and wishes of those thinking about living there, to ensure it will be suitable for anyone who does move in. People`s health is monitored, and they are enabled to receive support from relevant professionals. Their privacy and choices are respected, and their independence promoted. They enjoy the meals provided by the home, which are eaten in surroundings which suit them. They have clean, homely accommodation. People are enabled to be or remain part of the local community, maintaining their support networks of family and friends, and enjoying activities in the local area. What the care home could do better: The home must provide people with up to date, accurate information about the home and the service it provides. This upholds the rights of those currently receiving a service. It also enables people looking for a care service to make a properly informed choice about where to live. Assessments of people`s needs and subsequent care plans must be kept up to date, to ensure they receive appropriate support for all their various and individual health and welfare needs. And up to date photographs of individuals must be part of the information kept about them by the home. Each person should be involved in the reviews of their needs and agreeing the support they require, unless it can be shown why others must make decisions for them. Safe practises must be used when assisting people to manage their medication, to also protect and promote their health. Outdoor areas for people living at the home could be made more pleasant, for them to enjoy.People would be better safeguarded if additional risk assessments were carried out, the complaints procedure available to them was up to date, and if those supporting them at the home knew relevant safeguarding procedures. To ensure the health and welfare of those who live there, the registered owners and the registered manager should attend training or updating as required and recommended for both care workers and registered individuals, as they provide care and support to people at the home as well as being responsible for managing the home. There should be policies and practises in place which are based on current legislation and best practise guidance. To ensure that the home will be run in the best interest of those who live there, it should develop quality assurance systems that mean the home and the service it provides are safe, and that it is improved - in line with the views of those who use the service. Random inspection report Care homes for older people Name: Address: Highbray 84 Mount Pleasant Road Exeter Devon EX4 7AE one star adequate service 24/08/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Rachel Fleet Date: 2 1 0 5 2 0 1 0 Information about the care home Name of care home: Address: Highbray 84 Mount Pleasant Road Exeter Devon EX4 7AE 01392676863 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Lesley Ann McLeod Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Josefa McLeod care home 3 Number of places (if applicable): Under 65 Over 65 3 3 learning disability mental disorder, excluding learning disability or dementia Conditions of registration: Date of last inspection Brief description of the care home 0 0 2 4 0 8 2 0 0 9 Highbray is registered to provide accommodation and care for up to 3 people who are over 65 years of age, who have a learning disability or mental health needs. The home does not offer nursing care or intermediate care. Mr & Mrs McLeod, the registered service providers, live at the home. Their daughter in law, Lesley McLeod, the registered manager, lives near-by. There are no other staff, with care and support provided by the registered owners and manager. Care Homes for Older People Page 2 of 16 Brief description of the care home It is an end of terrace house in a residential area, with nothing to distinguish it from other houses as a care home. There is roadside parking. Local amenities include a health centre, shops, and bus routes to and from the city centre less than a mile away. The sitting room, kitchen-dining area, and first floor bathroom/toilet are shared by people living at the home and the McLeods. People have their own bedroom, each with a television provided by the home. The Service User Guide states that there are no time restrictions on bedtimes but people are asked to vacate the lounge, which is also used by Mr & Mrs McLeod, by 9pm to minimise disturbing others who may have already retired. A small garden to the front of the house separates it from the pavement, and a yard at the back of the house provides a private sitting out area. People living at the home must be able to manage steps, to go between the ground and first floors of the home as there is no lift, and to access the yard directly from the home. The second floor of the home is used for storage only. Weekly fees are £281-390 per week. Car transport provided by the home (to health appointments, for example) and some toiletries are included in the fees. Fees do not include other personal items, hairdressing, continence products (such as pads) and chiropody if required, unless eligible and provided through the NHS. Our previous reports are available at the home. Care Homes for Older People Page 3 of 16 What we found: Although only one inspector undertook this inspection, in the report there will be reference to what we did. This is because the report is written on behalf of the Care Quality Commission (CQC). This Random Inspection was carried out as part of our current routine inspection programme. It included an unannounced visit to the home. Before our visit, the home had sent us their Annual Quality Assurance Assessment (AQAA) as required. This is a form for telling us how they are meeting the needs of the people that live there, with numerical information also provided on matters relevant for a care service. We had previously sent surveys for the home to give to the 3 people living there, and all were returned. People had been helped to complete them by the manager. We were at the home on a week day for 3.5 hours, arriving at 9.45am. Mrs Lesley McLeod, the registered manager, assisted us. The registered providers were on holiday. When we arrived, 1 of the 3 people living at the home had already gone out for the day, and we did not meet them either. During our visit, we read care records for 2 people at the home. We followed up their care, daily life, etc., case-tracking them as a way of helping us find out more about how the home cares for or supports individuals. We observed how support and attention was provided. We looked around the home, and spoke with 2 people. We asked for other information that would help to tell us how the home is run - such as accident and maintenance records. There have been no admissions to the home since our last inspection. The manager confirmed the homes procedures for assessing peoples needs before admitting anyone were the same as at our last inspection, when procedures were found to be satisfactory. People would be invited to look around the home before deciding about moving in. The homes Statement of purpose and Service User Guide are legally required documents. They are intended for the benefit of prospective residents and people living at the home, as they inform about the home and the service it provides. At our last inspection, we required that these 2 documents be updated and given to people at the home. We noted this had not been done, as the manager confirmed, when we looked at them. People were given the opportunity to speak with us in private. One who did told us they were content with their life at the home. Our observations and conversations during our visit indicated people currently living at the home needed relatively little physical assistance, with their needs for support and prompting being greater. We asked one person about their care plan, and they replied that the manager hadnt gone through it with them so they couldnt comment on it. The manager explained it was written with the person first moved to the home, and we saw evidence that the person had been involved in this, but she had not discussed it with them since. Care Homes for Older People Page 4 of 16 Care plans we were shown were based on assessments of peoples needs carried out 2-3 years ago. We could see during our visit that peoples needs had changed and their independence had improved since the care plans were written, in some cases, as the manager also told us. It was positive to see that personal histories had been written about each person, because this helps carers to see them as an individual. Risk assessments in relation to peoples daily lives were not available or were out of date. For example, there were no risk assessments relating to people who went out independently, without staff. One person had a risk assessment relating to smoking, but we found that there were different arrangements for this now, with particular actions taken by the home to monitor this. This was not reflected in care planning. Nor was there assessment of individuals capacity to make various decisions for themselves, such as in relation to this matter. We saw records that showed us that the physical health of the people living at the home was monitored, and that they were helped to access professional health care services as necessary. Medical or health-related events were well recorded, although care plans did not always include peoples current medical needs (such as diabetes or infections), and how they should be met. Where people were prescribed medicines, they were mostly administered by the manager or the registered providers. We were told someone self-administered 1 medication, although this was not reflected in their records. Unwanted items returned to the supplying pharmacy were recorded, but medication received into the home was not always recorded, therefore there was no proper audit trail for peoples medications. Medicines were kept next to an oven, without monitoring of storage temperatures to ensure medication was kept as recommended by the manufacturers. Some belonged to someone who had not lived at the home for over a year. Some other medication was out of date. We found one medication was not being given as indicated on the persons medication administration record. Although the manager explained the reason for this (which was reflected in care records), there were no signatures to show the antibiotic had been given as we were told. The AQAA stated the home did not have a medication policy in place, which the manager confirmed during our visit, so there was nothing establishing the appropriate medication practises to be used. The manager told us that she last had medication training in 2006. Each person had his or her own bedroom. They felt their right to privacy was respected, as we generally observed during our visit also. The home does not manage peoples financial affairs nor hold any money for them, allowing them to keep their own spending monies and encouraging them instead to find external support for any financial matters. When we arrived at the home, people were planning to go out locally later in the day, with the manager. They told us they went out independently as well, when they wished, as one did during our visit. Daily diaries kept by the home for each person showed someone went to a lunch club, Care Homes for Older People Page 5 of 16 people made visits to the town or other local places of interest to them, and had contact with family or friends. The manager told us that people living at the home had recently started going to a community art group, which individuals confirmed. Someones relative came to see them during our visit, and another person told us about their outing with relatives the previous day. Some used public transport independently to visit friends outside Exeter. People we spoke with were satisfied with the food provided. During our visit, they had homemade soup for lunch, and were to have a mild curry for tea. Food was provided with regard for peoples special dietary needs. The manager explained there were 2 dining tables in the kitchen to particularly meet peoples mealtime support needs and preferences. The AQAA stated that the home had not received any complaints in the previous 12 months. We have not received any complaints about the home, and people we spoke with during our visit did not raise any issues about the home. Versions of the complaints procedure that we saw needed updating - with our contact details, for example. We asked what action would be taken if the manager suspected someone living at the home was being abused. She told us she would approach the individual concerned or go to the residents GP, but this is not in line with the local authoritys safeguarding adults procedure. At our last inspection, we recommended that the manager and the registered providers should attend training on safeguarding adults, but we were told they have not done this. We noted there were no care plans or risk assessments relating to peoples outings made alone, and no photo available of each person for reference should they go missing whilst out. We discussed that one person went out alone and the manager had said she was not always sure where they went. She told us the person always returned at the same agreed time, so she would use the Missing Persons policy/procedure if they did not return then. The environment was clean and homely. People we spoke with were happy with their bedrooms, and used them during our visit when reading and resting. Their rooms had sinks, much natural light and ventilation, and were of a good size. The home generally looked in good order when we visited. The people we spoke with told us repairs were addressed in a timely way and that there were no hazards to their safety that they were aware of. One person was sitting in the back yard when we arrived. This area had little making it attractive, and was in full sun without shade available to enable people to sit out without getting adverse effects from the sun. Someone who used to do gardening said they didnt want to do it now, but separately told us they had enjoyed a visit to a flower and garden show recently, suggesting they would still appreciate some garden features in the yard area. The one bathroom/toilet in the home is shared by the people living there and the McLeods. We have recommended that consideration be given to putting in a second toilet if this became possible, although people we spoke with said they had no problem with the current arrangements. We asked the manager if infection risks at the home had changed, as the AQAA indicated Care Homes for Older People Page 6 of 16 the home had made improvements to its infection control measures. She said risks had not changed, but the home was taking more care to prevent the spread of infection. Mrs Lesley McLeod, the manager, was on duty when we arrived. The registered owners usually live at the home and also provide care or support for those living at the home. No other staff are employed. Mrs McLeod moves into the home when the owners go away on holiday, and they provide cover when she goes on holiday. This arrangement appears to work well with the current residents, as none of them require a high level of personal care. Mrs McLeod told us that 2 of the owners sons were available for support in an emergency. In the AQAA, we ask services to tell us about improvements they have made or plan to make. In several of these sections, the home had written No changes have been made and We do not plan any changes. This sometimes included where the home had identified things it could do better, or where we asked about changes planned as a result of listening to people using the service. We found requirements and good practise recommendations made at our last inspection had not been addressed. The home had written under the Management & Administration section, We have no plans to change our practises at present. We feel no need to make any improvements. Mrs McLeod confirmed she and the registered providers have not had any training or updating as required and recommended at our last inspection. At this inspection, we found the home was not using safe medication practises, and Mrs McLeod was not fully aware of the local authoritys current safeguarding procedures. She confirmed that neither she nor the providers had current first aid certificates and that this had not been risk assessed. The home indicated in their AQAA that they will look at training and contact the relevant services in the next 12 months. We had previously recommended that all relevant written, policies, procedures and codes of practise are written up and kept at the home. On this visit, a medication policy was still not available. We were shown the survey used by the home for its quality assurance purposes. The manager told us surveys had been sent out to peoples relatives or friends where relevant in recent months, but none had been received back yet. Improving response rates can itself be part of quality assurance processes. The 3 surveys from people living at the home had been completed with help from the manager. We discussed whether peoples families and friends, rather than the manager, could have helped them complete our surveys for more impartiality when completing the surveys. Radiators were guarded, window restrictors were in place where we checked for them, and electrical items in the lounge had been checked for safety within the last year. The AQAA showed the home has not had gas appliances and heating systems serviced since 2006. The manager told us she has no budget for such work, and the owners have chosen not to get it done, despite it being raised at our last inspection, to ensure that they were safe to use. In 2008, the Health & Safety Executive issued the following advice among Key messages for care homes: Ensure that gas appliances and flues are maintained and serviced yearly. Have all installation, servicing, maintenance and safety checks carried out by a registered engineer. When we spoke recently to Exeters Environmental Health Department as the lead agency locally for health and safety in residential care homes, we were told it is still considered good practise to have annual Care Homes for Older People Page 7 of 16 servicing of gas appliances or systems. We noted there were no records in the homes accident book since June 2008, and the AQAA indicated no-one had been admitted to an Accident & Emergency department in the previous 12 months. The manager confirmed that there had been no other accidents, or events requiring such a visit to hospital more recently. The AQAA stated that fire safety systems had been serviced in November 2009, but the manager could not find evidence of this. We saw 2 fire doors wedged open, and spoke to the manager about them. There were no fire evacuation plans in peoples care records, although people who lived at the home that we spoke with said they would leave the building if they knew there was a fire. The manager told us the fire procedure was in the Service Users Guide, but was unable to locate the homes fire risk assessment. As we informed the manager during our visit, we have since spoken with the local fire service about our findings. What the care home does well: What they could do better: The home must provide people with up to date, accurate information about the home and the service it provides. This upholds the rights of those currently receiving a service. It also enables people looking for a care service to make a properly informed choice about where to live. Assessments of peoples needs and subsequent care plans must be kept up to date, to ensure they receive appropriate support for all their various and individual health and welfare needs. And up to date photographs of individuals must be part of the information kept about them by the home. Each person should be involved in the reviews of their needs and agreeing the support they require, unless it can be shown why others must make decisions for them. Safe practises must be used when assisting people to manage their medication, to also protect and promote their health. Outdoor areas for people living at the home could be made more pleasant, for them to enjoy. Care Homes for Older People Page 8 of 16 People would be better safeguarded if additional risk assessments were carried out, the complaints procedure available to them was up to date, and if those supporting them at the home knew relevant safeguarding procedures. To ensure the health and welfare of those who live there, the registered owners and the registered manager should attend training or updating as required and recommended for both care workers and registered individuals, as they provide care and support to people at the home as well as being responsible for managing the home. There should be policies and practises in place which are based on current legislation and best practise guidance. To ensure that the home will be run in the best interest of those who live there, it should develop quality assurance systems that mean the home and the service it provides are safe, and that it is improved - in line with the views of those who use the service. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 9 of 16 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 1 5 The Service User Guides 25/11/2009 need to be rewritten to include all of the information listed in Regulation 5 of the Care Homes Regulations. The information listed in National Minimum Standard 1 should also be included to meet this standard. All of the people who use the service must be given a Service User Guide. This is to ensure that people have access information they need about the service provided. 2 1 4 The Statement of Purpose 25/11/2009 must be rewritten to include all of the information listed in Regulation 4 and Schedule 1 of the Care Homes Regulations. This is to ensure that current and prospective residents and their representatives know what to expect from the home and the service provided. Care Homes for Older People Page 10 of 16 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 14 You must ensure that assessments of each persons needs are kept under review, and revised when their needs change So that there is a clear record of each persons current needs for establishing what support they need to ensure their health & welfare. 18/07/2010 2 7 15 You must keep each persons 18/07/2010 care plan under review, consulting with & informing individuals about any changes that are to be made to the plan So that they will continue to receive appropriate & agreed support they need to maintain their health & welfare and uphold their rights. 3 9 13 You must have training as is appropriate to ensure you have the skills for carrying on the care home, including 01/08/2010 Care Homes for Older People Page 11 of 16 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action training on the receipt, recording, storage, handling, administration & disposal of medication To ensure that people are supported safely & appropriately, including support to manage their medication. 4 9 13 You must ensure there are 18/07/2010 appropriate arrangements for the handling, keeping, administration & disposal of peoples medication, especially ensuring that Medication is stored according to manufacturers instructions, particularly with regard to storage temperatures & the shelf-life of medication; Records are kept that ensure there is clear audit trail of medication received into the home, administered & disposed of; There are clear up to date records of what medication each person has received; Medication that is no longer prescribed for any individual at the home is disposed of in a timely way; So that people receive effective medication that they require to promote their Care Homes for Older People Page 12 of 16 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action health. 5 18 13 You must take action, 18/07/2010 through staff training or other measures, to prevent people who live at the home being harmed or abused To safeguard them and their rights as indicated by the local authoritys multi-agency safeguarding procedures. You must ensure that any 18/07/2010 avoidable or unnecessary risks to the health or safety of people living at the home are identified and eliminated as much as possible, such as with regard to outings they make alone and servicing of gas appliances To promote the health, safety & welfare of those living at the home. 7 31 10 You must undertake training 18/09/2010 or updating as is appropriate to ensure you have the knowledge & skills for carrying on the care home, such as on fire safety, and caring for people with learning disabilities and mental illness So that people who live at the home receive a service from individuals who are qualified & competent to protect their welfare & promote the quality of their lives. Care Homes for Older People Page 13 of 16 6 18 13 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 8 37 17 You must keep an up to date 18/07/2010 photograph of each person who lives at the home For identification purposes so that their rights and best interests can be safeguarded. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 It is recommended that there is a written medication policy to clearly establish safe and appropriate procedures for handling of medication by the care home, seeking advice from a pharmacist regarding the policy. The written complaints procedure should be updated, including the Commissions current contact details, & given to each person at the home (and anyone acting on their behalf) so that they have access to appropriate information. You should include capacity assessments when planning care, including assessment of risks to peoples welfare, to ensure their rights to choice and autonomy are upheld appropriately. Outdoor areas for people living at the home should be attractive and safe for them to use, including provision of shade from the sun. You should ensure that relevant policies & procedures are available at the home. And, along with practises, that these are reviewed regularly, in the light of changing legislation & good practise guidance. You should establish an annual development plan for the home, reflecting aims & outcomes for people who live at the home, to improve the quality of support provided at the care home. Page 14 of 16 2 16 3 18 4 19 5 33 6 33 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 7 38 You should ensure there is appropriate provision for first aid at the home, either having a qualified first aider on duty with people living at the home or having a risk assessment in place that indicates other arrangements are appropriate. Care Homes for Older People Page 15 of 16 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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