Care Home: Highdowns Residential Home

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What the care home does well What has improved since the last inspection? This is the first key inspection under the new management arrangements. People who use the service said that there with the new management and staff changes the service remains a `thumbs up` and it has `gone better than we thought`. What the care home could do better: No statutory requirements were identified at this inspection. Some recommendations were identified to improve care practices further. These include: Whilst each person has a care plan, they would benefit from expansion so that staff are directed, informed and guided as to how to met a individuals care need in a consistent manner. Medication processes were in the main satisfactory but to improve on this further it is recommended that the medication cabinet should be fixed to the wall for additional security. A audit trial of `when required` medication should be maintained so that the medication stored in the cabinet tallies with the records held and that two staff members should witness when transcribing medication (handwritten entries) to ensure that it is recorded accurately as prescribed by the doctor so that dosages and times of medication is administered at the correct times. This will prevent medication errors. The registered manager should attend the local multi disciplinary safeguarding course to extend her knowledge and local practices in this area of care Mandatory staff training should be completed so that all staff has the relevant skills in the care they provide e.g. manual handling, health and safety, infection control. In addition they need access to equipment to allow them to complete their training e.g. computer as some training is on line. All staff should have an induction in the aims and philosophy of the Regard Partnership so that they are aware of what they are accountable for, which also meets Skills for Care guidelines.The registered provider is aware and will ensure that all events notifable under regulation 37 of the care Standards Act 2000 must be reported to the Commission as per legislation We would like to thank the People who use the service, staff and management team for their kind assistance during this inspection process. CARE HOME ADULTS 18-65 Highdowns Residential Home Highdowns Blackrock Camborne Cornwall TR14 9PD Lead Inspector Lynda Kirtland Unannounced Inspection 2nd December 2008 9:40 Highdowns Residential Home DS0000072309.V373323.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 Highdowns Residential Home DS0000072309.V373323.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. Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highdowns Residential Home Address Highdowns Blackrock Camborne Cornwall TR14 9PD 01209 832261 01209 832261 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) www.regard.co.uk The Regard Partnership Ltd Mrs Karen Palmer Care Home 9 Category(ies) of Learning disability (9), Mental disorder, registration, with number excluding learning disability or dementia (1) of places Highdowns Residential Home DS0000072309.V373323.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 either gender whose primary care needs on admission to the home are within the following categories: Learning disability (Code LD) Mental disorder (Code MD) - maximum of 1 place The maximum number of service users who can be accommodated is 9. 2. Date of last inspection First inspection Brief Description of the Service: Highdowns Residential home is a care home providing accommodation and personal care for up to nine adults with a learning disability. The Regard Partnership Ltd purchased the home and in September 2008 the Commission approved their registration to operate as a registered care home. A registered manager assisted by a deputy manager, senior carers and team of care staff run the home on a day-to-day basis. The premises consist of a two-storey building with a self-contained semiindependent unit in a converted barn for up to two people who use the service. It is set in its own, extensive grounds, slightly off the road. There is one ground floor bedroom in the main house, which provides suitable facilities for people with physical disabilities. All the bedrooms are single occupancy with en suite facilities. The home has a separate office, accessible by a keypad to ensure security of confidential information. There is a large communal lounge and a separate dining room. There are extensive gardens and people who use the service can access a paved patio area off the dining room, via French doors. People who use the service are able to access the communal kitchen and are given their own cupboards and fridges for storage purposes. The home has workshops, a variety of small farm animals and opportunities for people to grow organic vegetables in addition to ample opportunities for them to engage in activities in the wider community. The home’s location is very rural, outside of the town of Camborne although Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 5 there is a local village with a shop within walking distance. The home provides transport, within a set radius of the home, to help people who use the service to access a range of resources in the community in accordance with their assessed needs and personal preferences. Fees range from £900.00 - £2350.00 per week. The home’s statement of purpose is available on request and copies of the home’s service users’ guide are routinely provided to people who use the service in appropriate formats. Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The Regard Partnership Ltd purchased Highdowns Residential care home in November 2007. However they have recently been approved as the registered provider for this service in September 2008, therefore this is the first key inspection with the newly approved registered provider and management team. This unannounced key Inspection took place on 2 December 2008 and lasted for approximately eight hours. The purpose of the inspection was to ensure that people who use the service needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that people’s placements in the home result in good outcomes for them. Information received from and about the home since it’s opening has also been taken into consideration in making judgements about the quality of outcomes for the people living there. The inspection included meeting with the people who use the service currently living at highdowns. Other activities included an inspection of the premises, examination of care, safety and employment records and discussion with the staff and registered person. We talked to the people using the service, and asked staff about those people’s needs. We also looked at the care plans, medical records and daily notes for these people. This is called case tracking, which occurred with two people living at Highdowns. There were opportunities to directly observe aspects of people’s daily lives in the home and staff interaction with them. However it is to be noted that we received eight surveys from the people who use the service. The overall view from these surveys was that Highdowns provides good care and that all were satisfied with the level of activities, staff skills, accommodation and food. In speaking with the people who use the service they were very pleased at how the new owners are running the home and felt they are consulted ion all aspects of change in the home. They all said they felt able to approach the management team and staff if they had any worries/ concerns and could not identify any areas for improvement. The Commission received the Annual Quality Assurance Assessment, which is a questionnaire that the registered person completed. The AQAA describes the services and facilities that Highdowns provide and identifies what areas they do well in and where they want to make further improvements. Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 7 What the service does well: It was evident from looking at documentation, talking with people who use the service and a tour of the home that there was a planned moving in period to highdowns for the people who have recently moved to Highdowns. People who use the service said that the move to the home ‘went well’ and confirmed that they visited the home on a number of occasions before moving in. People who use the service were each provided with written and pictorial information about the home. The home operates like a shared domestic dwelling with staff support provided where it is needed to assist them to develop and maintain their skills and independence. Assessments prior to moving into highdowns are undertaken and based on the individuals health, social and personal care needs, including needs relating to their religious, ethnic and cultural backgrounds, to ensure they can be met in the homes setting. People who use the service are encouraged and supported to develop their skills and independence in many ways. They are involved in developing their own care plans with assistance and support from staff. They attend reviews so that they know why they are placed at the home and via their person centred planning process identify what aspirations they are aiming to achieve e.g. developing a particular element of self-care to promote their skills and independence. They have opportunities to make decisions about important aspects of their lives, with assistance from staff, if they need it and are supported to take risks so that they can enjoy fuller and more active lives in and out of the home. Access to health care is appropriate for the individuals needs and the medication systems in the home are robust so that the risk of medication errors is to a minimum. People who use the service have some information on what is expected of them and their rights as residents of a care home. The Regard Partnership is currently reviewing this. They are aware, for example, that they will be expected to help out with household tasks such as cooking and cleaning, so that they can develop their skills and independence and know what to do if they wish to make a formal complaint about something they do not like. People who use the service participate in the ‘food shop’ and developing the menus. They have free access to the kitchen so that they can make drinks and snacks for themselves when they wish and are encouraged to live and eat healthily. People who use the service are appropriately supported with their personal care so that they maintain their dignity. Staff were observed to assist them with their needs quietly and unobtrusively. Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 8 Highdowns is decorated and furnished to a satisfactory standard with new furnishings on order. People who use the service are consulted about the décor and furnishings so that the home is personalised to reflect their tastes and preferences. It was clean and tidy throughout. The staff team demonstrated throughout the inspection positive interactions with people who use the service and assisted them with personal care needs in a discrete manner. The inspector was welcomed to the home in a friendly manner by staff and People who use the service. All were aware of the reason of the inspection. What has improved since the last inspection? What they could do better: No statutory requirements were identified at this inspection. Some recommendations were identified to improve care practices further. These include: Whilst each person has a care plan, they would benefit from expansion so that staff are directed, informed and guided as to how to met a individuals care need in a consistent manner. Medication processes were in the main satisfactory but to improve on this further it is recommended that the medication cabinet should be fixed to the wall for additional security. A audit trial of ‘when required’ medication should be maintained so that the medication stored in the cabinet tallies with the records held and that two staff members should witness when transcribing medication (handwritten entries) to ensure that it is recorded accurately as prescribed by the doctor so that dosages and times of medication is administered at the correct times. This will prevent medication errors. The registered manager should attend the local multi disciplinary safeguarding course to extend her knowledge and local practices in this area of care Mandatory staff training should be completed so that all staff has the relevant skills in the care they provide e.g. manual handling, health and safety, infection control. In addition they need access to equipment to allow them to complete their training e.g. computer as some training is on line. All staff should have an induction in the aims and philosophy of the Regard Partnership so that they are aware of what they are accountable for, which also meets Skills for Care guidelines. Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 9 The registered provider is aware and will ensure that all events notifable under regulation 37 of the care Standards Act 2000 must be reported to the Commission as per legislation We would like to thank the People who use the service, staff and management team for their kind assistance during this inspection process. 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. Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 10 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 Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service needs are assessed prior to their admission so that they can be confident it will meet their health, personal and social care needs, including needs relating to their age, religion, cultural and ethnic backgrounds, abilities, gender and sexual orientation. EVIDENCE: From observations and talking with people who use the service it was evident that they are settled in the home, and that they get on well with each other and with the staff. People recently living at the home said that the move was positive, that they visited the home prior to moving in on a number of occasions and that staff and residents ‘made me feel welcome’. They could not think of how moving into the home could be improved on. They also said that they felt their family was ‘pleased’ with how the move went and that they were involved in the process The home’s statement of purpose is available. The Service Users Guide is placed on the individuals file. This is presented in written and pictorial formats and describes what services and facilities Highdowns provide to the people who use the service. From documentation inspected it was evident that admissions are made following a full assessment and in consultation with the individual, their family or advocate, and relevant professionals. Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 12 Transitional work for the person moving into the home was undertaken in a planned manner and at the persons pace, along with consulting with the current resident group so that all were able to express their views on a new member moving into their home. The registered manager said that the contracts in relation to the placement are currently being reviewed by the Regard partnership Ltd as it needs to set out clearly what the individuals’ rights are, what services they will be provided with and any financial cost implications. The registered manager was in agreement that if there are costs that the individual needs to pay as well as their benefit entitlements, these should be included in the contract. As the registered manager is actively working on this issue no recommendation has been identified at this time. Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 13 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): 6,7,8,9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have individual care plans, which in the main address their health, personal and social care needs, including needs relating to their individual and diverse backgrounds (age, religion, culture and ethnicity, abilities, gender and sexual orientation). They are able to take safely managed risks and make important decisions about their lives so that they develop their skills and independence. EVIDENCE: People have a care plan, which outlines their individual care needs. The care plan has specific headings to address their health, personal and social care needs. These would benefit from further expansion so that they direct, inform and guide staff in what caring interventions are to be provided so that care is given in a consistent manner, especially in light of new staff members joining the team. Person centred planning provides people who use the service with specific goals to work towards so that they are encouraged to fully maximise their skills for independent living. Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 14 People who use the service have an identified key worker who ensures that the care plan is kept updated and the person’s views are included in its development and reviews. During the inspection a six monthly review was occurring and the individual concerned and family members were involved in this process. People who use the service participate in making decisions about important aspects of their daily lives, according to their individual abilities and this was observed during the inspection. There are also formal meetings held each month so that they can discuss issues and make household decisions as a group. Staff were observed supporting individuals who required it, to make decisions about what to do during the day. People who use the service written care plans formally consider their abilities to make decisions for themselves and daily care records provide further evidence of the choices they make in their daily lives. Residents can choose the level of privacy they wish to enjoy in their private accommodation. Residents are able to take managed risks, backed up with written risk assessments and risk management plans, particularly with regard to their engagement in higher risk activities. Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 15 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): 11, 12,13,14,15,16,17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use the service are able to take part in a wide range of activities in and out of the home, which are appropriate to their ages, individual needs, interests and cultural backgrounds so that they develop their skills and confidence. They are supported to maintain valued social and family relationships so that they are not isolated or institutionalised. They are informed of their rights and responsibilities so that they are aware of what is expected of them. They are provided with a wholesome and varied diet so that they enjoy their meals and stay healthy. EVIDENCE: From talking with people who use the service it is evident that there is a number of activities that they are involved in. All were attending that evening the monthly ‘bite and bowl’ night, which they were looking forward too. People who use the service also spoke of attending college, work placements, clubs, local pub, and holding their own parties, having a resident DJ, arts and crafts, working on the farm and having a three weekly drumming session. It was Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 16 evident that all the people who use the service have a very active social life and they said that they choose what activities they wish to join in with. Individual care plans and daily care records provide good evidence that the person’s interests and abilities are fully considered in planning their daily activities, which are planned with them individually. This is written up as a guide but people who use the service said they do choose whether or not to be involved in their planned activity. At the time of the inspection a variety of different and appropriate activities in and out of the home, with staff support provided as necessary were observed. In addition daily care records show that they access a wide range of community resources with staff support, depending on their individual needs and abilities. People who use the service told us that they are encouraged to maintain valued relationships with their families and friends, with staff support as necessary. Daily records also confirmed this. People are able to make telephone calls in private if they wish. People who use the service said they could get up and go to bed when they wish and that staff knocked on their doors before entering (also observed). Locks are fitted to bedroom doors. People who use the service are supported and encouraged to eat healthily. They undertake shopping, planning for and preparing meals with assistance from staff. People who use the service told us that they assist with the menu planning for the week; they may assist with the ‘house shop’ and assist with the preparation of the meals. They also help with the laying of tables, washing and drying up dishes. Nutritional needs and preferences are considered as part of the care planning process. People who use the service looked healthy and well nourished. The home has an ordinary, domestic kitchen, which they can access freely, to prepare drinks and snacks when they want them. The majority of staff has gained the basic food hygiene course. One person has the intermediate food hygiene qualification. Records needed to be kept in respect of the handling of foods and cleaning schedules are maintained an environmental health inspection occurred on 20 November 2008 and did not identify any issues. Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service personal and healthcare needs are well met so that they are able to live full and active lives in and out of the home. Medication systems are satisfactory so that people who use the service health needs are managed safely. EVIDENCE: Care plans address the persons individual care needs and with sufficient bathroom facilities the person is able to attend to their personal care privately. Healthcare needs are considered as part of the care planning process and regularly reviewed. In discussions with people who use the service and documentation showed that they access external healthcare providers, including specialists, when they need to. People who use the service records provide evidence that they access a range of local NHS healthcare providers on a regular basis so that they maintain good physical health and emotional wellbeing. The registered person described how the home links with local specialist services to assist people with specific Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 18 behavioural and emotional needs and regularly consults with external professionals to ensure their needs are managed effectively and appropriately. All staff that handles medication are appropriately trained and there are certificates to provide evidence of this. Medication is stored in a locked cupboard but this needs to be attached to the wall for extra security. The mediation policy is satisfactory. Staff record medication that it has received, administered and disposed of. Documentation demonstrated that medication is administered and disposed of appropriately. There are limited controlled drugs on the premises and the home has attempted to gain a new controlled drug book to ensure that its receipt and administration is recorded accurately. The home uses in the main the Monitored Dose System, from a tablet count with records of tablets administered theses all tallied. It was recommended that with ‘loose’ medication i.e. not blister packed, that when surplus medication is carried over from one month to the next that this is recorded so that a audit trail of loose medication could be undertaken as this was difficult to do with certain ‘as and when required’ loose medicines in the home. The registered manager and deputy manager agreed with this and said they would action this immediately. Good practice was seen when medication instructions had been changed on a doctors visit in that the staff got the doctor to place this in writing and place this on the persons file so that staff were kept up to date with the most recent guidance. It is recommended that when a staff member transcribes (hand writes) medication to be administered on the medicine charts that a second member of staff to ensure that it is written as the doctor prescribed it so that medication is given at the correct dosage and at correct times witnesses this. There are protocols in place for ‘when required’ medication is used which guides staff in what situation s this medication should be administered. The registered manager is attempting to arrange updated training for staff in their awareness and the administration of epilepsy medication. In the meantime whilst this is ongoing the registered manager has ensured that a risk assessment in the light of an epilepsy seizure has been undertaken so that staff are clear as to what action they should take. The registered manager said that the home has a copy of the latest medicine guidance, Safe Handling of medicines in care homes but was unable to be located during the inspection. A pharmacy inspection occurred in October 2008 that was satisfactory. Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are listened to and respected so that their views, concerns and complaints are taken seriously and acted upon. There are formal and informal systems in place to ensure that they are able to feel safe in the home EVIDENCE: People who use the service were encouraged to speak to the inspector if they wished so that they could make their views known or raise any concerns. No concerns were raised and all said that they would talk to the management team or staff if they had any concerns. They all felt they would be listened too and that their concerns/ worries would be taken seriously. People who use the service are aware of how to raise any concerns and Highdowns has a formal complaints procedure and informal opportunities (e.g. house meetings, care plan reviews and 1:1 time) to raise any concerns with staff before they become serious complaints. The registered manager said that the home has investigated one concern that was raised by some people who use the service and staff and all expressed satisfaction as to how this was investigated and resolved. The complaints procedure is provided in written and pictorial form and is satisfactory. The Regard Partnership have corporate safeguarding, whistle blowing and complaints policies. These are satisfactory. The majority of staff have undertaken some safe guarding training at different levels. It is recommended that the registered manager attends the Multi Agency Safeguarding course and gains a copy of the safeguarding guidelines for Cornwall. Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 20 The registered manager is currently reviewing all the people who use the service finances/ benefit entitlement and is discussing with the Regard partnership what costs the individual is expected to pay. The registered manager explained this costing would then be included in the individual’s contract/ tenancy agreement. Currently the Regard partnership is paying for all transport costs until this is sorted out. A Regard policy and procedure in the management of their moneys is available but this is being reviewed along with the above. As this is being addressed no recommendation has been identified at this time. A person’s individual money can be ‘looked after’ by staff in a lockable facility. Observations of people who use the service requesting access to their money was seen and responded to promptly. Appropriate records appear to be kept and all transactions are recorded. There are records to show that staff are recruited on the basis that they are suitable to work with vulnerable adults in a care setting and appropriate checks are made. People who use the service are not isolated in the home, but take part in a range of activities in the local community and have relationships with people from outside of the home that they can communicate serious concerns to. Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,28,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s environment provides people who use the service with an ordinary, domestic setting so that they can develop their skills and independence in a non-institutional setting. Consultation with People who use the service has led to communal and private space being furnished to a comfortable and high standard. It is safe and clean so that People who use the service are protected from risks of cross-infection EVIDENCE: The home is a large, detached residential property, set in spacious grounds. It is comfortably furnished and tastefully decorated throughout and provides people who use the service with an ordinary, domestic-style environment. It appeared safe and well maintained and people who use the service said that they are satisfied with the accommodation provided to them. People who use the service bedrooms were personalised to reflect their tastes. The registered manager is in the process of ordering carpets for the dining room and lounge and has replaced some bedroom carpets. A shower has also Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 22 been replaced. The registered manager is aware of what improvements she wants to make to the accommodation and has discussed this with the people who use the service so that their views can also be taken into account. The home appeared clean and tidy at the time of the inspection, which was unannounced. The manager said that staff are provided with written guidance and training on how to maintain good hygiene in the home. No domestic staffs are employed; carers undertake this role with assistance from people who use the service. The registered manager is aware that staff need to attend an infection control course and is actively seeking to arrange this. The laundry facilities appeared satisfactory. All COSHH materials are kept secure. Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33,34,35,36. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There are sufficient numbers of qualified staff on duty so that people who use the service can have confidence in their competence and skills. Staff recruitment is on going. Staff training is being encouraged so that up to date research and knowledge can be gained for the benefit for the people who use the service The home’s recruitment policies and practices are fair, safe and effective so that people who use the service can be assured that staff are suitable to work in a care setting. Staff receive regular, formal supervision. EVIDENCE: In discussions with people who use the service and staff, plus surveys, all felt that there were sufficient staff on duty at all times. The current staff team are undertaking a lot of overtime to ensure there is sufficient staff cover as the registered manager confirmed that she has four carer vacancies. From inspecting the rota this showed that a minimum of 3 to 4 staff are present during the day with one person sleeping in – however it is to be noted that one person was on home leave and therefore the staffing ratio was reduced. The registered manager stated that there are usually five staff members on duty in the day and four in the evening. The registered manager needs to record her hours on the duty rota, especially as she is currently working shifts at the Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 24 home so that there is accountability for all staff present in the home at any one time. Care staff undertakes all personal care duties plus with people who use the service assistance cleaning and cooking tasks. From observations of staff interaction with people who use the service it was evident that they communicate with them in a competent, fair, patient manner and work with them at their pace. Some of the staff team were employed under the previous owners, with a lot of new staff now working at the home. The registered manager confirmed that the induction packs for staff have not been received from The Regard partnership headquarters and will request this. She also confirmed that as she is new to the Cornwall area she has been trying to identify training resources for staff as she is aware that staffs attendance at certain courses for example health and safety, manual handling, infection control are lacking and that some need to attend refresher courses such as first aid, food and medication. She has an overview of what training is needed and is actively trying to address this issue. Some of the courses will be done on line, however the home only has one computer and therefore access to it is problematic to be able to achieve this learning, as there is high demand for the computer. Staff echoed this frustration and therefore it is recommended that for training of staff to advance more quickly that a second computer is purchased so that access will be easier. The staff team are experienced in working in the area of learning disability. Four staff members (including the registered manager and deputy manager) have achieved NVQ level 4, and one has completed the Registered Managers award. Nine out of eleven staff have a minimum NVQ level 2 qualification. The home’s staff recruitment records indicate that staff are appointed on the basis of written application forms and equal opportunities interviews. Appropriate checks are made of their suitability to work with vulnerable adults in a care setting. People who use the service were aware of recent interviews and met with the applicants. Staff, confirmed by documentation, stated that there is regular formal supervision. Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 25 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): 37,38,39,40,41,42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The registered person is qualified and experienced to run a care home. The home is well run for the benefit of people who use the service. There are formal and informal systems in place to ensure that people who use the service views are accounted for in the day-to-day running and ongoing development of the home. The development of policies and procedures is ongoing. There are systems in place to protect service users from avoidable harm and injury. EVIDENCE: Karen Palmer has the skills and competence to manage a care service effectively. She has previous experience of managing a Regard care home, to which the rating under her leadership improved to that of an ‘good’ service. She ensures that her training is up to date so that her knowledge and skills base is increasing to the benefit for people who use the service. Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 26 Staff and People who use the service spoke highly of Ms Palmers skills and felt that she was approachable and listened to their ideas or concerns. From observations, all interacted with her in a relaxed manner. Staff and people who use the service spoke of how the transition from the Highdowns partnership to Regard partnership went smoothly and had minimal effect of the people who lived at the home, they felt Ms Palmer played a vital role in ensuring this smooth transition took place. The Regard Partnership has their own quality assurance process, which will be introduced to Highdowns. There are regulation 26 visits as per regulations so that an independent overseer can monitor practices at the home. Staff meetings occur every couple of months and residents meetings are monthly, minutes of these meetings were seen. The views from people who use the service, family and staff are being sought as the home is in the early stages of its development. The registered manager completed the Annual Quality Assurance Assessment within timescale set, which identified where they felt they had done well and what areas of work they want to improve on. Records are stored confidentially, and in the main recordings adhere to the data protection act (DPA). It is recommended that the communications book be reviewed to ensure this adheres to the DPA, as there are examples when confidential matters are recorded here. The registered manager was aware of this and aims to arrange a training day in February that will focus on how to make accurate and appropriate recordings. As this is in progress no recommendation has been made at this time. Advise was given to clarify when to notify the Commission of particular incidents under regulation 37 so that in future all incidents are reported. Policies and procedures are being reviewed alongside the corporate policies to ensure that they are appropriate to the service provided and inform and guide staff accurately as to what is expected of them. The home’s environment appeared safe and there are written individual and environmental risk assessments in place to minimise risks to people who use the service and staff working in the home. Maintenance of the home and its equipment are satisfactory. The home’s fire safety records were completed and up-to-date. There are records of regular tests and checks of safety equipment and procedures in the home to ensure people who use the service, staff and visitors safety. An independent consultant has undertaken fire training with staff and gave advice in respect of the homes fire risk assessment to ensure that it is in line with the new legislation. Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 27 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 3 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 4 3 3 LIFESTYLES Standard No Score 11 4 12 3 13 3 14 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 3 3 3 X Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 28 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. Standard Regulation Requirement Timescale for action 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 2 Refer to Standard YA6 YA20 Good Practice Recommendations Care plans would benefit from expansion so that staff are directed, informed and guided as to how to met an individuals care need with a consistent approach. a) The medication cabinet should be fixed to the wall for additional security. b) A audit trial of ‘when required’ medication should be maintained so that the medication stored in the cabinet tallies with the records held. c) Two staff members should witness when transcribing medication (handwritten entries) to ensure that it is recorded accurately as prescribed by the doctor. 3 YA23 The registered manager should attend the local multi disciplinary safeguarding course to extend her knowledge and local practices in this area of care. Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 29 4 YA35 Mandatory staff training should be completed so that all staff has the relevant skills in the care they provide. In addition they need access to equipment to allow them to complete their training e.g. computer. All staff should have an induction in the aims and philosophy of the Regard Partnership so that they are aware of what they are accountable for, which also meets Skills for Care guidelines. 5 YA36 Highdowns Residential Home DS0000072309.V373323.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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. 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