Care Home: Highfield

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What the care home does well What has improved since the last inspection? The dining room and the kitchen have been refurbished. The service has a new manager who is now registered with the Commission and there are other new and experienced staff working in the home. What the care home could do better: The management need to make sure that their booklets have all the right information in them. The management need to make sure that when people move to Highfield that they involve the people who use the service and the Registered Manager at the right times. The management need to make sure that before new people move into Highfield that they have all of the right checks and that this information is available in their individual plans of care.HighfieldDS0000012810.V375352.R01.S.docVersion 5.2The management need to do a risk assessment when people who use the service are involved in the administration of their own medication. The also need to make sure that they have the right storage for Controlled Medication. The management should consider removing the fireplaces from the two ground floor bedrooms at a time when this is convenient and acceptable to the individuals concerned. One of the rooms needs to be redecorated and the floor covering needs to be cleaned or replaced at a time when it is convenient and acceptable to the individual concerned. The management need to make sure that the people who use the service and the Registered Manager are involved in the recruitment of new staff at an early stage. They also need to look at the induction and mental health training programme to make sure that it contains all of the right information. The management must ensure that the Registered Manager is facilitated to resume the management qualification as specified in the report relating to the additional category of registration, which was granted by the Commission earlier in the year. The management must ensure that the certificate of registration is kept up to date by supplying the regional registration team with the right information in a timely way. Consideration should be given to fitting automatic closure devices to fire doors that are propped open. Key inspection report CARE HOME ADULTS 18-65 Highfield 50 Abington Avenue Northampton Northants NN1 4PA Lead Inspector Stephanie Vaughan Unannounced Inspection 12th May 2009 08:30 Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought 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. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highfield Address 50 Abington Avenue Northampton Northants NN1 4PA 01604 632614 01604 632614 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.mentauruk.com Mentaur Limited Ms Lucie Kaderabkova Care Home 6 Category(ies) of Learning disability (6), Mental disorder, registration, with number excluding learning disability or dementia (6) of places Highfield DS0000012810.V375352.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: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users that can be accommodated is: 6 25th June 2007 2. Date of last inspection Brief Description of the Service: Highfield is registered to provide care for up to six adults with learning disabilities and mental disorder. The home is situated close to Northampton town centre. It is convenient for local facilities including shops and leisure provision with good public transport links. Highfield is a large period terraced property providing accommodation over comprises four floors, the laundry is located in the cellar and the office is located on the second floor. There is a large refurbished kitchen and dining room on the ground floor along with two bedrooms. There is a small lounge situated on the first floor along with 4 further single bedrooms. There is a wellmaintained garden. At the time of the inspection, fees ranged from approximately £835.00 to £1,570.00 per week. The fees do not include Hairdressing, toiletries and personal items such as clothing, DVD’s and CD’s. Highfield is owned by Mentaur Ltd, the provider also owns six other services and a day centre in Northamptonshire. The Care Quality Commission Inspection reports are displayed in the office and can also be accessed via the Care Quality Commission Website www.cqc.org.uk Highfield DS0000012810.V375352.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 2 star. This means the people who use this service experience Good quality outcomes. Prior to this statutory inspection, a period of two hours was spent in preparation. This comprised a review of the previous inspection record, the previous key inspection report, annual service review and the Annual Quality Assurance Assessment and other information that had been sent to us about the service. There were no outstanding requirements from the previous Key inspection. We sent out four comment cards to the people who use the service and five to staff. As yet we have only received one competed comment card from a member of staff, which has been used to inform our inspection activity. The Commission have received no concerns or complaints about this service about this service. There have been three Safeguarding Adults allegations about this service since the last inspection, two of these were investigated and there was no evidence found to support the allegations. The most recent was referred to the Local Authority Safeguarding Adults Team and as yet we have not received a response from them, however the service has been informed that no further actions are required. The Commission have a focus on Equality and Diversity and issues relating to this are included in the main body of the report. This site visit to the home was conducted over a period of seven and a quarter hours during which the inspector made observations and spoke to four residents, some of the staff and the Registered Manager. A limited tour of the premises was conducted which involved viewing the communal areas and a selection of the private accommodation. Case tracking is the method used during inspection where of a sample of two residents were selected and all aspects of their care and experiences were reviewed, including individual plans of care and associated documentation. The service specialises in the provision of care for people with Learning Disability and Mental Disorder, as such discussion with some of the residents was limited due to their abilities to recall and their express their experiences and views. In these circumstances observations are used to inform the inspection. Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 6 The Registered Manager was present throughout. What the service does well: People who use the service have information about the service and are able to visit the service at different times to see what it is like to live at Highfield before they decide to live there. People who use the service told us that they were happy and that the liked living at Highfield. People who use the service can be involved in the development and review of their individual plans of care, these are very good and clearly show the staff how each person needs and wishes to be supported. People who use the service are able to choose their own Key Worker, this is a member of the staff who takes a special interest in them and helps them to do things like going shopping or keeping in touch with family. People who use the service are supported to lead interesting lives, they can make decisions about they way that they lead their lives and the running of the home such as planning the menus, the décor of the home and range of activities. One person said ‘ I like going out, I like exercise, I often go for walks round the park and I do aerobics and salsa dancing’. Another person told us how they liked going to the Towcester horse races. They are also supported to use the kitchen and do some household tasks. People who use the service are supported to get work placements, attend college and to get involved I other activities depending on their needs and wishes. Arrangements are in place for the people who use the service to vote in local and national elections. People who use the service told us that they liked the food. One person said ‘I help to plan the menus, I like the food that we have here and there is always enough’. We saw that the people who use the service are helped to get the right checks and treatment from the Doctor, Dentist, Physiotherapist and other health services. The manager is going to ask an Occupation Therapist to come to the home and check to see if more equipment is needed such as extra handrails. People who use the service get the tablets and medicines that the need in the right way. Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 7 People who use told us that they liked living at Highfield, that the staff were nice to them and that they felt safe. They know how to complain if they need to. The home is in general well maintained, two of the people who use the service showed us their bedrooms, they told us that they liked them and one told us that they had been able to choose the decoration. One person told us ‘I love my bed and I really like my room I keep it locked because I don’t like anyone going in there’. The management make sure that the staff have all of the right checks before they start working in the home and have a good training programme. We saw that the staff related very well to the people who use the service and that they had the right skills to help them. What has improved since the last inspection? What they could do better: The management need to make sure that their booklets have all the right information in them. The management need to make sure that when people move to Highfield that they involve the people who use the service and the Registered Manager at the right times. The management need to make sure that before new people move into Highfield that they have all of the right checks and that this information is available in their individual plans of care. Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 8 The management need to do a risk assessment when people who use the service are involved in the administration of their own medication. The also need to make sure that they have the right storage for Controlled Medication. The management should consider removing the fireplaces from the two ground floor bedrooms at a time when this is convenient and acceptable to the individuals concerned. One of the rooms needs to be redecorated and the floor covering needs to be cleaned or replaced at a time when it is convenient and acceptable to the individual concerned. The management need to make sure that the people who use the service and the Registered Manager are involved in the recruitment of new staff at an early stage. They also need to look at the induction and mental health training programme to make sure that it contains all of the right information. The management must ensure that the Registered Manager is facilitated to resume the management qualification as specified in the report relating to the additional category of registration, which was granted by the Commission earlier in the year. The management must ensure that the certificate of registration is kept up to date by supplying the regional registration team with the right information in a timely way. Consideration should be given to fitting automatic closure devices to fire doors that are propped open. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 9 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 Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, & 3 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service receive clear information to enable them to make a choice about whether they might wish to live at Highfield. EVIDENCE: The service has a Statement of Purpose, which in the main complies with the criteria specified in schedule 1 of the National Minimum Standards. However more information needs to be included such as the number of staff who have National Vocational Qualification in Care level 2 and how the service intends to meet the needs of people with Learning Disability and Mental Disorder. The service has a Service Users Guide, which is produced in an easy read format and contains most of the right information, including how to make a compliant. However it does not contain any information about fees and the views of the people who use the service. Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 11 We case tracked two people who use the service this involved looking at their individual plans of care. These showed that the service obtains assessments from the funding authority regarding the specified needs of the individual. These are used to form the basis of the individual plans of care, which provides information to staff about how the needs and wishes of the individual are to be met. However there was little information on file to show how the service had assessed as to whether the service was able to meet the needs of the individual. Both of the most recent admission had been admitted to the home at the time the new Manager commenced working in the home. She therefore had little opportunity to assess the new residents herself before they were admitted however she confirmed than a preadmission assessment had been conducted by senior management and that the residents had had opportunities to visit the home before deciding whether to move there. The Registered Manager confirmed her intention to be involved in the preadmission assessments of all new admission to the service to ensure that the service is able to meet the needs of the individual and also that the new residents is able to fit in well with the existing people who use the service. She also confirmed the intention to ensure that admissions are phased providing prospective residents with varied opportunities to visit the home and meet the existing residents and staff and to find out what it might be like to live there. Both of the people selected for case tracking purposes had an easy read, up to date contract on file. We spoke to four of the people who live at Highfield all said that they were happy and liked living at the home. Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, & 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have a detailed plan of care, which indicates that they are treated as individuals and that the service is able to meet their needs and wishes. EVIDENCE: We case tracked two people who use the service, this involved looking at the individual plans of care to see how people wanted and needed to be supported. These plans are based on the information obtained before and after admission to the home. Nearly all of the individual plans of care have now been reviewed and are of a very good standard, they are person centred and they provide staff with detailed and up to date information about aspects of the persons Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 13 health, personal and social care needs, including information relating to gender and sexuality. People who use the service have access to a chosen key worker who takes a special interest in them and involves them in the development and regular review of their care plans. One staff member commented ‘we make sure that the client’s needs are met on a daily basis. Everyone is different so we work together to meet the needs of the residents’. People who use the service are encouraged and supported to make decisions about their lives. They have regular meetings to make decisions about the running of the home such as menu planning, activities, outings and décor. They are also supported to make decisions about how they spend their time and the activities in which they participate. One of the people spoken to described how she enjoyed physical activity and enjoyed walks around the nearby park and attendance at a day centre where she enjoyed activities such as aerobics and salsa dancing. Two of the male residents showed us photographs of them on outings including trips to Towcester Horse Racing Track and these outings were evidently much enjoyed. There was evidence that people who use the service are offered access to independent advocacy services however they had declined preferring to use their Key Worker as their advocate. People who use the service are supported to take risks in their lives such as accessing their local community, going to the local shop, making their own drinks and participation in domestic activities in the home. Any limitations placed on the people who use the service are seen to be made in their best interests, with their agreement and are supported by detailed risk assessments which specify appropriate controls to reduce and manage the identified risk. One of the staff commented ‘we have to read the care plans and sign to say that we have done so’. Observations made during the inspection showed that people who use the service have a very good relationship with the staff and in particular their key workers. Key workers were highly knowledgeable about the needs of the people that they supported and demonstrated strong communication skills, which were clearly valued, by the people who use the service. Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 14 Highfield DS0000012810.V375352.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): This is what people staying in this care home experience: 12, 13, 15, 16 & 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are supported to have control over their lives to enable them to enjoy a lifestyle that promotes their independence EVIDENCE: People who use the service at Highfield are treated as individuals and their views are sought regarding opportunities to pursue educational and employment opportunities. One person attends a work placement scheme however most choose to attend the day centre run by Mentaur LTD on either a full or part time basis. Each person has their own activities programme and staff actively seek out activities, which the people who use the service may enjoy, in which they support them to participate. One person indicated that Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 16 they liked to go to the corner shop and the management are supporting him to take more responsibility for his own money. Arrangements were also being made for this individual to play snooker on a more regular basis and to learn more about magic according to his interests. Others attend a local dance studio to participate in salsa dancing and aerobics. There is also evidence that people can choose to opt out of activities should they wish to do so. One staff member commented ‘The home respects individuality, gives privacy, choice and choice of activities’. People who use the service are supported to maintain links with their family and friends. They are able to receive their chosen visitors at Highfield. One of the people spoken to said that they liked going to the day centre because they had made friends with other people there. Staff were also able to describe friendships that had arisen between the people living in the home. Daily routines were seen to be flexible; people who use the service were able to get up at the time that they wanted within the constraints of their planned activities. Individual plans of care contained detailed instruction to staff about the preferred routines of the people living there and how they wished to be supported. Staff were seen to relate well to the people who use the service, people who use the service were able to indicate that they were supported well by the staff and that they were sensitive to their needs and wishes. There was also evidence that meals and meal times are also flexible. People who use the service confirmed that they were able to contribute to the planning of the menu and that there were always choices available. A menu is displayed in the kitchen and appeared to offer a balanced diet, fresh fruit and fluids were available throughout the day. One resident said ‘I help to plan the menus, I like the food that we have here and there is always enough’. All exiting residents are White British as such the menu was appropriate for their cultural background. Highfield DS0000012810.V375352.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and Healthcare support is managed well at Highfield which means that the needs of the people who use the service are fully met. EVIDENCE: People who use the service have detailed individual plans of care that provide detailed instruction to staff about how each person needs and wishes to be supported. People who use the service were well presented and are able to express their personalities through their appearance and were dressed appropriately for their age and gender. Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 18 As the existing residents age increases the management are mindful of the need to provide appropriate care and support including the awareness of the National Minimum Standards ‘ Care Homes for Older People’ which includes the need to assess people for the risks of falls, nutrition, pressure and Movement and Handling. All of the existing residents are fully mobile at present however the management are mindful of the impact of the aging process on their abilities. Arrangements are in place to provide additional aids and adaptations such as grab rails to assist people, as they get older. The Registered Manager also expressed the intention of obtaining an assessment of the premises by an Occupational Therapist. The Registered Manager also intends to seek guidance from the community nursing team about the management of pressure, nutrition and Movement and Handling. Health care is managed well, people have the very good individual plans of care in place, these are specific to the needs of the individual and ensure that peoples health is monitored and guidance is sought form the appropriate health care professionals. There was also evidence that people who use the service have access to appropriate health professionals such as Hospital Services, General Practitioners, Dentists, Opticians, Physiotherapists and the Community Learning Disability Teams. Medication systems were reviewed and found to be in good order, there are robust arrangements in place for ensuring that people who use the service have access to appropriate supplies of their prescribed medication. Medication is dispensed by a local high street chemist within a monitored dose format wherever possible; this enables staff to maintain robust stock control systems. When medication cannot be dispensed in a monitored dose format additional robust stock control systems are in place. Medication Administration Records were seen to be in good order and to show that people who use the service receive their medication safely and as prescribed. Individual plans of care contain information about how the medication is to be administered, including the consent of the individual for the staff to manage and administer their medication for them. One of the individuals case tracked had specific needs, which were documented in the individual plans of care, a risk assessment was in place for the partial self-administration of this person’s medication, although this needs to be further developed to include more detail about how the associated risks are to be managed. Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 19 The service does not at present store any controlled medication however the existing storage does not at present comply with recent guidance issued by the Royal British Pharmaceutical Society. Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a robust complaints procedure and there is good staff awareness and attitude towards the Safeguarding of Adults ensuring that people who use the service are able to voice their concerns and are protected from abuse. EVIDENCE: People who use the service told us that they liked living at Highfield; they said that the staff were nice to them and that they felt safe. The told us that they knew how to complain although they had not needed to. One staff member commented ‘Residents are asked regularly if the have any complaints’. We looked at the complaints procedure and saw that it contains the right information and that it is produced in an easy read pictorial version, all of the people who use the service have their own copy. Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 21 We looked at the complaints file and saw that there have been no complaints about the service since the last inspection. The Care Quality Commission have received no concerns or complains about this service either. There have been three Safeguarding Adults allegations about this service since the last inspection. One of these referred to the care of a named resident, the incident was investigated and there was no evidence to support the allegation. The second referred to an incident involving the previous manager, this also was investigated and although no evidence was found to support the allegation the manager resigned her position. The third incident related to an incident of physical aggression between residents, this was referred to the Local Authority Safeguarding Adults Team, who have now notified the service that they are satisfied with the actions that have been taken. However as yet we the Commission have not yet received a formal outcome for the Local Authority. However since the new manager has been appointed there have been no further allegations. Staff have received training in the Safeguarding Adults and in the management of challenging behaviour. Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of the environment is generally good and provides people who use the service with a safe and comfortable place to live. EVIDENCE: Highfield is a period terraced house in keeping with the local community and close to the town centre with amenities such a shops, leisure facilities, health services and transport links. Highfield is a four-storey property registered to provide care for six people who are accommodated over the ground and first floors. The laundry facilities and located in the cellar and the office accommodation is located on the third floor. Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 23 There is a small sitting room located on the first floor, which could seat six people if required. There is a recently refurbished kitchen and dining room on the ground floor, this provides people with a pleasant place to prepare and eat their meals. Due to the design of the property the doorways and corridors are quite narrow and the stairs are steep meaning that the premises are not accessible for people who require the use of a wheel chair. Two of the people who we had been talking to offered to show us their bedrooms; both of these were located on the ground floor. Both rooms were fitted with appropriate furnishings, fixtures and fittings, including washbasins and privacy locks. Both rooms had previously been used as reception rooms both had imposing fireplaces, which are no longer in use. These have the potential to compromise the lay out of the rooms and restrict the usable space. Both rooms showed evidence of personalisation and both were able to confirm that they liked their rooms, one person was able to confirm that they had been involved in the choice of décor. The other room was in need of some maintenance to the decoration and the carpet also needed to be cleaned or replaced. People who use the service are able to hold keys to both their private accommodation and the front door if they are assessed as being safe to do so. Staff respect the privacy and wishes of the people who use the service. On person told us ‘I love my bed and I really like my room I keep it locked because I don’t like anyone going in there’. In general the home was seen to be clean and well maintained with adequate supplies of hot water and good procedures for the management of infection control. There is a well maintained garden to the rear of the premises, residents have been involved in some gardening activities such as the planting of hanging baskets which enhances the garden and provides the people who use the service with a pleasant place to relax. Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment of experienced and trained staff ensures that the people who use the service are in safe hands. EVIDENCE: The service has a duty rota, which shows which staff are on duty over a period of a week. There is one sleeping night staff on duty throughout the night. The service aims to have at least two members of staff on duty throughout the daytime shifts. The Registered Manager has dedicated time set aside to enable her to manage the home effectively. Staff told us that there is generally enough staff on duty to meet the needs of the people who use the service. One staff member commented that ‘Sometimes at the last Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 25 minute someone may not be able to work a shift for valid reasons, we try to make sure that support is offered and work together to cover the shift’. Staff files were reviewed and confirmed that the management ensure appropriate recruitment practices including obtaining appropriate references and police clearances before new staff are able to start working in the home. However the staff selection processes are often centralised meaning that neither the Registered Manager nor the people who use the service can be involved at an early stage of the staff selection process. All of the exiting staff are female, the Registered Manager is mindful of the need to wherever possible reflect the gender and culture of the existing residents within the staff group. The service has an induction programme which focuses in the main on the management systems and administration within the organisation. The specific information that staff need to know about such as how to care for individuals relies on the new staff reading the individual plans of care and shadowing an experienced member of staff. The induction programme needs to be reviewed to make sure that it compiles with current best practice and includes information about how to access health and social care services for staff who are new to this country. The staff at Highfield are a young enthusiastic, committed team who all have a minimum of National Vocational Qualification in Care level 2. Staff training appears to be generally managed well, staff files indicate that staff have access to all of the mandatory training such as Fire Safety, Basic Food Hygiene, First Aid, Infection Control, Safeguarding of Adults, Health and Safety, Movement and Handling. All of the staff spoken to have training and experience in the care of people with Learning Disability and Mental Disorder. Some of the staff have specific training and experience in Communication skills such as British Sign Language and Makaton. The staff training programme shows that there is some basic internal training on Learning Disability and Mental Disorder and this needs to be further developed to ensure that new staff have the skills to care for this client group. Staff files showed that staff have access to appropriate and timely staff supervision. Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 26 Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 27 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate leadership, guidance and direction means that the home is managed in the best interests of the people who use the service. EVIDENCE: The service applied for and was granted a Variation to their registration to include the categories of Mental Disorder in December 2008. Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 28 Since the last inspection a new manager has been appointed, she was registered with the Commission in April 2009. She has previous experience of being a registered manager at another home within the Mentaur Group providing support to a similar client group. She has a formal Social Work qualification and previous experience of working with people with Learning Disability and Mental Disorder. She has commenced the Registered Managers Award but was unable to continue with the qualifications due to unforeseen circumstances. However it is a condition of her registration that she resumes training for a formal management qualification. The Registered Manager has informed us that arrangements are currently being made with the Human Resources Department for this training to commence in the near future. The certificate of registration was displayed appropriately and was seen to be accurate with the exception of the named Responsible Individual. The provider needs to write to us formally and notify us who is nominated as the Responsible Individual and to request an amendment of the certificate of registration. Arrangements are in place to ensure appropriate quality assurance practices are used in the home. The organisation conducts annual quality assurance surveys, which are collated to give an overall picture for the performance of the combined services and specific information relating to individual homes. Feedback is generally positive and the findings are used to develop the service. The Responsible Individual has also nominated a service manager to conduct regular monthly visits to the service to ensure the service delivery is safe and meets the expected standard. The Registered Manager stated that she intended to conduct more frequent internal surveys and audits to ensure a prompt response. Regular audits are already being conducted on medication systems, care plans, residents money and fire records and kitchen records. All policies and procedures have been recently reviewed. The management of residents money was reviewed and seen to be in good order, appropriate receipt are retained to demonstrate appropriate expenditure and a running balance is maintained. Money is stored appropriately in Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 29 individual locked containers. A spot check was conducted and balances corresponded with the written records. The people who use the service are encouraged to put larger sums of money into an umbrella account, which is held separately and enables individuals to accrue appropriate interest. Money can be accessed form the accounts on advanced request. Accident and incident records were reviewed and found to be in good order. These are also being audited on a regular basis to identify trends and take action to prevent reoccurrence. Safe working practices were seen to be in place through out – no hazards were identified. Door wedges were in place on the ground, fist and third floor. The Registered Manager confirmed that these were removed at night and were included in the Fire Risk Assessments. However the service has been subject to a recent inspection by the fire officer and his report is awaited. Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 30 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 3 3 X 4 3 5 3 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Version 5.2 Page 31 Highfield DS0000012810.V375352.R01.S.doc 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 YA1 Regulation 4. Requirement The Statement of Purpose must be reviewed to ensure that it contains all of the required information. To ensure that people have access to up to date and appropriate information. The documentation relating to the providers preadmission assessment must be included in the individual plans of care. Risk assessments must contain more detail when people participate in any degree of selfmedication. The management must review the storage of controlled medication to ensure that it complies with the RBPG. Arrangements must be made for the Registered Manager to undertake a management qualification The management must provide the Regional Registration Team with the right information to enable the certificate of registration to be amended. Timescale for action 01/07/09 2. YA2 14. 01/07/09 3 YA20 13.2 01/07/09 4. YA20 13.2 01/07/09 5. YA37 9.2.b.i 01/09/09 6. YA37 7.2.c 01/07/09 Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 32 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 YA2 YA24 Good Practice Recommendations The preadmission assessment procedure should be reviewed to ensure that the Registered Manager is involved at an early stage. Consideration should be given to the removal of the fireplaces and surround from the two ground floor bedrooms at a time when this is convenient and acceptable to the individuals concerned. The management should ensure that one of the rooms is redecorated and the floor covering is cleaned or replaced at a time when it is convenient and acceptable to the individual concerned. The management should ensure that the people who use the service and the Registered Manager are involved in the recruitment of new staff at an early stage. The management should review the induction and mental health training programme to make sure that it contains all of the right information. Consideration should be given to the fitting of automatic closure devices to fire doors that are propped or wedged open. 3. YA24 4. 5. 6. YA34 YA35 YA42 Highfield DS0000012810.V375352.R01.S.doc Version 5.2 Page 33 Care Quality Commission Eastern Region Care Quality Commission Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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