Care Home: Highwater House

What the care home does well The residents` complex and diverse individual needs relating to their illness are fully understood by a knowledgeable and well trained staff team. There are extremely good links with other professionals who contribute to a very successful admission process. The service actively encourages the residents to participate in the local community. The service is well run and the residents are encouraged to participate in the running of the home; we were told by two of the residents that they had helped to choose some of the paintings for the new building and that they attended meetings with the staff and learnt things about the home. Staff members and two residents told us that the manager`s door was always open. People living in the home say they feel safe and that they know who to talk to if they have any concerns. They named people on the staff team who they could talk to including the manager. Most of the staff are well qualified and possess the skills to support the people living in this home. The staff told us that they do a lot of training. The health, welfare and safety of the residents and staff is managed well with good records in place to support this. What has improved since the last inspection? The whole of the environment has undergone a complete transformation ensuring that it now meets the National Minimum Standards for care homes. The recruitment process in the home has improved and the system that has been put in place now contributes to safeguarding the people who live there. What the care home could do better: There is nothing the home needs to do by law and the Commission thinks the staff are doing an excellent job. We have also not made any good practice recommendations, but the manager told us that there is always room for improvement and that they continually strive to do things that improve the care of the people who live in the home; also to look at ways of promoting the service and the work that is being done there. Our observations during the inspection confirm that this is the case. CARE HOME ADULTS 18-65 Highwater House Westwick Street Norwich Norfolk NR2 4SZ Lead Inspector Mrs Marilyn Fellingham Unannounced Inspection 15th May 2008 10:00 DS0000027464.V364709.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 DS0000027464.V364709.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. DS0000027464.V364709.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highwater House Address Westwick Street Norwich Norfolk NR2 4SZ 01603 766627 01603 766672 angela.herbert@stmartinshousing.org.uk 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) St Martins Housing Trust Miss Angela Herbert Care Home 22 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (22) of places DS0000027464.V364709.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th May 2006 Brief Description of the Service: Highwater House is a care home operated by the St Martins Housing Trust, a Norwich based registered charity working with people who have experienced homelessness. The care home is registered to accommodate up to a maximum of 22 people who fall within one or other or a combination of categories: people with mental disorder, learning difficulties (excluding dementia) or physical disabilities. Service users may also have problems with substance or alcohol misuse. Although the care home does not offer specific rehabilitative services, service users are encouraged to develop confidence and skills to potentially enable them to ultimately acquire greater independence. The premises have just recently undergone a radical rebuild ensuring that the National Minimum Standards for a care home are now met. The fees range from £536 to £556 per week. Copies of the CSCI’s inspection reports are made available to the residents and their relatives upon request. DS0000027464.V364709.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 3 star. This means that the people who use the service experience excellent outcomes. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. We have rules that tell us how to do this and we think some of these groups are more important than others because of the way they affect people’s safety. This inspection was unannounced and took place over six hours. During that time we spoke with three people living there, the manager and four staff members. We got other information from the Annual Quality Assurance Assessment (AQAA) that the manager had filled in before the inspection, and from records that we looked at in the home. We also had some written comments from some people who live in the home. What the service does well: The residents’ complex and diverse individual needs relating to their illness are fully understood by a knowledgeable and well trained staff team. There are extremely good links with other professionals who contribute to a very successful admission process. The service actively encourages the residents to participate in the local community. The service is well run and the residents are encouraged to participate in the running of the home; we were told by two of the residents that they had helped to choose some of the paintings for the new building and that they attended meetings with the staff and learnt things about the home. Staff members and two residents told us that the manager’s door was always open. People living in the home say they feel safe and that they know who to talk to if they have any concerns. They named people on the staff team who they could talk to including the manager. Most of the staff are well qualified and possess the skills to support the people living in this home. The staff told us that they do a lot of training. The health, welfare and safety of the residents and staff is managed well with good records in place to support this. DS0000027464.V364709.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000027464.V364709.R01.S.doc Version 5.2 Page 7 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 DS0000027464.V364709.R01.S.doc Version 5.2 Page 8 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The personalised and thorough assessment of needs on admission means that people’s diverse and complex needs are identified and planned for as they move into the home. EVIDENCE: Most of the residents who are admitted to the home are admitted under an emergency situation as they quite often have been living on the streets; others are referred to the home by other mental health agencies and quite often do not have the opportunity to ‘test drive’ the home first because of the nature of their conditions. The home therefore makes every effort to ensure that they get the first initial assessment of the prospective resident correct as this is as the manager stated “the key to the whole admission process” and “making sure we get the balance part right” and also “making sure that the mix and personalities of the other residents do not impinge in any way on the management of these clients”. The assessment is carried out by a care co-ordinator with possible input from the local Mental Health team based at the hospital and the Primary Care Team. There is also an on line system for referrals where information can be obtained. DS0000027464.V364709.R01.S.doc Version 5.2 Page 9 If, after the information is obtained, the service feels that the prospective resident’s needs cannot be met they will not admit that person. This is imperative as most of the residents that live in this home have very complex and diverse needs. The manager acknowledges in the AQAA, (Annual Quality Assurance Assessment), that they could improve the admission procedure by insisting on better information from social workers and more up to date risk assessments, however she feels that this could compromise someone’s admission by still being left on the streets inappropriately whilst information was gathered. The manager reiterated this again during the inspection. The assessment documentation was seen for two newly admitted residents, these were very informative and a contract of care was also seen for one of these people. DS0000027464.V364709.R01.S.doc Version 5.2 Page 10 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The residents are actively involved in the care planning process and encouraged to take risks that help them to lead independent lifestyles, but at the same time helping them to minimise the risks to themselves. EVIDENCE: We looked at four care plans; the thorough needs assessment had been used to formulate the plans of care that also included the therapeutic intervention. These care plans were detailed and related to the assessed needs of the residents. There was evidence of service user involvement in the care plans and one resident had done their own care plan. The care plans had evidence of review and had been updated when needed. We noted that the care plans also covered all aspects of need. The care plans also showed emphasis on developing (if needed) daily living skills such as money management, laundry management and behaviour modification. DS0000027464.V364709.R01.S.doc Version 5.2 Page 11 There were detailed daily logs with some information being entered on the care plans when appropriate. Risk assessments were in place and one service user told us that, “I go out and about and makes decisions about the life I want to lead”. During the inspection a number of residents were seen to be coming and going and leading almost independent lives in relation to their planned care. Risk assessments were related to the residents who are encouraged as part of their move towards independence to take risks. One resident told us that although he wants to do other things he knows that the care plan that they made with the key worker is necessary if he wants to move on. Another resident told us that “we are treated well and the key worker has helped me with my problems”. The residents take part and indeed are encouraged to take part in the day-today running of the home; an example of this is, that, they all helped to choose the décor and equipment for the refurbishment that has taken place. The staff work hard to make sure that the residents are involved with many aspects about the home through resident meetings, notice boards and letters are sent to the residents to give them information. DS0000027464.V364709.R01.S.doc Version 5.2 Page 12 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): 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 very supported and encouraged to be in control of their own lives and pursue their personal development to help them move on at a later stage to a more independent lifestyle. EVIDENCE: The home is well situated in the city of Norwich to make use of a number of community facilities that are within walking distance of the home. The manager described a number of activities that the residents can be involved with if they so wish, these ranged from going to restaurants, the theatre, the cinema, the library, bowling or going to the gym; these activities can either involve going with their key worker or on their own as part of their move towards more independence. One resident described to us how they “loved going to the home’s caravan” on the coast and that when they were there “I have to be responsible for cleaning DS0000027464.V364709.R01.S.doc Version 5.2 Page 13 the caravan”. Another resident told us that they “enjoyed swimming” and participated in a number of other activities including going to the cinema and “out in the people carrier”. They went on to say that they cleaned their own room. All the residents we spoke with told us there was plenty to do and that they were able to use the new activities room. The care plans that we looked at reflected daily activities including management of money, doing their own laundry and keeping their rooms clean; the care plans also referred to therapeutic care in relation to helping people develop life skills that will help them in the community. One resident explained to us how the home was helping them to manage his money and how to reduce the consumption of alcohol; this person also told us that, “the home works hard at integrating us back in the community”. The home has regular meetings with the residents and they are continually kept up to date with any changes taking place. We looked at the menus and spoke with the chef; the kitchen is well organised and very flexible when it comes to mealtimes and the provision of food so that if a resident does not like what is on the menu the chef will provide something else to their liking. We noted that there was fresh fruit and snacks available for the residents to have between meals. The kitchen has been totally refurbished and is more homely than the previous one. Foods such as yoghurts and fresh fruits are left out and are available to the residents at all times. There is also a drinks machine the residents can use. DS0000027464.V364709.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are well supported by staff and their safety is promoted by the safe handling and administration of medicines in the home. EVIDENCE: Service user’ surveys that were retuned to us were positive about the care they received in the home. All the residents in this home are very able and do not require ‘hands on care’, however they do receive personal support in the way that they choose. This was evident reading the information in the care plans and speaking with some service users. This support offered by the staff is through developing good working relationships with the residents and encouraging them to move towards more independence. One service user told us that he felt really “well supported” by his key worker who “treats me well and helps me with my problems”. Service users who are admitted to this home do not self medicate and when they are admitted they agree to the staff managing their medication. If a DS0000027464.V364709.R01.S.doc Version 5.2 Page 15 service user gets to the stage where they can manage their own medication, then this is facilitated by the home and the resident will be offered accommodation within the St Martins Trust. We carried out a random audit of the medication kept in stock and this tallied with the medicine record charts and the medication that had been given to the service user or refused. The staff keep clear records of all medicines received into the home and those that are returned and records were seen for this. The manager told us that she meets up with the GP frequently to review all medication prescribed to the residents. DS0000027464.V364709.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are systems in place to help ensure the protection of the residents from abuse and the residents feel that they are listened to. EVIDENCE: We spoke to two residents about how they aired their concerns and if they knew how to complain if they had to. One resident told us that they always went to their key worker if they had any concerns and that they were always sorted straight away. The other resident told us that the manager always had an open door and they would go to her if they had any problems. Records for complaints and concerns show that they are addressed quickly and within the time limit set out in the service user’s guide. Staff spoken with were aware of all issues relating to safeguarding adults and confirmed that they had had training sessions in relation to this; staff training records verified this. DS0000027464.V364709.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Highwater House has been completely rebuilt to provide a more homely and safe environment to help promote independence, privacy and provide a less institutionalised place to live. EVIDENCE: All those residents we spoke with were extremely happy with the revamped building and were enthusiastic about their rooms that had evidence of personalisation. They also told us that they had been given the opportunity to choose their new rooms, which we noted had been furnished in a homely way. The kitchen has been totally revamped as explained earlier; there is a lovely activities room with a variety of equipment for the residents to use. The communal areas are spacious and very relaxed in their style and in no way looked institutionalised. DS0000027464.V364709.R01.S.doc Version 5.2 Page 18 The area outside has been upgraded with pleasant areas for the residents to sit; we noted on our tour that a number of the residents were enjoying all these amenities. DS0000027464.V364709.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The people who use this service are cared for by an appropriately recruited and well-trained cohesive staff team who are employed in sufficient numbers to provide the support that the residents need. EVIDENCE: We looked at the staff rota for the week and noted that it was relevant to the staff on duty on the day of inspection; we also noted that the staffing levels were good and were appropriate in relation to one to one care and activities related to the assessed needs of the residents. Most of the staff at Highwater House are very well trained, a number of varied qualifications are held by the staff including psychology, counselling, nursing, music and Indian Head Massage. Our talk with the chef revealed that he was also included in the staff training including those sessions related to mental health. NVQ training is on going and 80 of staff have NVQ level 2 or above. Those three staff members we spoke with confirmed with us that they undergo training regularly. One member of staff said that “training is very good and if we want to do courses we are not prevented”. Another staff member told us DS0000027464.V364709.R01.S.doc Version 5.2 Page 20 that they “have a lot of training”, and that they were the health and safety officer and had done training to take on this role. The staff also told us that they received formal supervision every six weeks and staff records confirmed this. They also said that there was opportunity to discuss their professional development at the supervision sessions. There is a training matrix in place that reflected all the training that had been covered and that which is planned for the future. The manager herself does a lot of the in-house training which benefits the staff and overall the residents. Recruitment records for one newly appointed member of staff were seen and we noted that all the relevant checks had been made before employment. DS0000027464.V364709.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service has an efficient and competent manager and an effective quality assurance system in place, which clearly benefits the residents and the quality of support they receive. EVIDENCE: The manager of the service is well qualified and experienced; she holds the Registered Manager’s Award and is completing a course at the UEA for Dual Diagnosis, (this includes mental health support needs and other associated issues). After discussions with staff and three residents we gained the impression that the manager is seen as very approachable and comments were made such as “her door is always open, she’s good”, “manager has an open door policy”, “ she listens and is interested in us”. The manager is also DS0000027464.V364709.R01.S.doc Version 5.2 Page 22 well supported by her Operations Manager, who oversees this and other local St Martins Housing Trust facilities. We looked at a number of records relating to health and safety; these included fire records fire alarm and fire equipment. All certificates are in place relating to all the new building work that is now completed including electrical and gas. One staff member is a health and safety officer for the home and good records are kept. Systems are in place to monitor the quality of the service offered and also to monitor the outcomes for those people who use the service. For example, the manager writes monthly progress reports for the Trust and we looked at some of these during the inspection. These set out progress being made, e.g. by some of the residents and were informative. DS0000027464.V364709.R01.S.doc Version 5.2 Page 23 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 X 2 4 3 X 4 X 5 4 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 4 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 4 32 4 33 4 34 4 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 4 X LIFESTYLES Standard No Score 11 3 12 3 13 4 14 3 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 4 4 4 4 4 4 DS0000027464.V364709.R01.S.doc Version 5.2 Page 24 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. Refer to Standard Good Practice Recommendations DS0000027464.V364709.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000027464.V364709.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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