Inspection on 11/04/05 for 49 Stolford Rise

This inspection was carried out on 11th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

49 Stolford Rise 29/01/07

49 Stolford Rise 03/05/06

49 Stolford Rise 19/09/05

49 Stolford Rise 02/11/04

49 Stolford Rise 04/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Stolford Rise (49) Tattenhoe Milton Keynes Bucks MK4 3DW Lead Inspector Maureen Richards Unannounced 11th April 2005 09:45 a.m. 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 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 Stationary 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. Stolford Rise (49) Version 1.10 Page 3 SERVICE INFORMATION Name of service Stolford Rise (49) Address Tattenhoe, Milton Keynes, Bucks, MK4 3DW Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01908 505626 The Disabilities Trust Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Stolford Rise (49) Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1 This home is registered for three people with a learning disability. Date of last inspection 02 November 2004 Brief Description of the Service: Stolford Rise is a residential home providing care and support to three service users with a learning disability. The home is located in a residential area of Milton Keynes. It is close to local shops and is on a bus route to Milton Keynes where a wider range of activites and amenities are available. The home consists of a two storey building. All of the bedrooms are single and each serivce user has a separate individual lounge area. At the rear of the property is an enclosed garden with seating. Stolford Rise (49) Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced. It started at 9.40 am and lasted for four hours. Part of the inspection was spent talking with the staff on duty and looking at records to check progress with the requirements made at the previous inspection. The inspector walked around the home and spoke individually with two service users. What the service does well: What has improved since the last inspection? What they could do better: Further work is required to develop service users plans and risk assessments to ensure that individuals needs are met in a safe and consistent way. The most serious concern from this inspection is that staff do not have up to date safe working practice training in moving and handling and some staff do not have up to date basic first aid training. This has been highlighted at previous inspections and the organisation has failed to address it. The home has not had a registered manager for seven months. There is no clear management structure within the home, which means there has been no continuity in the management of this service. Stolford Rise (49) Version 1.10 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Stolford Rise (49) Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Stolford Rise (49) Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 Service users have the information available to them to enable them to make an informed choice about where to live. EVIDENCE: The statement of purpose and service users guide was included in service users files and a copy of both documents was available on the shelf in the office. The service users guide had been updated to reflect the change in manager and updated with the Commission’s contact details. A requirement was made at the previous inspection for the statement of purpose to be made available in the home and to service users and for the service users’ guide to be updated with the change of manager and the Commission’s contact details. The documents seen confirmed this had been addressed. A requirement was made at the previous announced inspection that the organisation must ensure that relevant care plans, risk assessments and agreements are obtained and made available to staff prior to a service user moving in. The home has had no new admission since the previous inspection. However staff meeting minutes confirm that this has been discussed and agreed as a team. Stolford Rise (49) Version 1.10 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 , 9 and 10 Some progress has been made in reorganising service user files and in developing guidelines to enable staff to meet service users needs in a consistent way. Risk assessments continue to contradict specific guidelines and do not make it clear to staff how specific situations should be managed which could potentially put service users and staff at risk. All of the service users information is not kept secure and therefore could breach service users confidentiality. EVIDENCE: Two service user plans were seen at this inspection. Both files have been reorganised, although both sections of the file contain duplicate information. One service user plan seen provided specific guidelines on how that individuals care needs were to be met in relation to managing finances, promoting independence, social and emotional support, managing inappropriate behaviour, managing aggression and support required in the use of equipment. Those guidelines were found to be specific, detailed and easy to follow. The care plan was signed by the service user, keyworker and manager and included a date of review. Stolford Rise (49) Version 1.10 Page 10 The second service user plan seen included guidelines on managing a medical condition, support required in developing life skills and identified the level of support required when out of the home or involved in a specific task. This plan included guidelines on managing aggression and outlined that staff should use appropriate techniques, but did not identify what were appropriate techniques. This plan included guidelines on crisis intervention and further guidelines on approaches and techniques. The three sets of guidelines referred to the management of a similar situation but contradicted each other in the management of that situation. This was highlighted at the previous announced inspection but has not been addressed. Both service user plans included a series of risk assessments. In one service user plan two similar situations posed a different level of risk. This was highlighted at the previous announced inspection but has not been addressed. The second service user plan seen included a series of risk assessments, which identified that the risk range was low to medium or medium to high. Risk assessments must clearly identify whether the risk is low, medium or high as the management plan for the risk will be dependant on the level of risk. A requirement will be made at this inspection to address this. Risk assessments seen were signed, dated and showed evidence of being reviewed. Service user daily logs, individual accident records and incident reports are kept in an unlocked drawer in the office. A requirement was made at the previous announced inspection that the manager must arrange for all service users information to be kept secure and confidential in the office. Staff on duty confirmed that this was due to be done, now that the filing cabinets had been reorganised and a new key had to be obtained for the existing filing cabinet. Stolford Rise (49) Version 1.10 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 Service users have individual programmes of activities to encourage personal development and leisure opportunities, however some service users choose not to engage in activities and individual programmes. EVIDENCE: Each service user plan included an individual programme of activities. One service user is supported to attend a local college three days a week. Staff at the home have worked with individuals in setting up work placements but the service user chose not to take this up. Staff continue to work with individuals in developing their leisure interest. A requirement was made at the previous announced inspection that the organisation must ensure that service users are given opportunities for activities in and out of the home and a record must be maintained to confirm what activities were offered and taken up. The activity is recorded in the daily log and transferred to service users plans. The record of activities in one file was last updated in March and in the other service user file it was updated at the beginning of April. Activities are on an ad hoc basis and are dependant on the service users’ motivation and willingness to attend. During the course of this inspection two service users spent all morning in their bedrooms even though their daily programme indicated they should have been involved in Stolford Rise (49) Version 1.10 Page 12 specific activities. The organisation must continue to ensure that opportunities for activities are made available to service users and staff should look at ways of motivating individuals to get involved in activities. Stolford Rise (49) Version 1.10 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 20 Good systems are in place to record any medical intervention and treatment prescribed to ensure that service user health needs are met. Some improvements, but not all that are necessary, have been made to medication practices and procedures to safeguard service users. EVIDENCE: Service user plans include a medical history section, which includes letters and communication from health professionals. Service user plans include a record of all health appointments and outcome. A requirement was made at the previous announced inspection that the organisation must ensure that service users choice of food is not restricted unless medical input has been obtained to support this decision. The service users’ files seen confirm that a dietician referral was made for one service user and the GP confirmed that the other service user was on a reducing diet. Two service users have prescribed medication, which is administered by staff. At the previous announced inspection the then manager confirmed that she had intended to purchase a medication cupboard, which would be kept in the office. To date this has not happened and the medication continues to be stored in a locked kitchen cupboard, which has previously been broken into by a service user. Stolford Rise (49) Version 1.10 Page 14 The medication records seen showed no gaps in the administration of medication. A requirement was made at the previous announced inspection that the organisation must ensure that a record of all medication returns is set up which outlines the number of tablets returned and includes signature of staff and pharmacist. The support worker on duty confirmed this was now in place but was with the pharmacist and therefore was not seen. A further requirement was made that the organisation must ensure that a homely remedies policy is developed. The support worker confirmed that it had been discussed but she was not sure if it had been developed. At the previous inspection a medication error was noted and no medical advice had been sought. Guidelines have now been developed on the administration of medication, which includes what to do if an error is made and the wrong medication is administered. It is recommended that these guidelines also include what to do if medication is omitted, as was the case in the above mentioned error. Stolford Rise (49) Version 1.10 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 The organisation’s adult protection policy has not been updated in line with interagency procedures, which could jeopardise any adult protection investigation. EVIDENCE: The organisation’s adult protection policy indicates that in the event of suspected abuse of a service user that the staff member should discuss the situation with the relevant manager and or professional e g GP/ consultant, whether an adult abuse investigation is appropriate. This policy is not in line with interagency adult protection procedures, which state that any allegation of abuse must be reported to the care manager who takes the lead and makes the decision on any adult protection investigation. This policy has not being reviewed and updated despite being made a requirement at the previous announced inspection. Training records indicate that new staff receive training in adult protection and staff on duty were aware of their responsibilities in reporting abuse. Stolford Rise (49) Version 1.10 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 Some improvements have been made to provide a safe environment for service users. However a planned programme of redecoration is required to improve the decor of the home to ensure that service users live in a homely and well-maintained environment. Systems and procedures are in place to ensure that the home is clean, hygienic and presentable for service users. EVIDENCE: Overhead closures have been fitted to the sitting room, kitchen and dining room doors. Doors on the ground floor have been decorated but to a poor standard. Decoration in the hallway, landing, bathroom and the one bedroom seen is becoming shabby and in need of redecorating. Staff on duty were not sure if there was a planned maintenance and renewal programme in place to keep the home maintained and redecorated. The home is clean and systems are in place to deal with laundry in the kitchen area. At the previous inspection the infection control policy was not accessible. This was now in place. Stolford Rise (49) Version 1.10 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 and 35 The rota does not reflect the actual staff on duty which has the potential of failing to meet service users needs. The progress in improving recruitment practices was not established to safeguard service users. Staff have not got up to date safe working practice training and therefore the needs of service users are not being met by appropriately trained staff. EVIDENCE: The rota seen indicated that there are two to three staff on the morning shift and two on the afternoon shift. However the rota seen did not clearly indicate the actual staff on duty on the day of the inspection and extra hours worked by staff were written in pencil. The acting manager was not on duty during the inspection. He arrived at the end of the inspection. Three requirements were made at the previous announced inspection to improve recruitment practices at the home. The progress in meeting those requirements was not established at this inspection. The organisation must ensure that previous requirements relating to their recruitment practices have been met and are being monitored and maintained. Stolford Rise (49) Version 1.10 Page 18 The acting manager has not got up to date safe working practice training in moving and handling and first aid. The majority of the staff team have not got up to date moving and handling training. A new member of staff working at the home, unsupervised, did not have up to date first aid training. This individual member of staff must no longer work unsupervised until first aid training has been provided. Staff confirmed that the fire training consisted of watching a video and completing a questionnaire. Requirements have been made at the two previous inspections for safe working practice training to be provided and kept updated. This has not been complied with and could put service users at risk. The home has no records of training for bank staff working at the home. All new staff undergo an induction programme prior to commencing work at the home. All staff have regular updates and training on autism and aspergers syndrome. One support worker confirmed that she has completed her NVQ 3 and another support worker has almost completed hers. Supervision records indicate that staff have supervision every other month. The supervision record for the acting manager indicated that he last had supervision in January 2005. The acting manager who arrived at the home at the end of the inspection confirmed that he had supervision monthly but had not kept his supervision record updated. Stolford Rise (49) Version 1.10 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 , 39 and 42 The home has lacked continuity of leadership, which has lead to inconsistencies in the management of the home. The home lacks effective quality monitoring systems and therefore service users input into the development of the home is limited. Some health and safety practices are unsatisfactory and therefore do not promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: The home has had no registered manager since August 2004. A manager previously appointed decided not to continue in this role. A support worker who has worked at the home since it was set up has taken on an acting manager role. He advised that he is going for an interview for the registered manager position. There is no management structure within the home and when the Stolford Rise (49) Version 1.10 Page 20 registered manager has left there has been no nominated senior person within the team to take on the management responsibilities. At the previous inspection staff and service users confirmed that there was conflict within the team. The staff on duty during this inspection felt this was now resolved and that staff are working together as a team. One service user commented, “ things are better”. A requirement was made at the previous announced inspection that the organisation must develop and carry out an annual quality audit, which seeks the views of service users, staff, family and other professionals. The organisation was required to send a summary of the quality audit and action plan to the Commission. The action plan from that inspection indicated that this would be actioned by the 30/03/05. Staff on duty were unable to access such a report. Service users have been reluctant to have regular service users meetings where they could contribute to the development of the home and the service. The organisation has been carrying out monthly monitoring visits of the service but has previously failed to send copies of those reports to the Commission. All outstanding monthly visits reports have now been received. This must be maintained. The home has systems in place to ensure the health and safety of service users. However recent weekly fire test records were not dated and the fire drill records indicated the number of staff and service users present during a drill but did not indicate who those individuals were. One service user had his lounge door and bedroom door wedged open. Staff at the home are decanting cleaning materials from the main container to a spray bottle. The spray container does not clearly identify what the cleaning fluid is. In the event of an accident there would be a delay in identifying the cleaning material and subsequently in being able to obtain the correct COSHH data sheet. Stolford Rise (49) Version 1.10 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 N/A N/A N/A N/A Standard No 22 23 ENVIRONMENT Score N/A 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 N/A N/A 2 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 N/A N/A N/A N/A N/A 3 Standard No 11 12 13 14 15 Stolford Rise (49) N/A N/A 2 N/A N/A Standard No 31 32 33 34 35 36 Score N/A x 2 N/A 1 2 Version 1.10 Page 22 16 17 N/A N/A CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score N/A 3 2 N/A Standard No 37 38 39 40 41 42 43 Score 1 x 2 N/A N/A 2 N/A Stolford Rise (49) Version 1.10 Page 23 yes 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 6 Regulation 15 Requirement The organisation must ensure that all service user plans provide clear and specifc guidelines to meet service users needs. Guidelines must not contradict each other and any specific techniques to be used to deal with a situation must be clearly defined. The organisation must ensure that service users risk assessment clearly outline the level of risk and approriate action must be taken to reduce that risk. The manager must arrange for all service users information to be kept secure and confidential. (Previous timescale of 30th November 2004 not met) The organisation must ensure that a homely remedies policy is developed and the home must establish with the GPs that the use of those homley remedies does not interact with individuals prescribed medication. ( previous timescale of the 31st December 2004 not met) The organisations vulnerable Version 1.10 Timescale for action 31st May 2005 2. 9 13 31st May 2005 3. 10 17 15th May 2005 4. 20 13 15th May 2005 5. 23 13 15th May Page 24 Stolford Rise (49) 6. 24 23 7. 35 18 & 13 8. 33 18 9. 39 24 10. 42 23 11. 42 13 adults policy must be developed in line with interagency procedures. ( Previous requirement of the 31st January 2005 not met) The organisation must make a planned maintenance and renewal programme available for the home. The organisation must ensure that all staff including bank staff have up to date safe working practice training.Records must be maintained to confirm this. ( previous timescale of 21st December 2004 not met) The organisaiton must ensure that the staff rota clearly identifies staff on duty and staff who are working extra hours. Amendments to rota must not be written in pencil. The organisation must develop and carry out an annual quality audit, which seeks the views of service users users, staff, family and other professionals. A summary of the quality audit and action plan to be sent to the Commission.( Previous timescale of 30th March 2005 not met) The organisation must ensure that doors are not wedged open. If service users require doors to be kept open, the organisation must liase with the fire authority regarding the use of appropriate recommended devices. The organisation must ensure that staff do not decant cleaning materials from original packing into an unmarked container. 2005 30th June 2005. 15th May 2005 15th April 2005 30th June 2005 15th May 2005 15th May 2005 Stolford Rise (49) Version 1.10 Page 25 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. 3. 4. Refer to Standard 14 20 42 42 Good Practice Recommendations The organisation should ensure that individual servcie users activites records are kept up to date. Medication guidelines should include action to be taken if a service users medication is omitted. The organisation should esnure that weekly fire test records are dated accordingly. Fire drill records should be updated to include the names of staff and service users in the home at the time of the fire drill. Stolford Rise (49) Version 1.10 Page 26 Commission for Social Care Inspection Cambridge House, 8 Bell Business Park, Smeaton Close Aylesbury Bucks, HP19 8JR National Enquiry Line: 0845 015 0120 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 Stolford Rise (49) Version 1.10 Page 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. 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