Inspection on 04/12/07 for Care at Stennings

This inspection was carried out on 4th December 2007.

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 no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Care at Stennings 07/09/06

Care at Stennings 25/10/05

Care at Stennings 10/05/05

Care at Stennings 06/10/04

Care at Stennings 10/05/04

Care at Stennings 19/01/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Care at Stennings Stennings Brookview Copthorne West Sussex RH10 3PL Lead Inspector Niki Palmer Unannounced Inspection 4 December 2007 14:50 th Care at Stennings DS0000047546.V349647.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 Care at Stennings DS0000047546.V349647.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. Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Care at Stennings Address Stennings Brookview Copthorne West Sussex RH10 3PL 01342 719388 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) careatstennings@aol.com Ms Susan Margaret Snelling Mrs J Day Miss Fiona Baines Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th September 2006 Brief Description of the Service: Care at Stennings is a care home for up to eight younger adults with learning disabilities. The home is located in the village of Copthorne, approximately five miles from Crawley, West Sussex. The premises are two adjoined large detached houses situated at the end of a residential close. The houses are connected by a conservatory, and form one residential home, which offers comfortable and well-equipped accommodation. All rooms are for single occupancy with en-suite facilities. The accommodation is not suited to people with reduced mobility or wheelchair users. The people who use the service have a choice of two lounges and dining rooms as well as kitchens. All areas of the home are accessible. Attractive gardens surround the property and there is good access to local transport, leisure and shopping facilities. Weekly fees range from £1200 to £1700 dependant upon individual needs. People who use the service are expected to purchase their own toiletries, gifts for relatives/others and clothing from their own personal funds. This information was provided to the CSCI on the 10th December 2007. Prospective residents and their relatives are provided with written information regarding the services and facilities provided at the home prior to admission in the form of a Statement of Purpose and Service Users’ Guide. A copy of the home’s most recent inspection report is available on request from the home. Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 use the term ‘service user’ to describe those living in care home settings. The Registered Manager of the home confirmed that they use the term ‘people who use the service’ and/or ‘residents’. For the purpose of this report people living at Care at Stennings will be referred to as residents or people. This key unannounced inspection took place over five hours on the 4th December 2007. The inspection began mid-afternoon and lasted until 8pm. This enabled the Inspector to observe the evening routine and meet and talk with a number of residents. Eight people were accommodated on the day of the inspection, three women and five men. The Inspector received six feedback survey forms prior to the inspection, all of which had been completed by residents’ relatives. This enabled the Inspector to highlight areas of good practice, but also to identify and focus on any particular areas of concern that had been raised by them during the inspection. A number of relatives’ comments have been reflected throughout this report. The inspection began with talking with residents, staff and the Registered Providers. Two residents kindly gave the Inspector a tour of the premises and showed her their bedrooms. In order to gather evidence on how the home is performing, individual discussions took place with four residents and two members of staff. Three individual plans of care were looked at for the purpose of monitoring care. Other records and documentation inspected included: the home’s Statement of Purpose and Service Users’ Guide, medication procedures, complaints procedure and the systems in place to safeguard people from harm, the procedures for dealing with residents’ monies, staff recruitment and the provision of training and the home’s quality assurance systems. Much of the inspection was facilitated by the Deputy Manager as the Registered Manager was on leave at the time of the inspection. A telephone conversation was held with the Registered Manager on her return from annual leave three days after the inspection. An Annual Quality Assurance Assessment (AQAA) was completed by the Registered Manager and returned to the CSCI prior to the inspection. This gave the service the opportunity to tell the CSCI about how they are performing including: how they ensure that the views of people using the service are upheld and incorporated into what they do, what the service does well, identify any barriers to improvements that have been faced over the past Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 6 12 months and how the service plans to make improvements within the next 12 months. What the service does well: What has improved since the last inspection? What they could do better: The home has experienced significant difficulties in recruiting new staff. As a result, they are reliant on using relief and agency staff therefore people who use the service are at risk of not receiving a consistent approach to the care and support they receive. Whilst all people who use the service have individuals plans of care in place, they are not easy to read, follow and understand [particularly if a staff Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 7 member is new or not familiar with working with individuals]. The home must make sure that all care staff have easy access to sufficiently detailed written information in order to help support them in meeting individuals’ personal care needs. The home’s induction processes for new staff fails to equip them to get to know and understand the needs of each person living in the service. The Manager must make sure that at all times suitably qualified, competent and experienced persons are employed to work at the home. Untrained staff are expected to administer medicines. This seriously compromises the health and safety of people who use the service. The Manager must make sure that no member of staff administers medicines unless they have received the appropriate training and they have been deemed as competent to do so. 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. Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 8 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 Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and others are provided with sufficient information prior to admission in order to support their decision of where to live. Good systems are in place to ensure that only people whose needs can be met are admitted to the home. EVIDENCE: The home has a Statement of Purpose and Service Users’ Guide in place, both of which have been recently updated. They provide the reader with an overview of the home’s ethos, details of what the home has to offer, the provision of staff, contract and fees payable and the processes for moving in and what people can expect from the service. The Manager explained in the AQAA that the home bases their assessment of individuals’ needs on the Holistic Assessment Tool (HAT); an assessment used in West Sussex based on a Supported Living Framework. One person has moved into the home since the last inspection. Care records showed that the home had undertaken their own assessment, much of which had been directly taken from the HAT, although there was evidence that Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 10 additional information had been sought from relatives. Information gathered included: the person’s physical healthcare needs, life skills, money matters, community leisure and employment, accommodation and support. Whilst the assessment had been signed by the Manager it had not been dated. The Manager was reminded that in line with good record keeping practices, all records should be dated. Three of the residents spoken with said that they had all had the opportunity to visit the home before deciding to move in. One person said that they particularly liked Stennings because it was big, cheerful, calm and not too far from her parents. Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. 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 consulted about many aspects of the home and are supported to make decisions in all aspects of their lives to the best of their abilities. Clearly assessed and managed risks enable them to undertake a wide range of activities in order to promote their independence. EVIDENCE: The AQAA identified that person centred care plans are in progress and the Manager explained that she is keen for Social Workers, advocates and relatives to become involved in this process. The home’s progress with this will be followed up at the next inspection. The Deputy Manager explained that he is responsible for ensuring that all people who use the service have an individualised plan of care in place, although more able residents are encouraged to write their own plans of care Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 12 with support, two of which do so on their own laptops [these were not seen during this inspection]. The three care plans that were seen were each noted to be very different in style and content. The Deputy Manager explained that this was largely due to individuals’ needs and preferences. There is a lot of information within each file, but it must be noted that they were not easy to read, follow and understand [particularly if a staff member is new or not familiar with working with individuals]. As the home is reliant on using agency staff and regular relief support workers, the Registered Manager is required to ensure that all care staff have easy access to detailed written information in order to help support them in meeting individuals’ personal care needs. People who use the service confirmed that the home supports them as much as possible to make decisions in all aspects of their lives and care staff encourage them as much as possible to participate in many aspects of life in the home. They explained that they make their own decisions about what they do on a daily basis including going to college and/or work, going on holidays and are consulted to the best of their abilities about how the home is run including the recruitment of staff. All residents are encouraged to take responsible risks where necessary in order to promote their independence. Detailed risk assessments and guidance are in place for all activities of daily living, based on the needs of individuals. Throughout the duration of the inspection and through discussions with the staff team, it became clear that the home is keen to support people to develop independence skills such as using public transport, managing their own medication, meal preparation and handling their own finances and budgeting. One person spoken with said that the home is supporting him in working towards living more independently. A comment received from a relative: “The home is good at treating each resident as an individual. They always try to make the lifestyle varied and interesting with outings etc. and teach the residents independent lifestyle skills” Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14, 15, 16 and 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use the service are supported to take part in a wide range of activities to lead fulfilling lives, meet their needs and ensure their personal development. They play an active and fulfilling role in their community and maintain positive relationships with family and friends. EVIDENCE: All of the people spoken with said that they are encouraged to lead busy and active lifestyles inside and out of the home. Some attend local colleges in the area and are involved in courses such as drama, IT and independent living skills. Certificates of achievement are displayed in individual bedrooms. One person told the Inspector how she enjoys carriage riding, horse-riding, swimming, shopping, going to local clubs and taking part in some evening Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 14 activities further a field in Brighton. She explained that she also works nearby on a voluntary basis for one day a week. People who use the service are supported to play an active role in their local community and make good use of public transport facilities; although the home does have access it’s own transport. When asked about what is good about living at the home, one person said: “Going out on my own. I go to the cinema, football matches, swimming, and am able to use public transport on my own. I’m using the home as a stepping stone to moving into supported living accommodation”. Each person has regular holidays, some of which are abroad. Residents said that they are offered a choice about where they would like to go and who with. One person said that they were looking forward to going to Florida next year and how they had really enjoyed going to Spain last year. Residents confirmed that they are well supported by staff to keep in regular contact with their families and friends. Some have their own mobile phones, although a payphone is available at the home. Some choose to spend weekends at home with their relatives. Visitors are always made to feel welcome at the home at anytime. One relative commented: “I have plenty of contact both with my son and the home” People who use the service explained that they each have their own budget for purchasing food from the local supermarket. Assistance with meal preparation is offered by care staff as necessary at flexible times in order to fit in with daily routines, activities and outings. This means that people rarely sit down together for a meal but are more likely to eat with just one or two people, thus making mealtimes more relaxed. Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst people who use the service receive a good level of support to meet individual needs, the home fails to ensure their health and welfare in respect of the safe handling of medication. EVIDENCE: Most of the people who use the service are fairly independent and therefore require minimal assistance with personal care. All people are registered with a local GP and dentist and are supported to all healthcare appointments if necessary. The home has developed close working relationships with the local Community Learning Disability Team (CLDT). Recent requests for referrals have included support from a Community Nurse and Speech and Language Therapist. The home’s AQAA stated: Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 16 “Where appropriate we have Health Action Plans in place to assist everyone keeping up to date with health needs and making sure the person remains healthy”. One person’s Health Action Plan was requested on the day of inspection, however it could not be found. This will not be reflected as a recommendation or requirement at this time but will be followed up at the next inspection. The home’s medication systems and records were viewed. People who use the service are supported to collect their medicines from the pharmacy. Some are prepared in a monitored dosage system, whilst others are dispensed from individually labelled containers. Where possible people who use the service are supported to take responsibility for their own prescribed medicines; this includes self-administration and signing the medication administration records (MARS) themselves. This was not clear however on one person’s MARS, as they had been signing ‘A’, which on closer examination, indicated that they had been ‘absent’ from the home. This was highlighted to the Deputy manager on the day of inspection. Another concern was raised in respect of MARS: one person had been written up for Paracetamol and Lemsip (homely remedies), however there was no further guidance in respect of the dose or frequency. The only written guidance in place for Lemsip stated: “Administer as per Paracetamol guidelines”, however there were not any in place. In addition to the above, both homely remedies had been handwritten by a member of staff, although had not been signed or dated. In order to prevent the risk of human error, it is good practice that all handwritten entries be countersigned and dated. It is stated within the AQAA that all care staff are trained in the safe administration of medicines. Whilst most relief workers are included within this training (although not all), agency staff are not [this was confirmed by the Manager of one of the employment agencies used]. As the home is heavily reliant on using agency staff, this raised concerns. The Manager explained that she is aware of this and that on occasions where it has been necessary for untrained staff to administer medicines due to staffing problems, she has talked this through with them over the phone at the time medicines are being given. This practice is unsafe and places people who use the service at risk. The Manager is required to ensure that no member of staff administers medicines unless they have received the appropriate training and they have been deemed as competent to do so. Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service can be assured that the home will listen to and act upon any concerns or complaints they may have. The home has good systems in place to protect individuals from potential harm, neglect and abuse. EVIDENCE: There is a clear and accessible complaints procedure in place, which has been simplified for people who use the service. It details who a complaint can be made by and the timescale within which they can expect it to be dealt with. A number of complaints have been made by people who use the service in recent months, details of which were seen on the day of inspection. Examples of these included other people stealing food from their cupboards and playing their music too loudly. It was good to note that the home encourages people to voice their concerns and opinions and there was evidence in place to show that they were appropriately handled by the home. One relative said: “I am satisfied with the way my relative is looked after at Stennings. I am sure that if he or I were not happy, then the appropriate action would be taken” The home has a detailed Safeguarding Vulnerable Adults policy and procedure in place in accordance with local multi-agency guidelines. The Deputy Manager has recently attended training provided by West Sussex County Council, which he said will be cascaded to all staff. Two alerts have been appropriately raised Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 18 by the home in the past year. The appropriate action has been taken by the home in order to safeguard the well-being of people who use the service. People who use the service are encouraged and supported to handle and look after their own monies and finances as much as possible. Each person has their own lockable money tin, most of which are stored in a locked safe. Some have their own bank debit cards and cheque books and are supported well by staff to use these. Care staff check all money tins on a daily basis and record and sign their findings. One tin was checked on the day of inspection and found to be slightly over – this was checked and rectified by a member of staff during the inspection. Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care at Stennings offers a friendly and relaxed environment that is kept in good decorative order. It presents as a clean, well-maintained and homely place to live. EVIDENCE: People who use the service showed the Inspector around all communal areas and two individual bedrooms. The home is two large detached properties, which are adjoined by a conservatory. All rooms are for single occupancy with en-suite facilities over two floors. There is an office and separate sleep-in room for staff on the first floor. All areas seen were noted to be clean, well-maintained and homely. It was evident that people who use the service have been involved in choosing their Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 20 own furniture, accessories and décor. They all have their own TV, video and stereo equipment in their rooms, most of which are kept locked [at the request of some individuals]. There are a number of photographs displayed throughout the home of each of the residents, all of which have been nicely framed and presented. Communal facilities include two lounge areas, separate dining areas, two small kitchens, a separate laundry and a large garden to the rear of the property. Residents commented that they are encouraged to help keep the home clean and tidy. There is a picture notice board in each of the two lounges, which shows which staff are working on that day/sleep-in and any forthcoming events. In addition, letters written on behalf of people who use the service were seen on display. One of the residents told the Inspector that he looks after two chickens, which are housed outside. It is recommended that outside lighting be provided for this area as visibility is poor during the dark winter evenings. One person commented that the providers are generally very good at ensuring that any faults or repairs are dealt with quickly. One relative wrote: “The atmosphere is homely”. Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst the home ensures that all staff have the appropriate pre-employment checks in place, people who use the service do not receive a consistent approach to the care and support they receive. EVIDENCE: A number of concerns were raised by relatives prior to the inspection in respect of staffing at the home: “There is a certain inevitable reliance on agency staff e.g. at weekends and these don’t always seem to have the right skills to deal with specific issues” “Permanent staff have the right skills and experience and know the residents well, but sometimes the agency staff seem less capable” “The home would be better for all if more permanent staff could be found and not have to use agency staff who do not know the residents” Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 22 Discussions with people who use the service, the Deputy Manager and staffing rotas confirmed the above. There are currently only two full-time contracted members of staff [the Manager and Deputy] and 11 part-time relief workers; although it must be noted that a number of relief workers have worked at the home over a period of time and have therefore got to know people well. In addition, agency staff are used via an employment agency. The home stated that they do try as much as possible to request the same staff each time from the agency, however this is not always possible. One member of staff said: “We do not have continuity and it shows”. Whilst staffing records confirmed that all new relief workers are subject to thorough recruitment checks, including the submission of a written application form, two written references and police checks, a number of concerns were raised: - New workers undertake a three day induction to the home. Records and staff spoken with confirmed that this is mostly focused on the home’s health and safety procedures. It does not allow for getting to understand the needs of the people who use the service or ‘shadowing’ other more experienced members of staff. - Rotas and staff confirmed that after the initial three day induction, new staff work unsupervised. It was noted that after only three weeks of work, one person was allocated shift leader, fire person and first aider – responsible for overseeing the general running of the home including the administration of medicines [without having been given any training], whilst another person worked a lone sleep-in duty after only four weeks. The Manager explained that she considered these people as ‘ experienced and competent’. However there was no documentary evidence in place such as supervision or training records to demonstrate how these decisions had been reached. - Shift planners and rotas identified a number of days whereby there was only one ‘familiar’ member of staff working with two agency staff. - Agency staff were on occasions being asked to cover lone sleep-in duties and administer medicines. These concerns were brought directly to the attention of the Providers and the Deputy Manager on the day of inspection and were discussed with the Registered Manager of the home following the inspection. Care at Stennings acknowledged that the recruitment and retention of staff at the home is an area of concern that they are aware of and assured the Inspector that they are in the process of taking the necessary steps to address these shortfalls. A requirement has been made in respect of this. Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst people who use the service express an overall level of satisfaction with the way in which the home is managed, their health and safety in respect of how the home manages staffing and medication are compromised. EVIDENCE: The Registered Manager has been registered with the CSCI since August 2005 and has the required experience and qualifications to run the home to meet its stated purpose, aims and objectives. Through discussions with staff, people who use the service and the Manager following the inspection, she is clear about her role and liaises closely with the owners of the home. A requirement was made following the last two inspection reports for the Providers of the home to implement and establish a quality assurance system Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 24 in order to seek feedback and the views of people who use the service. The AQAA and evidence seen on the day of inspection confirmed that feedback questionnaires were sent out to all people who use the service and their relatives in January 2007. Not withstanding that the overall feedback and comments received by the home were positive [with the exception of staffing], it is recommended that the results of all surveys and questionnaires are published and made available to all people who use the service in an easy to read and understand format. One of the people who use the service talked about the weekly fire alarm tests that are carried out by the home. She was clearly able to describe the procedures that must be followed in the event of the fire alarm being activated. Residents and staff confirmed that the Registered Providers are good at making sure that all maintenance checks and any repairs are dealt with quickly. The home appeared safe and well-maintained on the day of inspection. The manager wrote in the AQAA that regular checks are made on services to the home as well as fire fighting equipment. In light of the concerns that have been raised in respect of staffing and the safe administration and handling of medicines, the CSCI considers that there are shortfalls, which seriously compromise the health and welfare of people who use the service. Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 X 34 3 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 4 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 1 X 2 X 3 X 3 3 X Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 YA6 YA18 Regulation 15(1)(2) Requirement That all care staff have easy access to sufficiently detailed written information in order to help support them in meeting individuals’ personal care needs. This information must be easy to read, understand and follow. 2. YA20 17(1)(2)(3) That medication administration records (MARS) and guidelines 18(1) are clearly maintained. Schedule 3 That no member of staff administers medicines unless they have received the appropriate training and they have been deemed as competent to do so. That all times suitably qualified, competent and experienced persons are employed to work at the home. All new care staff must undertake a thorough induction to the home. 29/02/08 31/12/07 Timescale for action 29/02/08 3. YA32 YA35YA37 18(1)(a-c) (i)(ii) Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 27 All staff must receive training appropriate to the work they are to perform. 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 YA41 YA20 Good Practice Recommendations That in line with good record keeping practices, all records should be signed and dated by the person responsible. That all handwritten entries on medication administration records (MARS) be countersigned and dated. This will help to reduce the risk of human error occurring. That outside lighting be provided near the area where the chickens are housed. That the results of all feedback surveys and questionnaires are published and made available to all people who use the service in an easy to read and understand format. 3. 4. YA24 YA39 Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Care at Stennings DS0000047546.V349647.R01.S.doc Version 5.2 Page 29 - 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. You have been warned!