Inspection on 06/09/07 for Cornerstone

This inspection was carried out on 6th September 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

Cornerstone 09/08/06

Cornerstone 19/01/06

Cornerstone 18/08/05

Cornerstone 07/02/05

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

CARE HOME ADULTS 18-65 Cornerstone 51 Pease Street Darlington Durham DL1 4EX Lead Inspector Mr Stephen Ellis Unannounced Inspection 6th September 2007 09:45 Cornerstone DS0000061043.V351891.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 Cornerstone DS0000061043.V351891.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. Cornerstone DS0000061043.V351891.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cornerstone Address 51 Pease Street Darlington Durham DL1 4EX 01325 261658 0871 7142628 rich@cornerstonecare.co.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) Cornerstone Care (Durham) Ltd Richard McManners Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Cornerstone DS0000061043.V351891.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th August 2006 Brief Description of the Service: Cornerstone is a residential care home providing residential care services for up to 12 adults in the Category of Learning Disability (LD). Cornerstone is owned and managed by Cornerstone Care (Durham) Ltd. Cornerstone is located in a residential part of Darlington and within walking distance of the town centre and all of its amenities. Cornerstone is a large end terrace house that has been extended to provide suitable living accommodation for the residents. The accommodation comprises 10 single and one double bedroom along with a range of communal spaces and garden areas. Cornerstone has its own separate day centre called the Ruby Centre within its grounds. Weekly fees vary between £352 and £402, plus top-up fees for additional inputs where appropriate. The actual amount payable will depend on individual circumstances. The weekly fee covers all accommodation, personal care and meals and drinks. Service users have a weekly personal allowance of at least £20. Cornerstone DS0000061043.V351891.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A series of unannounced fieldwork visits to Cornerstone Care Home took place on 6th and 11th September and 3rd October (9 hours in total), and an announced visit took place on 31st October 2007 (2 hours), as part of the statutory inspection of the service. In addition, the inspector took part in a number of meetings with Darlington Borough Council in connection with several adult protection matters between 6th September and 2nd November 2007, and had the opportunity to participate in discussions with a range of social and health care professional staff involved with service users at Cornerstone. Information received prior to the fieldwork visits was used in preparation and during the visits. Visits to the home occurred at various times, including one evening visit after 8 pm. Visits included a tour of the building, a meal with service users, examination of some of the records that the home is required to keep, and discussions with service users, staff and visitors to the home. Comments were received during the visits and from surveys carried out by the Commission for Social Care Inspection during November 2007. In total there were comments received from 9 service users, one relative, 7 staff, the responsible individual (Joan McManners), the registered manager (Rich McManners) and 9 external health and social care professionals. What the service does well: The service is long established and tries to provide service users with personal and practical support so that they can live fulfilling lives as members of the wider community. A person centred approach is followed whereby the individual needs and aspirations of each service user are addressed. There is a supportive and increasingly well-trained and qualified staff group, and service users also have much input from external agencies, including independent advocates and health and social care staff. The home is adequately organised and managed with good policies and procedures, although some improvements to its quality assurance systems are needed. Service users like the homely, supportive environment and each has a spacious bedroom, which they have personalised. Service users are supported to exercise choice and independence and to take responsible risks. They participate in social and recreational activities within the wider community and are encouraged to exercise their right to vote in political elections. Residents have access to the home’s own day centre (the Ruby Centre), which adjoins the care home and provides a wide range of activities and support for a good number of residents to enjoy. Service users’ privacy and dignity are respected and these values are reflected in the home’s charter of rights and in the attitudes and practices of staff. Cornerstone DS0000061043.V351891.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. Cornerstone DS0000061043.V351891.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 Cornerstone DS0000061043.V351891.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): 1, 2. People who use the service experience good quality outcomes in this area. Prospective service users and their representatives have the information needed to choose a home, which will meet their needs. They have their needs assessed. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Social care professionals and staff confirmed that there had been thorough assessments of service users’ needs prior to admission. Comprehensive and detailed assessments were found in service users’ case files. The manager and staff confirmed that the home’s admission policy is followed, so that only people whose needs are known and whose needs can be met, are admitted, bearing in mind the needs of other service users. The aspirations of service users were partially known by staff and partially reflected in their plans of care and daily lives. The home is looking to develop person centred planning, which will focus on personal goals and aspirations as well as the activities of daily living. The service user guide was very helpful and had many pictures of scenes involving residents. However, some of this information, such as the name of the registered manager, needs to be updated. Also, thought should be given to writing the guide in a style that is more accessible by service users. For example, by using pictorial images for each issue being addressed, such as complaints and protection. Cornerstone DS0000061043.V351891.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People who use the service experience good quality outcomes in this area. Individuals are involved in decisions about their lives, and play an active role in planning the care and support they receive. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: There were numerous examples of responsible risk taking by service users. Service users lead active lives, participating in a variety of recreational and educational activities, including attendance at adult centres, holidays and outings to places of interest. Residents exercise choice and act independently, with support and encouragement from staff (such as choice of clothing, times of getting up and going to bed, choice of menu, choice of activities). There is input from external specialist staff, such as psychologist, physiotherapist, speech and language therapist, occupational therapist and community nurse, as required. External, commissioning social care professional staff are routinely involved in reviews of care needs and the suitability of the service, making recommendations for improvements wherever appropriate. Cornerstone DS0000061043.V351891.R01.S.doc Version 5.2 Page 10 It was observed that service users were treated with respect and their individuality was acknowledged. Members of staff adopt a ‘person-centred’ approach, with attention given to promoting people’s dignity and privacy. These values were reflected in the Residents’ Charter in the service user’s guide and in the service users’ plans of care/support plans. These were in the process of being updated and transferred into new, more accessible formats during the course of the fieldwork visits, with assistance from specialist staff from Darlington Borough Council. Although these support plans were not always up to date, they helped provide basic, written guidance to staff about service users’ individual needs and how these should be met. Several residents confirmed that they discussed their needs and personal goals with staff and staff took note of these issues and helped them. There was evidence of such communication and personal care planning found in the plans of care. Ideally, the home should try to introduce person centred planning for each service user, so that people’s individual needs and personal aspirations can be fully known, understood and reviewed. Cornerstone DS0000061043.V351891.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. People who use the service experience good quality outcomes in this area. People who use services are able to make choices about their life style, and are supported to develop their life skills. Social, educational, cultural and recreational activities meet individuals’ expectations. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Comments received from service users and staff confirmed that a good number of residents take part in a range of appropriate activities, including outings to places of local interest, holidays, parties, social clubs and discos and attendance at local adult centres. Some residents attend the adjoining Ruby Centre, where they were observed to take part in rewarding activities such as hairdressing, art, crafts and food preparation. Residents’ sexuality is acknowledged in their plans of care as part of their activities of daily living and personal aspirations where known. Several residents said that they received visits from relatives and friends, sometimes going out with them. Visitors were welcome at any reasonable time. Cornerstone DS0000061043.V351891.R01.S.doc Version 5.2 Page 12 There are good links with the wider community, with evidence of residents visiting local pubs and clubs, going swimming at Northallerton and taking part in community events such as political elections. Residents often use taxi tokens to travel locally, but many also have access to the home’s minibus that can sit 6 or 7 passengers in comfort. Activities and stimulation on a one-toone basis are also provided, in accordance with individual needs, using equipment and facilities such as jigsaws, art books, soft toys and music. Photographs of residents taking part in social activities are kept in albums and some displayed in frames. It might be desirable to display these photographs more widely and it is recommended that consideration be given to making collages and displaying them widely on communal walls, in celebration of people’s lives and as a talking point. Several service users indicated that they were pleased to be living at Cornerstone and to have the lifestyle they had. However, the home might like to consider doing Life story work with residents. This can assist person-centred care, affirming and validating individuals’ unique experience and identity. All the residents spoken to said the catering was good. There was a wide choice and care staff understood their preferences. Residents mainly dined together in the dining room. They could, however, eat their meals elsewhere and at different times if required. Staff members were observed to assist several residents who need help to eat their meals. They carried this out in a skilful, caring manner. Records are kept of meals served, available for inspection. Staff and records confirmed the varied, appetising menu. Cornerstone DS0000061043.V351891.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use the service experience good quality outcomes in this area. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Comments from service users and staff indicated good levels of satisfaction experienced by service users concerning their health care, personal care and social care. Medical and community nursing care was described as being readily available and very helpful. All residents are registered with a GP, optician and dentist of their choice on admission. Professional input has also been provided over the past year by external health and social care personnel, such as physiotherapists, occupational therapists, psychologists, social workers, Local Authority contracts officers and speech and language therapists. Residents spoke highly of the staff, describing them as friendly, understanding and supportive. Each resident has a named key worker of their choice from the home’s team of staff. Two service users have independent advocates involved in their care and support and who visit once a fortnight. This service can be extended to other service users if required (for example, Darlington Borough Council can help facilitate this involvement where appropriate). Staff members confirmed that they have defined roles and responsibilities and are encouraged to recognise their own professional limitations. Service users are Cornerstone DS0000061043.V351891.R01.S.doc Version 5.2 Page 14 encouraged to take responsible risks, such as food preparation activities, visits to local pubs and clubs, plus swimming and caravan holidays. It was observed that service users were treated with respect and their individuality was acknowledged. Members of staff adopt a ‘person-centred’ approach, with attention given to promoting people’s dignity and privacy. These values were reflected in the home’s charter of rights and in the service users’ plans of care (although most were in the process of being updated and transferred into improved formats) providing foundation guidance to staff about service users’ individual needs and how these should be met. Staff training records confirmed wide ranging staff qualifications and training, reinforcing the essential value base, respecting and supporting each person as a unique individual. For example, 8 members of permanent staff (73 ) have achieved National Vocational Qualifications (NVQ) in health and social care at level 2 or above (including 4 at level 3 and 2 at level 4). The remaining 3 staff members are currently working towards NVQ level 2. Six members of care staff have completed Safe Handling of Medicines training and a further 4 have done medicine awareness training. Further training and development in the safe handling of medicines is planned with a local pharmacist and, if necessary, with a local college. Policies and procedures for the safe storage, administration and disposal of medicines are satisfactory, although care must be taken to record accurately any ‘as required’ medicines or food supplements such as ‘thickeners’. An independent pharmacy audit was carried out in the summer and the findings were satisfactory provided that the storage temperatures of medicines were kept within their maximum limit. In practice, residents tend to delegate responsibility for their medicines to the staff, although residents may administer their own medicines, subject to risk assessment. The medicine cabinet was observed to be well organised with medicines stored safely. Cornerstone DS0000061043.V351891.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use the service experience good quality outcomes in this area. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Pre-employment checks are carried out on staff, including enhanced checks with the Criminal Record Bureau plus Protection of Vulnerable Adult checks. Also, two references are obtained in respect of each new employee, with special attention given to the last employment. This is to ensure that unsuitable people are not employed to care for vulnerable adults. New staff members go through induction and foundation training so that they have the right knowledge and skills to do their jobs competently. Residents indicated a caring, supportive atmosphere in the home, and this we observed to be well established. They said that they got on well with each member of staff and felt they could confide in them. The home has a user-friendly ‘complaining about things’ leaflet that was developed with the help of the residents. Good teamwork was again evident, reinforcing the caring culture and provider policies concerning adult protection. Staff expressed confidence in the manager and seniors, describing them as being supportive, approachable and understanding. They would not hesitate to approach the manager and/or seniors about any suspected abuse or neglect of residents. However, only a limited programme of formal staff supervision and appraisal is being conducted and it is recommended that the manager provides each member of staff with at least 6 supervision sessions per year (one to one) and that these are recorded. Most members of staff have undergone training in the Protection of Vulnerable Adults (POVA), such as ‘No Secrets’ training, and are familiar with Cornerstone DS0000061043.V351891.R01.S.doc Version 5.2 Page 16 the local multi-agency safeguarding adults policy and the lead role played by the Adult Social Services Department. Good arrangements were observed to be in place concerning the handling of service users’ personal monies. The company’s accountant is the person appointed to administer service users’ monies. She does this by keeping individual accounts for each service user, deducting monies owed for bed fees etc. from monies received in respect of each service user and maintaining records. She also ensures that each service user receives a personal allowance of £20.40 per week, paying some of that into the service user’s personal bank account (where one exists) and ensuring that the remainder is available as cash kept in individual containers at the home. The home sends the individual cash sheet (account) for each service user’s personal cash transactions (expenditure and income) each month to the accountant, along with appropriate receipts, so that a comprehensive audit trail is maintained. Service users have ready access to their cash monies kept at the home and also have prompt access to monies kept in their bank accounts when larger amounts are required. Seven service users have personal bank accounts and negotiations are taking place to open one more for another service user with a local Building Society. The home likes to ensure that service users have about £20 cash available in their personal containers at the home each week, and this money is kept securely on behalf of residents. Six individual containers were examined, and checked against the corresponding individual cash sheets, and were found to be accurate and as described. Several adult protection alerts have been made over the past year concerning the safety, welfare and possible neglect of service users. These have been investigated and demonstrate that the safeguarding policies and procedures are working. Although service users are not thought to have been abused or neglected, some concerns have been expressed about certain aspects of care practice, such as the moving and handling of some residents, whether support plans are up to date and being fully implemented, and the level of cooperation with treatment plans devised by external professional staff. This has highlighted some difficulties experienced in working in partnership with external agencies. There is a need to find a way forward, improving communication and trust wherever possible. Cornerstone DS0000061043.V351891.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): 24, 27 and 30. People who use the service experience adequate quality outcomes in this area. The physical design and layout of the home enables people who use the service to live in a reasonably safe, well-maintained and comfortable environment, which encourages independence, although some improvements are required. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: There were no unpleasant odours and the home was found to be clean in all the areas inspected, with the exception of 3 bedrooms on the first day of the fieldwork visits. These have been treated subsequently, and very successfully, with a special ozone-sanitizing machine that the home has on trial at present. It is desirable for the home to continue using this machine at frequent intervals, in the absence of any alternative method of keeping floor covering clean and fresh, in the interest of health and hygiene, and in promoting service users’ dignity. Paper towels and liquid soap were provided in some toilets and bathrooms in wall-mounted containers, to promote hygienic practices (although residents have personal flannels and towels in their rooms). Residents indicated that they were pleased with the premises, especially their bedrooms, finding them comfortable and homely as well as practical. All Cornerstone DS0000061043.V351891.R01.S.doc Version 5.2 Page 18 bedrooms were seen and most were spacious and attractively decorated and furnished, reflecting the individuality of service users. A small minority of bedrooms had broken furniture, such as chests of drawers, with handles and panels damaged, although plausible explanations were given. If service users are damaging their property, the causes need to be examined and addressed in support plans, and furniture should be repaired or replaced promptly with items that promote dignity and choice, but are also hardwearing. Staff confirmed that the home is generally well maintained, with repairs and servicing being carried out promptly and according to schedule. It was noticed, however, that the first floor bathrooms were in need of attention (for example, showers that either did not work or were not used; absence of liquid soap, paper towels, toilet paper and suitable door locks; plus fluorescent lights in the gents’ bathroom that did not work properly). It is understood that some remedial work was planned for November. These facilities must be brought up to a good standard, especially the toilets, in the interest of privacy, dignity and choice (mainly for the benefit of service users on the first floor). Liquid soap and paper towels must be provided in each toilet and bathroom in the interest of hygiene. Cornerstone DS0000061043.V351891.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): 32, 34, 35 and 36. People who use the service experience good quality outcomes in this area. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Staffing levels were found to be appropriate, in accordance with the guidance issued by the Commission for Social Care Inspection and residents’ assessed needs. At the time of inspection, there were 11 residents being accommodated, with staffing levels varying between 4 and 2 members of care staff on duty throughout the day (for example, 4 on duty during the early part of the day and 3 or 4 during the evening). At night, there is one member of staff awake on duty and another on-call on the premises. Comments received from both residents and staff confirmed that staffing levels and skills were sufficient for the needs of the home. A senior carer is always deployed on each shift. A full staff-training programme is provided, including managing challenging behaviour, safe handling of medicines, protection of vulnerable adults, working with older people with a learning disability, food hygiene, moving and handling, first aid, risk assessment, fire safety and National Vocational Qualifications in Cornerstone DS0000061043.V351891.R01.S.doc Version 5.2 Page 20 health and social care at levels 2, 3 and 4. Comprehensive induction and foundation training is provided for all staff. Individual records of staff training and development are kept, as well as staff group records. Eight of the 11 permanent members of care staff (73 ) have achieved NVQ level 2 or above in health and social care, which is commendable. The home’s recruitment policy and practice is sound, ensuring that all preemployment checks are carried out as required, including Criminal Record Bureau enhanced checks, Protection of Vulnerable Adults checks and the taking up of two written references. Service users’ views concerning the suitability of new staff are taken into consideration and there is a probationary period of 3 months for new staff to serve. Although staff felt well supported and supervised, only a limited programme of formal staff supervision (one to one) and appraisal is being conducted and it is recommended that the manager provides each member of staff with at least 6 supervision sessions per year (one of which may be an appraisal) and that these are recorded. Cornerstone DS0000061043.V351891.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): 37, 38, 39 and 42. People who use the service experience adequate quality outcomes in this area. The management and administration of the home is based on openness and respect to a large extent, and has partially effective quality assurance systems developed by an experienced manager who hopes to complete his qualification in management soon. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Residents and staff expressed satisfaction with the way the home was run and the good standards that were evident in many instances. Other comments received from a variety of sources, including external agencies and some relatives, revealed some dissatisfaction with certain aspects of the home’s management, and the care and support provided to residents. The home has responded constructively to such criticisms and complaints, but more is required to be done to address this problem. The quality and frequency of communication between the management and other stakeholders, such as Cornerstone DS0000061043.V351891.R01.S.doc Version 5.2 Page 22 commissioners and relatives, needs to be examined and improved wherever possible. The registered manager has achieved National Vocational Qualifications (NVQ) in health and social care at level 4. He is working towards NVQ level 4 in management (Registered Manager’s Award). He has substantial experience of working at a senior level in a care home setting and knows many of the residents very well because of his long involvement with Cornerstone and its service users. He is supported in his role by a Deputy and senior staff who have appropriate qualifications and experience. Management carries out annual quality assurance surveys, seeking the views of a wide range of people about the performance of the service, including relatives and staff. It is desirable for a summary of the results of such surveys, along with various suggestions for improvement, to be published and brought to the attention of all stakeholders in the service. A newsletter or notice might be a suitable means by which this could be achieved and it would invite further discussion about how residents’ quality of life might be promoted. It is also recommended that the home’s manager consider providing weekly ‘surgeries’ at times convenient to service user representatives, along with any other ‘proactive’ measures, which help develop communication with stakeholders. Staff comments indicated that they believed the home was safe and run in the best interests of residents, with good communication. For example, there is frequent consultation with service users and their representatives about key issues affecting the lives of residents (for example, 2 residents have independent advocates who visit once a fortnight and there are periodic reviews of service users’ plans of care involving external commissioners and specialist staff. There is also regular consultation and correspondence with external specialist staff, such as physiotherapists and speech and language therapists). There are monthly, staff group meetings conducted by the manager or senior staff, at which health and safety issues are discussed. The home is generally well maintained and attractively decorated, with servicing and repairs being carried out promptly (notwithstanding some urgent repairs required to the two first floor bathrooms as detailed in the Environment section of this report). There is, however, a need for the registered provider’s representative to report on the findings of the monthly, unannounced visits to the home, in keeping with regulation 26 of the Care Homes Regulations 2001, by sending copies each month to the Commission for Social Care Inspection (CSCI) (as well as to the home’s manager, and the registered provider). The person doing these visits and reports cannot be the home’s manager. This will enable the CSCI to monitor key developments and progress after a period of uncertainty earlier Cornerstone DS0000061043.V351891.R01.S.doc Version 5.2 Page 23 this year, when a number of significant questions were raised about the home’s performance. Cornerstone DS0000061043.V351891.R01.S.doc Version 5.2 Page 24 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 X 4 X 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 X 26 X 27 2 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 2 2 X X 3 x Cornerstone DS0000061043.V351891.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard YA1 1 6 (a) Regulation Requirement The service user guide was very helpful and had many pictures of scenes involving residents. However, some of this information, such as the name of the registered manager, needs to be updated. Support plans need to be systematically reviewed and kept up to date, and to reflect the advice and guidance of external health and social care professionals. Care must be taken to record accurately any prescribed ‘as required’ medicines or prescribed food supplements such as ‘thickeners’. The bathroom and toilet facilities on the first floor must be brought up to a good standard, especially the toilets, in the interest of privacy, dignity and choice (mainly for the benefit of service users on the first floor). Liquid soap and paper towels must be provided in each toilet and bathroom in the interest of hygiene. Timescale for action 31/03/08 2 YA6 15 (1) (2) (b) (c) (d) 31/12/07 3 YA20 13 (2) YA27 30/11/07 4 23 (2) (c) (j) 13 (3) 31/01/08 Cornerstone DS0000061043.V351891.R01.S.doc Version 5.2 Page 26 5 YA30 YA39 6 Floor covering must be kept clean and free from offensive 23 (2) (d) odours. The good progress made recently with the cleaning of floor covering needs to be sustained. The registered provider’s representative is required to 24 (2) (3) report on the findings of the monthly, unannounced visits to the home, in keeping with 26 (2) (a) regulation 26 of the Care Homes (c) (3) (4) Regulations 2001, by sending (a) (b) (5) copies each month to the (a) (b) (c) Commission for Social Care Inspection (CSCI) (as well as to (1) the home’s manager, and the registered provider). 31/12/07 31/12/07 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 YA18 2 YA14 3 Refer to Standard YA1 Good Practice Recommendations Where possible, the service user’s guide should be rewritten in a style that is more accessible by service users: For example, by using pictorial images for each issue being addressed, such as complaints and protection. Ideally, the home should try to introduce person centred planning for each service user, so that people’s individual needs and personal aspirations can be fully known, understood and reviewed. It might be desirable to display photographs of service users more widely and it is recommended that consideration be given to making collages and displaying them widely on communal walls, in celebration of people’s lives and as a talking point. The home might like to consider doing Life story work with residents. This can assist person-centred care, affirming and validating individuals’ unique experience and identity. If service users are damaging their property, the causes need to be examined and addressed in support plans, and furniture should be repaired or replaced promptly with DS0000061043.V351891.R01.S.doc Version 5.2 Page 27 YA18 4 YA18 5 Cornerstone YA36 6 YA39 7 YA39 8 items that promote dignity and choice, but are also hardwearing. Although staff felt well supported and supervised, only a limited programme of formal staff supervision (one to one) and appraisal is being conducted and it is recommended that the manager provides each member of staff with at least 6 supervision sessions per year (one of which may be an appraisal) and that these are recorded. It is desirable for a summary of the results of the home’s quality assurance surveys, along with various suggestions for improvement, to be published and brought to the attention of all stakeholders in the service. A newsletter or notice might be a suitable means by which this could be achieved and it would invite further discussion about how residents’ quality of life might be promoted. The home’s manager should consider providing weekly ‘surgeries’ at times convenient to service user representatives, along with any other ‘proactive’ measures, which help develop communication and trust with stakeholders. Some concerns have been expressed about certain aspects of care practice, such as the moving and handling of some residents, whether support plans are up to date and being fully implemented, and the level of cooperation with treatment plans devised by external professional staff. This has highlighted some difficulties experienced in working in partnership with external agencies. There is a need to find a way forward, improving communication and trust wherever possible. Cornerstone DS0000061043.V351891.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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