Inspection on 12/09/06 for Cornerstone Trust

This inspection was carried out on 12th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cornerstone Trust 03/03/08

Cornerstone Trust 07/02/06

Cornerstone Trust 13/05/05

Cornerstone Trust 27/08/04

Cornerstone Trust 04/05/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Cornerstone Trust Thicketford Place 132 Thicketford Road Bolton Lancashire BL2 2LU Lead Inspector Sue Evans Unannounced Inspection 12th September 2006 11:45 Cornerstone Trust DS0000009314.V297320.R02.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 Trust DS0000009314.V297320.R02.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 Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cornerstone Trust Address Thicketford Place 132 Thicketford Road Bolton Lancashire BL2 2LU 01204 392043 01204 389940 cornerstonetrust@ntlworld.com 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 Trust Mr Clive Owen Olive Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 6 service users to include: up to 6 service users in the category of LD The service should at all times employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. 7th February 2006 Date of last inspection Brief Description of the Service: Thicketford Place is a small care home, providing long-term support to six people with learning disabilities. A local, voluntary, Christian organisation, the Cornerstone Trust set up the home in 1993. A group of trustees oversee its running, with the day to day management carried out by the registered manager and deputy manager. The home is on a main road, in a residential area in Bolton. There is good access to local buses and there are nearby shops, pubs and other local amenities within walking distance. Thicketford Place is a large, converted, end-terraced house. There are six, single bedrooms, one on the ground floor, four on the first floor and one on the second (attic) floor. There is a very small garden at the front of the house and an enclosed, patio garden to the rear. There is on-street parking adjacent to the home. The organisation has a contract with the Local Authority to provide the service as a whole. Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection included an unannounced visit to the home. The inspector spent 8¼ hours in the home, looking round, watching what went on, talking in depth to 1 resident and briefly with 2 others, interviewing a staff member and the deputy manager, and examining some key records. The registered manager was on leave at the time of the visit, so the inspector spoke to him by telephone a week later. Several weeks before the visit, questionnaires were sent to the home to be given out to residents and regular visitors. All six residents and five relatives returned completed questionnaires. Some residents had received help with the questionnaires from their befriender or advocate. Written comments were also received from a GP and a Social Worker. What the service does well: Thicketford place provides a homely, comfortable environment for the occupants. Written and verbal comments from residents indicated that they were happy living there. Comments from residents included, “I like living here”. Comments from relatives included, “I have always been fully satisfied with the home my relative lives in” and “Overall a high standard of care with committed and conscientious staff”. Staff are very knowledgeable about the needs and wishes of the residents, and are aware of how their needs are to be supported. They are able to interpret the wishes and feelings of the residents, even though some are unable to tell them verbally. They use creative ways to help residents make their own decisions, for example use of pictures that residents can point to. Some residents have advocates, who are not employed in the home, to speak on their behalf. There is very detailed written information to guide staff on how to meet residents’ needs. This information is written in a respectful, sensitive way, and includes residents’ preferences. A Social Worker commented, “From what I saw and what was discussed, the residents’ needs were being met as identified on the care plan”. Residents are helped to become involved in community activities such as college courses and leisure pursuits, helping them to lead lives that are meaningful and fulfilling. The numbers of staff on duty are arranged to accommodate this. Regular residents meetings are held. Residents’ comments indicated that they felt that staff listened to them and acted upon their wishes. One comment was, “With my carer by me I would gesture and what I say would be listened to and acted upon straight away”. Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 6 The service makes sure that before staff start work they are properly checked to make sure they are suitable to support the people living in the home. Staff receive training and support to help them to do their jobs well. The service works co-operatively with the CSCI, and requirements made during previous inspections have been acted upon. 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. Cornerstone Trust DS0000009314.V297320.R02.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 Trust DS0000009314.V297320.R02.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 at least once during a 12 month period. 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 the service. Needs are assessed before anyone is admitted to the home, written information about what the home offers is provided, and trial visits are arranged, so that all concerned can decide whether the home will be suitable. EVIDENCE: The home had a Statement of Purpose and Service Users’ Guide. The Service Users’ Guide comprised of a big folder with pictures. Discussion took place about the need to produce it in a more portable form (for example leaflet or tape) that could be given to prospective new residents to take away with them. The current resident group had lived in the home for several years, and so there had been no recent admissions to the home. The last admission was approximately 6 years ago. However, the written comments provided by the residents suggested that they had received enough information about the home before moving in. One said that they came to visit before moving in. Another said that they had visited several times for tea, stayed overnight and for a weekend, and then moved in. Residents’ written and verbal comments indicated that they were happy living in the home. One resident’s written comments included, “I like living here”. Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 9 However, there has been an ongoing problem in relation to the compatibility of some residents that the home has been trying to resolve. The deputy manager confirmed that any prospective new residents would be introduced to the home gradually, according to their individual needs. She said that this would be discussed with existing residents at a residents’ meeting. The staff member who was spoken with, had worked in the home a long time. She confirmed that there was an introductory period for new residents. The personal files relating to 2 residents were looked at. They contained assessments and review notes from the placing authority. There was also detailed information about the home’s assessment of needs and risks. Discussion took place with the deputy manager about how the home would meet the needs of residents from ethnic minority groups. She described how the home met the needs of a resident of Asian origin who already lived there, for example helping her to buy appropriate clothing. She said that new referrals would be made aware that the home was run by a Christian charity, but advice would be sought about how to meet the cultural and spiritual needs of anyone of another religion. Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Care plans and risk assessments are very detailed and they are sensitively written. Staff know the residents well and are able to interpret their wishes. Residents are helped to be as independent as possible, whilst keeping any risks to their health and welfare to a minimum. EVIDENCE: Personal files relating to 2 of the residents were looked at. They contained very detailed written information including an essential life plan, a care plan, detailed guidance on residents’ preferred routines, and various risk assessments. The Essential Life Plan included a useful pen picture, written in the first person (with assistance from an advocate if needed), and detailed guidance on the things that were essential to the person, things that were important to them, their likes and dislikes, their support needs, and details of things that staff must not do, for example in one case staff were instructed not to rush the resident. There was also a “Communication Script” on each file which gave very useful guidance on interpreting what the resident might say, or what their non-verbal signs meant. These documents were very sensitively Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 11 and respectfully written, and demonstrated the sound value base of this service. The resident who was spoken with knew about her written records. The deputy manager said that key workers met regularly with residents to work on their person centred plans and this gave them the opportunity to discuss their care plans with them. The home was advised to encourage residents to sign their care plans where possible, or to note on them that they had been discussed with the resident. Records showed that annual reviews were carried out by the placing authority. The home also carried out a review in between. The home’s own reviews included details of the resident’s plans, hopes and dreams. Minutes of the meetings showed that the residents had taken part in the reviews. The deputy manager and the staff member who was spoken with were clearly very knowledgeable about the needs of the residents, and their descriptions of the support needs of the residents matched the written information in the care notes. A Social Worker and a GP who provided written comments said that staff demonstrated a clear understanding of the needs of the residents. The social worker said, “From what I saw and what was discussed, the residents’ needs were being met as identified on the care plan”. It was noted that the residents’ routines of daily living were flexible as far as possible. This was easier at weekends. During the week, those who attended day centres needed to be up in good time to be ready. Some residents communicated by non verbal means, but discussions and observations showed that staff members were able to interpret their wishes. Pictures were sometimes used to help people make choices. Some residents had independent advocates who were able to help them make decisions. One resident’s questionnaire, which an advocate had helped to complete, stated “I can communicate with my support workers with my actions. Therefore they know if I am not enjoying myself. Therefore I am making my decision and they act on this”. Residents’ meetings were held approximately every 6 to 8 weeks to discuss various things that were relevant to the group. Minutes of the last meeting were looked at. Risk assessments had been completed, with risks balanced against the resident’s right to independence. Risk assessments covered lots of areas including use of equipment, finance, activities, and behaviour (of the resident and others). Behavioural risk assessments were sensitively written, and recognised that challenging behaviour was a form of communication. Strategies looked at understanding why the behaviour might occur, and how to try and prevent it (for example recognising signs of anxiety and trying to divert the person’s attention on to something else). There was also reference to Breakaway techniques being used if necessary. Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 12 The residents, relatives, and health and social care professionals who gave their views about the home said that they were satisfied with the support provided. One relative commented, “Overall a high standard of care with committed and conscientious staff”. Another said, “I have always been fully satisfied with the home my relative lives in”. A resident’s questionnaire included the comment, “A very responsive staff and management group”. Discussions with a staff member showed that she understood what confidentiality meant, including the need to pass on information to a manager if needed. Confidential written information was locked away. Cornerstone Trust DS0000009314.V297320.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Residents are assisted to take part in community activities that help them to live fulfilling, valued lifestyles. Care practices in the home respect residents’ rights, a varied healthy diet is provided, and contact with family and friends encouraged. EVIDENCE: Discussions, observations and written records showed that residents took part in a range of activities. Staff rotas were arranged to enable staff to support people outside the home. All residents needed some degree of support to take part in community activities. However, there was evidence of the home encouraging greater independence, if safe, for example a resident is now able to take a taxi to Church unaccompanied, after a gradual plan to increase her independence was followed. At the start of the inspection visit, 4 residents were out a day centre, and one had gone out to a local park with a staff member. During the evening, a resident went out, accompanied by staff, to a local weight watchers group. Other regular community activities included shopping, meals out, walking, Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 14 swimming, bowling, cinema and attending places of worship. One resident said that she was doing a college course in crafts. No one was in paid employment although one resident said that she had worked in a charity shop for several years but had recently finished. Residents had the opportunity to go on holiday, with staff support. The manager said that funding for holidays had previously been included in the budget from the Local Authority, but this had now been withdrawn. However, the home was continuing to try and find ways for residents to be able to have a holiday. One resident was looking forward to a forthcoming holiday in Spain. At home, people engaged in whatever they were interested in, for example looking at magazines, watching TV, listening to music, using a foot spa, or relaxing with sound and light therapy. All residents kept in contact with family and friends. Some regularly visited their families, or sometimes their families visited them. Some had regular telephone contact with family members. Residents’ involvement in the community gave them opportunities to meet new people. The relative who sent in written comments said that they were made welcome in the home, and that they could see their relative in private. As already stated in this report, daily routines were as flexible as possible. For example, when not attending day centres, people could have a lie-in if they wanted. A staff member described how residents’ privacy was respected, for example by knocking on residents’ doors. This was confirmed by a resident, and also observed during the visit. The staff member also said that keyworkers took mail items to the resident and helped them to open them. Some residents took part in household tasks such as food shopping. One resident liked to help out in the kitchen, prepare her own packed lunch to take to the day centre and make drinks, including drinks for visitors. Another resident liked to choose fresh flowers for the home each week. It was observed during the inspection, that staff spoke respectfully to residents and there was a natural rapport. It was clear, from discussions with staff, and looking at written records, that residents’ rights to privacy, respect, choice and fulfilment were respected. Individual menu records were kept. They showed that there was a choice of meals, and menus were varied. Healthy eating was encouraged, with plenty of fruit and vegetables. One resident who had joined a weight watchers group, was being helped and encouraged to follow a healthy diet. Another, who needed a gluten free diet, was being provided with appropriate foodstuffs. Two residents, who gave their views during the visit, felt that the meals were good, and they had enough to eat. It was observed that drinks were available throughout the visit. The deputy said that everyone’s evening meal was generally cooked at the same time, but residents didn’t necessarily eat together. Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 15 Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 16 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 the following standard(s): 18, 19 and 20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Personal and health care needs are promoted, and medication storage and procedures promote good health and safety. EVIDENCE: Residents needed varying degrees of support with personal care needs. There were very detailed records describing how residents liked their support to be given. For example, guidelines for the morning weekday routine for someone who attended a day centre began with, “Knock on the door, say ‘good morning’ and that her bath is running. She likes a few minutes to stretch and wake up properly”. Health action plans were in place. Accident records were kept. The deputy said that the manager would input accident records onto computer and monitor them. Records were kept of individual health appointments, including GPs, Continence Advisor, Dentist, Podiatrist, and Asthma Nurse. During the inspection visit, a behaviour management expert came to see one resident. During discussions, staff demonstrated awareness of residents’ health needs, and they gave examples of how they encouraged and supported them to Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 17 maintain good health, and follow the instructions given by health professionals. For example, residents were encouraged to take exercise, and follow appropriate eating plans. There were written guidelines covering medication. Medicines were kept locked away. A monitored dosage system was being used which included pre-printed MAR (Medication Administration Records). The (MAR) sheets were appropriately completed. Records were kept of medicines received into the home. The “returns” book wasn’t looked at this time. A staff member confirmed that one was maintained and that it was kept in the staff room. In line with good practice, residents’ photographs were attached to the MAR to aid identification, and a list of staff members’ usual signatures was maintained. A staff member said that accredited training in the safe handling of medicines formed part of the staff induction programme. She said that no one administered medicines until they had been trained. The home was asked to provide written guidelines for staff in respect of an identified resident who regularly needed to take medicines out of the home. It was noted that weekday lunchtime medicines for one resident were sent to the day centre in their original box (at the insistence of the day centre). The home was removing the weekend supply, and placing it in a dosette box (secondary dispensing). Following discussions with the pharmacist inspector, an alternative storage and recording method was advised that involved keeping the tablets in their original foil packs, and keeping a running record of medication given, and balance held. Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 18 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 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 the service. Residents know how to complain and they feel they would be listened to. Protection policies and procedures, and staff understanding of their adult protection responsibilities, ensure that the service has the means to be able to respond appropriately to any suspicion or allegation of abuse. EVIDENCE: The service had a written complaints procedure. A written version was displayed in the hallway. There was also a pictorial version for residents. The home also had a ‘Complaints and Compliments’ book, with pictures to enable residents to express themselves better. Residents’ verbal and written comments showed that, although not everyone could communicate verbally, they knew how to make a complaint, and that they felt staff would listen and take action. Comments included, “The team of staff watch and listen and act quickly”, and “ With my carer by me I would gesture and what I say would be listened to and acted upon straight away”. Of the 6 relatives who sent back written comments, 5 said that they were aware of the complaints procedure. The home had a copy of the multi-agency adult protection procedures. Discussions with the deputy manager showed that she was aware of her responsibilities to refer staff members under POVA (Protection of Vulnerable Adults) procedures if there were concerns about their conduct. Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 19 A staff member was aware of her responsibility to report any suspicions of abuse. She said that she had attended a formal training course in Adult Protection. Samples of training certificates were seen on staff files. It was noted that the organisation ensured that all staff completed a POVA and CRB (Protection of Vulnerable Adults Register/Criminal Records Bureau) check before they commenced work. Systems were in place to safeguard residents’ finances. The home had oversight of residents’ finances although 1 person was supported to look after small amounts. Personal monies were distributed from a cash float of £200, as and when residents needed it. Receipts and cash vouchers were kept. The registered manager took responsibility for reconciling individual balances, with records being kept on computer. He said that accounts were audited annually. The home had a number of written policies covering, for example, bullying, equal opportunities and racial harassment. Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 20 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 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 the service. The home provides a homely, comfortable, clean and safe environment for those who live there. EVIDENCE: The home was situated in a residential area of Bolton near to bus stops, local shops, and other local amenities. The house was a three storey terraced property, and was similar to other properties in the area. Thus it did not stand out as a care home. Outside there was a small garden at the front, and a yard at the back, with patio area and seating so that residents could sit out in nice weather. There was no passenger lift so access to upper floors was by stairs. All areas of the home were looked at. The home had a large, comfortable lounge, with a dining table at one end, a conservatory, a domestic style kitchen, and a quiet room. The laundry room was in an outer building. Furnishings were domestic in style. Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 21 There was a bathroom with toilet on the 1st floor and a toilet just off the ground floor hallway. The bathroom had been fitted with a new shower and bathroom suite, and had been re-tiled, and a new floor covering put down. Some smaller items of work were awaited in order to completely finish the job. There were 6 single bedrooms - one the ground floor, four on the 1st floor, and one on the 2nd floor. Bedrooms were personalised with residents’ own items. One bedroom had recently been redecorated, and was due to be fitted with a new sink, carpet, and bed. Colours had been chosen that would provide a tranquil environment. Another bedroom had been redecorated and the deputy manager said that it was planned to buy new curtains. Another bedroom was decorated and furnished to reflect the ethnicity of its occupant. She had chosen her own colour scheme. The carpet in one bedroom was due for renewal. The deputy manager said that the resident disliked change, and staff would work with him to look at how he could gradually get used to, and accept the change. The deputy said that she had recently produced an inventory of items identified to improve the environment for residents. She said that the registered manager was intending to include this in the home’s overall improvement plan. The manager said that it was difficult to put timescales for completion of the work because it was unclear at present what funds would be available. There are also plans under consideration for converting the ground floor office and adjoining room into a bedroom and bathroom, freeing up a small bedroom for use as an office. Whilst the environmental standards in the home are satisfactory at present, there will remain a need for ongoing redecoration and refurbishment in order to keep up standards. The home looked clean and tidy. The home employs a domestic assistant 3 days a week. Liquid soap was provided for hand washing in the bathroom, toilet and kitchen. All 6 residents said in their written comments that the home was always fresh and clean. Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to the service. Staffing levels are good, and staff members receive appropriate training, supervision and support to enable them to carry out their duties, and develop professionally. Residents are protected by safe recruitment practices. EVIDENCE: Discussions and examination of records showed that the staff team had a range of knowledge and experience. Observations showed that residents were quite comfortable in approaching staff members, and that staff members were able to understand what they wanted. Training in specialist topics was provided. Half the team had achieved NVQ level 2 or above and others were currently working through the course. The home was therefore making good progress in this area. Staffing levels in the home were good, with at least 3 support workers on duty between 7am and 10am, and 3pm and 10pm during the week, and from 7am to 10pm at weekends. Staffing levels were therefore sufficient to allow outside activities for residents who needed to be accompanied outside the home. Five of the 6 relatives who returned written comments felt that there were always sufficient numbers of staff on duty. Both male and female support workers were employed. The deputy manager was asked to show the actual times Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 23 worked on staff rotas rather than just showing “7” or “8” which just indicates the number of hours worked (please see the next section of this report “Conduct and Management”). As required at the time of the last inspection, the home had produced an oncall rota. A sample of staff recruitment records were looked at. They indicated that all necessary recruitment checks had been undertaken. Employment checks that had been done included obtaining proof of identity including a photograph, criminal convictions declarations, employment histories with reasons for leaving previous employers, written references, medical questionnaires, CRB (Criminal Records Bureau) disclosures and POVA (Protection of Vulnerable Adults) register checks. Details of the interview assessment were kept on file. Records showed that new recruits received induction training. A staff member said that new recruits shadowed an experienced worker at first who showed them all they needed to know about health and safety in the home. In respect of working with residents, new staff initially observed the experienced staff member, and then vice versa to ensure that the new staff member could carry out a task competently. She said that new staff were expected to read care plans and policies and procedures during their induction. The deputy manager said that, in addition to the home’s induction, new recruits went on a 7 day induction course run by the Local Authority. She said that the course covered a range of topics including the philosophy of care. A certificate for this was seen on a staff member’s file. The deputy said that a recent recruit was due to go on the course on October 2nd and that courses in Person Centred Planning and Managing Challenging Behaviour were also planned for her. These training plans were confirmed by the new starter. A sample of staff training records, including certificates, were looked at. Courses provided included managing challenging behaviour, moving and handling, moving and handling risk assessment, food hygiene, first aid, fire training, epilepsy, adult protection, autism, and LDAF (Learning Disability Award Framework). A staff member said that the home was good in providing training for staff. A staff member felt that the she received enough support from managers to do her job well. She said managers provided informal support as well as formal. She said that she received regular 1 to 1 supervision from the deputy manager, usually monthly. However, she said that if necessary, the deputy would make time for a supervision meeting at short notice. She also said that regular staff meetings were held. The manager said that she tried to carry out supervision meetings around every 6 weeks and confirmed that a meeting could be requested anytime. Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42 Quality in this outcome area is good. This judgment has been made using available evidence including visits to this service. Residents benefit from a well run home. The home has several ways to find out what people think of the service provided. The health and safety of service users and staff is promoted by means of regular safety checks. EVIDENCE: The manager is registered with the CSCI, and he has completed the RMA (Registered Managers Award). The deputy manager has just started the RMA. The manager was on annual leave at the time of the inspection visit, but the inspector spoke with him by telephone the following week. The manager has been employed in care services for many years. He has been registered manager at this home for 2½ years. He previously managed a day centre for people with learning disabilities for 27 years. He is a registered nurse (RMN and RNLD). Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 25 A staff member described the home as well run, and she said that she felt listened to. The manager works co-operatively with the CSCI and any requirements made during previous inspections have been acted upon. Communication within the home takes several forms including verbal handovers, written records, residents’ meetings, and various staff and management meetings. As stated under the “Staffing” section of this report, staff rotas need to show the actual hours worked by the staff team. The home had several methods of checking out the quality of the service. For example, records showed that a member of the trust visited the home regularly and reported upon standards. The home also recorded any concerns that were raised. Regular meetings took place, for staff and residents, where they could express their views. The deputy said that people were also asked for their opinions at the in-house review meetings. She said that a family questionnaire had recently been sent out, and it was planned that the returned questionnaires would be discussed at a seniors meeting. Discussion took place about the need to seek views from as many different sources as possible (for example residents, staff, social workers, health professionals, and managers’ own self audits). The home needs to produce an annual report of the outcomes of its quality surveys, together with an improvement plan which will show residents, and others, that that their views have been listened to. A copy of the annual report should also be sent to the CSCI. Several safety records were checked. These included electrical installation, gas safety, portable electrical appliance tests, servicing of fire alarms and fire fighting equipment, and weekly checking of fire alarms, lighting, fire fighting equipment and means of escape. There was a query about the servicing of the emergency lighting which the manager was able to clarify during the telephone conversation following the visit. The last fire drill took place on 24/8/06. The home had a fire risk assessment. A valid Employers Liability Certificate was seen. Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 26 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 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 3 33 4 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 3 LIFESTYLES Standard No Score 11 X 12 3 13 4 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 3 X 2 X 2 3 X Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 27 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 YA39 Regulation 21,24 Timescale for action A copy of the improvement plan 30/11/06 outlining the outcomes of the most recent quality audit must be forwarded to the CSCI by the date in the end column. Requirement 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. Refer to Standard YA1 Good Practice Recommendations The home needs to look at producing the Service Users’ Guide in a format (for example a leaflet, or audio tape) that allows prospective new residents to take the information away with them. If possible, residents should be asked to sign to confirm that they agree their care plans. If this is not possible, the home is advised to make a note of the date the care plan was discussed with the resident. Individual arrangements for the safe supply and management of leave medication should be recorded. 2. YA6 3. YA20 Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 28 4. YA24 Although environmental standards in the home are good, the home needs to keep an up to date maintenance and renewal programme to ensure that standards are maintained. Rotas need to reflect the actual times worked. 5. YA41 Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 Cornerstone Trust DS0000009314.V297320.R02.S.doc Version 5.2 Page 30 - 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. 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