Inspection on 16/11/05 for Cornerstones

This inspection was carried out on 16th November 2005.

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

Cornerstones 04/10/06

Cornerstones 07/04/05

Cornerstones 20/10/04

Cornerstones 08/07/04

Cornerstones 23/03/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Cornerstones 43-45 St. John`s Road Exmouth Devon EX8 4DD Lead Inspector Belinda Heginworth Unannounced Inspection 16th November 2005 09:15 Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 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 Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 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. Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cornerstones Address 43-45 St. John`s Road Exmouth Devon EX8 4DD 01395 275892 01395 275892 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) Devon Partnership NHS Trust Mrs Jacqueline Rosemary Watson Care Home 5 Category(ies) of Learning disability (5), Physical disability (5) registration, with number of places Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age 18 to 40 Date of last inspection 7th April 2005 Brief Description of the Service: Cornerstones provides support and personal care for five residents with a learning disability. The home consists of two semi detached bungalows which are linked internally. One bungalow provides care for one resident and the other for four. Each house has a lounge, dining room, kitchen, bathroom and bedrooms. The home also has an additional toilet and an office. There are gardens to the front and rear of the property. The home is operated by Trust Residential Services who are part of Devon Partnership NHS Trust. Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. I would like to thank the staff for the warm welcome and help throughout the inspection. This unannounced inspection took place over 2 hours with the “acting” deputy manager being present throughout. The people living at Cornerstones have limited verbal communication skills and some sensory impairment. They were unable to contribute fully to the inspection process. Time was spent with the residents at various points of the inspection and observations were made. Three permanent staff, one bank staff and the “acting” deputy manager were consulted and their views on the home discussed. Parts of the building were inspected and some records were looked at. What the service does well: What has improved since the last inspection? Information provided to potential residents is clearer and explains about extra costs to residents. Medication is now held more securely. Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 Page 6 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. Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 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 Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 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 Resident’s benefit from good admission and assessment practices, which ensure that the home is able to meet their needs. EVIDENCE: The residents have lived at Cornerstones for a number of years. A detailed assessment of need would be completed to ensure the home is able to meet that person’s needs prior to admission. Care management assessments would also be completed. Residents would be admitted to the home on a trial basis before making a decision to live there. During the last inspection it was highlighted that additional information was needed relating to what residents have to pay for over and above the fees. This information has been added to the home’s Statement of Purpose. Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Care planning and risk assessments provide staff with the information they require to satisfactorily meet residents’ needs safely. EVIDENCE: Residents have limited communication skills and have a limited understanding of care plans and are therefore unable to contribute to their formulation or reviews. Care plans provide good information and guidance about residents’ needs and set out individual goals that encourage independent living skills. Relatives and the staff team advocate on behalf of the residents and work hard to identify any changes in their assessed needs. Staff demonstrated an excellent knowledge and understanding of the plans. Risks to residents are carefully identified and clear guidelines are recorded on what staff should do to reduce the risks. During the last inspection it was highlighted that the home uses a listening device to meet the health needs of one resident. This was discussed with relatives but not with other professionals. It was recommended that when using such devices there might be an impact upon a resident’s privacy, Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 Page 10 therefore it should always be discussed and agreed with families and community professionals. The manager intends to complete this work at care plan reviews where care managers and relatives are usually present. Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 & 16 Links with the community are good and staff support residents’ social and educational opportunities. EVIDENCE: It was clear through observations made that residents have a good relationship with staff. Residents were treated kindly and with respect. Due to limited verbal communication residents were unable to talk about leisure, social or educational pursuits. However, the home has an activity plan for staff to follow. Staff have a good knowledge of residents’ needs, likes and dislikes. The plans are drawn from this knowledge and observations made on activities. Activities range from walks, swimming, shopping, pubs, cafes and many more. Staff support residents to maintain contact with relatives. Some residents visit their families regularly. Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 Page 12 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 & 20 Residents’ health and emotional needs are well met and medication systems protect residents’ welfare. EVIDENCE: Staff were seen to help, support and guide residents in a way that was respectful but also kept them safe. Care plans and risk assessments provide staff with good information on residents’ likes, dislikes and preferences. Staff had a good knowledge of the residents and demonstrated a good understanding of what was written in the care plans and risk assessments. Health care needs are regularly assessed and clearly recorded. Staff write a daily record of all events for each resident. Any health issues are also recorded and monitored. It was highlighted during the last inspection that the manager provides inhouse training on the safe administration of medicines. Medication policies and procedures give staff additional information and guidelines. Medication was stored in a locked filing cabinet in the staff sleeping–in room. The CSCI pharmacy inspector had advised that the cabinet should be secured to a wall or floor. This work has been completed the cabinet is now bolted to the wall. He has also advised on appropriate training for staff. This remains the same, staff Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 Page 13 only receive training through the manager and no regular assessments of staffs’ competencies are completed. Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 Page 14 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): 0 Not inspected on this occasion but met during the last inspection. EVIDENCE: Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 Page 15 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 & 30 The standard of décor within the home is adequate with evidence of improvement through maintenance or future planning. Improvements are needed in the prevention of infection throughout the home. EVIDENCE: A number of areas in the home were identified during the last inspection as in need of improvement. Two showers and a bath surround need replacing. Some walls around the home have holes in them due to damage caused by residents. A garden bench is broken and could cause harm to anyone who sits on it. A cooker in one of the kitchens needs replacing. A window was boarded up due to broken glass and there was no door on a bathroom due to residents removing it the day before. (The window and door have been mended) The provider has arranged for this work to be completed. Once completed the home will be safer and more homely for residents. Not all of this work has been completed. Due to the complex behaviours of some residents there is an ongoing maintenance programme and work is slowly being completed. On the surface the home looks clean and fairly tidy. However, practices to prevent the spread of infection were poor. For example, separate mops and buckets were not being used for cleaning the kitchen and bathrooms. Mop Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 Page 16 heads had not been changed for some time. The mop bucket was filled at the kitchen sink. The kitchen area at one end of the house was used for storage as well as cooking and looked very untidy with an unclean floor. There is no separate hand washing facilities in either kitchen. Alcoholic sprays are provided to staff to use before using the kitchen sink to wash their hands but there was no hand drying towels in one kitchen. Staff said they used the kitchen tea towel. Due to complex behaviours of some residents toilet paper was not provided and alcoholic spray was only provided in one toilet. On the day of the inspection that spray was in the kitchen because a resident had removed it from the toilet wall. Staff were not seen to encourage residents to wash their hands after using the toilet and they were not seen to provide residents with soap or towels. Staff admitted that door handles were not cleaned regularly. It was agreed that a better routine for ensuring the risk of spreading infection could and must be implemented. Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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 Resident’s benefit from a competent and effective staff team. EVIDENCE: It clear through observations made that staff are kind, caring and respectful. The relationship between staff and residents appeared very good. The home provides a minimum of 4 staff on duty per day and two at night. Two staff are allocated to each end of the house. The manager is in the process of trying to secure extra funding to provide more one to one staffing for residents who need it. Staff demonstrated a good knowledge of residents’ needs and said they receive a wide range of training to help them meet those needs. Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 Page 18 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): 42 The health, safety and welfare of residents are promoted and protected. EVIDENCE: The manager completed a questionnaire prior to the last inspection. This provides information about staff and residents and confirms to the CSCI that policies and procedures are in place. The policies and procedures ensure residents’ safety and welfare is protected by staff following them. The fire logbook was found to be up to date and included a record of staff fire training, thus protecting resident’s safety. Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 X X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cornerstones Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score X X X X X 3 X DS0000021916.V265995.R01.S.doc Version 5.0 Page 20 N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA30 Regulation 13 (3) Timescale for action The registered person shall make 30/12/05 suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. The registered person shall having regard to the size of the care home and the number and needs of service users – (j) after consultation with the environmental health authority, make suitable arrangements for maintaining satisfactory standards of hygiene in the care home. (This refers to the poor standards of hygiene and the limited hand washing facilities for staff and residents) Requirement 16 (2) (j) Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 Page 21 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 YA20 Good Practice Recommendations Training on the Safe Handling and Administration of Medicines should be obtained for all staff who adminster medicine. (This is a repeated recommendation) All repairs and replacements should be carried out in the home as soon as possible. (This is a repeated recommendation) 2 YA24 Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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 Cornerstones DS0000021916.V265995.R01.S.doc Version 5.0 Page 23 - 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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