Inspection on 11/04/05 for High Street (10)

This inspection was carried out on 11th April 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

High Street (10) 22/04/09

High Street (10) 24/04/08

High Street (10) 14/11/07

High Street (10) 06/09/06

High Street (10) 18/10/05

High Street (10) 11/11/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 10 High Street Semington Trowbridge Wiltshire BA14 6JR Lead Inspector Jacqui Burvill Unannounced 11th April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 10 High Street Version 1.10 Page 3 SERVICE INFORMATION Name of service 10 High Street Address Semington Trowbridge Wiltshire BA14 6JR 01380 870061 016720569477 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Cornerstones (UK) Ltd Mrs Lorna Jayne Hale Care Home 8 Category(ies) of LD Learnning disability 8 registration, with number of places 10 High Street Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1. The company must employ one or more administrators working for a period of not less than 5 hour per week in this home. This person must provide the home with administrative support in the maintenance of good records, including financial records, and any other documentation and relevant paperwork necessary for running a care home. The administrator must be in place by 1 October 2004 2. Cornerstones (UK) Ltd must ensure that a quality assurance audit is carried out at least annually as to the way this home is performing. This audit must also specify any corrective measures that need to be put in place with suggested timescales for action. Any such audit must be carried out by a reputable and competent person or company with experience of quality assurance systems and processes. A copy of the audit must be provided by 4 July 2005. 3. Any placement for short-term care or for an emergency placement must be agreed with the Commission before the placement commences. For purpose of this condition, short-term is defined as a placement that is expected not to last longer than 3 months. An emergency admission is defined as an admission whereby someone is likely to be placed at short notice without an up-to-date assessment of needs having been carried out and the person has not had the opportunity to visit the home prior to placement. Date of last inspection 11th November 2004 Brief Description of the Service: 10 High Street is a detached house in the village of Semington, which is close to the towns of Semington and Trowbridge. The home is one of a number owned by Mr and Mrs Sinclair and is registered under the company name of Cornerstones UK Ltd. 10 High Street provide care and accomodation for service users with a learning disability aged between 18 - 65 years. Each service user has their own bedroom. Three bedrooms have ensuite bathrooms, with a bath, toilet and hand washbasin. The remaining rooms do not have ensuites, nor do they have hand washbasins. There is a communal bathroom and toilet on the first floor and a shower room and toilet on the ground floor. There is a small lounge, a dining room and a kitchen. There is a rear garden, with a patio, lawn and parking for several cars. Staff provide 24 hour cover, which includes one member of staff sleeping in each night. The staff sleep in room is on ground floor. One service user bedroom is on the ground floor and the remainder are on the first floor. Two of ground floors rooms are currently used as offices. There is no call bell system. Access to first floor is by stairs only. 10 High Street Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over part of a day, taking five and a half hours. The inspector spoke to and met four residents and two staff, including the manager. Three residents were at home during the inspection and one resident came back from day care in the afternoon. The manager showed the inspector around the home. A number of records were looked at. These included medication, staff training records, the rota, care plans and support plans, daily notes, accident and incident records and fire safety records. What the service does well: What has improved since the last inspection? What they could do better: Records need to be more consistent, especially care plans and risk assessments, in order to ensure that residents changing needs are regularly reviewed and followed up. Staff need more training and regular updates on some mandatory training such as adult protection. Specialised training that meets the needs of residents would give staff a factual basis on which to develop care plans. Care plans and complaints procedures could be more accessible to residents. Three of the requirements from the last inspection have been carried forward and four of the five recommendations have been carried forward. The CSCI will consider taking action to enforce the requirements, as one of them has not 10 High Street Version 1.10 Page 6 been met since15.5.03. This is about residents’ contracts being in place in the home. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 10 High Street Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection 10 High Street Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 5 The residents do not have a copy of the contract following the change of the company name. EVIDENCE: No new service users have been admitted to the home since the last inspection. Resident’s contracts are still not signed. If this continues after this requirement, then enforcement action will be considered. This has been a continuing requirement since 15.5.03 10 High Street Version 1.10 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 Care plans are not consistently detailed for all of the residents. Care plans are not accessible to the residents and therefore, their involvement is limited. The practice of reviewing care plans every three months is positive, however, this is not done consistently. EVIDENCE: Care plans are very lengthy. Each document runs to some 80 pages. Not all of the care plans have been fully completed. Staff are expected to complete a three monthly summary. For one resident this had not been completed since July to October 2004. For residents who had this record completed it provided a clear overview of changing needs. There is also a sheet recording amendments to the care plan. There are inconsistencies in some of the plans with a lack of dates and signatures. It is hard to see how this plan is accessible to residents, who have communication needs. There are shorter support plans with daily notes. Staff must try to record support provided more objectively and words such as ‘silly’ should not be used when describing behaviour. One care plan had been shared with the family, who had taken it away from the home. No copy had been left in the home. 10 High Street Version 1.10 Page 10 Risk assessments were in place, had been reviewed, and were signed and dated. There some restrictions in the home. The reasons for these restrictions are described in the care plan. 10 High Street Version 1.10 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 16, 17 Residents attend a range of day care activities and social events that they are interested in and tailored to meet their needs. They are involved in community events. Menus do not record the choices residents make for lunch nor any alternatives that are provided. There is a previous requirement that will be carried forward regarding the alternatives being recorded on the menu. The impact on the residents is that is it not clear what they will have had to eat, not is there enough evidence to show that this is a balanced and nutritious diet. EVIDENCE: Staff explained what activities residents like to take part in and what activities were due that day. One resident had made a choice not to attend day care that day. There are a variety of activities, including a new day care service in the Savernake Forest. The manager and staff team have also hired a local village hall on a regular basis, providing art and craft activities for service users in their home. The manager explained that residents were responding to the sessions more positively and becoming more involved when these activities took place outside of the home. Residents also attend events in the local community. 10 High Street Version 1.10 Page 12 At lunch, staff and residents’ interactions were observed. Looking at the menu plan, it is hard to see how residents are able to choose what they want where personal choice is described. Some residents are able to lead staff to what they want, others are asked and can say what they would like. There is not a clear description of the lunch- time choices, although there is space on the menu to write this. 10 High Street Version 1.10 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 There are details in the care plan for staff to follow when providing personal care. Staff described these methods clearly. Residents were not able to confirm that this is what happens. Staff do not receive medication training that includes administration and nor is there a full understanding of medication that is used in the home. EVIDENCE: Staff explained how they interpret the signs and gestures for some residents and how this helps residents make choices e.g. what clothes they would like to wear that day and having a bath. There are descriptions of signs and gestures for staff to follow. This could be developed further after receiving guidance and advice form a speech and language therapist. Behaviour charts are used following support from specialist nurses in the community. There are epilepsy charts and records showing when residents have seen their GP or other healthcare professionals. These records show what action has been taken. There are three different medication systems in the home, as there are three GP surgeries used. The systems have been simplified, following a previous visit from the CSCI pharmacy inspector. Staff must receive training in medication administration. There was a gap in one record and it was not clear if medication had been given on that occasion. There must not be gaps in the 10 High Street Version 1.10 Page 14 medication administration records. Staff must use the codes described on the record sheet, as not to do so, could place residents at risk. No residents self medicate. 10 High Street Version 1.10 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 The complaints procedure has been shared with the families. Those residents without families are not aware of the home’s complaint procedure. Not all staff are trained in awareness of adult protection and local procedures. EVIDENCE: There are details in the care plan that show families have been given copies of the complaints procedure, as it is not felt that residents would understand or be able to use the procedure independently. No complaints have been received by the home, or the CSCI. Not all staff have received training in adult protection and abuse awareness, including the Wiltshire ‘No Secrets’ procedure. Staff who received this training in 2002 should receive refresher training. 10 High Street Version 1.10 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 27, 28, 30 Improvements to the environment continued to be made. However, an action plan was not available showing when the remaining areas of the home will be improved. The home was clean and tidy. EVIDENCE: Rooms looked attractive and all areas of the home were clean and tidy. A member of the care staff team was observed cleaning communal areas of the home and doing laundry. There have been some improvements to the home where one resident had chosen a new colour for her room, which had also been re carpeted. One first floor bedroom has been redecorated and now needs new flooring and electrical sockets. The bath panel in the first floor bathroom needs replacing. There is a hole in the carpet in the lounge. An action plan is needed to show what needs to be accomplished. There are plans for some major changes to the dining room and utility room, which will improve this area for residents, with more natural light and make it appear more homely. 10 High Street Version 1.10 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 35 There are sufficient staff on duty to meet the needs of residents. There have been some changes to the staff team and more changes are planned. Staff training records must be up to date and staff must receive at least five training days per year. EVIDENCE: There have been some changes to the staff team very recently. Two long standing members have left and one is planning to leave. These posts will be replaced by two part time posts, which are being advertised. The home is also considering reducing resident numbers from 8 to 7. One member of the team provides one to one support for a service user and this is detailed on the rota. Staff training records show that staff are not receiving at least five paid training days per year. This could impact of the residents, as staff may not have the a full range of skills and knowledge with which to meet their needs. Staff have recently completed first aid and basic food hygiene training. Two staff are to be registered to do NVQ level 3. 10 High Street Version 1.10 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 42 The quality assurance system has not been put into full operation yet. Fire safety records and checks had not been carried out regularly. This could seriously affect residents’ safety. EVIDENCE: The organisation has bought a quality assurance pack. This is so the organisation can assess the quality of care that they provide to their residents. The questionnaire process is to start soon. There is a condition to the registration that a report on quality assurance is completed by 4th July 2005. This must include residents’ views and the views of families and stakeholders. An immediate requirement was issued for three fire safety concerns, these were that the fire alarm had not been tested since 15.3.05, staff had not received fire safety training in the first quarter of this year – January to March 2005 and there had been no record of a check on Means of Escape since 1.11.04 . This could present a serious risk to resident’s well being. There are 10 High Street Version 1.10 Page 19 accident and incident reports that are linked to care notes, showing that staff report and record these incidents fully. There is a COSSH file, with details of products that are used in the home. SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 x 3 3 x 3 Standard No 11 10 High Street x Standard No 31 32 33 Version 1.10 Score x 2 x Page 20 12 13 14 15 16 17 3 x x x x 2 34 35 36 x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 1 x 10 High Street Version 1.10 Page 21 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 17(2) and Schedule 4.9 Timescale for action Copies of contracts and terms 30th May and conditions must specify fees 2005 and any extra charges and what these are for. These must be held in home.( Previous timescale of 31st December 2004 not met. This requirement has been brought forward from inspection dated 15.5.03) Enforcement action will be taken if requirement is not met by timescale set. Care plans must be consistantly 30th May reviewed for all residents. 2005 and from now on The alternatives box on menu 30th May must show what residents ate. 2005 and This includes lunch when from now residents eat at home. ( Previous on timescale of 31st December 2004 not met) Staff must receive accredited 30th training in administration of September medication 2005 The manager must find ways of 30th July enabling residents to access 2005 complaints procedure. All staff must receive training in 30th adult protection, signs and September symptoms of abuse and 2005 Version 1.10 Page 22 Requirement 2. YA6 15 (1) (2) 3. YA17 17 (2) AND Schedule 4.13 13 (2) 22 (2) 13 (6) 4. 5. 6. YA20 YA22 YA23 10 High Street Wiltshire No Sectrets guidance. 7. YA41 19 (1) The registered manager must show evidence to support descisions that may be made when results appear on CRB checks. (Previous timescale of 31st December 2004 not met) 30th September 2005 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 YA35 Good Practice Recommendations Staff should have at least five paid training days per year. This should include equal opportunities training, including disability equality training, provided by disabled trainers, race equality and anti racism training. (Brought forward from inspection 16.10.03) When staff are handwriting detais of medication onto a blank MAR sheet, or entering new medication into a blank box, then two staff check and sign this on actual sheet. (Brought forward from inspection 11.11.04) The death and dying procedure needs to be amended to contain clear instructions about contacting emergency services in case of a sudden death. Residents should be involved in their own care plan. A referral should be made to a speech and language therapist to develop communication needs for residents in home. An action plan should be devised when areas of home are to be improved. 2. YA20 3. 4. 5. 6. YA21 YA6 YA6 YA24 10 High Street Version 1.10 Page 23 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 10 High Street Version 1.10 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. 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