Inspection on 14/11/07 for High Street (10)

This inspection was carried out on 14th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 8 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) 06/09/06

High Street (10) 18/10/05

High Street (10) 11/04/05

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 High Street (10) Semington Trowbridge Wiltshire BA14 6JR Lead Inspector Malcolm Kippax Key Unannounced Inspection 14th November 2007 1:50 High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Street (10) Address Semington Trowbridge Wiltshire BA14 6JR 01380 870061 01672 569477 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) Cornerstones (UK) Ltd Vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Any placement for short-term care or for an emergency placement must be agreed with the Commission before the placement commences. For the 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. 6th September 2006 Date of last inspection Brief Description of the Service: 10 High Street is a detached property in Semington, which is a village between the towns of Melksham and Trowbridge. 10 High Street is one of a number of care homes in Wiltshire that are run by Cornerstones UK Ltd. The home provides care and accommodation to up to eight people with a learning disability. Each person has their own bedroom. One of the bedrooms is on the ground floor and the others are on the first floor. Some of the rooms have en-suite facilities. The communal rooms consist of an open plan lounge and dining room, and another separate lounge that is also used as a sensory room. On the first floor there is an office and sleeping-in room for staff use. There is a domestic type kitchen and a separate laundry room. At the rear of the property there is a large garden with a patio area and a parking space for several cars. A permanent staff team provides 24 hour support to the service users. A minimum of two people are on duty during the day and one member of staff sleeps-in during the night. 10 High Street was without a registered manager at the time of this inspection. Mr S. Smitherman had been appointed to manage the home, but the Commission had not yet received an application to register a new manager. The weekly fee was £1385. Inspection reports can be obtained from the home and are also available through the Commission’s website at: www.csci.org.uk High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit to the home on 14th November 2007, between 1.50 pm and 6.00 pm. A second visit was arranged with the home’s manager, Mr Shaun Smitherman, in order to complete the inspection. This took place on 27th November 2007 at 9.25 am. The Inspector was accompanied by an ‘Expert by Experience’ and their supporter during the visit on 14 November 2007. An Expert by Experience is a person who uses services and who is helping the Commission for Social Care Inspection to inspect care services. The Expert by Experience’s observations are reflected in this report. Evidence was obtained during the visits through: • • • • Time spent with the service users and with staff members. A meeting with Mr Smitherman. Observation and a tour of the home. Examination of records, including three of the service users’ personal files. Other information has been taken into account as part of this inspection: • An Annual Quality Assurance Assessment (referred to as the AQAA) that was completed by Mr Smitherman. The AQAA is the provider’s own assessment of how well they are performing. It also provides information about what has happened in the home during the last 12 months. Surveys that were completed by three of the service users’ relatives and by six staff members. Notifications and reports that the Commission has received about the home since the last key inspection. Correspondence that was received from Mr Smitherman after the visits. • • • The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. What the service does well: People’s individual needs are assessed before they move into 10 High Street, so that a decision can be made about whether the home is suitable for them. The home receives a range of information about the new service user, which helps staff to get to know the person and their routines. People’s right to make decisions is respected, although there are some restrictions, which are mainly for safety reasons. They can make choices in their daily lives, such as what meals to have and how to spend their time. One person chooses not to participate in some of the planned day activities and is able to stay at home on these occasions. High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 6 People’s needs and preferences are clearly shown in their individual plans. The plans provide guidance for staff when providing personal care. People receive the support that they need with their healthcare and medication. Risk assessments are being carried out, which helps to ensure that people are safe when in the home and when doing their activities. The assessments are well referenced within people’s individual plans, so that the information is clearly identified and readily available to staff. People have regular contact with the local community and are supported with keeping in touch with their families. The relatives who completed surveys responded positively about the home and the work that staff do. The environment is generally homely and there is a good sized garden. People have their own rooms, which they can decorate and personalise as they wish. What has improved since the last inspection? What they could do better: 10 High Street has not had a registered manager working in the home during the last year. Service users have therefore not had the reassurance of knowing that the person managing the home has been approved and is registered under the Care Standards Act. Cornerstones (UK) must ensure that an application is made to register a new manager without further delay. A representative of Cornerstones (UK) visits the home regularly, but this has not ensured that people in the home have always been well protected or that the manager and staff have been well supported. For example, a staff member started working in the home before their name had been checked against the Protection of Vulnerable Adults (POVA) list. If this list is not checked, then people in the home are at risk of having contact with somebody who has been barred from working with vulnerable adults. It was found at the last inspection that there had been a lack of information about when service users had to pay from their own money for the cost of High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 7 activities, meals and other items. There had been no policy about this and the arrangements being made for charging needed to be agreed with the relevant parties. Requirements were made in connection with this, to ensure that the arrangements were transparent and service users would be less at risk from financial abuse. These requirements have not been met. Cornerstones (UK) should produce clear guidelines about the times when service users are expected to contribute to the costs of things from their own money. People’s care plans generally reflect their needs. However they could be improved by having better information, for example about the support people need with achieving their goals and the involvement of outside professionals. Work should be undertaken to make information, such as the care plans, easier to understand for people. The Expert by Experience thought that the support being provided was not as ‘person centred’ as it could be. They were concerned that it was difficult for some people to communicate their needs and wondered how they would be able to make a complaint. Formal supervision meetings for staff have not been taking place as required. Mr Smitherman is addressing this. There needs to be a more consistent approach to the provision of training. People in the home will be better supported by staff who are regularly supervised and have received the training that is specified in the home’s training plan. Some shortcomings and areas for improvement are being identified, but not being followed up and put right. The system for quality assurance needs to ensure that action is taken to meet inspection requirements and other deficiencies. This is so that people in the home can have confidence in how the home is being run and how shortcomings are being responded to. Matters concerning health and safety in the home are in need of attention. Some checks have not been carried out consistently during the last year. Staff members had not received fire instruction since September 2006. Mr Smitherman was aware that staff needed to receive further training. Requests had been made for the training to be arranged and Mr Smitherman had expressed concern to Cornerstones (UK) about the lack of provision for this. Cornerstones (UK) need to maintain a better overview of how the home is running and provide better support for the manager. This will help ensure that people are not at risk and are living in a safe environment. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is adequate overall and it is poor in respect of the information that is available to people. People have their needs assessed before moving into the home. However, they are not given accurate and up to date information about some important matters. This judgement has been made using available evidence including the visits to the home. EVIDENCE: The home’s Statement of Purpose has been reviewed since the last inspection. The Commission has received a version, which was dated 30th June 2007. It was found at the last inspection that there had been a lack of information about when service users had to pay from their own money for the cost of activities, meals and other items. There had been no policy about this and the arrangements being made for charging needed to be agreed with the relevant parties. This was to ensure that the arrangements were consistent with people’s terms and conditions. Requirements had been made in connection with this and about the need to ensure that details of the arrangements for charging were available to people. These requirements were due to have been complied with by the end of High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 10 December 2006. This timescale had not been met. Mr Smitherman has since reported that the relevant details are to be confirmed by March 2008, when they will be included in new Service User’s guides. Mr Smitherman reported that more information would now be included in the service users’ care plans about how their personal money is used. It was then the intention to seek agreement from the relevant parties when the six monthly care plan review meetings take place. Mr Smitherman expected that a policy in respect of additional charges would be completed by the end of December 2007. One new service user had moved into 10 High Street since the last inspection. A needs assessment and a care plan had been received from the person’s placing authority. The home had completed its own assessments. Other information had been recorded about the individual, including personal risk assessments and guidelines for staff about how they should be supported. This information was kept in the service user’s individual file and was readily available to staff. A new care plan had been produced shortly after the person moved into the home. High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, and 9 Quality in this outcome area is good overall. People’s needs and preferences are reflected in individual plans. However, people would benefit from better information about their personal goals. People are supported with making decisions, although there are limitations on what they can do. This judgement has been made using available evidence including the visits to the home. EVIDENCE: Each service user had a personal file containing a care plan and a number of different assessment forms. These covered a range of needs, such as ‘Health Awareness’, ‘Safety Awareness’, ‘Communication’, ‘Diet’, and ‘Behaviour’. They provided guidance for staff about the service users’ needs and preferences in different areas of their lives. There was information about people’s likes and dislikes and their preferred routines. Some personal details were also recorded in a ‘Useful tips’ section of High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 12 the care plans. These included for example, how somebody liked to dry their hair and the sort of meals that they liked. The care plans showed when a risk assessment had been undertaken in relation to a particular activity or need. The care plans had been dated to show when they had been reviewed. However it was not clear who had been involved in the review, or who had contributed to the care planning process. There were sections in the care plans about ‘strengths and needs’ and ‘individual goals’. The content of these sections varied and there was a lack of detail about how some goals would be monitored and how achievement would be measured. The written format of the plans meant that they were not easily accessible to all service users or meeting their individual needs. Service users could make decisions about what meals they wanted and how to spend their time. One service user was choosing not to participate in some of the planned day activities and was able to stay at home on these occasions. People could choose how they wanted to decorate their own rooms. Some people had keys to their rooms. The care plans referred to some restrictions that were in place about the service users’ movements. These included the use of the kitchen when a staff member was not present. Other restrictions related to limiting independence, for example when a service user required support when bathing. The Expert by Experience reported that everyone had their own room and could choose the decorations. The Expert by Experience saw that some people could not easily communicate their needs. They were concerned that it was difficult for people to be given day to day choices and that some information was not easily accessible to them. Mr Smitherman told the Expert by Experience that advocates and relatives were involved when decisions were made about people’s care. In their surveys, the three relatives felt that the home was meeting people’s needs. High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good overall. People participate in a range of activities outside the home. They have contact with their relatives and with the local community. People appear to be offered a varied menu, although there is a lack of detail being recorded about the meals. This judgement has been made using available evidence including the visits to the home. EVIDENCE: It was reported at the last inspection that there had been a change in the service users’ usual occupation during the week. This was because some outside activities were no longer available to them. Cornerstones (UK) were providing people with the opportunities to join in with some activities that they arranged outside the home. These included, for example, arts and crafts sessions held at a village hall, which had been hired for the occasion. High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 14 This programme of activities has continued during the year and formed people’s main occupation during the week. The home’s staff were now less directly involved in arranging the day activities that Cornerstones (UK) provide for people outside the home. Mr Smitherman said that this had been beneficial for service users, as the roles of staff were now clearer and the day services were better co-ordinated. During the visit on 14th November 2007, the planned activity was a pub lunch and a skittles match in a nearby town. One service user had chosen not to go out with the others on 14th November. They spent time in their room and were in the dining room later when the other service users returned from their day activities. The Expert by Experience met people at this time and commented ‘There was not much evidence of staff chatting or interacting with residents. Most sat or stood around on their own’. The Expert by Experience asked staff about people’s routines, and reported: ‘Most have a day service but not much happens in the evenings. Sometimes people go out on a Sunday to the pub or swimming. If residents need personal shopping they can have one to one support. Each resident gets a holiday and goes with other residents or on their own. They don’t all go as a group’. People’s personal files contained information about their family backgrounds and significant relationships. In their surveys, relatives commented positively about the way in which the home helped people to keep in touch with them. They also felt that they were kept up to date with important issues affecting their relatives in the home. The care plans included a section on ‘Diet’, which provided information about people’s individual needs and preferences. People had their main meal together in the evening. A menu was written each week. A selection of old menus was looked at. These provided basic details of the different meals served. However, entries on the menus such as ‘veg’ and ‘personal choice’, meant that there was limited information about some dishes and meals. The Expert by Experience observed that everyone was offered a drink when they returned to the home and that these were served to people in plastic beakers. The Expert by Experience commented on one restriction: ‘The kitchen is closed at 10pm and no snacks or hot drinks are available. This is because there are no waking staff at night. Residents can’t or are not encouraged to help themselves, I think this was to do with health and safety’. High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good overall People’s personal care and health needs are being met, however their medication has not always been well managed. This judgement has been made using available evidence including the visits to the home. EVIDENCE: People’s day to day personal care needs were described in their individual plans. The plans included guidance for staff about people’s preferred routines at different times of day. There was evidence on people’s personal files of the involvement of outside professionals and of people receiving support from the local Community Team for People with Learning Disabilities (C.T.P.L.D.). The personal files contained ‘My Health’ booklets, which include relevant information should a service user need to leave the home or be admitted to hospital. In their surveys, relatives confirmed that people in the home were receiving the care and support that they would expect. High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 16 People received support with the administration and safekeeping of their medication. A ‘Medication Profile’ had been completed for each service user. Their medication was being kept securely. It was seen from the minutes of staff meetings held during April and September 2007 that there had been discussions about the administration of medication. Staff members had not always been completing the medication records appropriately. They had been reminded at the meetings of the need to sign the record on each occasion that medication was administered, or to use the correct code when necessary. Examples of the current medication administration records were looked at. These had been completed appropriately. High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate overall. Some people in the home are dependent on others to raise any concerns on their behalf. There are procedures in place that help with this, however people have not been adequately protected by the home’s recruitment practice. This judgement has been made using available evidence including the visits to the home. EVIDENCE: Cornerstones (UK) had produced a policy on complaints, which was kept on the home’s complaints file. The address of the registration authority was not accurate, as it had not been changed from the National Care Standards Commission to the Commission for Social Care Inspection. The name of the person with responsibility for managing complaints had not been recorded. It was reported in the AQAA that the home had not received any complaints during the last year. The Commission has not received complaints about the home during this period. A pictorial complaints procedure had been produced for service users. People varied in their capacity to make a complaint and the support that they would need with this. In their surveys, the relatives confirmed that they knew how to make a complaint if they needed to. The Expert by Experience observed that several residents did not communicate with words and was concerned about how they could complain if they needed to. High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 18 In the AQAA, Mr Smitherman reported that one of the things that the home could do better was to provide a clearer and more effective system for recording concerns and complaints, taking into account each service user’s needs and their ability to communicate. Cornerstones (UK) had produced a policy and procedure about responding to abuse and the action to take. The home had a copy of Swindon and Wiltshire’s policy and procedures for safeguarding vulnerable adults. Copies of the ‘No Secrets’ booklet were available to staff members. This gave guidance about the local procedures for reporting allegations of abuse. Staff members confirmed in their surveys that they knew what to do if a concern was raised with them. The home has had experience of the safeguarding adults process, but there were reported to be no current investigations. Abuse awareness was included in Cornerstones (UK)’s staff training programme. It was also included as a topic in the Learning Disability Award Framework training that new staff members received. The arrangements for carrying out checks of the POVA (Protection of Vulnerable Adults) list were discussed with Mr Smitherman during the visit on 14th November 2007. A new member of staff had started working in the home before the outcome of their POVA check was known. See ‘Staffing’ section of this report. High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate and improving. The accommodation is meeting people’s needs and being improved with the provision of new facilities. This judgement has been made using available evidence including the visits to the home. EVIDENCE: 10 High Street is a detached house in a prominent position within the village. There is a large garden and a car parking area at the rear of the property. Various changes have been made to the accommodation over the years and these have continued since the last 12 months. Recent work has focussed on redecoration and on increasing the number of bedroom en-suite facilities. Each service user has their own bedroom. One service user has an en-suite bathroom and another person has an en-suite shower. A lounge has received attention since the last inspection. Facilities have been added so that it can be used as a sensory room. Mr Smitherman said that it High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 20 was not well used at present and he was looking at ways in which the room could be improved and made more comfortable. The Expert by Experience saw the room and thought that it was not as welcoming and comfortable as it could be. The other communal room was used more often and it was where people usually gathered together. One half of the room was a sitting area with sofas and a television. The other half was used as a dining area. The carpet in the sitting area was stained when it was seen during the visit on 14th November 2007. Mr Smitherman said that there were plans to replace this carpet with a vinyl floor covering. This choice of covering was discussed and Mr Smitherman was recommended to do some research on types of carpet type floor coverings that would be suitable for the location, and would also not be a slipping hazard if it became wet. A new carpet had been fitted by the time that the second visit was made on 27th November 2007. It was seen at the last inspection that chains had been fitted on bedroom windows, although it was unclear what their purpose was as they did not significantly restrict the opening of the windows. The chain in one service user’s room had been broken. It was recommended at the time that the use of the chains on windows was reviewed and action taken to ensure that the window openings were suitably restricted where assessments showed this to be necessary. No action has been taken in respect of the chains. Mr Smitherman reported that it was the intention to carry out a risk assessment in respect of each window, to ascertain if there was a need for these chains to be in place. The home was generally clean and tidy at the time of the inspection. The bathroom would benefit from further attention in order to produce a more hygienic appearance. The paintwork was showing some ‘wear and tear’ and there was a cracked tile. The toilet was in need of a more thorough clean to remove stains. High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is adequate overall. It is poor in respect of Standard 34. There are shortcomings in the staffing arrangements, which reduce the staff team’s effectiveness and may put people at risk. This judgement has been made using available evidence including the visits to the home. EVIDENCE: There was a staff team of seven people, of whom three had achieved a National Vocational Qualification (NVQ) in care at level 2 or above. Two staff were currently working towards their NVQ at level 2. One new staff member had been appointed since the last inspection. This person was working when the home was visited on 14th November 2007. The home’s recruitment practice was discussed with Mr Smitherman. There was a policy on recruitment. This confirmed the need for references, proof of identity and police checks to be obtained. When the arrangements were looked at in respect of the new staff member it was found that this person did not have a Criminal Records Bureau (CRB) disclosure and their name had not High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 22 been checked against the Protection of Vulnerable Adults (POVA) list. Mr Smitherman said that a CRB had been applied for and that a POVA first request had not yet been returned. Mr Smitherman was advised to discuss this with the responsible individual for Cornerstones (UK) and to take appropriate action concerning the staff member’s continuing contact with people in the home. Cornerstones (UK) had a training manager who arranged courses and training events for staff members. There was a training policy, which set out the training that staff would receive. Areas of training were listed under the headings of ‘Essential’, ‘Desirable’, ‘Specialist’ and ‘Mandatory’. The training plan looked very comprehensive. Priorities were identified for the training events that staff members needed to attend during their first year. There was a white board in the office which showed when certain training courses had been attended and when refresher training was due. This gave an overview of how some training needs were being met. The records in the home did not reflect all areas of training, as set out in the training policy. It had been recommended at the last inspection that staff attended a wider range of training, including disability and equality training, which was listed in the training plan as essential. The home’s deputy manager co-ordinated training in the home and identified the courses that staff members needed to attend. Requests were then made for courses and the home received a monthly training schedule, which included details of training events arranged for the coming months. Sometimes requests needed to be made a number of times before a particular course or training event became available. Refer to the ‘Conduct and Management of the Home’ section of this report. The deputy manager confirmed that all staff were up to date with first aid training, except for one staff member who had not been able to attend the course that had previously been arranged. A request had been made for this person to attend a course. It was reported at the last inspection that individual supervision meetings had not taken place on a regular basis during the last year. The manager had confirmed at the time that a plan for supervision was to be implemented. They reported that each staff member would have regular supervision meetings at least six times a year and that these would be recorded. Mr Smitherman confirmed that the current records only showed that staff members had attended two supervision meetings since January 2007. Other meetings were reported to have taken place but not recorded or pre-planned. Mr Smitherman reported that supervision meetings from January 2008 would be planned in advance and identified on the monthly staff rota. High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 23 Staff members were asked in the surveys if their manager met with them to give support and discuss how they are working. Of the four possible responses (Regularly, Often, Sometimes or Never), three staff members stated ‘Sometimes’, two stated ‘Regularly’ and one person responded ‘Often’. High Street (10) DS0000060341.V351399.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is poor. 10 High Street was without a registered manager at the time of this inspection. Service users cannot feel confident that the running of the home is being appropriately overseen by Cornerstones (UK). This judgement has been made using available evidence including the visits to the home. EVIDENCE: At the time of the last inspection, the home’s registered manager was on longterm leave. Mr Smitherman was appointed to manage the home and the registered manager did not return. During the last year, there has been correspondence with the responsible individual for Cornerstones (UK), confirming the need to apply for the registration of a new manager. In spite of this, the Commission has not received an application and it has been several months before any action has been taken in connection with this. High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 25 It was reported in the home’s Statement of Purpose, dated June 2007, that an application to register a new manager was shortly to be made. During the visit on 14th November 2007, Mr Smitherman said that he had applied for a Criminal Records Bureau (CRB) but this had not yet been returned. This is a prerequisite check that must be made before an application can be made to register as manager. A representative of Cornerstones (UK) was visiting the home regularly in order to report on the conduct of the home. A director of the company was also in the role of ‘responsible individual’. These arrangements have not ensured that the home is being run appropriately. Apart from the delay in registering a new manager, the home’s recruitment process has not sufficiently protected service users, as reported in the Staffing section of this report. There are requirements from the previous inspection that have not been addressed. In the absence of a registered manager, it is the responsibility of Cornerstones (UK) as the registered provider to ensure that inspection requirements are complied with. Cornerstones (UK) had produced a plan for quality assurance. The system for quality assurance included an internal audit of how well the home was meeting National Minimum Standards. The records of the audits undertaken in recent months showed the actions that were required in order to meet the standards and the dates by which these were to be completed. However in most cases the actions had not been completed and the audit records did not show what, if any, progress had been made within the specified timescales. The arrangements being made for quality assurance also included the sending out of questionnaires. It had been recommended at the last inspection that the views of service users are sought on a more individual basis as part of the home’s system of quality assurance. Mr Smitherman reported that questionnaires had been forwarded to the home, which would enable the service users’ views to be recorded and actioned in line with the quality assurance programme. There was a policy for ‘Health, Safety and Welfare at Work’, although this was in the name of another home that was run by Cornerstones (UK). There was a file containing records of risk assessments which had been undertaken in respect of certain hazards in the home. Some review dates had been changed, although the reason for this was not clear from the records. For example, the risk assessment of a radiator had been carried out in March 2006 and the date for reviewing the assessment had been changed from March 2007 to March 2008. A staff member completed a health and safety inspection checklist each month. The home’s fire risk assessment had been reviewed in October 2007. It was seen from the minutes of staff meetings held since the last inspection that there had been discussions about the need to attend to health and safety High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 26 matters in the home. It was recorded on different occasions that health and safety and kitchen checks were not being completed as they should be. Staff members had not received fire instruction since September 2006. Mr Smitherman was aware that staff needed to receive further training. Requests had been made for the training to be arranged. Mr Smitherman had expressed concern to Cornerstones (UK) about the lack of provision for this. There was a record in the fire log book stating that he had asked for this to be urgently looked into. Following the visits to the home, Mr Smitherman has reported that arrangements had been made for staff to receive fire training and this would be completed by 7th December 2007. High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 27 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 2 2 X 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 1 X 2 X X 1 X High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes 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 YA1 Regulation 6 Requirement The Statement of Purpose and the Service User’s guide must be kept under review and, where appropriate, revised. This requirement from the previous inspection has been met in part. 2 YA1 17(2) 5 (1) Details of the total fee payable and the arrangements in place for charging and paying for any additional services must be included in the Service User’s guide and in the service users’ terms and conditions statements. This requirement is outstanding from the previous inspection. 3 YA1 5 12(1) The registered provider must 31/03/08 demonstrate that the arrangements made for the use of service users’ personal money on activities and meals outside the home are appropriate, consistent with the terms of their contracts and have been agreed with the relevant parties. This requirement is outstanding from the previous inspection. High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 29 Timescale for action 31/03/08 31/03/08 4 YA34 19 There must be a thorough recruitment procedure which ensures the protection of service users. New staff must only have contact with a service user after a check has been made of the Protection of Vulnerable Adults (POVA) list and this is satisfactory. Each staff member must have regular, recorded supervision meetings at least six times a year. This requirement from the previous inspection has been met in part. 15/11/07 5 YA36 18 (2) 31/12/07 6 YA37 8(1) Cornerstones (UK), as the registered person, must ensure that an application to register a manager is made without delay. The Commission must be a supplied with a report which includes an evaluation of the quality of services provided at the care home. The report must refer to those matters which are detailed in Regulation 24(2) of the Care Homes Regulations 2001. Cornerstones (UK) must ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. In order to show compliance with this requirement, the arrangements that the home is making for monitoring health and safety need to be implemented consistently. 15/11/07 7 YA39 24(2) 31/03/08 8 YA42 12(4) 28/11/07 High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 30 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 That a policy is produced regarding the use of service users’ money, including the financial contribution that service users are expected to make towards the cost of day activities and meals taken outside the home. This recommendation is outstanding from the previous inspection. 2 YA6 That the care plans are produced in formats that meet the needs of individual service users. This recommendation is outstanding from the previous inspection. 3 YA6 That the service users’ objectives are more clearly defined. This will enable progress with achieving the objectives to be more accurately measured. This recommendation is outstanding from the previous inspection. 4 YA6 That service users are more closely involved in the care planning process and that this is reflected in the format used and the way that the plans are written. This recommendation is outstanding from the previous inspection. 5 YA17 That the weekly menus include more detail about the meals that are being served. This is in order to show that service users receive a varied menu that meets their individual needs. That the use of the chains on windows is reviewed and appropriate action taken to ensure that window openings are suitably restricted where assessments show this to be necessary. This recommendation is outstanding from the previous inspection. 6 YA24 High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 31 7 YA35 That 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. This recommendation is outstanding from the previous inspection. 8 YA35 That a staff training and development plan is produced which reflects all areas of training, as identified in the training policy, and shows timescales for staff to attend courses where necessary. That the views of service users are sought on a more individual basis as part of the home’s system of quality assurance. This recommendation is outstanding from the previous inspection. 9 YA39 High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI High Street (10) DS0000060341.V351399.R01.S.doc Version 5.2 Page 33 - 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. 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