Inspection on 18/10/05 for High Street (10)

This inspection was carried out on 18th October 2005.

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

The inspector found 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 9 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) 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 Unannounced Inspection 18th October 2005 11:15 High Street (10) DS0000060341.V257164.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 High Street (10) DS0000060341.V257164.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. High Street (10) DS0000060341.V257164.R01.S.doc Version 5.0 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 Mrs Lorna Jayne Hale Care Home 8 Category(ies) of Learning disability (8) registration, with number of places High Street (10) DS0000060341.V257164.R01.S.doc Version 5.0 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. 11th April 2005 Date of last inspection Brief Description of the Service: 10 High Street is a detached house in the village of Semington, which is close to the towns of Melksham 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 provides care and accommodation 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 separate lounge, a dining room with a seating area and a kitchen. There is a separate laundry room. One service user’s bedroom is on the ground floor and the remainder are on the first floor. The office and sleep in room is on the ground floor. Access to the first floor is by stairs only. 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 and a one to one arrangement for one service user. High Street (10) DS0000060341.V257164.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over five and a quarter hours. There was a partial tour of the premises and the inspector looked at the following records; medication records, care plans and needs’ assessments, daily notes, menu records, the accident book and fire safety records. Two service users were at home and later all of the service users returned after their day care sessions. Five service users were spoken with. Not all of the service users can comment directly about the care they receive. Observations of the way service users are able to communicate and make themselves understood formed part of the inspection. The inspector spoke to two staff and the manager who was on duty. The registration certificates had recently been amended and sent to the responsible individual and these were not in place at the time of the inspection. What the service does well: What has improved since the last inspection? The environment has improved dramatically since the last inspection. The laundry room has been removed, which has created natural light and space in the dining room. This room has been redecorated and sectioned off with some carpeting to create an additional comfortable seating area. A new laundry room has been fitted into the previous staff sleep in room. The staff office has been expanded by removing an internal door, which is now an office and sleep in room. Other parts of the home have been redecorated and re carpeted. This includes service users’ ensuites and bedrooms. Service users have been involved in making choices over colours. High Street (10) DS0000060341.V257164.R01.S.doc Version 5.0 Page 6 This change and the vacant bed seems to have helped to create a calmer atmosphere in the home. Service users are reported to be more relaxed and positive changes in their behaviour have been noted. This has included improvements in eating habits, which may also have contributed to the change in behaviour and atmosphere. 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. High Street (10) DS0000060341.V257164.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 High Street (10) DS0000060341.V257164.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): 2 and 5 Standard 2 was not assessed on this occasion as no new service users have been admitted to the home. The service users, their families, or purchasing authorities may not be aware of any additional costs borne by the service users. EVIDENCE: The service users’ contracts were looked at, as this was a continuing requirement from previous inspections. The new contract stating the new name of the organisation is in place and attempts have been made by the manager to ensure that the placing authority signed them. Not all of the placing authorities would do this and there are letters on file to show this. The new contract still does not specify any extra charges and what they are for. Service users are expected to contribute towards petrol costs for communal vehicles and these charges or any other extras the service user pays for are not detailed. High Street (10) DS0000060341.V257164.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 and 7 Standard 9 was assessed and met at the last inspection. Care plans are not accessible to service users and therefore their involvement is limited. Service users’ needs have been comprehensively assessed, which should lead to clearer care plans. EVIDENCE: These standards were looked at during the last inspection and were looked again as requirements had been set. The care plans previously in place are about to be discarded, as they are too unwieldy for staff to use. A new format has been shared among the managers for discussion and a needs assessment has been completed on all service users. The issue of relevant and meaningful care plans that involve the service users was discussed as part of the inspection. It is hoped that any discussions about new formats will be shared with the CSCI before they are introduced. Needs assessments were completed and showed a good range of detail about the service users’ needs. This would easily lead into a care plan, which shows how the need is to be met. High Street (10) DS0000060341.V257164.R01.S.doc Version 5.0 Page 10 Staff are expected to complete a monthly review on service users and send a copy of this to the care manager in the placing authority. This includes any changes in physical health, occupational and recreational activities. There is little evidence that service users are involved in their care plans or in how they make decisions about their own lives. High Street (10) DS0000060341.V257164.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): 15, 17 Standards 12, 13, 16 and 17 were assessed at the last inspection. Standard 17 was not met. Service users have relationships with other service users and family members. Service users benefit from a varied diet where they are able to make choices over food and meals. EVIDENCE: Service users have some difficulties with making positive relationships with each other in the home, due to the different needs and communication methods. However, staff try to ensure that service users communicate with each other clearly and try to help them understand the other’s point of view. Other service users have appropriate family relationships. Menu records were looked at and the range of food in the kitchen. There are two new fridges and the freezer is now in the laundry room. Menus show when service users have made particular choices when the meals are being planned. This is good practice. High Street (10) DS0000060341.V257164.R01.S.doc Version 5.0 Page 12 Menus are drawn up weekly with a service user involvement and a separate lunchtime menu is now kept. There is a high level of detail and combined with the main meal menu shows the variety of meals that service users have. The home aims to support service users with healthy options. The diet for one service user was discussed and advice will be sought from healthcare professionals to ensure that nutritional needs are met. Staff reported that service users who had a limited diet due to their choices had now expanded the range of foods they will eat and staff had noticed a positive change in their behaviour. High Street (10) DS0000060341.V257164.R01.S.doc Version 5.0 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 the following standard(s): 20 Standard 18, 19 were assessed as met at the last inspection. Some aspects of medication recording and safekeeping puts service users at risk. EVIDENCE: The medication file contains information about ordering, collection, storage, administration and if service users self -administer their medication. There is a new medication storage unit, which needs to be chained to the wall. The manager was aware of this and has asked for this to be done as a recent pharmacy inspection also highlighted this. Medication is received in to the home from two different pharmacies, in a fourweek cycle. The CSCI pharmacy inspector has provided advice and guidance, which has been followed. None of the service users have been assessed as able to self medicate. There was one occasion in a previous month when one whole day’s worth of medication was not recorded. The staff member concerned was spoken with about this during a supervision session. There are clear records regarding the ordering, collection and storage of medication. Staff have not been using codes consistently when medication is taken to the service users’ day care. High Street (10) DS0000060341.V257164.R01.S.doc Version 5.0 Page 14 A distance learning pack has been ordered for staff to receive medication training. This should start in November 2005. High Street (10) DS0000060341.V257164.R01.S.doc Version 5.0 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 the following standard(s): 23 Standard 22 was assessed as met at the last inspection. Service users are at risk as staff may not be familiar with adult protection procedures. EVIDENCE: Staff training records could not provide evidence of staff training. This includes adult protection. The deputy manager will be taking a lead on identifying training in the home, whilst training across the company is organised by another staff member from one of the other homes. Staff who received this training in 2002 should receive refresher training as since then, the ‘No Secrets’ guidance has been produced. High Street (10) DS0000060341.V257164.R01.S.doc Version 5.0 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 the following standard(s): 24 and 30 Service users benefit from improvements in the home’s layout and refurbishment. EVIDENCE: These standards were looked again as they were not met at the last inspection. An action plan was required to show when work would take place. The manager showed the inspector a letter dated in May 2005, which included a copy of the plans for the work to be completed in the home. The CSCI did no appear to have received a copy of this letter or the plans. It is not clear whether other regulatory bodies have inspected the work and a letter was sent to the home following the inspection to advise about this. A substantial amount of work has taken place that has improved the home enormously. The dining room has been extended into the previous laundry room. This has increased the amount of natural light into this room as well as increasing the space. There are two large dining tables and the manager plans to replace these with three round dining tables. One area of the dining room has been sectioned off with carpet and a new seating area has been made, with a sofa and an armchair and a small T.V. High Street (10) DS0000060341.V257164.R01.S.doc Version 5.0 Page 17 The staff sleep in room has been made into a laundry room. This has a new washing machine and dryer, as well as a sink and cupboards. The flooring has not been installed yet. One of the ground floor bedrooms has been extended slightly, as a small hallway entrance to the bedroom has been removed. This plus the removal of a fireplace has made the room large enough to be used as an office and staff sleep in room. There are further plans to renovate one of the first floor bedrooms. All the ensuite bathrooms have had a new bath side panel and new flooring and other service users have had their bedrooms decorated, with some support in choosing colours. A number of doors do not have automatic closures. This would help with the ambience of the home, as doors will be able to be kept opened when connected to the fire alarm system. All parts of the home were clean and tidy. High Street (10) DS0000060341.V257164.R01.S.doc Version 5.0 Page 18 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 and 35 Service users do not benefit from a competent and qualified staff team. EVIDENCE: Standard 32 and 35 were assessed as having minor shortfalls at the last inspection. There are still shortfalls in staff training. Staff are completing an induction handbook and the manager stated that due to changes in the home, all staff will be re – inducted. It was noted that the trainer and the trainee had completed not all sections. One staff member is working towards NVQ level 3. The range of information on staff training was not current. An action plan must be devised with a plan of training that staff are to take part in over the next twelve months. Some staff who work at 10 High Street also work at other Cornerstones homes. The range of records about their training and recruitment were not in place. High Street (10) DS0000060341.V257164.R01.S.doc Version 5.0 Page 19 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 Service users are partly protected by a range of safety records and checks. EVIDENCE: Standard 39 was assessed at the last inspection. It was not met at that time, but since then Cornerstones and the CSCI have met and a quality assurance system is in place and a report has been written. Fire safety records are in order. The accident record has been completed correctly, although there has been some confusion over the new format. The completed individual sheets can be filed in the Service users’ files. There is a locked cupboard for cleaning materials in the new laundry room. COSHH safety data sheets need to be obtained for all products in use in the home. High Street (10) DS0000060341.V257164.R01.S.doc Version 5.0 Page 20 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 X X X X 2 Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 X X 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 X 13 X 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 X X 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 High Street (10) Score X X 2 X Standard No 37 38 39 40 41 42 43 Score X X X X X 2 X DS0000060341.V257164.R01.S.doc Version 5.0 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 Requirement Timescale for action 31/03/06 2. 3. YA6 YA20 4. YA20 17(2)& Sch Copies of contracts and terms 4.9 and conditions must specify fees and any extra charges and what these are for. These must be held in the 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 the requirement is not met by the timescale set. Met in part on 18.10.05 as fees and service user’s contributions are detailed, but any extras paid for by the service user are not. 15 (1) (2) Care plans must be consistently 30/12/05 reviewed for all residents. 13(2) Staff must ensure that the 30/10/05 correct codes are used when recording when medication is administered by outside agencies. 13 (2) Staff must receive training in 30/12/05 administration of medication that includes recording and information about types of medication and possible side effects. (Carried forward from the last inspection) DS0000060341.V257164.R01.S.doc Version 5.0 High Street (10) Page 22 5. YA23 6. 7. YA30 YA35 8 YA35 9. YA42 All staff must receive training in adult protection, signs and symptoms of abuse and Wiltshire No Secrets guidance. (Carried forward from the last inspection.) 23 (2) (b) The laundry room must have waterproof flooring installed. 18(1)(a)(c) An action plan must be (i) (ii) produced to show what training staff are expected to take part in the next twelve months. 19(4) Staff who are employed in a (a)(b) (c) range of Cornerstones homes, must have their training records recruitment records in place in each home are employed in. 13 (4) (a) COSHH records must be in place for any cleaning product in use in the home. 13 (6) 30/12/05 30/11/05 30/11/05 30/11/05 30/11/05 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 Good Practice Recommendations Standard YA35 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) YA21 The death and dying procedure needs to be amended to contain clear instructions about contacting emergency services in case of a sudden death. YA6 Service users should be involved in their own care plan. YA6 A referral should be made to a speech and language therapist to develop the communication needs for service users in the home. YA24 Door guards connected to the fire alarm system should be installed. 2. 3. 4. 5. High Street (10) DS0000060341.V257164.R01.S.doc Version 5.0 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. 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