Inspection on 22/04/09 for High Street (10)

This inspection was carried out on 22nd April 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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) 11/04/05

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 09/07/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: High Street (10) High Street (10) Semington Trowbridge Wiltshire BA14 6JR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Malcolm Kippax     Date: 2 9 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 37 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 37 Information about the care home Name of care home: Address: High Street (10) High Street (10) Semington Trowbridge Wiltshire BA14 6JR 01380870061 01672569477 semington@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Cornerstones (UK) Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 8 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. Date of last inspection Brief description of the care home 10 High Street is one of a number of care homes in Wiltshire that are run by Cornerstones (UK) Ltd. 10 High Street is a detached property in Semington, a village between Melksham and Trowbridge. Each person at the home has their own bedroom. There are two bedrooms on the ground floor and the others are on the first floor. Some of the bedrooms have en-suite facilities. The communal rooms include an open plan lounge and dining room. There is another lounge that is also used as a sensory room. Care Homes for Adults (18-65 years) Page 4 of 37 Brief description of the care home 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 and a car parking area. People who use the service receive support from a manager, deputy manager and a team of support workers. The weekly fee is 1385 pounds per week. Inspection reports can be obtained from the home and are also available through the Commissions website at www.cqc.org.uk Care Homes for Adults (18-65 years) Page 5 of 37 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Before visiting 10 High Street, we asked the home to complete an Annual Quality Assurance Assessment known as the AQAA. This was their own assessment of how they were performing. It gave us information about what has happened during the last year, and about their plans for the future. We sent surveys to the home so that these could be given out to staff members and to outside professionals. We had surveys back from six staff members and from two health professionals. We looked at all the information that we have received about the home since the last inspection. This helped us to decide what we should focus on during an unannounced Care Homes for Adults (18-65 years) Page 6 of 37 visit to the home, which took place on 22nd April 2009. During the visit we met with some of the people who live and work at 10 High Street. We went around the accommodation and looked at some of the homes records. We met with other people from the home at a nearby community centre that they were using. A staff member assisted us during the visit, as the homes manager was on leave. We went back to 10 High Street on 29th April 2009 in order to complete the inspection and give feedback about what we had found. We met with the homes manager during that visit. The judgements contained in the report have been made from all the evidence gathered during the inspection, including the visits. The previous key inspection of 10 High Street was in April 2008. What the care home does well: What has improved since the last inspection? Information about the home has been updated, so that people have the correct details about the management and staffing arrangements. Some of the homes policies and procedures have been reviewed. This includes the policy for the provision of personal care, and the procedure for using a monitoring device with somebody who has epilepsy. There is now clearer guidance about good practice in these areas. The recording of peoples medication has also improved. Its clearer to see that people have had the right medication at the right time. A pictorial menu board is now being used, which means that it is easier to know whats on the menu for a particular day. Some new training has been arranged for staff. This has included a course about how to communicate better with the people who use the service. Staff members are working with one person at the home in particular, to help this person develop their communication skills. A speech therapist has been involved, and given the staff team Care Homes for Adults (18-65 years) Page 8 of 37 guidance about best to do this. Cornerstones (UK) have opened a new day centre, which can be used by the people who live at 10 High Street. People can meet with friends there and are able to try some new activities. Work has continued in the home to improve the decoration and upkeep of the accommodation. The kitchen and the main communal area have been refurbished. These rooms have a more modern and stylish look, which people at the home said they liked. What they could do better: 10 High Street has been without a registered manager at the last two key inspections. We told Cornerstones (UK) at these inspections that the registration of a manager was a priority. This was to ensure that Cornerstones (UK) met its statutory responsibilities, and the people who used the service knew that the manager was a fit person to run the home. Managers have been appointed, but they have left before the registration process was completed. A new manager started in January 2009 and is applying to be registered. It is important that a period of stability is now maintained. This is so that people can be confident about how the service is being managed, and how it will develop in the future. There is a lack of information about peoples personal goals, and how they will achieve these. The individual plans tend to focus on needs and problems, rather than on what people can do and would like to achieve in the future. This is likely to affect the quality of life that people experience. The home should produce information in ways that makes it easier for the people who use the service to understand. We thought that people would benefit from having more support that helps them to maintain and develop particular skills. This would include for example, support with communication skills, and with domestic skills such as cooking. Health action plans should be produced with the people who use the service. This will ensure that there is good information about peoples health needs, and the health services that they may need in the future. The homes medication procedures have improved, however further changes are needed to ensure that people who use the service are fully protected. A staff training plan should be produced, which covers all areas of training as identified in the homes training policy. This will help to ensure that the people who use the service benefit from staff who are well trained, and who are increasing their knowledge and skills. The views of the people who use the service should be sought on a more individual Care Homes for Adults (18-65 years) Page 9 of 37 basis, as part of the homes system of quality assurance. Surveys have been used in the past, although people find these hard to complete, and the questions difficult to answer. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 37 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 37 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available to help people decide whether the home will meet their needs. However the written format of the information is not suitable for the people who use the service. There are plans to address this by producing some of the information in a different way. Evidence: A Statement of Purpose for 10 High Street was kept in the home, and this was available to interested parties. Each person who lived at the home also had a Service Users guide. The guides were kept on peoples personal files. The Statement of Purpose and Service Users guide had both been updated during the last year. They included details of the current management and staffing arrangements. The Service Users guide had more information about what the fees cover, and what they dont. This helped to ensure that there were no misunderstandings about how things were funded, and what people who use the service had to pay for out of their own money. Care Homes for Adults (18-65 years) Page 12 of 37 Evidence: The Service Users guide included pictures, as well as words. This made the guide more interesting to look at. However the guides had not been produced in a format that would meet the communication needs of the people who used the service. We were told in the AQAA that the homes plans for improvement included producing information for people in accessible formats. The manager said that they would be using a video camera to produce information in a different format, which would help people understand the contents of the Service Users guide and their own care plans. Most people at 10 High Street have lived together at the home for several years, although one person moved in during 2007. We inspected the home shortly after the person had moved in, and looked at the admission arrangements at that time. We saw that a needs assessment and a care plan had been received from the persons placing authority. The home had also completed its own assessments. Other information had been recorded about the persons needs. This included personal risk assessments and guidelines for staff about how the person should be supported. A new care plan had been produced shortly after the person moved into the home. We did not look at the assessment arrangements again during this inspection, as the homes occupancy has not changed since the person moved in during 2007. Care Homes for Adults (18-65 years) Page 13 of 37 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs and preferences are reflected in their individual plans. However there is little information about peoples personal goals and the new things that they would like to do. This is likely to be affecting peoples quality of life. Peoples right to make decisions is being respected. Staff are looking at new ways of working with people. This will help to ensure that people can express their own choices as much as possible. Evidence: Each person who used the service had a file which contained an individual care plan and a range of assessment forms. We looked at three peoples files. Two people had plans that had been written in April 2008. The plans included review and amendment sections, where more recent information about peoples needs had been recorded. This helped to ensure that staff were aware of any changes in peoples care plans and in the support that they needed. The third person had a new care plan, which was dated Care Homes for Adults (18-65 years) Page 14 of 37 Evidence: April 2009. The care plan had been agreed at a review meeting which was held in March 2009. Staff members told us in their surveys that they were being given up to date information for example in the care plan about the needs of the people they supported. Peoples plans covered a range of needs, such as Health, Safety, Communication, Diet, Behaviour and Spiritual Awareness. The plans provided guidance for staff about peoples needs and preferences in different areas of their lives. There was information on peoples files about their likes and dislikes, and their preferred routines. We had recommended at previous inspections that peoples personal objectives are more clearly identified within their individual plans. There were sections in the plans about strengths and needs and individual goals. However, we have found that these were not being completed consistently. During this inspection we saw that there was still a lack of information about peoples personal goals, and how they would be supported with achieving these. The person who had a new care plan in April 2009 did have some goals identified. However, these related to health and care needs, rather than on nice things that they might like to do. One goal was to have a health action plan and another was to be referred for new boots. The staff member we met on 22nd April 2009 acknowledged that the plans focussed on peoples needs and problems, rather than on their goals and abilities. The plans were in a written format, which meant that they would not be understood by the people who lived at the home. We talked to the manager about producing a version of the plans in a different format that would meet peoples communication needs. We were told in the AQAA that the home had a video camera, which they were planning to use to produce information in a new way. A system of cross-referencing was being used in peoples care plans to show when risk assessments had been undertaken. Activities, such as travelling in the homes vehicle, and using the stairs, were being assessed. Assessment forms had been completed, which included guidance for staff about how to reduce the risks for people. The care plans referred to some restrictions that were in place about peoples movements. These included using the kitchen, or leaving the home without staff support. It was reported that these restrictions were in place for safety reasons. We saw examples of how people made decisions in the home. People had helped to Care Homes for Adults (18-65 years) Page 15 of 37 Evidence: choose colour schemes for the accommodation, and they could have their own rooms as they wished. Some people had keys to their rooms. A risk assessment had been undertaken in connection with one persons room. This showed that staff respected how the person wanted to keep things in their room, but also wanted to make sure that this would not create a hazard for the person, or for other people. When we visited the home on 22 April 2009, one person stayed in during the day, rather than attend a planned outside activity with other people. We were told that this was something that they chose to do on a regular basis. In their survey, one health professional told us that they thought the staff were very committed to giving people at the home opportunities and experiences to improve their lives. However, they commented about the need for a more proactive and strategic approach to meeting some peoples individual needs. This included using different communication approaches with people, and ensuring that specific interventions were consistently applied. The other health professional also mentioned that peoples individual needs were mostly met but let down by some aspects of inconsistency. We saw that there had been developments since the last inspection in relation to supporting people with their communication needs. A pictorial menu board was now being used. This meant that it was easier for people at the home to know what was being served for the evening meal. We thought that the menu board could be developed further to include all the meals for the day or week, and as a means by which people could make choices. Staff members had started working with one person who used the service, to help this person develop their communication skills. A speech therapist had been involved, and given the staff team guidance about how best to do this. P.E.C.S. (Picture Exchange Communication System) was being used. A staff member said that it was the intention to work with this person on a daily basis, in order to increase their knowledge and understanding of the system. Records of the interactions were being kept, although these were not being completed each day. We were told that staff were also to start using P.E.C.S. with a second person. Care Homes for Adults (18-65 years) Page 16 of 37 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have well established daily routines. Most people go out on a regular basis. People can meet with friends and take part in different activities at a new community centre. Further opportunities for personal development should continue to be sought. People are provided with a range of meals that they enjoy. However, there is a lack of detail about the meals, which makes it difficult to assess their nutritional content. Evidence: People were doing different things when we visited the home on 22nd April 2009. Most people went to a day activity that had been planned, but one person went out separately with a staff member. This was part of the one to one support that they received during the day. Somebody else was having a home-based day. Staff told us that they preferred this, rather than doing things outside the home. Care Homes for Adults (18-65 years) Page 17 of 37 Evidence: There was information on peoples personal files about their daily activities and how they liked to spend their time. During the last year, Cornerstones (UK) have been arranging a regular programme of weekly activities, which most people at 10 High Street have attended. The activities were also available to people who used the other services that are run by Cornerstones (UK). They included such things as a skittles match and lunch at a local pub, and arts and crafts sessions at a village hall, which had been hired for the occasion. When we visited on 22nd April 2009 we heard that people at the home had just started using a new day facility, known as the Community Centre that had been bought by Cornerstones (UK). Later in the day we visited the centre, and met with people from the home. The centre had recently opened and programmes of activities were being set up. Some of these, such as gardening and cooking, were to be provided at the Community Centre. Others were planned to take place in the local area, using the Community Centre as a base. We were told in the AQAA that family relationships were actively encouraged. Staff members spoke to us about the visits that were made involving the people who used the service, and their relatives. Peoples personal files contained information about their family backgrounds and significant relationships. We read on one persons file that their relatives had been invited to a recent review meeting. They had attended the meeting and later written to the home confirming their positive view of the care and support that their relative in the home was receiving. The individual care plans included a section on Diet. This provided information about peoples individual needs and preferences. People had their main meal together in the evening. People who commented said that they liked the meals. A menu was being written each week. The menus looked varied, and staff said that they were based on peoples known likes and dislikes. We had recommended at the last inspection that the menu records included more details about the meals being served. This was so that there was a better record of peoples individual choices, and of the nutritional content of the meals. We saw that some further information was being recorded, for example about the type of vegetables that were being served with the main dish. However there was no information being recorded about a second course. A staff member said that people often had fruit or a yoghurt after the main course, but this was not shown on the menus. Care Homes for Adults (18-65 years) Page 18 of 37 Evidence: One person had lunch in the home during our visit on 22nd April 2009. Staff asked this person what they would like, and it was then made for them. The person did not have any planned activities during the day and we asked about whether they would be able to prepare their own meal, with support from staff where needed. We thought that this would help the person to maintain some independence and to develop their domestic skills. Staff members responded positively to this idea. The person was already taking some responsibility for doing their own laundry. Care Homes for Adults (18-65 years) Page 19 of 37 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples main care needs are being met. The recording of medication is improving, yet further changes are needed to ensure that people are fully protected. Evidence: Peoples individual care plans included information about their personal care, medication, and health needs. We read about peoples needs in areas such as bathing, taking a shower, and their personal appearance. There was guidance for staff about the type of support that people needed, for example about whether this involved supervision, or prompting only. This helped to ensure that the support that staff provided reflected what people were able to do for themselves. The plans included guidance for staff about peoples preferred routines. This was well set out so that staff would know what support people needed at different times of day. We saw that the homes policy on gender and personal care had been amended since the last inspection. This now included clearer guidance for staff about the circumstances in which staff members would provide personal care to people of a Care Homes for Adults (18-65 years) Page 20 of 37 Evidence: different gender. In addition to their care plan files, each person at the home had a separate file for the recording of health related matters. The files included a My Health booklet, which included relevant information, should people need to leave the home or be admitted to hospital. We were told in the AQAA that health action plans were to be produced with people in the coming year. The manager confirmed this during our visit. It is important that these plans are produced, as they will help to ensure that arrangements are in place, and services are available, to meet peoples changing health needs in the future. Health appointments and their outcome were being recorded. This helped staff to monitor the progress that people were making with particular health conditions. We saw correspondence from a range of outside professionals, such as consultant psychiatrist, speech therapist, podiatrist, and community nurses. We asked the health professionals in their surveys whether the service met peoples individual health care needs. The two health professionals responded Usually to this question. One commented: But need support to identify and carry these out in some instances. One of the files we looked at was for a person who had epilepsy. There was information about how their epileptic activity was being monitored and recorded by staff. Charts were being maintained, which gave an overview of the activity that had taken place. This information would help when the persons epilepsy profile was next reviewed. There was an agreement about the use of a monitoring device in this persons room. We had reported at the last key inspection that the home needed to have a written protocol about this. This was to show that the use of the device was limited to specific times only, and was operated in a way which respected the persons privacy as far as possible. During the last year, a written procedure for staff has been written, and we saw this displayed in the homes office. The person had an epilepsy profile, which had been produced in December 2008 with the involvement of a learning disability nurse from the community team. The profile included guidance about the administration of emergency medication to this person. Staff members confirmed that they had been trained to administer this medication. Each person had a Medication Profile on their personal file. These provided an overview of peoples needs in relation to medication. We saw that changes in peoples prescribed medication were being recorded in the review and amendment sections of Care Homes for Adults (18-65 years) Page 21 of 37 Evidence: their care plans. This helped to ensure that staff were up to date about the support that people needed with their medication. One person had recently been prescribed new medication that was to be taken on a PRN (as required) basis. We spoke to a staff member about the circumstances in which it would be administered. A full protocol for its use was still to be written. In the meantime, staff were referring to the homes general guidance about the use of PRN medication. This included contacting the manager, or on-call senior, to discuss whether the medication was needed. There have been shortcomings at the last two key inspections in the recording and management of peoples medication. We made a requirement at the last inspection that the administration of medication records must be fully completed, to show that people have received their medication, or not received medication for a particular reason. We looked at the current medication administration records and saw that these were up to date, with no unexplained gaps. Records were being kept of medication coming into the home. We met with the staff member who had responsibility for checking medication and for making sure that the records were completed as required. The staff member confirmed that they checked the records each month. The medication records had been reorganised, so that information was more clearly presented and easier to find. We saw that some prescribing instructions had been handwritten on the medication administration records. These entries needed to be signed, to show who had taken responsibility for ensuring the accuracy of the information recorded. We also talked to the staff member about the administration of one persons medication. Prior to administration, staff were removing this medication from its original container and transferring it to a dosset box. We confirmed that this was not a safe practice. No controlled medication was being stored at the time of our visits. However we have recommended that a suitable cabinet is obtained for the storage of any controlled medication in the future. Care Homes for Adults (18-65 years) Page 22 of 37 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are dependant on others to raise concerns on their behalf. There are procedures in place, which help to ensure that concerns are followed up appropriately, and this reduces the risk of people being harmed. Evidence: Cornerstones (UK) had produced a written complaints procedure. The Service Users guide also included a procedure in pictorial format. The people who lived at 10 High Street had communication needs, which meant that they would be dependant upon other people to raise any concerns formally. We were told in the AQAA that families were actively encouraged to be involved. It was also reported that the homes plans for improvement included making arrangements for people with no family involvement to be able to use an advocate. This would help to ensure that each person who used the service knew somebody who was independent of the home, and who could follow up any concerns on their behalf. Staff members told us in their surveys that they knew what to do if somebody had concerns about the home. We were told in the AQAA that the home had not received any complaints during the last year. In their survey, one health professional commented: The service does usually respond well to any concerns that have been raised. Care Homes for Adults (18-65 years) Page 23 of 37 Evidence: The homes policies and procedures file included a copy of the Department of Healths Guidance on developing and implementing multiagency policies and procedures to protect vulnerable adults from abuse. We confirmed at the last inspection that the purpose of this documentation was to assist organisations when producing their own policies and procedures, rather than it being an off the shelf policy and procedure for use in the home. Cornerstones (UK) had produced other, more specific guidance concerning the protection of people who used the service, and their rights. This included a policy on whistleblowing, and information about the local procedures for safeguarding vulnerable adults. The home also had copies of the No Secrets booklet, which summarises the procedures. Staff members were given a copy of this. The home has had experience of being involved in safeguarding adults investigations. We reported at the last key inspection that one investigation had highlighted the need for the home to report any relevant concerns to the appropriate authorities without delay. The home has kept us informed of various events and incidents during the last year. 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. We looked at the arrangements being made for managing money that is kept in the home on behalf of the people who use the service. Cash account forms were being used to record transactions involving peoples personal money. Receipts for expenditure were being obtained and recorded on the account forms, which had been signed by staff. A staff member said that the records were being checked and audited by a finance officer from Cornerstones (UK). Care Homes for Adults (18-65 years) Page 24 of 37 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in an environment that is generally homely and being improved in a planned way. Evidence: 10 High Street is a detached house which has a prominent position in the village. There was a large garden and car parking area at the rear of the property. Various changes and improvements have been made to the accommodation over the last few years. These have continued during the last twelve months. Recent work has included the refurbishment of the kitchen and the main communal room. These rooms have a more modern and stylish look, which people at the home said they liked. Work had also taken place to improve the appearance of the garden. We were told in the AQAA that the programme of decoration will continue in the next 12 months. There were two communal rooms. The main room was at the back of the house, and this 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. Care Homes for Adults (18-65 years) Page 25 of 37 Evidence: In their survey, one health professional commented: Some meetings and training is done in the dining room / living room area that is not always private to other service users present. The second communal room was used as a lounge and could be available as a quieter area. This room has had some lights and other items installed so that it can be used as a sensory room. There was a domestic type kitchen off the main communal room. We saw that people who live at home could use this room, but with staff present for safety reasons. We had a look at other parts of the accommodation, including some of the bedrooms. Two bedrooms had en-suite bathrooms and two had en-suite showers. There was a bathroom on the first floor which was available to those people who did not have ensuite facilities. The lock on the bathroom door was broken and needed to be replaced to ensure peoples privacy. This was brought to a staff members attention. One person had a latch type lock on their bedroom door, but they did not have a key. It was agreed that, if the person did not wish to have their own key, then the lock should be changed so that the person could get into their room independently. The home had a policy and procedure about infection control. The home generally looked clean and tidy at the time of our visits. Care Homes for Adults (18-65 years) Page 26 of 37 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service benefit from a staff team who know their needs well. Staff training is developing although would be improved by a more planned and consistent approach. Evidence: The home had a team of nine staff members, four of whom worked parttime. It was reported in the AQAA that all the staff had completed induction training as recommended by Skills for Care. We asked staff members in their surveys whether their induction had covered everything that they needed to know when starting the job. Staff members responded Very well and Mostly to this question. The number of qualified staff had increased during the last year. Seven staff members had now achieved a National Vocational Qualification (NVQ) in care at level 2 or above. We had looked at the homes recruitment procedure and records at the last inspection. No requirements or recommendations were made about this. There have been no new staff employed since that inspection, so we did not look at the recruitment procedure again during this inspection. Care Homes for Adults (18-65 years) Page 27 of 37 Evidence: The majority of staff members had worked in the home for several years. In their survey, one of the health professionals commented: A friendly staff team who are welcoming. Another told us The staff at 10 High Street are dedicated and devoted to their jobs. Their care of individuals in very obvious. During our visits we also saw staff going about their work in a friendly and positive manner. When we asked in the surveys what the home did well, one staff member commented: Consistent staff team, apart from the manager the staff team has been the same for many years which benefits the service users. Another staff member told us I am happy and confident in my role and have regular supervisions, which give me the one to one time I need. All the staff members who completed surveys confirmed that their manager met with them regularly to give them support and discuss how they were working. A plan for supervision meetings was displayed in the homes office. 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. We have reported at previous inspections that the training that staff received did not include all the subjects, as set out in the training policy. We looked at training records again during this inspection and were provided with information in the homes AQAA. Staff members were up to date in respect of Mandatory training. Staff members had received training in some other subjects, as specified in the training policy. This included training in equality and diversity, and in communication. We were told in the AQAA that all staff needed to receive training in person centred planning. However there was no staff training and development plan which reflected all areas of training, as identified in the policy. This has been recommended at previous inspections. It would show a commitment to ensuring that all staff attend the full range of training in a planned way, as detailed in the training policy. Staff told us in their surveys that they were being given training that was relevant to their roles, and helped them to understand and meet the needs of people who use the service. We asked the health professionals whether care staff had the right skills and Care Homes for Adults (18-65 years) Page 28 of 37 Evidence: experience to support individuals social and health care needs. They responded Sometimes to this question. One commented There could be improvements across the service to get the right skills and training to meet the needs of individuals. However most of the staff are highly experienced and dedicated to their jobs. Care Homes for Adults (18-65 years) Page 29 of 37 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have not benefited from the arrangements being made for managing the home in recent years. A new manager needs to be registered, and a period of stability maintained. This is so that people can be confident about how the service is being managed, and how it will develop in the future. Evidence: 10 High Street has been without a registered manager at the last two key inspections. We told Cornerstones (UK) at these inspections that the registration of a manager was a priority. This was to ensure that Cornerstones (UK) met its statutory responsibilities, and the people who used the service knew that the home was being managed by somebody who had been approved as a fit person. We have asked the home to complete improvement plans following the two previous key inspections. Four managers have been appointed one on a temporary basis since the previous registered manager was in post. Of these, three have left without applying for registration, or before the application process has been completed. Care Homes for Adults (18-65 years) Page 30 of 37 Evidence: We have made a requirement at previous inspections that Cornerstones (UK) must ensure that an application to register a manager is made. The home continued to be without a registered manager at the time of this inspection. The current manager had started in January 2009 and they told us that they had applied to be registered. It is important that a period of stability is now maintained. This is so that people can be confident about how the service is being managed and how it will develop in the future. The manager confirmed that a director from Cornerstones (UK) was visiting the home each month, in accordance with Regulation 26 of the Care Homes Regulations 2001. We talked to the manager about the content of these visits. Reports of some visits were kept in the home, although not all reports were available for inspection. We were given a copy of a quality assurance report for 2007 - 2008 at the previous inspection of the home in April 2008. This included an audit of standards, which showed areas for improvement and how improvements had been made in the last year. It was stated in the quality assurance report that people who used the service had received annual satisfaction surveys. The report included the outcome of surveys that had been sent to stakeholders, but did not show how the views of people who used the service had been taken into account. We had recommended at the last inspection that their views are sought on a more individual basis as part of the homes system of quality assurance. The manager told us during this inspection that a new quality assurance report would be produced in the coming year. A new audit of the environmental standards had been undertaken. It was planned to send out new surveys to a range of people. We talked to the manager about ways of obtaining feedback from the people who use the service, which would be more appropriate than using written surveys. We were given some information in the AQAA about the arrangements being made for health and safety. We also looked at records in the home. A fire risk assessment was undertaken in January 2009. An in-house health and safety checklist was being completed each month. This helped to identify any maintenance items and hazards that were in need of attention. The local authority had visited the home in January 2009 in order to inspect the premises in relation to Health and Safety at Work legislation. We were told that no Care Homes for Adults (18-65 years) Page 31 of 37 Evidence: requirements were made as a result of this visit. Some booklets were left with the home for guidance when the risk assessments were next reviewed. Care Homes for Adults (18-65 years) Page 32 of 37 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 33 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 Staff must only administer medication from the original containers. This is to reduce the risk of errors being made, and to ensure that people receive their medication in the way that it has been prepared by the dispensing pharmacist. 31/05/2009 2 20 13 When information is handwritten on a persons medication record, the record must be dated and signed by the person who made the alteration including a witness when this is possible. This is to show that any changes to the records have been made appropriately and are accurate. 31/05/2009 3 39 26 Cornerstones (UK) must ensure that reports of all visits that are made to the home in accordance with Regulation 26 of the Care 31/05/2009 Care Homes for Adults (18-65 years) Page 34 of 37 Homes Regulations 2001, are kept in the home and available for inspection. This is to ensure that there is a record of the visits and the findings, and that the people who use the service can be confident that the running of the home is being appropriately monitored by Cornerstones (UK). Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 1 6 The home should produce information in ways that makes it easier for the people who use the service to understand. That peoples care plans are produced in formats that meet their individual needs. This recommendation is outstanding from previous inspections. That peoples objectives are more clearly defined in their individual plans. This will enable progress with achieving the objectives to be more accurately measured. This recommendation is outstanding from previous inspections. That P.E.C.S is used consistently with people, in accordance with the professional guidance that has been received. That support with domestic tasks, such as preparing meals, is provided with the aim of helping people to maintain and develop their independence and lifeskills. That the weekly menus include more details about the meals that are being served. This is in order to show that people receive a varied menu that meets their individual needs in relation to diet and nutrition. This recommendation is outstanding from previous inspections. That Health Action plans are completed with the people who use the service. A cupboard that meets the current storage regulations for controlled drugs, the Misuse of Drugs (Safe custody) (Amendment) Regulations 2007 should be installed. This is Page 35 of 37 3 6 4 5 7 11 6 17 7 8 19 20 Care Homes for Adults (18-65 years) so that any controlled drugs that are prescribed can be stored safely if they need to be kept in the home in the future. 9 35 That a staff training and development plan is produced which reflects all areas of training, as identified in the training policy. It should show timescales for staff to attend courses where necessary. This recommendation is outstanding from previous inspections. That the views of the people who use the service are sought on a more individual basis as part of the homes system of quality assurance. This recommendation is outstanding from previous inspections. 10 39 Care Homes for Adults (18-65 years) Page 36 of 37 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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