Inspection on 24/04/08 for High Street (10)

This inspection was carried out on 24th April 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 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) 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 09/07/2008.

CARE HOME ADULTS 18-65 High Street (10) Semington Trowbridge Wiltshire BA14 6JR Lead Inspector Malcolm Kippax Unannounced Inspection 24th April 2008 10:00 High Street (10) DS0000060341.V360670.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.V360670.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.V360670.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.V360670.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. 14th November 2007 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. Two of the residents’ bedrooms are on the ground floor and the others are on the first floor. Some of the bedrooms 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. Residents receive support from a manager, deputy manager and a team of support workers. 10 High Street was without a registered manager at the time of this inspection. There were six people living at the home. 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.V360670.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Following our inspection of 10 High Street in November 2007 we had a number of concerns about how the home was being run. The manager at the time was not registered with us, and they have since left the home. After the last inspection we met with a director from Cornerstones (UK) and asked them to produce an improvement plan for the home. Surveys were sent to residents, staff and the placing authorities, so that we could get people’s views about the home. Surveys were returned from four residents and from four staff members. We have also received information about two safeguarding adults investigations that have been undertaken since we last inspected the home. We have reviewed 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 a visit to the home. We made an unannounced visit to the home on 24th April 2008. We met with the residents and with two staff members. We looked at some records and saw the communal areas of the home. We made a second visit to the home on 7th May 2008. This was in order to complete the inspection and to discuss the outcome with Mrs Teresa Guthrie, who was managing the home on a temporary basis. The judgements contained in the report have been made from all the evidence gathered during the inspection, including the visits. Where appropriate, we have also referred to our findings from the last inspection. What the service does well: People can make choices in their daily lives, for example about what meals to have and how to spend their time. One person chooses not to take part in some of the planned day activities and is able to stay at home on these occasions. People’s needs and preferences are clearly shown in their individual plans. Risk assessments are being undertaken, which help 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. High Street (10) DS0000060341.V360670.R01.S.doc Version 5.2 Page 6 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. Residents 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. The home is being managed on a temporary basis until the Commission receives an application to register somebody as the permanent manager Some information in the Statement of Purpose needs to be changed to ensure that it contains accurate and consistent information. Cornerstones has a policy about who can provide personal care to female residents, although this was not being applied in the home. This puts residents and staff at risk, and means that the residents may not be receiving personal support in the way that they require and prefer. If the policy cannot be implemented, then the reasons for any deviation must be clearly explained and agreed with the appropriate parties. Medication needs to be better managed in the home. This is to ensure that the residents are safe and not being put at risk because the right procedures are not being followed. High Street (10) DS0000060341.V360670.R01.S.doc Version 5.2 Page 7 We saw that a baby monitoring/listening device was being used in the home, but it was not being operated in a way that respected the residents’ privacy. An appropriate protocol for its use should be agreed and confirmed in writing. There are other policies and procedures which need attention, so that they provide clear guidance for staff and safeguard the residents’ interests. The residents’ views should be sought on a more individual basis as part of the home’s system of quality assurance and reflected better in the action plan. People’s care plans generally reflect their needs. However the plans 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 also be undertaken to make information, such as the care plans, easier to understand for people. Staff training needs to receive better attention and a plan produced and implemented, which covers all areas of training as identified in the training policy. This will help to develop the staff members’ knowledge and understanding of learning disabilities and the residents’ individual circumstances, so that they can provide support in the most effective ways. 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.V360670.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.V360670.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 Quality in this outcome area is adequate overall. People are being given better information about what they can expect from the home, although there is still a lack of clarity in some areas. This judgement has been made using available evidence including the visits to this service. EVIDENCE: We found at the last inspection that the written information that Cornerstones (UK) had produced about the home was not up to date and did not include all the details that people would expect. In particular, there had been a lack of information about the things that people had to pay for out of their own money, because these were not being paid for by the home. During the visit on 24th April 2008 we looked at copies of new guides that had been produced for each person in the home. The guides had been personalised and they included photographs, which helped to show what was being described in the guides. New information had been included, in a ‘How I spend my money’ section, about people’s expenditures and their financial contributions. For example, it was stated in the guides that people paid £20 per week towards transport. They also paid for social activities when attending the day care that Cornerstones arranged, and made a contribution towards drinks and the cooking classes at the centre. High Street (10) DS0000060341.V360670.R01.S.doc Version 5.2 Page 10 We read in the guides that people paid for ‘take-away’ meals, when they chose to have these. Mrs Guthrie later said that she would expect all meals to be paid for out of the home’s budget. We have recommended at previous inspections that the home’s policy about this is written down, to ensure that there is a consistent approach from staff. During the visit we were also given a copy of a revised ‘Statement of Purpose’ for the home. This version, dated 4th April 2008, gave more information about the home, and the services and facilities provided. It had a list of contents, which included the required topics. It was also better presented than previous versions we have seen, although the text had not been proof read very well. We read in one part of the ‘Statement of Purpose’ that there will be a minimum of three people on duty during the day. In another part, it was stated that the home would ‘endeavour to meet the minimum staffing level of 2 staff per shift’. There was a section about ‘Emergency Admissions’, which stated that these would be accepted, subject to certain criteria being met. ‘Respite care’ was not referred to, although since the last inspection the home has been approached about providing this type of service to one individual. The ‘Statement of Purpose’ included information about how to make a complaint and who could be contacted. Some of the details in this section were not accurate. (See comment made under Standard 22 of this report). Standard 2 was not looked at during the visit, because nobody had moved into the home since the last inspection. We had assessed this standard in November 2007, as a new resident had moved into 10 High Street during the last year. We had found that this standard was being met. 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.V360670.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 adequate overall. People’s needs and preferences are reflected in their individual plans. However, there is a lack of information about people’s personal goals and the progress being made with these. 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 this service. EVIDENCE: Each resident 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 peoples’ needs and preferences in different areas of their lives. High Street (10) DS0000060341.V360670.R01.S.doc Version 5.2 Page 12 There was information about people’s likes and dislikes and their preferred routines. We had recommended at the last inspection that the residents’ personal objectives are more clearly identified within their individual plans. We saw that there were sections in the care plans about ‘strengths and needs’ and ‘individual goals’. However, these were inconsistently completed and there continues to be a lack of information about the residents’ goals and the support they need to achieve these. A staff member we spoke with felt that this was something that could be improved on, although they felt it was difficult to obtain some people’s views about what they wanted to do in the future. Mrs Guthrie said that the goal plans must be completed and that a start would be made on these. There was clear guidance in the care plans to show 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. The written format of the plans meant that they were not easily accessible to all the residents or meeting their individual needs. People could make decisions about what meals they wanted and how to spend their time. People could choose how they wanted to decorate their own rooms. Some people had keys to their rooms. One person was choosing not to participate in some of the planned day activities and was able to stay at home on these occasions. The care plans referred to some restrictions that were in place about the residents’ movements. These included leaving the home or using the kitchen without the support of a staff member. This was for safety reasons. Other restrictions related to limiting independence, for example when a service user required support when bathing. In their surveys, three staff members reported that they were always given up to date information about the needs of the people they supported. One staff member said that they usually were and another that they sometimes were. High Street (10) DS0000060341.V360670.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. Most 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 content of the meals. This judgement has been made using available evidence including the visits to this service. EVIDENCE: It was reported at the last inspection that there had been a change in the residents’ 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.V360670.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) provided for people outside the home. Some of the activities were based at a village hall and others involved going out into the community, for example having a game of skittles and lunch at a local pub. A trip to Savernake Forest and a picnic lunch had been planned when we visited on 24th April 2008, although this was changed on the day because of the weather. One of the residents received support from a family member with completing a survey. They mentioned that there had been big day care changes over the last year; they now attended Cornerstones Day Care and said that they ‘really like some things and choose to go’. They said that they could stay at home if they did not want to join a particular activity. This person also commented: ‘things are more relaxed at weekends with less structured activities’. People’s personal files contained information about their family backgrounds and significant relationships. At the last inspection we received surveys from three relatives who 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. People who commented said that they liked the meals. A menu was written each week. We reported at the last inspection that the menu looked varied, although we had recommended that it included more details about the meals that were being served. This would demonstrate that attention is being given to meeting people’s individual choices and show the way in which particular dishes were prepared. The menus that we saw during this inspection still showed a lack of detail about the meals served. For example, entries on the menus such as ‘veg’ did not show whether fresh ingredients were used, or the type of vegetable. High Street (10) DS0000060341.V360670.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 adequate overall. People’s primary needs are being met. However some people may be at risk of not receiving personal support in the ways that they require and prefer. Medication is not being well managed in the home. This judgement has been made using available evidence including the visits to this service. EVIDENCE: We looked at some people’s files at the last inspection and reported that their care and health needs were being met. Their personal files contained ‘My Health’ booklets, which included relevant information, should they need to leave the home or be admitted to hospital. In their surveys, the relatives had confirmed that people in the home were receiving the care and support that they would expect. We looked at the records for three people, whose files had not been seen at the last inspection. 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. This was well set out so that staff would know what support people needed at different times of day. There was evidence on High Street (10) DS0000060341.V360670.R01.S.doc Version 5.2 Page 16 people’s 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.). Two people’s personal care needs have been discussed at safeguarding adults meetings since the last inspection. We have been informed of the outcome of these meetings and of how people’s care needs are to be followed up. The needs of one person with epilepsy were being reviewed. The home was waiting to receive some new aids that would help alert staff if this person were to have an epileptic seizure during the night. A baby-monitoring/listening device was currently being used so that staff could hear any untoward noises in their bedroom at night. The device was on in the office when we visited. There was no written protocol about the use of the device. This would help to ensure that its use is limited and people’s privacy is respected as far as possible. A new chart had been produced for recording disturbances and epileptic activity during the night. Staff were recording some details, but not all columns on the chart were being completed. However, details of seizures were being more fully recorded elsewhere. One person has exhibited self-harming behaviours and these had been discussed at one of the safeguarding adults meetings. Their care plan had been reviewed in April 2008, although it was not clear what amendments had been made at the time. The plan and risk assessments had not been updated to reflect some recent observations about new behaviour. The care plan included a description of their morning and night care routines. It was reported that ‘both male and female staff are able to support xxx in her morning and night routines’. We later saw that Cornerstones (UK) had a policy about this, which stated that only female staff would undertake the personal care of female residents. There was a section on the policy form for recording ‘Individual Homes Deviations’ (from the policy). It was recorded that ‘male staff do support in all areas of personal care’. We spoke to a staff member who was not aware why this deviation from the policy was in place. It was reported in the care plan that this resident wore two incontinence pads at night, ‘as when one is worn it can leak and increase the chance of sores and prevent leakages’. We discussed this with a staff member who said that a referral had been made in order for the resident to be assessed for a new type of pad that would better meet their needs. Another female resident’s care plan also included a statement about male and female staff providing support. Their care plan referred to self-harming behaviour and making allegations. There was a risk assessment concerning ‘Making Accusations’ and another for personal care (shower). Under control measures it was stated that ‘male and female staff support xxx with personal care’ although it was not clear in what way this would be a control measure. High Street (10) DS0000060341.V360670.R01.S.doc Version 5.2 Page 17 We had looked at the home’s medication arrangements at the last inspection. A ‘Medication Profile’ had been completed for each person and the medication was being kept securely. However, we had found that there had been problems during the last year with how the medication records were being completed. We had judged that people’s medication had not always been well managed, but we felt after looking at the current records that the recording of medication was improving. During this inspection we looked again at the medication forms and other records. It was recorded in the minutes of a staff meeting in January 2008 that ‘staff need to be more aware and vigilant when administering medication …. signing of medication when given is imperative’. We looked at the medication records and saw that since that meeting there had been one occasion, on 2nd April 2008, when somebody’s medication had not been signed for on the medication form. There was a medication file that contained a policy on homely remedies, although this was not up date as it referred to people who no were longer living at the home. A staff member showed us a new medication file that was being put together. They told us that staff did not administer medication before they had received the necessary training. They said that the newest member of staff was not administering medication, as they had not yet received the training. High Street (10) DS0000060341.V360670.R01.S.doc Version 5.2 Page 18 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. People in the home are dependent on others to raise any concerns on their behalf. Events since the last inspection have highlighted changes that are needed in the home’s procedures, to ensure that people are better protected in the future. This judgement has been made using available evidence including the visits to this service. EVIDENCE: We had looked at the home’s complaint procedures at the last inspection. A pictorial complaints procedure had been produced for people in the home. Residents varied in their capacity to make a complaint and the support that they would need with this. In their surveys, the relatives had confirmed that they knew how to make a complaint if they needed to. The manager at the time had reported that one thing the home could do better would be to provide a clearer and more effective system for recording concerns and complaints, taking into account each person’s needs and their ability to communicate. It was reported at the last inspection that the home had not received any complaints during the last year. The Commission has not received complaints about the home since the last inspection. The Statement of Purpose had a section about complaints. This included the comment that: ‘The Commission for Social Care Inspection only receives complaints regarding the care/welfare of the service users’. This is not an accurate description of the Commission’s role in respect of complaints. High Street (10) DS0000060341.V360670.R01.S.doc Version 5.2 Page 19 There have been two safeguarding adults investigations since the last inspection. In terms of the process, one investigation highlighted the need for the home to ensure that any concerns are reported to the appropriate authorities without delay. We looked at the home’s policy and procedure about protecting people from abuse. This reproduced the Department of Health’s ‘Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse’. However the purpose of this guidance is so that organisations can produce their own appropriate policies and procedures, rather than it being an ‘off the shelf’ policy and procedure for use in the home. This was brought to Mrs Guthrie’s attention. The home also 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 have confirmed in surveys that they knew what to do if a concern was raised with them. 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 residents. Cash account forms were being used to record transactions involving the residents’ money. The forms had two columns where staff could sign to confirm the transaction made. This would help to ensure that the details of the transaction were accurately recorded, although in practice only one person was signing the form. As reported under the ‘Personal and Healthcare Support’ section, the Cornerstones (UK) policy on gender and support with personal care was not being adhered to in the home. High Street (10) DS0000060341.V360670.R01.S.doc Version 5.2 Page 20 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 good overall. People benefit from an environment that is generally homely and is being improved with the provision of new facilities. This judgement has been made using available evidence including the visits to this service. 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 during the last twelve months. Recent work has focussed on redecoration and on increasing the number of bedroom en-suite facilities. Two bedrooms have en-suite bathrooms and two have en-suite showers. There were two communal rooms. The main room was at the back of the house, and was where people usually gathered together. One half of the room High Street (10) DS0000060341.V360670.R01.S.doc Version 5.2 Page 21 was a sitting area with sofas and a television. The other half was used as a dining area. There was a domestic type kitchen off this room. The second room was used as a lounge and could be available as a quieter area. During the last year this room has had some lights and other items installed so that it can be used as a sensory room. We had looked at the environment and the residents’ accommodation at the last inspection and judged that this was meeting people’s needs. We looked at the communal areas again during the visit on 24th April 2008. New carpets have been fitted in the main lounge and the sofas in this room had been replaced with new ones. Other areas of the home have also had new carpets fitted and been redecorated. The home’s quality assurance report 2007/2008 included a section on the environment. Wheelchair access was identified as needing to be improved and there were plans to do this by September 2008. It is also reported that a maintenance and renewal programme for 2008-9 is to be produced by the same date. Policies and procedures about infection control have been reviewed and updated during the last year. The home generally looked clean and tidy at the time of our visits. We reported at the last inspection that the bathroom would benefit from further attention in order to produce a more hygienic appearance. The paintwork had been showing some ‘wear and tear’. Some areas looked cleaner and a cracked tile had been replaced. High Street (10) DS0000060341.V360670.R01.S.doc Version 5.2 Page 22 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 and 35 Quality in this outcome area is adequate overall. People are supported by staff who know them well, but whose effectiveness is likely to be reduced because of a lack of specialist training. This judgement has been made using available evidence including the visits to this service. EVIDENCE: We had looked at the staffing arrangements when we inspected the home in November 2007. 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. The majority of staff members had worked in the home for several years. One of the resident’s relatives commented on behalf of the resident ‘the stable staff group really helps as I don’t cope with changes very well’. One new member of staff had started and was working in the home when we had visited as part of the inspection in November 2007. We had found that this person had started working in the home before all the necessary recruitment checks had been completed. We had made a requirement that there must be a thorough recruitment procedure, which ensures the protection High Street (10) DS0000060341.V360670.R01.S.doc Version 5.2 Page 23 of residents. In particular, the home needed to ensure that new staff only had contact with people after a check had been made of the Protection of Vulnerable Adults (POVA) list and this was satisfactory. In their improvement plan, Cornerstones (UK) confirmed that their policy on recruitment had been revised, and that in future no person may be employed without a POVA first check and a Criminal Records Bureau (CRB) check having been applied for. No new staff had been employed since we inspected the home in November 2007. We looked at the recruitment procedure again to see what further checks had been undertaken on the staff member who was most recently appointed. There were records to confirm that POVA first and CRB checks had been carried out. Two written references and proof of the applicant’s I.D. had been obtained. An application form had been completed and the applicant had made a declaration about their health. We also saw records of induction, which the new staff member had signed. Dates of supervision had been recorded. In their improvement plan, Cornerstones (UK) reported that a programme of staff supervisions had started in February 2008. A plan for supervision was displayed in the home’s office and this showed that staff had last received supervision during February and March 2008. In their surveys, two staff members said that their induction had covered everything they needed to know very well when they started. Two other staff reported that it had mostly covered what they needed to know. We reported at the last inspection that 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. Records of training received and planned for staff do not reflect all areas of training, as set out in the training policy. We had recommended at the last inspection that a staff training and development plan is produced which reflects all areas of training, as identified in the policy, and shows timescales for staff to attend courses where necessary. Events since the last inspection have also highlighted ‘self-harming behaviour’ as a relevant area of training for staff. A staff member we spoke to during the visit thought that this would be useful. It was reported in the Improvement Plan that staff require specific training in equal opportunities and non-verbal communication. High Street (10) DS0000060341.V360670.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 and 42 Quality in this outcome area is adequate overall. People have not benefited from a well run home during the last year. Temporary management arrangements have been agreed since the last inspection, as part of an improvement plan for the home. This judgement has been made using available evidence including the visits to this service. EVIDENCE: We reported at the last inspection that 10 High Street had not had a registered manager working at the home during the last year. Residents had therefore not had the reassurance of knowing that the person managing the home had been approved and was registered under the Care Standards Act. We did receive an application to register a manager after the last inspection, although the manager who was working at the time has since left the home. High Street (10) DS0000060341.V360670.R01.S.doc Version 5.2 Page 25 We have had discussions with Cornerstones (UK) about the temporary management of the home and the need for the Commission to receive another application to register a manager. Mrs Teresa Guthrie was in the role of temporary manager and has previous experience as the registered manager of another home that is run by Cornerstones (UK). We were given a copy of a quality assurance report for 2007/2008 when we visited the home on 24th April 2008.. This included an audit of standards, which showed areas for improvement and how improvements had been made in the last year. Timescales were identified for completing a number of required actions. The quality assurance report included statements about what the home does well and what could be improved. This process showed that the home is assessing its own performance, although it was unclear how some judgements had been reached. For example under ‘What we do well’, it was stated that ‘recording of medication is thorough and consistent with legislation’. However, the evidence from documentation in the home and the manager’s comments during the last year was that this has been a problem area. Some policies and procedures have been reviewed during the last year. We recommended at the last inspection that the views of residents are sought on a more individual basis as part of the home’s system of quality assurance. The quality assurance report refers to residents receiving annual satisfaction surveys and it includes the outcome of surveys that had been sent to other stakeholders. However the action plan part of the report does not reflect on the feedback that has been received, or on how the views of residents with limited capacity have been taken into account. Arrangements for health and safety were looked at during the last inspection. The home’s fire risk assessment had been reviewed in October 2007. The manager at the time reported that there had been problems in accessing training and staff were overdue receiving fire instruction. We had looked at other records and had found that some health and safety related activities were not being carried out consistently. We looked at records again on 24th April 2008 and saw that staff had received fire instruction following the last inspection and again in the period January – March 2008. Two staff members had missed receiving instruction in March 2008 but had received this by the time we returned to the home on 7th May 2008. Fire drills had been held in December 2007 and January 2008. The fire alarm system was being tested regularly. A monthly health and safety inspection checklist was being completed for the home environment and the residents’ accommodation. Specific procedures and checks for the kitchen had been identified although it was recorded in the staff meeting minutes that these were not being consistently completed. High Street (10) DS0000060341.V360670.R01.S.doc Version 5.2 Page 26 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 X 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 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 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 1 3 2 X 2 X 3 X X 2 X High Street (10) DS0000060341.V360670.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? In part 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 must be kept under review and, where appropriate, revised to ensure that it contains accurate and consistent information. This requirement from the previous inspection has been met in part. Arrangements must be made to ensure that the home is conducted in a manner which respects the privacy and dignity of residents. Timescale for action 30/06/08 2. YA18 12(4) 30/06/08 3 YA18 12(1) In order to show compliance with this requirement, the use of the baby monitoring/listening device must be limited to appropriate times and operated in a way which respects the residents’ privacy as far as possible. A protocol for its use should be agreed and confirmed in writing. The home must be conducted in 30/06/08 a way which promotes and make proper provision for the health and welfare of residents. In order to show compliance with High Street (10) DS0000060341.V360670.R01.S.doc Version 5.2 Page 28 4. YA20 13(2) this requirement, the residents’ personal care must be provided in a way that is consistent with the organisation’s policy. The reasons for any deviation from the policy must be clearly explained and agreed with the appropriate parties. Arrangements must be made for the safe administration and recording of medication of medicines received into the home. 08/05/08 5. YA42 12(4) In order to show compliance with this requirement, the administration of medication records must be fully completed, as confirmation that the residents have received their medication, or not received medication for a particular reason. 08/05/08 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. This requirement from the previous inspection has been met in part. High Street (10) DS0000060341.V360670.R01.S.doc Version 5.2 Page 29 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 written policy is produced regarding the use of residents’ money, including the financial contribution that residents are expected to make towards the cost of day activities and meals taken outside the home. It would be good practice to check with care managers that these arrangements are appropriate. This recommendation is outstanding from the previous inspection. That the care plans are produced in formats that meet the needs of individual service users. This recommendation is outstanding from the previous inspection. That the residents’ 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. That residents’ 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. 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. This recommendation is outstanding from the previous inspection. That a second person signs the residents’ cash account forms to confirm when a transaction has been made. This would help to ensure that the details of the transaction are accurate and appropriately recorded. 2. YA6 3. YA6 4. YA6 5. YA17 6. YA23 High Street (10) DS0000060341.V360670.R01.S.doc Version 5.2 Page 30 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. 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. This recommendation is outstanding from the previous inspection. That the residents’ views 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. 8. YA35 9. YA39 High Street (10) DS0000060341.V360670.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West 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. 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