Inspection on 06/09/06 for High Street (10)

This inspection was carried out on 6th September 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 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) 24/04/08

High Street (10) 14/11/07

High Street (10) 18/10/05

High Street (10) 11/04/05

High Street (10) 11/11/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 High Street (10) Semington Trowbridge Wiltshire BA14 6JR Lead Inspector Malcolm Kippax Key Unannounced Inspection 6th September 2006 10:00 High Street (10) DS0000060341.V311150.R02.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.V311150.R02.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.V311150.R02.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 Mrs Lorna Jayne Hale Care Home 8 Category(ies) of Learning disability (8) registration, with number of places High Street (10) DS0000060341.V311150.R02.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. 18th October 2005 Date of last inspection Brief Description of the Service: 10 High Street is a detached property in the village of Semington, which is between the towns of Melksham and Trowbridge. 10 High Street is one of a number of care homes in Wiltshire that are run by Cornerstones UK Ltd. The home provides care and accommodation to up to eight service users with a learning disability who are aged between 18 - 65 years. Each service user has their own bedroom. One of these is on the ground floor, the others are on the first floor. Some of the rooms have en-suite facilities, which include a bath and a shower. The communal rooms consist of an open plan lounge / dining room and a separate lounge. On the first floor there is an office / 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 parking for several cars. Service users receive support throughout the day from a manager and staff team. There is a minimum of two people working during the day and one member of staff sleeps-in during the night. The weekly fee at the time of the inspection was £1385 High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit to the home, which took place on 6 September between 12.10 pm and 5.20 pm. A second visit was arranged with the home’s acting manager in order to complete the inspection. This took place on 21 September between 9.30 am and 1.30 pm. The home’s registered manager, Lorna Hale was on long-term leave at the time of the inspection. Mr Shaun Smitherman was managing the home in her absence. Evidence was obtained during the visits through: • • • • Discussion with the service users, deputy manager, staff members and acting manager. Observation A tour of the accommodation. Examination of some of the home’s records. This included the personal files for three service users. Other information has been received and taken into account as part of the inspection: • • • The acting manager completed a pre-inspection questionnaire about the home. Three of the service users’ relatives have completed comment cards and given feedback about the home. Documentation was received from Cornerstones (UK) about the organisation’s system of quality assurance. The judgements contained in this report have been made from the evidence gathered during the inspection, including the visits to the home. What the service does well: A new service user moved in after making several visits to the home and has got to know the other service users and staff. Staff members had good information about the new service user’s needs and routines. The service user has been well supported with settling into the home. The service users’ needs and preferences are well reflected in their individual care plans. The plans include guidance for staff about what service users like to do and how they can best be supported. Risk assessments are being carried out and these are well referenced within the plans, which helps to ensure that staff have the information they need. The service users’ right to make decisions is respected, although there are some agreed restrictions in place for safety reasons. High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 6 The service users’ care plans provide clear guidance for staff when providing personal care. Service users receive the support that they need with their healthcare and medication. New pastimes and social events outside the home have been arranged for service users whose previous day activities have stopped or become less regular. Within the home, service users can make choices and are encouraged to be involved in the domestic routines, within their capabilities and can treat the home as their own. They benefit from a varied diet and enjoy the meals. Service users have regular contact with the local community and are supported with keeping in touch with their families. The relatives who commented were very positive in their views about the home Formal complaints are not being raised. The environment is generally homely and there is a good-sized garden. Each service user has their own room, which they decorate and keep as they wish. Service users benefit from staff members who know their needs well and are developing as a staff team. Service users are benefiting from the temporary management arrangements that are currently in place, while the registered manager is on leave. Quality assurance is being well developed at an organisational level. Service users are protected by the arrangements being made in the home for their health and safety. What has improved since the last inspection? What they could do better: The service users have personal goals recorded in their care plans. Some goals had specific information about what needed to be achieved, whereas High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 7 others lacked detail. A more consistent approach is needed and in some cases further information would help to show how progress in meeting the goals is to be measured. The written format of the plans meant that they were not accessible to all service users or met their individual needs. Service users could also be more closely involved in the care planning process and have their own views better reflected in the plans. Service users are involved in some new day activities outside the home. They contribute to the cost of these, which may not be an appropriate use of their personal money. The absence of a policy on expenditure meant that there was a lack of clarity about the circumstances in which service users should pay for activities and meals outside the home. The arrangements made for charging also need to be included in a revised Service User’s guide. Some recommendations made at previous inspections have not been met. These include providing staff with training in equality and diversity issues. Not all staff have completed a certificated course in first aid and a timescale for this was agreed with the acting manager. Formal supervision meetings for staff have not been taking place as required. Service users will be better supported by staff who are regularly supervised and have the opportunity to raise any concerns that they may have. Quality assurance within Cornerstones (UK) is helping to identify the home’s strengths and areas for improvement. Feedback from interested parties is being obtained although it is recommended that the views of service users are sought on a more individual basis and included within the system of quality assurance. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. High Street (10) DS0000060341.V311150.R02.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.V311150.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is adequate. This judgement has been made from evidence gathered before and during the visits to the home. The home’s Statement of Purpose and Service User’s guide will need to be updated in the light of recent changes. The absence of a policy on expenditure meant that there was a lack of clarity and information about the circumstances in which service users should pay for their day activities and meals outside the home. Assessments have been undertaken, providing staff members with good information about a new service user’s needs and routines. The new service user has been well supported with settling into the home. EVIDENCE: There was discussion with the acting manager about the home’s Statement of Purpose and Service User’s guide. The Statement of Purpose is currently under review and is to be updated following changes made in the running of the home and the accommodation. The Service User’s guide does not include full details of fees payable and the arrangements in place for charging and paying for any additional services. The acting manager confirmed that the guide will also be revised, in accordance with the amended regulation, and copies of both documents would be sent to the Commission. High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 10 It was stated on the service users’ weekly activities timetable that staff should check that service users have the correct funds to pay for their activities and that this money comes from their personal accounts. The acting manager said that service users also pay for meals that are bought when outside the home, although this may replace a meal that would otherwise be provided by the home. There was no written policy concerning the expenditure of service users’ money on day activities and meals out and how much they are expected to contribute. One new service user had moved into 10 High Street during the last year. The service user was previously living in another home run by Cornerstones (UK), but moved to 10 High Street as it was felt that their needs would be better met there. The service user was already known to staff at 10 High Street and had visited on a number of occasions before a final decision was made. The new service user’s existing assessment and care records were transferred to 10 High Street and updated following the move. The service user had their own garden swing, which was brought with them and has now been installed at 10 High Street. The service user enjoyed using the swing during the visits. The service user also came with some electronic sound and light equipment that they liked using. The service user’s room was being set up for the installation of this equipment and some new items that have been bought. High Street (10) DS0000060341.V311150.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made from evidence gathered before and during the visits to the home. The service users’ needs and preferences are well reflected in individual care plans. Their individual goals and how they will be supported with these are less well identified. The service users’ right to make decisions is respected, subject to some agreed restrictions being in place for safety reasons. Service users benefit from the home’s approach to risk taking. EVIDENCE: Each of the three service users’ personal files looked at contained a care plan that had been written or revised during the last three months. The plans consisted of a range of forms, covering areas, such as ‘Safety Awareness’, ‘Social Skills’, ‘Communication’, ‘Medication’ and ‘Daily Routines’. They provided clear guidance for staff about the service users’ needs and preferences in these areas. High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 12 The care plans had been signed by certain parties but did not show who had contributed to the care planning process or include a contents sheet. There were good references within the plans to show where risk assessments had been undertaken in relation to a particular activity or occupation. One part of the care plans included a section on ‘Strengths and needs’ and individual goals. The goals covered a range of areas, with the aim of improving aspects of the service users’ lives. Although some goals had specific information about what needed to be achieved, others lacked detail that would help with monitoring progress. These included for example, a goal for a reduction in certain behaviour and another for an increase in bathing, although further information was needed to show how success in these areas would be measured. The written format of the plans meant that they were not accessible to all service users or meeting their individual needs. Service users could make decisions about what meals they wanted and how to spend their time. During the visit on 6 September, one service user had chosen not to go out with the others and was able to stay at home to do some domestic tasks. The service users had personalised their bedrooms and some had keys to their rooms. The service users’ care plans referred to some restrictions that are in place about the service users’ movements. These mainly concern the use of the kitchen when staff are not present. Other restrictions relate to limiting independence, for example when a service user requires support when bathing. High Street (10) DS0000060341.V311150.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made from evidence gathered before and during the visits to the home. Services users are benefiting from their participation in some new day activities. The provision of activities should be kept under review, to ensure that they meet the service users’ needs in the long term. Service users can make choices and are encouraged to be involved in the domestic routines, within their capabilities. They treat the home as their own, subject to some agreed restrictions. Service users have regular contact with the local community and receive support with their relationships. They benefit from a varied menu and enjoy their meals. EVIDENCE: High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 14 There has been a change in the service users’ day activities since the last inspection. Some outside activities are no longer available, which left gaps in the service users’ weekly timetables. New timetables have been drawn up involving the use of local facilities and new activities that Cornerstones (UK) have arranged. These include arts and crafts sessions at a local village hall, hired by Cornerstones (UK). During the visit on 6 September 2006, the main activity for the majority of service users was a pub lunch and skittles match in a local town. The new activities arranged by Cornerstones (UK) have helped to keep service users occupied during the week. The acting manager said that none of the service users attended college courses or had work placements outside Cornerstones (UK). The service users’ care plans included an ‘Eating’ section, providing information about individual needs and preferences. During the visit on 6 September, one service user had chosen not to go out with the others and did some domestic tasks, including laundry. The service user did some tasks on their own, such as loading up the washing machine. The service user was asked what they would like for lunch. Menus are recorded and show that service users have chosen particular meals as part of weekly menu planning. Staff said they aimed to provide service users with healthy options. One of the staff members met with described her role as keyworker, which included supporting service users with their family relationships. An example was given of how the staff member had liaised with the close relatives of a service user who needed support with hospital appointments. In their comment cards, the three relatives confirmed that they are kept informed of important matters and feel welcome to visit the home at any time. High Street (10) DS0000060341.V311150.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made from evidence gathered before and during the visits to the home. The service users’ care plans provide clear guidance for staff when providing personal care. Service users receive the support that they need with their healthcare and medication. EVIDENCE: Day to day needs were described in the service users’ care plans, which also included guidance for staff about their usual routines at different times of day. There was evidence of the involvement of outside professionals and support from the local Community Team for People with Learning Disabilities (C.T.P.L.D.). One service user had an epilepsy profile / management plan, which the Community Nurse was reviewing at the time of the inspection. Risk assessments were being updated and one concerning emergencies had just been completed. High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 16 A letter had been sent to the C.T.P.L.D. in August 2006 requesting the involvement of a Behavioural Nurse. The service user in question was put on a waiting list for this service. The acting manager said that with the support of staff, one service user had successfully reduced their need to use continence aids. The service users’ files contained a ‘My Health’ booklet, which included relevant information should a service user need to leave the home or be admitted to hospital. These looked very useful. There was evidence in the service users’ health records of their recent contact with GPs and other healthcare professionals. One service user had a record of ‘Hand and Toe Nail Care’ although this was not seen for other service users. In their comment cards, the three relatives confirmed that they are satisfied with the overall care provided. Each relative had very positive comments to make, such as ‘we are sure she is getting the best care’, ‘the care is exceptional’ and ‘all staff are very helpful’. Service users were receiving support with the administration and safekeeping of their medication. A ‘Medication Profile’ had been completed for each service user. The procedures and the practical arrangements had improved since the last inspection. The requirements made at the last inspection had been met. Medication was kept securely and the administration records were up to date. High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made from evidence gathered before and during the visits to the home. Formal complaints are not being raised. Service users receive support with their day to day concerns. Staff members have received training and guidance, which means that service users are better protected. EVIDENCE: The acting manager reported that the home had not received any complaints during the last year. The Commission has also not received complaints about the home during this period. A pictorial complaints procedure had been produced for service users. The deputy manager said that this was explained to service users and that ‘we listen to people’. Service users varied in their capacity to make a complaint and the support that they would need with this. In their comment cards, the three relatives confirmed that they are aware of the home’s complaints procedure. One relative commented that ‘on the few occasions we have had a grumble, this has been resolved’. The deputy manager had just obtained a copy of the September 2006 publication, ‘Policy and Procedures for Safeguarding Vulnerable Adults in Swindon and Wiltshire’ and said that this would be gone through with staff at the next staff meeting. A staff member confirmed that she was familiar with the ‘No Secrets in Swindon and Wilshire’ booklet and had visited the local Vulnerable Adults Unit. High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 18 The home has had experience of an adult protection investigation and what this involves. During the last year, six staff members have attended training in the prevention of abuse and in physical intervention with service users. Abuse was also reported by staff to be a topic that is covered in the Learning Disability Award Framework training that new staff members receive. High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate and improving. This judgement has been made from evidence gathered before and during the visits to the home. There is a homely environment, which is being improved with the provision of new facilities. The home is generally clean and tidy. EVIDENCE: 10 High Street is a detached house in a prominent position within the village. It benefits from having a good-sized garden and a car parking area at the rear of the property. Various changes have been made to the accommodation over recent years and these have continued during the last twelve months. The latest improvements have focused on redecoration and on increasing the number of bedroom en-suite facilities. A new en-suite shower in an unoccupied bedroom was being finished off at the time of the inspection. A new floor covering has been fitted in the laundry since the last inspection. High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 20 A number of relatively small items were seen to be in need of attention during a tour of the home. Some repair and redecoration was needed in a bathroom around the boxed-in pipes. A socket cover in the front lounge was cracked and needed replacement. This was brought to the acting manager’s attention. The handle on one service user’s bedroom door was broken. Chains had been fitted on bedroom windows although it was unclear what their purpose was, as they did not significantly restrict their opening. The chain was broken in one service user’s room. An environmental health officer had visited the home in August 2006. The acting manager said that there were no requirements identified as a result of the visit, although a number of recommendations were being followed up. The home looked clean and tidy at the time of the inspection. The décor and condition of some of the older facilities, for example the toilet, was making it difficult to achieve a hygienic appearance. High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is adequate and improving. This judgement has been made from evidence gathered before and during the visits to the home. Service users benefit from staff members who are developing their skills and being given new responsibilities. However, there has been a lack of formal supervision for staff. EVIDENCE: There was a staff team of 11 people, of whom four had achieved a National Vocational Qualification (NVQ) in care at level 2 or above. The number of staff with NVQ is therefore below 50 of the staff team, although the acting manager said that this figure would increase in the near future because of people who are currently completing their NVQs. One of the staff members met with had recently completed Learning Disability Award Framework (LDAF) training. During the last year, other staff members have also completed LDAF training, which was not available to them when they were first employed. One new staff member had been appointed since the last inspection. This staff member’s employment file included their application form, references, proof of identity and a health form. A Criminal Records Bureau (C.R.B.) disclosure was not available at the time of the visit on 6 September 2006 and the details of this have since been confirmed. The disclosure and a Protection of Vulnerable High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 22 Adults (POVA) list check had been obtained prior to the staff member starting in the home, as had the two written references. Cornerstones (UK) has a training manager who co-ordinates staff attendance on a range of courses and training events. The home received a monthly training schedule / record, which included details of training events arranged for the coming months. Staff members had individual training records, which are kept in the home. During the last year staff members have attended a range of courses, including medication, abuse, infection control, physical intervention, fire safety, epilepsy and first aid. The manager reported that training was planned in the areas of food hygiene and health & safety. Not all staff had undertaken a certificated course in first aid and the acting manager confirmed that this would be arranged. The arrangements for supervision were discussed with the acting manager, deputy manager and a staff member. Individual supervision meetings have not taken place on a regular basis during the last year. The deputy manager said that supervision meetings had just been started with the support workers that she had responsibility for and it was the intention that these would be monthly. The acting manager confirmed that a plan for supervision would be implemented and that each staff member would receive an individual supervision meeting by the end of November 2006. Staff meetings have taken place, which the acting manager said had been useful in clarifying the staff members’ roles and discussing how the staff team can take on further responsibilities within the home. An ‘Organisation Plan’ was seen, which listed out the new responsibilities and tasks that staff members have taken on in recent months. This included areas such as infection control, nutrition and medication. The staff members spoken with were very positive about this development and felt that their roles had been enhanced. High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made from evidence gathered before, during and after the visits to the home. Service users are benefiting from the temporary management arrangements that are currently in place. Quality assurance is being well developed at an organisational level. Service users are protected by the arrangements being made in the home for their health and safety. EVIDENCE: The registered manager, Lorna Hale, was on long-term leave at the time of this inspection. Shaun Smitherman was appointed to manage the home in Lorna Hale’s absence. Shaun Smitherman has completed NVQ in care at level 4 and said that he intends to undertake the Registered Managers Award. High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 24 As reported under the ‘Staffing’ section, the staff members met with spoke positively about their roles and the support they received. Shaun Smitherman appeared to have got to know the service users and staff team well and had initiated some new developments. Priorities for attention were identified in the home’s ‘Organisation Plan’. Quality assurance has been developed during the last year. A Cornerstones (UK) plan for quality assurance was produced in September 2006. This is a comprehensive document, setting out the organisation’ intentions and how these will be put into practice. The system included an internal audit of the standards, the most recent of which concerned the environment. Since the last inspection, questionnaires have also been sent to outside professionals and to the service users’ relatives. Action plans are produced throughout the year. The quality assurance plan included a section on communication with service users and how the organisation will seek to establish effective methods to achieve this. This was discussed with the acting manager, in respect of the service users at 10 High Street, who vary in their ability to give feedback about the home and what they like. The acting manager said that further attention would be given to finding ways in which the views of service users can be gained and included within the organisation’s system of quality assurance. Staff members have taken on some new responsibilities for health and safety in the home. These include fire precautions and risk assessments. A monthly health and safety inspection had been carried out up to May 2006. The acting manager said that this was to be reintroduced from October 2006. Risk assessments had been undertaken in respect of aspects of the environment that may present a risk to service users. Information was received from the acting manager about the maintenance and servicing arrangements that are in place, involving outside contractors. Electrical checks (PAT and wiring) had taken place in March 2006. C.O.S.H.H. assessments had been completed. Fire drills were held monthly. High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 25 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 3 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 3 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 2 33 x 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 6 Requirement The Statement of Purpose and the Service User’s guide must be kept under review and, where appropriate, revised. Details of the total fee payable and the arrangements in place for charging and paying for any additional services must be included in the Service User’s guide and in the service users’ terms and conditions statements. Timescale for action 31/12/06 2. YA1 17(2) 5 (1) 31/12/06 3. YA1 5 12 (1) The registered provider must 30/11/06 demonstrate that the arrangements made for the use of service users’ personal money on activities and meals outside the home are appropriate, consistent with the terms of their contracts and have been agreed with the relevant parties. Each staff member must attend a certificated course in first aid. 31/12/06 4. YA35 13 (4) High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 27 5. YA36 18(2) Each staff member must have regular, recorded supervision meetings at least six times a year. 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations That a policy is produced regarding the use of service users’ money, including the financial contribution that service users are expected to make towards the cost of day activities and meals taken outside the home. That the care plans are produced in formats that meet the needs of individual service users. That the service users’ objectives are more clearly defined. This will enable progress with achieving the objectives to be more accurately measured. That service users are more closely involved in the care planning process and that this is reflected in the format used and the way that the plans are written. A referral should be made to a speech and language therapist to develop the communication needs for service users in the home. (Recommendation outstanding from previous inspections). That the provision of day activities is kept under review to ensure that these meet the service users’ individual needs. 2. YA6 3. YA6 4. YA6 5. YA6 6. YA12 High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 28 YA18 7. That a record of hand and toenail care is maintained for each service user. YA24 That the use of the chains on windows is reviewed and appropriate action taken to ensure that window openings are suitably restricted where assessments show this to be necessary. 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. (Recommendation outstanding from previous inspections). The death and dying procedure needs to be amended to contain clear instructions about contacting emergency services in case of a sudden death. (Recommendation outstanding from previous inspection). That the views of service users are sought on a more individual basis as part of the home’s system of quality assurance. 8. 9. YA35 10. YA21 11. YA39 High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI High Street (10) DS0000060341.V311150.R02.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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