This inspection was carried out on 23rd June 2009.
CQC found this care home to be providing an Excellent service.
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 4 statutory requirements (actions the home must comply with) as a result of this inspection.
Random inspection report
Care homes for adults (18-65 years)
Name: Address: National Star College Ullenwood Manor National Star College Ullenwood Cheltenham Glos GL53 9QU three star excellent service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Lynne Bennett Date: 2 3 0 6 2 0 0 9 Information about the care home
Name of care home: Address: National Star College Ullenwood Manor National Star College Ullenwood Cheltenham Glos GL53 9QU 01242527631 Telephone number: Fax number: Email address: Provider web address: lbarrett@natstar.ac.uk Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : National Star College care home 88 Number of places (if applicable): Under 65 Over 65 0 physical disability Conditions of registration: 88 The maximum number of service users who can be accommodated is 88. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Physical disability (Code PD) Date of last inspection Brief description of the care home The National Star College is a College of Further Education, providing residential accommodation for students with physical disabilities or acquired brain injuries. The main campus is based at Ullenwood Manor, situated in beautiful grounds, above Cheltenham town centre. The campus is made up of various education buildings, a large sports centre with swimming pool, administrative offices and accommodation areas; all are accessible to people who use wheelchairs. Accommodation is provided in
Care Homes for Adults (18-65 years) Page 2 of 10 Brief description of the care home a number of units on site. Wilson Court, is home to 43 students in single bedrooms on two floors, accessed by a shaft lift. There are assisted toilets, bath and shower facilities. The students also have a large lounge with kitchen facilities on the first floor. Cotswold has 12 en-suite single rooms for students who have a high level of need. This has a dining and living room, with a purpose built kitchen. Cotswold also has additional therapy rooms, a relaxation unit, and a large lounge/dining area. The Shortwood complex has been fully refurbished and houses 13 students. There is a kitchen and communal lounge area. A garden flat at the side of the house provides shared accommodation, plus cooking and bathroom facilities for two students. Malvern provides 10 well equipped single rooms, 5 with en-suite facilities, 4 sharing 2 bathrooms and 1 independence flat with en suite. Students also have access to a lounge/diner with kitchen facilities. Cleeve provides single en-suite bedrooms plus dining and lounge facilities for 10 students. The medical base for the campus is in the same building as Cotswold: it has a dedicated sick room and consultation rooms. The provider supplies information about the service, including the most recent CQC report, to students and their advocates on request. The current scale of charges is maintained within the Learning and Skills Council matrix. Care Homes for Adults (18-65 years) Page 3 of 10 What we found:
This inspection took place on 23rd June by 2 Inspectors in response to concerns raised from two recent notifications to us (the Care Quality Commission) and safeguarding alerts. We concentrated on the personal and health care provided to students living in Shortwood, one of the residences on campus. We talked to the manager of Shortwood, staff, the senior nurse and management of the campus. We also observed the care being provided to people being case tracked. We looked at care plans and associated documents at Shortwood for 4 people and sampled plans for a fifth person. We discussed nursing care plans with the senior nurse and also systems for taking medication off campus for periods of social leave. We looked at training records for staff working in Shortwood. Each person had a care plan and supporting documentation in place, and an additional nursing care plan which was not kept at Shortwood. There were inconsistencies in the recording of information on these care plans. For one person there was excessive recording monitoring their health and well being. For others discrepancies were noted in what was recorded for instance supporting them with continence or nutrition. Care plans in Shortwood did not reflect nursing care plans. We were told by a member of care staff, that the nursing care plan would not be specific to practical care. This viewpoint had been mirrored by a visiting health care professional. It was apparent that care staff need to have access to nursing care plans to be able to support peoples personal and health care needs. An example of this would be the impact of continence and nutrition on tissue viability. Staff spoken with did have a good understanding of continence issues and would promptly report any concerns to the nursing staff. This was confirmed by a senior nurse. However care plans did not reflect this practice and did not give care staff clear guidance on potential problems. Staff were clearly monitoring tissue viability using body maps to record concerns. For one person who had very fragile skin body maps were being completed throughout the day. It was difficult to see from the large number of areas highlighted each day how staff were monitoring areas of concern. There did not appear to be a system in place to highlight an area which had appeared the day before. Records confirmed close monitoring by nurses and the care team of a person with a pressure sore but we had not been informed about this. A person taking a nutrition supplement (which was supplied weekly to Shortwood) had records indicating when this was being given - 60 mls with drinks which reflected what was on the label. The nurse had told us they were taking this along with additional supplements of yogurt and powder added to meals. There was no record of the latter being given. It was also difficult to ascertain that the student was having sufficient quantities of these nutritional supplements or what was being used each week. The care plan for another person stated that there were concerns about their nutrition and tissue viability. Their daily records did not provide sufficient detail about their diet indicating only that they had eaten a meal. Their weight was being monitored twice a year. Staff said that if they had concerns about the diet of any students they would monitor their weight more closely. The senior nurse stated that a referral to Tissue Viability and Continence specialists would be made promptly and a copy of their assessment emailed to the relevant care staff. Risk assessments were in place including moving and handling plans. There was some inconsistency in the review of these documents. Staff indicated that they would be reviewed as changes occurred and some examined confirmed this. However other moving
Care Homes for Adults (18-65 years) Page 4 of 10 and handling risk assessments had not been reviewed since January 2008. The college later provided evidence that this had been a clerical error and that all had been reviewed in 2009. Specialist equipment was provided for students where needed such as bed sides and bumpers, listening devices and hoists. The latter were serviced at appropriate intervals. The manager of Shortwood said that bumpers would be used after discussion with the student and assessment by nurses or the occupational therapist. Some people bring their own equipment with them such as sleep systems and wheelchairs. Some people have lap belts or arm restraints when using their wheelchairs. After the inspection the college supplied us with copies of consent forms they have in place for the use of this equipment. Some students had behavioural management plans in place describing how staff should support them when anxious or angry. Monitoring records such as incident (ABC) charts were being completed which indicated that staff were following the guidelines on management of behaviour. The manager of Shortwood said that he was part of the behavioural management team and they would provide support to staff after an incident as well as training. On one persons file there were indications that sanctions were being used after incidents such as preventing them to use the college bar. The college stated that this was used in the best interests of the students or other students in the college. Staff said the care needs of people living in Shortwood were more complex this year and that they had staffing difficulties earlier in the year. There had been occasions when agency or other staff had been used in the unit who did not always have the skills or knowledge of students. Staff said they had not received training specific to peoples needs including tissue viability, Prader Willi and management of challenging behaviour. The senior nurse said that she had delivered training to care staff as she was delivering care or treatment to students with pressure sores. Management said that staff had received training in the management of challenging behaviour at two levels, the second focusing on students individual support needs. Training records in Shortwood did not include information about this training. We were told that this was noted in supervision and continuing development files held centrally. Staff spoken with had a good understanding of the personal care needs of people they were supporting. They were observed supporting people with their nutritional needs which were in line with their care plans, for instance individual support from a carer and ensuring they were in the correct seating position. Staff were also observed treating people with dignity and respect, providing choice and asking permission to do personal care tasks. The college had reviewed issues relating to interdepartmental communication ensuring that all staff involved in an individuals care have access to all relevant information. A daily form had been developed which provided space for nurses to record health and medical issues. These appeared not to be used and nurses confirmed that they did not always have time to complete this. One entry noted, indicated spoke with nurse re continence but gave no further details. The college management team have addressed some communication issues to date and anticipate further developments with the implementation of a new computer system at the beginning of the new academic year. This included allocating a nurse to each residential unit on site to facilitate care planning and hold reviews for specific health concerns. A new database was also being put in place which would enable all staff to access information about individual students in one place. A team email system had been set up for one student and this would be cascaded to all students in the new term ensuring all staff involved in a students care receive access to relevant information. The nursing team said they would have more involvement this year in the
Care Homes for Adults (18-65 years) Page 5 of 10 admissions and the assessment process. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 20 13(2) Upgrade the storage arrangements for controlled drugs to comply with the Misuse of Drugs (Safe Custody) Regulations 1973. This is to make sure these medicines are stored securely and in accordance with the law. 01/08/2008 Care Homes for Adults (18-65 years) Page 7 of 10 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 6 12 The registered person must 24/11/2009 make sure that care plans relating to personal and medical care are synchronised and information accessible to all staff. This is to make proper provision for the care, treatment and supervision of students. 2 17 17 The registered person must make sure that a full record of food provided is kept for students. This is so that the diet and nutritional well being of students can be monitored. 24/07/2009 3 19 37 The registered person must notify us where a student has developed a pressure sore of grade 2 or above. This is to make sure that the student is receiving the correct care and attention. 24/07/2009 4 35 18 The registered person must 24/11/2009
Page 8 of 10 Care Homes for Adults (18-65 years) Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action make sure that at all times there are sufficient suitably qualified staff competent to support students working in the residence. This is to make sure that students needs can be met. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 6 Systems should be put in place to improve communication between the nursing team and care staff ensuring consistency of approach. Consider highlighting areas of concern on body maps to improve monitoring of risk areas. 2 6 Care Homes for Adults (18-65 years) Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 10 of 10 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
