Inspection on 19/07/06 for Stairways

This inspection was carried out on 19th July 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stairways 20/07/07

Stairways 08/11/05

Stairways 24/05/05

Stairways 23/11/04

Stairways 21/07/04

Stairways 12/12/03

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

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

CARE HOME ADULTS 18-65 Stairways 19 Douglas Road Harpenden Hertfordshire AL5 2EN Lead Inspector Angela Dalton Unannounced Inspection 19th July 2006 10:45 Stairways DS0000019550.V304528.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 Stairways DS0000019550.V304528.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. Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stairways Address 19 Douglas Road Harpenden Hertfordshire AL5 2EN 01582 460 055 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) Harpenden Mencap Society Darren Lelliott Care Home 17 Category(ies) of Learning disability (17), Physical disability (17) registration, with number of places Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home may accommodate children and adults with learning disability or physical disability (when associated with learning disability). 8th November 2005 Date of last inspection Brief Description of the Service: Stairways is a care home for seventeen people with a learning disability, who may also have an associated physical disability. This total includes the provision of respite care to four children. The home is a large Edwardian property in Harpenden, divided into four self-contained flats, each with kitchen, lounge, toilet, bathroom and bedrooms. Flat 1 accommodates up to 5 service users with a learning disability; Flat 2 accommodates up to 4 service users with severe learning disability who occasionally display behavioural difficulties and Flat 4 accommodates up to 4 service users with moderate to severe learning disability. The short-term care unit accommodates up to 4 children plus day care for 1 child. This unit comprises a kitchen/dining room, bathroom/toilet, utility room, bathroom, toilet, lounge, playroom and four single bedrooms. There are spacious grounds surrounding the house and car parking for several vehicles at the front. The house is near Harpenden shops and other community amenities and public transport routes to St Albans and Luton are accessible. Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection consisted of an unannounced site visit conducted by one Inspector on 19th July 2006. The Inspector spent time in all of the flats with both service users and staff. A high standard of care is delivered at Stairways and staff cope well with the restrictions of the layout of the building. The weather was extremely hot during the inspection (37ºC) and staff coped admirably with this challenge and took measures to minimise discomfort to service users. The manager was aware of the Heat Wave guidance issued by the Department of Health and had implemented the advice given. Service users spoke highly of the support that they received and the Inspector observed staff being kind, gentle and patient with service users who could not express their needs verbally. The atmosphere in each flat was calm and welcoming. A core of staff have worked within the home for many years and stated that they enjoyed their work and derived satisfaction from it. A new member of staff confirmed that they had been well supported during their induction period and were able to ask for any information they were unsure of. The home also operates a separate respite unit for children between 5 and 19 years of age, consistent with the previous inspection reports it is the view of the Commission that the Children’s Homes Regulations 2001 and the National Minimum Standards for Children’s Homes apply to this aspect of the service provision. This is therefore reflected in the text of the report where appropriate. Weekly fees range from £724.46 to £1440.88. What the service does well: The focus of the home is the service users and Stairways strives hard to ensure that each flat reflects the personalities of the service users and it is a homely environment. A rolling training programme is offered and staff are supported in monthly supervision sessions. Staff know service users well and work hard to ensure partnership with families. This was especially evident in the short term care flat (Children) and correspondence reflected that consistent care takes place. Each flat has access to transport and more independent service users are encouraged to use public transport where possible. Criminal Record Bureau checks are carried out three yearly, which exceeds current recommendations. Care plans provide detailed information about service users’ needs and how they are met. Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Individual needs are assessed and form the basis for the care plan. Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. EVIDENCE: No new adult service users have been admitted to the service since the previous inspection. A comprehensive assessment process takes place before any service user moves into Stairways. The staff team visit service users and their families prior to any visit to the home and seek additional information from members of the multi-disciplinary team. This was evident in the short term care flat where there was a wealth of information in place from professionals which forms the basis for a comprehensive care plan. Assessment is ongoing as care plans are reviewed and individual needs change – this information is incorporated into care plans. Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Care plans are informative and service users are encouraged to take risks. Service users make informed choices enabling them to live full and varied lives. All the children using the respite service have not had a placement plan review due to the inaction of the placing authority. Pilot reviews are scheduled but not for every child. Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. EVIDENCE: Each service user has a comprehensive care plan and the manager is exploring options to streamline the content. This will ensure that historical information is still accessible but that files do not become bulky and overwhelming. Risk assessments reflected that service users independence is maintained and personal choices are respected. A previous requirement has been addressed as the Local Authority have now scheduled a pilot scheme to review children’s placement plans. This requirement will remain in place until each child has had their plan reviewed. Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 10 The judgement reflects that the delay has not been caused by Stairways and the manager has persevered in ensuring that reviews are held. Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Service users fully participate within the community. Mealtimes are service user led. Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users have a presence in the local community. During the inspection some service users went on a picnic. As discussed earlier the home has access to its own transport and staff make good use of this. One service user spoke with the inspector about the local Highland games that they had attended the previous weekend. Some service users have recently been on holiday and shared their reasons about the choice of destination. If service users wish to observe a particular faith they are encouraged to do so. The home currently has some staff vacancies but ensures that regular staff are employed from an agency so that the disruption to service users is minimised. Links with friends and family are encouraged and the home has flexible arrangements to facilitate visits. Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 12 Two mealtimes were observed during the inspection in different flats. Service users’ choices and health requirements were taken into consideration. Staff have a good knowledge of dietary requirements and individual needs. Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Service users’ individual wishes are respected. Health needs are reflected in care plans to reflect good care delivery. A safe medication system is not in place. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector spoke with service users who confirmed that staff were mindful of their privacy and dignity. This was evident regarding one service user who had a lie in and called for staff support at intervals whilst bathing. Some staff work in a number of flats but are mindful of confidentiality and ensure that this is observed. One service user stated that if they had concerns or wanted to make a complaint they would go to a member of staff and could identify whom they had a good relationship with. Health needs of service users are well met but sadly, physiotherapy support is to be withdrawn in the near future and service users will be expected to fund this provision independently. The manager is exploring alternatives. Staff receive training on a regular basis to ensure that they are able to meet service users’ changing needs. Some staff have recently attended dementia training and this will ensure that one service user’s needs are met and appropriate care is delivered. Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 14 A requirement has been made regarding medication: medication is stored in a domestic fridge as opposed to a medication fridge; storage temperatures are not recorded; medication must be stored according to the manufacturers instructions or the effectiveness may be compromised. Handwritten instructions do not reflect the route medication is to be given or signed by staff, this could result in an error in administration. Service users who self medicate do not have an assessment in place to reflect their capability and professional agreement. The reverse of the Medication recording sheet does not reflect reasons for refusal or omission of medication so it is not possible to accurately audit regular refusal of medication. One service user is given covert medication as it is not available in liquid form – a multi disciplinary agreement must be in place to reflect that this practise is safe and acceptable. The home uses a recording system unique to Stairways and whilst it is time consuming staff commented that it worked well and the errors were minimal. Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Service users views are encouraged and incorporated into the running of the home. The protection of service users is assured. Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is available in the service user’s guides for both adults and children’s services. Service users confirmed they were aware of how to go about making a complaint and were confident that any concerns raised would be dealt with. Staff are aware of local policies relating to Adult and Child Protection and receive updated training regularly. Staff confirmed that they were familiar with the relevant procedures. Staff who work with children attend annual training on peaceful restraint and distraction. This ensures that children who pose a risk to their own safety or that of others can be managed safely. Records of any intervention or sanctions are recorded and signed by the manager. Families are informed of any issues during a child’s stay at Stairways. Regular service user meetings are held - service users stressed that they would always bring any problems or concerns to staff. Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Although the environment could be better suited to the needs of service users it is clean and well maintained. Soap and hand towels could be better situated to ensure good infection control practice is observed. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was clean, tidy and odour free whilst maintaining a homely and friendly atmosphere. As cited in the previous report the design of the elderly building continues to limit the adaptations and improvements that could realistically be carried out to create a more child oriented physical environment, especially for wheelchair users or other physically disabled children. Space is relatively limited and the bathing facilities are unsophisticated. Despite these challenges staff have achieved a colourful, bright and child friendly environment. The requirement to continue to update the Commission with regard to development of the service remains in place. Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 17 To enhance infection control procedures soap and paper hand towels should be provided in the shower/toilet in the short-term care flat: staff and children currently have to go into the adjacent bathroom to access these provisions. A recommendation has been made. Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,24 & 35 Staff know service users well and work together as a team. They are competent to meet current service users’ needs. Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. EVIDENCE: Two new staff files were inspected and found to be in good order. One recently recruited member of staff said that following her formal induction she had commenced Learning Disability Award Framework accredited training. The home retains a large core of staff who state that they enjoy their work and the rewards that they get from it. Training occurs regularly and staff are encouraged to attend relevant courses. If staff identify an appropriate course they are generally able to attend and feedback to colleagues. An example of this is staff who have attended health and safety courses and training in dementia. Although the home currently has some staff vacancies great efforts are made to minimise disruption to service users. Permanent staff are often willing to work additional shifts and regular agency staff are employed as they know service users. Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 A quality assurance system is in place. The home is run in the best interest of service users. Some minor improvements are recommended regarding health and safety issues. Quality in this outcome area is adequate; this judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has a good knowledge of the home and spends time in each flat to ensure he is available to staff and service users. Quality assurance is monitored through questionnaires to service users and their families. Staff receive this information directly and are able to discuss it within their team meetings. A report is issued for the Trustees. Stairways is well run and effective communication takes place due to the ‘open door’ policy of the management team. Key staff are responsible for the implementation of health and safety and attend regular training. Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 20 There is currently no missing person information or current photograph in place if a service user became separated from staff or did not return home. This may make the circulation of a recent photograph and description to the relevant authorities difficult. The fire protocol should be expanded so that staff are fully aware of what action is required with every individual in the event of a fire e.g. staff remaining with service users. A recommendation has been made. Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 21 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 X 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 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X 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 2 X 3 X 3 X X 2 X Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard CH3 Regulation 12 Requirement A formal system should be introduced, in order to ensure that each child has a placement plan review, involving the child, parents and professionals as appropriate. (Previous requirement). Although this is partially addressed via the pilot scheme the requirement will remain until all children have been reviewed. Timescale for action 31/12/06 2. CH23 31 The physical design and layout of 31/12/06 the building are not suitable for the purpose of effectively achieving the aims and objectives of the childrens respite unit. (This would be addressed in the Organisations proposal to completely upgrade the accommodation for the adults and childrens services. The Director of Services to submit plans to the Commission for consideration. (This requirement has been made previously) The medication system must ensure service users’ safety. DS0000019550.V304528.R01.S.doc 3. YA20 13(2) 08/08/06 Stairways Version 5.2 Page 23 Medication must be stored at a correct temperature and records kept; Staff must receive accredited training; Medication must not be stored in a domestic refrigerator; The route of medication must be recorded on the medication record sheet; Handwritten instruction must be signed; Reasons for refusal or omission must be recorded. One service user is given covert medication as it is not available in liquid form – a multi disciplinary agreement must be in place to reflect that this practise is safe and acceptable 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 YA30 Good Practice Recommendations Soap and paper hand towels should be provided in the shower/toilet in the short term care flat: staff and children currently have to go into the adjacent bathroom to access these provisions. A missing person form should be in ‘at risk’ service users’ files with a current photograph. A comprehensive fire protocol should identify action needed with individual service users. 2 3 YA42 YA42 Stairways DS0000019550.V304528.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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