Inspection on 14/04/05 for Stepping Stones

This inspection was carried out on 14th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Stepping Stones 11/07/07

Stepping Stones 04/07/06

Stepping Stones 20/10/05

Stepping Stones 18/11/04

Stepping Stones 10/06/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Cornerstones

Bethesda

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

CARE HOME ADULTS 18-65 Stepping Stones 1-6 Boxhill Close Chard Barton, Honicknowle Plymouth PL5 3QB Lead Inspector Kim Fowler Announced 14 April 2005 th 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 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 Stationary 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. Stepping Stones D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Stepping Stones Address 1-6 Boxhill Close, Chard Barton, Honicknowle, Plymouth, Devon. PL5 3QB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01752 788273 01752 768613 Tamar Housing Society Mrs Susan Davidson Care Home 15 Category(ies) of Physical Disability (15) registration, with number of places Stepping Stones D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age 18-65yrs 2. One named Service User in the category Learning Disability may reside at the home Date of last inspection 18/11/04 Brief Description of the Service: Tamar Housing Society, which is a housing association registered with the Housing Corporation own Stepping Stones. The home is a care home providing care for fifteen people, aged 18 – 65, with physical disabilities. The home is for long stay placements but do try to aim to work with service users to develop independent living skills to enable them to move out into their own accommodation. The length of stay depends on the individual’s needs as identified with the Care Manager and through care plans.The home is located at the end of a cul de sac on a housing estate in the residential area of Honicknowle, close to shops, pubs, the post office and other amenities. The home is purpose built and was opened in 1994. It is comprised of two selfcontained bungalows, each providing six bedrooms, and three one-person flats. All the home’s bedrooms are single and bedrooms in the bungalows do not have en suite facilities. Each bungalow and flat has its own facilities, amenities and services with the design and layout enabling ease of access for people whose main source of mobility is wheelchairs. The home has plenty of communal space and consists of a kitchen and combined dining and lounge areas in each bungalow. The home has spacious and attractive grounds, with raised flowerbeds, which are accessible by service users. Stepping Stones D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 5 hours and was a planned Announced inspection. A partial tour of the premises took place and staff and care records took place. 3 of the staff and 6 of the 15 service users were spoken with during this inspection as well as the Registered Manager. The CSCI received 5 Relatives/Visitors comment cards and 5 Service users comment card. What the service does well: What has improved since the last inspection? What they could do better: Stepping Stones D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Version 1.20 Page 6 The home has good a quality assurance system in place and completed forms from family members were examined. The home may benefit from expanding these questionnaires to the service users in the home and visiting professionals. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Stepping Stones D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Stepping Stones D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Version 1.20 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 standard(s) 1/2/5 Service users can be confident that Stepping Stones provide information in the Statement of Purpose and Service Users Guide enabling them to make an informed choice of care home. EVIDENCE: Seen as evidence during this inspection were the homes Statement of Purpose and Service Users Guide having a recent review date written onto the document and signed by the manager. These documents were seen displayed for all visitors to the home. The manager informed the inspector that the home offers Physiotherapy and evidence was seen recorded into a service user care plan of the dates of the visits and the exercise programme left for the staff to follow. This programme was dated and signed by the Physiotherapist. One service user informed the inspector that they attend a local college for Physiotherapy when required. The manager informed the inspector that this college hold an open clinic, which any service users can attend and the written exercise programme is carried out. Case tracking provided evidence of a contract that was seen for one service users in their individual care plan and this contract was signed dated and had the terms and conditions of occupancy on. The home also had a copy seen during the inspection of a contract with the paying authority of the same service user. Stepping Stones D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Version 1.20 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 standard(s) 6/7/9 Service users can make decisions about their own lives. EVIDENCE: Case tracking provided evidence on 2 service users in the home. Both the care plans seen were comprehensive in detail. One service user has requested to go out socially on their own. The home has produced detailed risk assessment to support this and a further discussion and plans were set out to support this service user. This included limited activities on their own but a detailed plan for staff support. Any self harm from service users is recorded into service users care plans and the inspector has seen this during a previous inspection for one service user who required the home support during self harm episodes. The manager informed the inspector that the home continues with a key worker system, these staff are called Facilitators. Each facilitator name is recorded into the individual files. Evidence was seen recorded and one service user informed the inspector that they are involved in their review and actively participate in their care plans. One service user informed the inspector how they had made the decision to move from one of the bungalows into a self contained flat. Evidence was seen in the form of leaflets that one service user had collected to apply for some local college courses. Stepping Stones D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Version 1.20 Page 10 Clearly recorded into the care plan were you manages the service users finance and clear records are kept of all transactions. Case tracking provide written evidence of comprehensive risk assessments carried out by the home. These included assessments for inside and outside of the home. Service users had signed some of the risk assessments seen during this inspection. Stepping Stones D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Version 1.20 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 standard(s) 12/13/15/16/17. Service users can be confident that the home will provide support for them to access the local community and leisure activities. EVIDENCE: One service user confirmed that they attend a work placement and another service user informed the inspector that they work in a local shop. This service user also said that he had been to the local college to find out about educational course. Each service users has a daily planner and all this information was seen recorded onto this record. Other planners confirmed day placement and other daily activities. One service user is going out with their facilitator to learn social skills to enable them to develop life skills. Several service users informed the inspector that they either visit family members and that family and friends visit the home. Several staff members and service users held a discussion on attendance to a local concert event and that extra staff were provided to cover the event. The local election are due Stepping Stones D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Version 1.20 Page 12 soon and the manager informed the inspector that staff will support service users either to attend the polling station or use their postal vote. 5 family members responded to the CSCI Feedback surveys and written onto the feedback cards was information about family visiting the home. All service users said they go out of the house to visit local shops and pubs. The daily activities sheets seen in the care plans and the rota in the kitchen have recorded the house keeping task each service user is involved in. The home has a clear policy and procedure in place for staff to knock on service user doors and several service users confirmed that staff do respect their privacy. All service users are able to lock their bedroom door if required and all service users who live in the flats confirmed that they have keys to their own flats. All service users have assess to the home as the home provides ramps level floor and wide doors. The 6 service users spoken with during this inspection informed the inspector of planned and taken holidays and visits out to local shops pubs and cafes. Stepping Stones D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Version 1.20 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 standard(s) 18/19/20 The home continues to provide excellent personal support for service users in the home. EVIDENCE: All personal care needs are recorded into individual care plans. The care plans seen and read during this inspection had details of this personal care and completed risk assessments attached to support the staff and service users. Case tracking also showed that the Physiotherapist assessments are working along side these care plans with the Manual Handling risk assessment. The service users informed the inspector that time to go to bed is flexible and the preferred time is recorded into individual care plans. The homes rotas support that the staff team are of mixed gender and age range. The District Nurse visits the home regularly and each service users has a individual file kept in each bedroom. Extra support for service users from District Nurse’s is available on request from the GP practice. Case tracking provided evidence that the home checks regularly for service users for pressure sores and a water low chart was seen as evidence and this was signed and updated monthly. The service users in the home visit the dentist at the local hospital and all service users can choose their own GP. Stepping Stones D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Version 1.20 Page 14 The home has comprehensive policies and procedure seen in place. All staff who administer medication have attended training and the certificates were seen as evidence. Also the manager, who is a trained nurse, informed the inspector that she had completed a in-house training programme that the staff sign to say when they feel competent. Case tracking provided evidence that the service users sign to say they agree that staff can administer medication. Stepping Stones D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Version 1.20 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 standard(s) 22/23 The home has a clear complaints procedure in place and has this displayed for all visitors to the home. And service users can be confident that their complaints or concerns will be listened to and acted upon. EVIDENCE: The CSCI has not received any complaints. The home has a designated complaints file that was seen during this inspection and confirmed that the complaints the home had received were clearly documented and included outcome and actions taken. The complaints procedure was seen displayed on the homes notice board for easy access for the visitors to the home. The completed families Quality Assurance forms were seen as evidence during this inspection and a section on this form includes complaints and concerns. All staff has completed the Adult Protection course provided by the NHS Learning Disability service. The certificates supporting this completed course were seen during this inspection. Stepping Stones D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Version 1.20 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 standard(s) 24/25/26/27/28/29/30 The home continues to maintain a suitable environment for its stated purpose. EVIDENCE: Stepping Stones is a purpose built home with two bungalows accommodating six people in each and three individual flats. The premises are accessible to all the service users with level access throughout, automatically opening front doors and two-way bedroom doors. Areas inspected were found to be comfortable, well furnished and clean. Evident during the inspection was ongoing maintenance work with the replacement of many internal doors. All rooms are single and several service users showed the inspector their bedroom and confirmed that these bedrooms are individually decorated and reflect the person occupying the room with many personal possessions. The home has sufficient bathrooms and toilets and plenty of communal space. The home is purpose built and the aids and adaptations, such as hand/grab rails, bath/mobile hoists and electric/manual wheelchairs, to met the needs of the service users. The home has a call alarm system as well as being adapted to accommodate wheelchair users with such items as lowered light switches, accessible power points, lowered work surfaces, sinks and cooker hobs that Stepping Stones D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Version 1.20 Page 17 moved up and down, and recharging facilities for wheelchairs. The inspector found the home to be clean and free from offensive odours. The home has an infection control policy and all staff completes an infection control course and certificate evidence was seen of completed courses. Stepping Stones D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Version 1.20 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32/33/35/36 Staff training is supported and promoted enabling service users to receive the best possible service. EVIDENCE: The Registered Manager is undertaking job evaluation to ensure job descriptions are suitable for the stated purpose. The homes training files were seen and include updated training certificates including mandatory course and one staff completing a teaching certificate to assist staff with training. The homes rotas were seen ensuring extra staff available when required. 12 of the 17 have completed their NVQ’s and the training plan was seen for the year 05/06 which includes TOPSS Induction programmes. Case tracking provided evidence of supervision session and appraisals sessions have been carried out and staff files also contained completed CRB’s and all appropriate checks for staff. Stepping Stones D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Version 1.20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37/39/42 The management of this home is very good and ensures that records are effectively maintained. Staff are well trained and above all service users are happy and their needs are met. EVIDENCE: The Registered Manager is a qualified nurse and has the Registered Managers award and continues with her own personal development by attending course to assist staff training. The homes Quality Assurance system was seen including completed questionnaires. Service users meeting minutes were seen and one service user spoken with during the inspection confirmed that they had attended this meeting and were able to voice their opinion. The Registered Manager ensures safe working practice by all staff completing mandatory training course including manual handling, fire safety, and first aid and the staff certificates were seen of these course having been completed and updated regularly. Contracts and certificates were seen in place for PAT’s testing, Gas boiler maintenance and risk assessment for legionaires disease. Stepping Stones D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Version 1.20 Page 20 The home has had a recent visit from the environmental health department and the report read by the inspector confirmed the home met the required standard. The home has a comprehensive policy and procedure file in place that has been seen at previous inspections. The home accidents policy was seen and read and case tracking provided evidence on the procedure being carried out by staff by the completion of the homes accident forms. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 4 x x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Stepping Stones Score 4 3 x 4 x Standard No 24 25 26 27 28 29 30 STAFFING Score 4 4 4 3 3 4 3 Standard No D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Score Version 1.20 Page 21 LIFESTYLES Standard No 11 12 13 14 15 16 17 Score x 3 4 x 3 4 3 31 32 33 34 35 36 x 4 4 x 4 4 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 x Standard No 37 38 39 40 41 42 43 Score 4 x 3 x x 3 x Stepping Stones D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Version 1.20 Page 22 No 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 Regulation Requirement Timescale for action 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 Good Practice Recommendations Stepping Stones D52-D04 S3560 Stepping Stones V210469 140405 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP 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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