Inspection on 19/02/06 for Stepping Stones

This inspection was carried out on 19th February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stepping Stones 14/07/08

Stepping Stones 04/08/07

Stepping Stones 17/10/06

Stepping Stones 06/09/05

Stepping Stones 11/01/05

Stepping Stones 20/04/04

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 Stepping Stones Broadoak Newnham-on-Severn Gloucestershire GL14 1JF Lead Inspector Ms Tanya Harding Unannounced Inspection 19th February 2006 8:30 Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 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 Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 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. Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Stepping Stones Address Broadoak Newnham-on-Severn Gloucestershire GL14 1JF 01452 760304 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) Stepping Stones Resettlement Unit Limited Mr Nigel John Greenhalgh Care Home 33 Category(ies) of Learning disability (33), Sensory impairment (1) registration, with number of places Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Sensory Impairment category applies to one (1) named service user only. Category to be removed when service user leaves the home. 6th September 2005 Date of last inspection Brief Description of the Service: Stepping Stones is a registered care home for 33 adults with a learning disability who may also exhibit challenging behaviour. Accomodation is provided in 7 small units. Each unit accomodates between 3 and 7 service users. There are further developments planned in the long term to provide self contained accomodation for up to 6 people. The home is set in extensive grounds which includes a horticultural area, an aviary and a swimming pool. There is also a day centre on site which is staffed separately. It is attended by service users from Stepping Stones and also from other homes in the Stepping Stones group. Stepping Stones Resettlement Unit Ltd has recently retained its ISO 9002 award. Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Sunday morning and lasted approximately three hours. Three units were visited including Cedar Falls, Pine Brook and Poplars Cottage. The main focus of this visit was to follow up the requirements made after the last inspection and this report should be read in conjunction with the report from September 2005 for a fuller picture of the service provided at Stepping Stones. This visit was supported by the team leader and other staff on duty. One service user also provided information and support and showed the inspector around Cedar Falls. Time was spent observing activity and interactions between staff and service users at Pine Brook and the majority of the requirements made in this report are based on these observations. Following this inspection the home has received a visit from the pharmacy inspector and a separate report has been provided to the home with detailed findings. This will be referred to in the next inspection report. What the service does well: What has improved since the last inspection? The home obtained a variation to its registration as required in the last report. Personal records were seen to be kept securely and staff confirmed that records of food provided to service users are kept. A lockable container has been obtained for transporting the medication around the site. Some improvements have been made to the environment as required in the last inspection report. Emergency lighting tests were seen to be recorded monthly. All cars are now parked in a specific area which has been secured to prevent access to service users. Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 6 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. Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 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 Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 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): Not assessed. EVIDENCE: The home accommodates a service user with sensory impairments and has obtained a variation to its registration categories reflecting this. Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 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, 8 and 9 Service users may not always be consulted about their preferences in how they want to be supported. Introduction of person centred plans should address the current shortfalls in care guidance which may be compromising the quality of support provided to the service users. EVIDENCE: A number of care files were examined in Pine Brook. Service users here have complex communication and behaviour needs. The majority of the service users are dependent on staff for most aspects of their care, including personal care and taking part in fulfilling and meaningful activities. Care plans were seen to be very few and limited in content. The home needs to review the care planning approach to ensure the following: 1. Care plans should be based on assessed needs and provide detailed guidance on how these needs will be supported; 2. There must be care plans about all aspects of service users’ lives, providing the necessary detail of the holistic support needed to maintain a good quality of life for each individual. Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 10 3. There must be evidence that service users or their representatives (independent of the care home) are consulted with about aspects of their care and support; 4. Care plans need to be person centred and refer to service users’ preferences and future goals. A distinction should be made where objectives have been set by staff not individuals to show clearly whether a particular aspect of care is important to the service user or seen as important because of group living for example. 5. Care plans need to make reference to how service users will be supported to be as independent as possible and reference would need to be made to any perceived risks, which would be assessed on the basis of relevant factors, such as service users’ vulnerability, historical information, available resources and so on. Any limitations which are imposed to safeguard the person or for any other reason must be detailed with reference to who has been involved in this decision and how this limitation is seen to be in the best interest of the service user. Some care records were out of date and there was limited information about how people’s communication needs are supported. For one service user there was a communication care plan which stated that the person has some Makaton skills and responds to pictures and symbols and is willing to learn. The care plan directed staff to talk and sign to the person. However, no interaction of any kind was observed with the service user from the care staff for one hour during the inspection visit. This must be addressed. The person spoken with advised that there are no service user meetings. Some people who live in the home are able to self- advocate. Some service users have complex communication needs. It was not clear how people were being consulted about their care. Some timetables were seen of activities people may be involved in and these were in symbols. The use of Total Communication resources may be more appropriate in view of very individual needs in this area, but this was not evident. Efforts must be made to develop Total Communication resources and involve service users as much as possible to ensure these resources are meaningful to them. Total Communication principles could be used to promote more effective communication between staff and service users, to make relevant information more accessible to people, increase opportunities for inclusive approaches and to empower individuals to make choices and decisions. There were risk assessments on files which made reference to service users displaying very challenging behaviours. In some cases there was no specific information as to what these behaviours are and this needs to be provided. The registered manager advised that an approach called ‘The Macintyre Approach’ is being introduced to compile reactive strategies for behaviour Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 11 management and this should ensure that the necessary detail about individual behaviours and best responses are available for staff to follow. The registered manager advised of the steps which are already being taken to address some of the above shortfalls. This included introduction of person centred care plans for which training is being delivered to the team leaders and managers in March 2006. Other care staff will also have access to this training in the near future. All care plans and support guidance will be changed to reflect the new approach. Introduction of person centred planning is seen as a positive step and should ensure that service users are more involved in the process. Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 12 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 Service users who live at Pine Brook may have limited opportunities to engage in meaningful activities during weekends. EVIDENCE: On arrival at Cedar Falls, three of the service users were up and welcomed the inspector and offered a drink. One staff member was present in the kitchen involved in preparing Sunday lunch. Service users commented positively about living at Cedar Falls. Care files were sampled for service users who live in Pine Brook. Several records showed that people do not like to get bored and were more likely to display challenging behaviours if they were not occupied. On the day of the inspection the majority of the time was spent at Pine Brook, observing the activity in the home and interactions between staff and service users. It was noted that no structured activities were offered to people during the course of the morning. The service users accommodated here have complex emotional and behavioural needs. One service user was observed sitting on the sofa during the visit and was not spoken with or offered any activity for over an hour. The person was given a drink. Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 13 One service user was very vocal and appeared upset. The person was given attention from staff. One person was displaying inappropriate behaviour and staff assisted the person with personal care. Two service users were offered the option of going outside into the yard/ garden towards the end of the visit. One person was seen wandering in and out of the lounge and the staff member explained that the person likes to go up to their room, where they can listen to their music. On one occasion the person indicated that they wanted the staff member to follow them upstairs. The staff member advised that the person could manage themselves as their room was open and the music would always be on. Better practice would have been to respond to the person’s request. Staff advised there are no structured activities during weekends and service users can listen to music, watch TV or do activities such as sewing. During the week service users are offered structured activities through the on-site day centre. Timetables of activities which take place Monday to Friday were seen on files. The registered manager advised that there are a number of systems in place to ensure service users with complex needs are suitably occupied. This includes regular monitoring of individual activity levels by the day care staff who have taken on a role of mentoring the support staff at Pine Brook. This is to ensure that support staff have the necessary understanding and communication skills to help the residents engage in activities. The manager also explained that there are resources in individual units for offering activities in house and staff should be aware of their role in facilitating these. Staff spoken with advised that there are general menu sheets and records of individual food intake are made in daily records. A number of daily records were examined and showed that details of food/ drinks consumed were these are different from the set menu are being recorded for individuals. Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 14 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 and 20 Service users dignity and privacy may at times be significantly compromised. Further improvements to the way medication is stored and recorded would further reduce any potential for error. EVIDENCE: One person was displaying inappropriate behaviours on the day of the visit and this was seen to upset one of the other service users. No reference was seen on file about this behaviour. Staff were asked how these behaviours are managed to protect the dignity of the service user as well as to stop anyone else getting upset. The team leader advised that this was a new and unusual behaviour and no responsive strategies have been agreed as yet. This needs to be done as soon as possible. Records of health visits were seen on individual files. Weight charts are kept. A health action plan was seen for one person and this was up to date, being last reviewed on 2/02/06. The main medication storage is separate from the units in ‘the surgery’. This room was visited. It was noted that some medication in a blister pack was left out on the tabletop when it should have been locked away in the medication Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 15 cabinet. This was for a service user who attends day care at Stepping Stones. The medication for Friday and Saturday (prior to this visit) remained in the blister pack. This may mean that the service user potentially has not received the medication they were prescribed on those days. The team leader was alerted to this. Procedures for managing medication for service users who do not live in the home must be more robust to minimise confusion and avoid errors. The home has provided a lockable bag which is used to transport medication from the ‘surgery’ to individual units. The inspector was advised that only team leaders and some trained senior staff are able to administer medication and the team leader on duty would be responsible for administering medication on their shift to service users in six different units. Poplars Cottage have their own administration procedures. The medication file contained protocols for ‘as required’ medication. Those seen were up-to-date. Some gaps in signatures were noted in medication administration records where it was not clear if the medication has been administered or not. The team leader advised that there is a system for checking MAR sheets to pick up on any discrepancies. It appears that this has not been effective in this example. Subsequent to this inspection the home has received a visit from the pharmacy inspector who carried out a detailed audit of medication administration systems in the home. The findings are detailed in a separate report. Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 16 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 Lack of accessible information and communication resources may mean that some service users may be unable to raise or express concerns. Better guidance on acceptable physical intervention approaches for individual service users would ensure that people are better protected from staff using inappropriate and dangerous techniques. EVIDENCE: Pine Brook. Service users files contained copies of the home’s complaint procedure. This was not in an accessible format and may not mean much to some service users in the home. An accessible version needs to be provided and use of Total Communication principles should be used to develop this in a format which is meaningful to different individuals. Files contained body maps. These are completed when a service user acquires an injury. It is recommended that reference be made on body maps to whether the cause of injury is known or not and whether this has been investigated. Files contained detailed risk and behaviour assessments, which for some individuals referred to use of physical intervention. However, no individual physical intervention protocols were seen. These must be available on file for each service user who may need such intervention and must detail clearly the type of intervention required (including techniques which may be used). Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 17 Poplars Cottage. Two service users were present. One person had sores on their hands. Records around this self-harm behaviour were examined and appeared to be suitably detailed. Staff confirmed that a body map would ordinarily be completed for each injury or mark found on the service users. However, this was not done on this occasion. The incident took place the day before this inspection. This will be monitored at future visits. Care information and guidance about managing aggression was seen for one service user. This appeared detailed and made reference to how any physical intervention would be carried out. This is a better example of guidance which needs to be provided for each individual who may need physical intervention. The home is aware of the procedure for involving the adult protection team and for reporting significant incidents to the Commission. Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 18 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 Some aspects of the environment could be improved to provide a more homely and pleasant environment for the service users. EVIDENCE: A number of requirements were made in the last inspection report about improvements that were needed to aspects of the environment. Some were not followed up at this inspection and will be revisited at the next inspection. The environments at Cedar Falls and at Poplars Cottage were noted to be odour free and clean in appearance. However, the following shortfalls have been noted at Pine Brook: 1. There are no curtains or blinds in the communal areas; 2. The cushion on one leather sofa was completely ripped and springs/ base under the cushion was seen to be broken. It was surprising to see that this sofa was still in use as this could be potentially hazardous. Staff advised that this matter is being rectified. 3. The first floor bathroom which is used by the male residents was noted to be odorous during the last visit. This was odour free on this visit. There is no window in this room. Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 19 4. The second communal bathroom which is used by the female residents was odorous even though the window was open to ventilate this room. There are three bins stored in this room which are used for collecting soiled continence pads. The odour was quite noticeable and this is despite staff advising that the bins are emptied every day. More appropriate storage needs to be found for these bins to ensure that the adverse odour does not spoil the otherwise pleasant experience service users may have in this bathroom as well as to control the spread of infection. The lounge had a very dark décor and the carpet was soiled and slightly odorous and this detracted greatly from the homely look. The registered manager advised that as part of the planned maintenance this room has been redecorated and the carpets cleaned. The dining room table has benches instead of chairs. Staff explained that this is because of recognised risks. The arrangement does look quite restrictive in that if all service users were seated, some may not be able to leave the table when they wanted to. However, the registered manager explained that service users do not use the table during meals all at once and are always supported by care staff. The manager confirmed that the requirements to investigate the smell of urine and to replace cushions on the sofa in Rose Lawn have been addressed immediately after the last inspection. The improvements to the kitchen in Poplars Cottage were noted. The space has been increased and can be used to support the service users in domestic and self-help tasks much safer than before. Better food storage practices were noted here, with foods which have been opened, being covered and labelled with the date of opening. Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 20 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 and 33 There is an aim to provide consistency of support offered which has clear benefits to the service users in ensuring that people receive the care in the way they are used to and are happy with. The approach used by staff may not always be professional and this may mean that service users are not treated as respectfully as they should be. EVIDENCE: The team leader on duty supported the inspection. She explained that there are minimum of two staff on duty in four of the units and a minimum of one staff in each of the bungalows. Poplars Cottage have their own staffing arrangements. The team leader advised that this ratio is exceeded wherever possible to provide 11 or even 12 staff. She said it is the aim to provide at least 11 staff during the weekdays and 12 staff during evenings and weekends. There are seven service users accommodated at Cedar Falls and five at Pine Brook. Each of the bungalows accommodates three service users. The team leader has the responsibility for ensuring that staff are deployed to each unit at the beginning of each shift. She advised that generally it is seen as good practice to have the same staff supporting each unit as this increased consistency of approach and enables for service users to build relationships with staff. Service users at Cedar Falls commented that they preferred for the staff known to them to provide the support. Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 21 Because of the staffing levels being at its minimum (10 staff for six units), no outings have been planned on the day of the visit until later in the afternoon, when one or possibly two extra members of staff were expected. Examination of the fire book provided evidence that on at least one occasion in February 2006 there were just nine staff covering an evening shift. A requirement is made to ensure there are always sufficient staff on duty and to consider the limitations of just 10 staff supporting the majority of the service users during weekends and evenings. One service user at Pine Brook was getting quite anxious and upset indicating that they wanted to go out. The person was told that this would not be possible until much later. Staff spoken with said that some service users require very intensive support to access the community. It is accepted that weekend activities are more flexible than more structured days from Monday to Friday. However, the minimum staff ratio is seen to be very limiting during weekends and consideration should be given to whether there are sufficient opportunities for meaningful and fulfilling activities during weekends are being provided to the service users. The discussion with the registered manager provided evidence that community access during weekends is being monitored. There has been an overall improvement in this area as noted in the last inspection report. There is a dedicated member of staff who is rostered to organise and support activities and outings during weekends. It was observed that staff were using terms of endearment mainly ‘darling’, ‘sweetheart’ and ‘love’ when addressing the service users. These terms of address were used much more frequently than the person’s own name and this was not seen as professional and could potentially be seen as denying the service users’ individual identity. Staff must receive guidance about professional approaches and service users should be addressed by their name or alternative preferred term of address as recorded in personal files. Poplars Cottage. Three staff were on duty at the time of the visit, including a senior care worker. The inspector was advised that there are at least four staff on duty Monday to Friday, when more activities take place. Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 22 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 and 42 Systems for monitoring practices in individual units and improved care guidance (when in place) should mean that staff are aware of good practice approaches and use these when supporting the service users. Health and safety systems are evident but could be further improved to ensure more robust protection for service users. EVIDENCE: The registered manager has the role of overseeing seven separate units on one site. The Organisation has a structure and administrative personnel to support the manager in his role. Overseeing the care side of the service in addition to the registered manager there is a deputy manager and several team leaders. There is also clinical and training support for the home as well as to the other homes within the Organisation. As noted during the visit, there was just one team leader on duty with responsibility for six of the units and being included in the staffing ratio. This potentially presents constraints to the role of a team leader. The registered Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 23 manager advised that there are plans to delegate more responsibilities to each unit by creating more senior roles and allocating responsibility for the medication to the individual units. This should enable each unit to function more autonomously and have more accountability for the work they do with the service users. The registered manager appeared well informed about the matters in each unit and has already identified a number of issues which are commented in this report as needing improvement. Poplars Cottage has a dedicated team leader and senior staff. The registered manager advised that he and his deputy make regular visits to each unit and hold regular meetings with the team leaders. The manager recognised the importance of observation of practices in each unit and reflected on changes which have already taken place and future plans for further improvement to ensure that the service delivered at Stepping Stones is in line with the National Minimum Standards. It was noted that the door into the lounge in Pine Brook was propped open with a chair at the start of the visit. This is a fire door and needs to be kept closed. If the door needs to stay open during the day to enable ease of access, a suitable self-closing device must be provided. The fire logbook was seen in Pine Brook. The team leader advised that the same alarm system links all four units in the main building. The fire logbook had a record of fire alarm tests and emergency lighting tests from December 2005 to date. Checks were being done at the required intervals. Records of previous checks were not available as were being stored by the registered provider. The fire logbook needs to have information about which premises the checks are being carried out in as well as detail of who is responsible for ensuring that these are done. There is also a fire book which records who is on premises during each shift as well as any visitors. Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 24 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 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 2 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X 2 2 X LIFESTYLES Standard No Score 11 X 12 X 13 2 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 X 2 X 3 X X X X 2 X Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 25 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 YA6 Regulation 15 Requirement Care plans were seen to be very few and limited in content. The home needs to review the care planning approach to reflect the issues listed in the text (bullet points 1 – 5) Care files need to be audited to ensure that all care records present are relevant and up –to date. Care files must contain detailed information about people’s communication needs and how these need to be supported. This must include guidance on how people can be consulted about their care. 4 YA9 14 There must be clear information in personal files about the service users’ behaviours that may challenge the service. Provide guidance for staff on how to respond to a specific service user (as described in the text) to ensure the person’s dignity is protected. DS0000016589.V283084.R01.S.doc Timescale for action 31/05/06 2 YA6 17 (1) 31/05/06 3 YA6 12 30/04/06 30/04/06 5 YA18 12 31/03/06 Stepping Stones Version 5.1 Page 26 6 YA20 13(2) Procedures for managing medication for service users who do not live in the home must be more robust to minimise confusion and avoid errors. Medication administration records must be completed accurately at all times. 31/03/06 7 YA22 22 8 YA23 13(6) An accessible version of the Complaints procedure needs to be provided which is more meaningful to people with communication difficulties. Individual physical intervention protocols must be available for each service user who may need such intervention and where these are not in place or are too general. These protocols must detail clearly the type of intervention, which staff may use as a last resort (including reference to specific techniques and to any perceived risks). 30/04/06 30/04/06 9 YA24 23 Address the necessary improvements to the environment as detailed for Pine Brook: 1. Provide suitable window coverings in communal areas (if appropriate) 2. Find a more appropriate storage for continence bins to address the unpleasant odour in the communal bathroom. Staff must receive guidance about professional approaches and meaningful interactions with service users. DS0000016589.V283084.R01.S.doc 30/04/06 10 YA32 18 30/04/06 Stepping Stones Version 5.1 Page 27 Service users need to be addressed by their name or preferred term of address (if such is known and recorded on personal file). 11 YA33 18 Ensure that at all times there are sufficient staff on duty to ensure the health and welfare of the service users. Ensure all fire doors are used appropriately. Provide suitable self-closing devices where the fire doors need to remain open for ease of access. The fire logbook needs to have information about which premises the checks are being carried out in as well as detail of who is responsible for ensuring that these are done. 31/03/06 12 YA42 23 31/03/06 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 YA23 Good Practice Recommendations It is recommended that reference be made on body maps to whether the cause of injury is known or not and whether this has been investigated. Develop Total Communication resources and staff skills in this area to promote a more inclusive and effective communication approach in each unit. Consider establishing a regular forum which promotes self advocacy, such as a residents meeting. Consideration should be given to whether there are sufficient opportunities for meaningful and fulfilling DS0000016589.V283084.R01.S.doc Version 5.1 Page 28 2 3 4 YA6 YA7 YA13 Stepping Stones activities during weekends are being provided to the service users (specific reference to Pine Brook). Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Stepping Stones DS0000016589.V283084.R01.S.doc Version 5.1 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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