Inspection on 04/08/07 for Stepping Stones

This inspection was carried out on 4th August 2007.

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 2 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 17/10/06

Stepping Stones 19/02/06

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 Mr Tim Cotterell Unannounced Inspection 4 August, 12 and 21st September 2007 10:00 th th Beeches (The) (Seven Kings) DS0000016589.V339043.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 Beeches (The) (Seven Kings) DS0000016589.V339043.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. Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 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 Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 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. 17th October 2006 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. Accommodation is provided in 7 small units. Each unit accommodates between 3 and 7 service users. There are further developments planned in the long term to provide self-contained accommodation 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. Copies of the last inspection report are available in the home. The current fees of the home are from £1400-to £2450 per week. Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The inspection was undertaken over three visits. Two were unannounced and one announced. The first visit was in response to a concern raised about the number of staff on duty at weekends. In the circumstances the visit was seen as the first day of the key inspection with the subsequent visits to complete the inspection. During the inspection the Inspectors spoke to the Registered Manager, the deputy Manager, the majority of the care staff on duty and a number of residents. Discussions also took place with the Activities Manager, Human Resources Manager, cognitive therapist, health and safety adviser, chef, and maintenance person. All of the houses were visited with communal areas seen and a number of bedrooms in each house. A number of the Commissions surveys sent to relatives and residents were returned completed, they consisted of eight residents and two relatives. What the service does well: The completed residents surveys said that they felt staff were caring and good listeners, and that they felt safe and comfortable in the home. The relatives surveys returned said that they felt happy about the services provided. A number of the residents were seen and spoken to by the Inspectors and it was clear that they enjoyed living in the home and felt that staff were caring and supportive. All residents are able to make choices about how they spend their time in the home. All residents have plans of care, which clearly indicated their needs and wishes. Subject to risk assessment residents are able to exercise choice about how they spend their time Beeches (The) (Seven Kings) DS0000016589.V339043.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. The summary of this inspection report can be made available in other formats on request. Beeches (The) (Seven Kings) DS0000016589.V339043.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 Beeches (The) (Seven Kings) DS0000016589.V339043.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of the prospective residents are assessed in detail before admission and this includes a formal plan of action to achieve the specific aims. EVIDENCE: The Deputy Manager and the home’s cognitive therapist complete a preadmission assessment. Two pre-admission assessments were seen including one for a resident who was being admitted shortly. There was a detailed assessment process including information from previous placements and supporting professionals. A comprehensive risk assessment and support plan had been completed and this included behaviour management in detail. The information was very clear for staff to follow and a copy was already in the home for staff to read before the person was admitted. Skills objectives were also identified and a clear plan of how this could be achieved was seen. People usually visit the home before admission and have a meal, the family are also invited. The road outside the home is very busy and if there is a high risk of people absconding it is felt that they may not be placed at the home. There are security gates to access the homes. Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 9 A new pictorial Service User Guide has been produced and will be made available to all residents. Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual needs are assessed, planned and written and the objectives are specific to ensure all needs are well met. Residents are encouraged to make their opinions known in a safe and supportive environment. Responsible risk taking is encouraged and managed in a competent manner. EVIDENCE: The deputy manager is registered nurse learning disabilities and has a good knowledge of the care plans seen by the inspector. The home also has an experienced cognitive behaviour therapist who completes the support strategies used by the care staff. There is a good liaison with CLDT. Referrals are regularly made to them through the GP to ensure that the people in the home have the professional support and guidance they require. Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 11 Three care plans were looked at in detail and several people with some challenging behaviours were discussed with the homes cognitive therapist. On the second inspection visit the new person admitted was spoken to and the care plan was seen. Most of the people living in the home were spoken to, including two people who had requested to speak to an inspector in the Commissions surveys. The care plans contained detailed information about previous care to help staff establish continuity. Detailed risk assessments are recorded and strategies to limit the risk are detailed. Behavioural triggers and a list of distraction are recorded and what action to take should any restraint be required. Staff spoken to were able to tell the inspectors what they did and the level of restraint they may use and how they had been trained to complete it. Staff spoken to said restraint was rarely used as distraction strategies usually worked. Pictorial activity rotas are in place for everyone and are an important part of their care, people were seen completing some activities and engaging well with the staff. Monitoring sheets are completed by the staff to establish that the strategies are working. The cognitive behaviour therapist sees all incident reports and completes a graph as a aid to establishing prevention strategies. Some people may require extensive monitoring every fifteen minutes should they be capable of self-harming. Ten people have mood charts recording their behaviour, which are converted into bar charts by the cognitive therapist to monitor progress. Each person has a social skills care plan to help enable them to progress and develop independence. Each person has a keyworker that writes a monthly report regarding any incidents and progress made or otherwise. Daily records seen were informative and there were comments on social skills. There are some house rules relating to personal relationships and Independent Mental Capacity Advocates (IMCA) from the partnership trust are used to support people making decisions. All the information is given to the GP should there be concerns and a healthcare professional from the CLDT would visit the home. The GP visits the home weekly providing good support and also reviewing medication when required. After speaking to the residents and staff it was felt that the plans in question were appropriate and realistic and written in a manner, which was comprehensive, but clear and practical. Many of the residnts have difficulty in communicating their needs and wishes however it was evident that staff are attempting to redress this. One way is through the plan of care where specific needs are noted, another is the reformed residents meetings which are now held and minuted. It was clear that the more able resident saw this as a way of presenting their thoughts about Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 12 the service they receive. During the inspection there were a number of events which provided evidence of residents making choices and this was undertaken in a calm and relaxed manner by staff who respected the residents right to make such decisions e.g. the ability to stay in their room/house and not attend activities. Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13 15.16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home assesses the needs/wishes of the residents and from a range of internal/external facilities ensure they have an active and appropriate lifestyle. Residents are involved in the community and links with families are encouraged and supported. Residents enjoy healthy eating and are able to exercise choice over what they have. EVIDENCE: The home has a resource centre in the grounds of Stepping Stones and this provides a range of activities, which includes sewing/textiles, art design and ceramics. The Inspectors visited the resource centre and observed a number of activities. After talking to staff and the residents who were taking part it was Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 14 evident that the residents enjoyed what they were doing and were pleased to show their work to the Inspectors. The inspectors spoke to the manager and staff of the resource centre and felt that they were making great efforts to provide an appropriate, stimulating and caring environment. It is hoped that some residents will be supported to enter the special Olympics. The size of classes should be carefully reviewed to ensure that residents are appropriately supervised/supported. The Inspectors discussed the role of Gloucestershire Industrial Services and specifically their role in supporting adults with learning disabilities in supported employment. Residents also attend the local colleges and the Inspectors spoke to one who confirmed that he enjoyed attending and looked forward to each visit. The home undertakes shopping trips in the local community and the visits to local pubs and places of interest ensure that they are actively involved in their immediate community. Subject to some restrictions (which were written) residents are supported to maintain contact with family and friends. Where residents have friends within the home staff are sensitive to their ability to understand and consent and provide unobtrusive help if and when necessary. In spite of the high dependency of some resident’s staff were seen to respond to individual wishes, e.g. one resident did not wish to attend the activities but preferred to stay in his room and listen to music. This wish was accommodated in a calm and relaxed way. Whilst there is structure at Stepping-Stones it was evident that residents are able to determine how they spend their time. The Inspectors spoke to one employee who was employed as a chef and had compiled healthy eating menus for the houses on campus. This has resulted in staff preparing meals with fresh ingredients wherever possible and avoiding the use of tinned or prepared foods. Examples seen were staff preparing homemade soup for lunch and a chicken curry using individual spices and fresh ingredients including fresh ginger. Residents were seen in a number of houses at mealtimes and it was clear that they enjoyed their meals. The menus indicated that there was always an alternative. During the inspection the food storage was seen and there was a lot of fresh food available including fruits and vegetables. There is a folder in each home with very good detailed recipes to help staff prepare varied and nutritious food for the six weekly menus and any alternatives from the alternatives menu. It may be helpful if the dietician attached to the Forest Community Learning Disability Team is asked to comment on the new menus. Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 15 Some people accommodated help the staff prepare the evening meal and one person has a separate vegetarian menu for each day. The inspectors saw the surveys completed by the people accommodated and the staff to assess the new procedures. The surveys were overall positive although some staff said they needed more cooking lessons, which the chef was providing. The chef said that staff were becoming more enthusiastic about cooking and were producing some good food. Healthy desserts were provided such as fresh fruit and yogurt; however, one person had requested ice cream on their survey. The chef was trying to ensure low fat deserts were served, but said fruit crumbles could be made occasionally using apples from the orchard. There may be a need to provide a variety of low fat deserts. There were no complaints from the people living in the home about the food provided. The food provided looked good and the chef and manager will monitor the new healthy eating regime to ensure it has the desired outcomes for everyone. All staff who prepared food had completed basic food hygiene training and all the kitchens seen were clean and well organised. Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18.19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Healthcare needs are clearly identified and met and where appropriate support is provided. Medication is managed well and information for individuals administration preferences are recorded which helps to ensure clear and safe practice. EVIDENCE: Healthcare assessments are recorded separately and include consent for healthcare. Previous healthcare needs are recorded and there was evidence of healthcare professional involvement, e.g. a physiotherapists report, and information from the speech and language therapist regarding a Percutaneous Endoscopic Gastrostomy (PEG) feed for someone unable to swallow. The staff spoken to, who were managing the PEG feeds, were able to describe the regime and practice used to ensure safe administration and comfort for the person receiving it. Dietary assessments are made and weight is regularly monitored. A dietician’s visit had been arranged to support a resident recently admitted. Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 17 Sensory assessments are made and the appropriate checks completed and any aids and adaptations provided. Any history of falls is recorded and monitored by the staff. The community nurse visits the home for any wound care required, currently there was one resident requiring some attention for a chronic wound which the deputy manager said was healing well. The continence adviser supports residents when required. Medication is administered using a monitored dosage system and currently no one self medicates. Each home has a clear medication policy for staff to follow. There is a list of homely remedies agreed by the doctor and information sheets on each one and any first aid action required. It is recommended that a time limit should be added to the procedure for the administration of homely remedies, to include how many doses could safely be given before contacting the doctor. It is advisable that a record of any homely remedies given should be kept with the administration records. There is a good pictorial assessment of ‘how I take my tablets’, which some residents living in the home had signed and was a helpful record for all staff to follow. The protocols seen for medication taken ‘as required’ were very good and a separate record for staff to follow was kept for administration. The deputy manager completes a monthly audit of ‘as required’ medication, which is good practice and would highlight any deficiencies. There was a good protocol and record of administration for an ‘as required’ medication for the management of an epileptic seizure. The deputy manager stated that any medication omissions are recorded and these are looked at to ensure safe handling and administration of medication. It was recommended that a monthly audit be recorded for all medication administered to ensure compliance with procedures. All medication returned to the pharmacy is recorded and there are currently no controlled drugs. The medication storage was secure in the home looked at. The inspector completed an audit of a residents medication, which was complete. Liquid medication was dated when opened and staff had information regarding the length of time after which various medication should be discarded, to include creams. All staff that administer medication have in house training to a good standard, the resources used are endorsed by the Royal Pharmaceutical Society. An example of the training material was seen. Staff are shadowed initially and receive annual medication training refreshers. The deputy manager stated that the local pharmacist may be completing the annual refresher courses for staff this year. The home has a 2007 British National Formulary for reference in the main office and various others in a few home offices. As there may not be access to Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 18 the main office at all times it is recommended that there is always the latest BNF or similar available. Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a complaints procedure, which was seen as more user friendly and it was evident that staff, through the formal and informal channels would ensure that residents are protected from any form of abuse. EVIDENCE: Many of the residents would have difficulty in undstanding any written complaints procedure, but the Inspectors felt that staff were aware of the major sources of abuse and would respond quickly and appropriately if there was any evidence of abuse. Most of the issues raised on a day-to-day level are resolved quickly and informally. The home has a new Service Users Guide and this has an updated and user-friendly pictorial procedure for concerns/complaints. Staff continue to have training for the Protection of the Vulnerable Adults and the last training day was held on 20 September 2007, it is essential that everyone has the initial training and is updated on a regular basis. Residents meetings have been reintroduced and this was seen by staff as a good avenue for residents to raise issues of interest. Minutes are to be kept of the meetings and their effectiveness will be reviewed. Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 20 The home received one complaint but this was investigated by the local authority who was responsible for the funding of the resident. The use of the local advocacy scheme was discussed. The service had been used by the home and staff were aware of the types of concems which would benefit from an independent view. Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides accommodation for the residents that is maintained to an adequate standard. EVIDENCE: All of the houses were visited. The communal rooms were seen and a number of bedrooms were chosen at random Cedar Falls, 7 residents. The lounge carpet is stained and worn. One corner cupboard has no handles and looks unsightly. The use of this area should be reviewed and the furniture repaired/replaced. Rooms clean and odour free Elm Lake, 5 residents. Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 22 Accommodation was satisfactory rooms were clean and odour free Pine brook, five residents. The lounge and hallway carpet is worn and stained. The inspectors were advised that there are plans to replace the dining furniture. One bedroom window is not restricted. Bedrooms have been personalised Poplars View, five residents. The home would benefit from a programme of redecoration. One fire bedroom was door propped open (see management section for more details). The bathroom window should be risk assessed (not restricted) Rose Lawn, 3 residents. Carpets in hall and lounge were worn and stained and should be cleaned/replaced. Front door damaged and needs repainting. Willow Green, 3 residents. One bed mattress was worn and provides little support/comfort. Poplars Cottage, five residents. All accommodation in good decorative order and appropriately furnished. Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32.34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staffing levels have improved since the first day of the inspection and are now meeting the agreed minimum for day support, which is 13 support workers on each day shift. EVIDENCE: Staff on duty were spoken to and the Inspectors felt that they had a good relationship with the residents and were able to manage the challenging behaviours that occurred during the inspection visits. What concerned the inspectors was the fact that there were shortages identified during the visit on Saturday 4 August 2007 and this was addressed in the letter from the Commission dated 7 August 2007. During the inspection it was noted that there were occasions when a house staffed with two support workers would be reduced to one when the second person had duties elsewhere. In the cases seen the team leader on shift had to leave the house to deal with medication matters elsewhere on within the home. Each house must be staffed by sufficient numbers (in this case deemed to be two) and that number must not Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 24 be reduced for any reason and the team leader must be able to respond to other duties without having to leave a house understaffed. It would seem reasonable that the team leader is on duty and in addition to support staff in the houses and not one of the support staff. The home employs a training officer for all the homes in the group and a copy of the years training was seen A sample of the appointments made in 2007 were seen. All of the Criminal Records Disclosures for the staff appointed in 2007 had been obtained and were seen. There was some discussion with the Human Recourses Manager about references at the point of recruitment. One employee had been employed but no reference from the previous employer had been requested or received. The home has made appointments before all checks have been undertaken. The appointment of staff having received Protection of Vulnerable Adults clearance but not a Criminal Records Disclosure is not seen as good practice, and should only be used when it is essential and that the failure to appoint would place residents at risk. One reference was seen by Stepping Stones as a reference from an employer whereas it was from a person receiving care through an agency which employed the prospective employee. It is the duty of the home to satisfy itself regarding the authenticity of references. Another file contained a reference from a deputy manager of a care home. However, the care home was not mentioned as a previous employer and we are therefore uncertain as to the length of the employment or the reason for leaving. One file contained the fact that the employee had worked in a care home for two years previously however no reference was obtained and there was no evidence of any written /verification of the reason for leaving. Where prospective employees have worked with vulnerable adults your attention is drawn to Regulation 19, fitness of workers, Schedule 2 (3) and (4) which states: “The registered person shall not employ a person to work at the care home unless:Two written reference including where applicable a reference relating to the last period of employment, which involved work with children or vulnerable adults, of not less than three months duration. Where a person has previously worked in a position, which involved contact with children or vulnerable adults, written verification of the reason why he/she ceased to work in that position unless it is not reasonably practicable to obtain such verification”. Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 25 The Inspectors were advised that the home was advertising for support workers and that the response to a recent advert was good. The home also felt that the retention of staff was improving. At the time of the inspection there were five vacancies for day support workers and two vacancies for night support workers. The issue of adequate staffing is raised in the Management section of this report (standards 39 to 42) and refers to the findings of this visit and the unannounced visit of 4 August 2007, our letter of 7 August 2007 and the response of Stepping Stones dated 9 August 2007 refers. Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management style of the home enables residents to live in a friendly and supportive environment where irrespective of the degree of disability dignity is assured. Adequate care and support can only be provided when there are sufficient staff on duty to meet the many and diverse needs of the residents. EVIDENCE: Earlier this year Stepping Stones proposed a new Registered Manager however the Inspector was recently informed by letter that the application had been withdrawn. The person who is registered as the Registered Manager is to continue acting in this position and the applicant who had intended to manage Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 27 has been appointed as the Deputy Manager. In view of the roles of the Registered Manager, a number of which refer to other homes in the Company it was felt that it is essential that the organisational structure at Stepping Stones included a deputy manager. There are no changes in registration required as the current certificate of registration reflects the correct details. The Registered Manager and deputy manager were seen as competent and providing good examples to support staff. The Company must ensure they are supported `and provide them with sufficient resources to meet the needs of a dependant and vulnerable resident group. The number of staff on duty in the respective houses at Stepping Stones must be based on the needs of the residents who are accommodated not on any anticipated figures of “occupancy” at a future date. The staffing arrangements on the visit dated 4 August 2007 were found to be inadequate and the minimum numbers are shown in the staffing section of this report. The home maintains records of all health and safety checks and a competent person checks the fire equipment on a quarterly basis, the records are held in the home. The Inspector was advised that the fire procedures are tested by simulation. Under the new Regulatory Reform (Fire Safety) Order 2005, “stay put” policies are no longer acceptable and registered services need to review their evacuation procedures. The home should therefore consult the Fire and Rescue Service over how this could be best done to ensure the safety and dignity of the residents. Requirement 4 of the last inspection stated that the home must “ensure all fire doors are used appropriately and provide suitable self closing devices where the fire doors need to remain open for ease of access”. The inspectors were advised that all of the requirements had been met but during the inspection in Poplars View one bedroom door was propped open to enable access by a wheelchair. The health and safety officer was spoken to and we saw the fire safety questionnaires given to staff annually to test their knowledge of what to do and for him to see any shortfalls. Certificates for asbestos checks were seen and PAT testing was being completed annually. The electrical wiring periodic test every 5 years is currently halfway through the recommendations. Risk assessments have been completed. The Environmental Health Officer visited 2 years ago and was apparently satisfied, but recommended kitchen floors are steam cleaned to get rid of any grease. The home has purchased a steam cleaner for this job, all kitchen floors are non-slip. Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 28 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 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 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X X X 3 X X 3 X Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 29 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 YA42 Regulation 23 Requirement Timescale for action 31/10/07 2 YA24 23 Ensure all fire doors are used appropriately. Provide suitable self-closing devices where the fire doors need to remain open for ease of access. (Previous timescale 31/03/06) Ensure that all fire doors close properly. (previously required October 2006) The registered person must 30/11/07 undertake the repairs/cleaning/ replacement of furniture/carpets as identified in this report. The registered person must risk assess the windows in each house and where appropriate restrict openings. Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 30 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. 2 Refer to Standard YA19 YA19 Good Practice Recommendations Undertake a monthly audit for medication and add a time limit to the homely medicines procedure. Ensure there is a British National Formula available in all houses. Beeches (The) (Seven Kings) DS0000016589.V339043.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Regional Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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