Inspection on 28/01/08 for Stibbs House

This inspection was carried out on 28th January 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stibbs House 01/11/06

Stibbs House 06/12/05

Stibbs House 03/06/05

Stibbs House 22/12/04

Stibbs House 24/05/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Stibbs House 74 Stibbs Hill St George Bristol BS5 8NA Lead Inspector David Smith Announced Key Inspection 28th January 2008 10:00 Stibbs House DS0000020256.V352025.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 Stibbs House DS0000020256.V352025.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. Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stibbs House Address 74 Stibbs Hill St George Bristol BS5 8NA 0117 9619137 0117 9476786 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) admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Miss Cheryl Christine Anstey Care Home 10 Category(ies) of Learning disability (10), Physical disability (10) registration, with number of places Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 10 Adults with learning disabilities which may include those with physical disabilities Manager must be a RN on parts 5 or 14 of the NMC register Date of last inspection 1st November 2006. Brief Description of the Service: Stibbs House is one of the services operated by Aspects and Milestones Trust. It is a registered care home with nursing offering respite care for up to 10 people who have learning disabilities, in particular those who have profound multiple disabilities. The majority of service users are in need of nursing care. The care staff are experienced in this type of care and are led by a team of Registered Nurses. The house is situated in a suburban area and is easily accessible by car or bus. There is easy access to local shops and community facilities. Stibbs House is a modern purpose built home. There are 10 single rooms on two floors accessible by a lift. There are two lounges, a dining room and a multi sensory room. There is a large secure garden and patio to the rear of the home. Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an announced visit to the home as part of a Key Inspection of this service. We did announce this visit to the home, giving only a few days notice, to ensure staff would be available to support the inspection process. The review of evidence and pre-inspection planning involved reviewing the report of the last Key Inspection carried out in November 2006 and the service history, which details all contact with the home including notifications of significant events which they have reported to us. We (the CSCI) provided the home with their Annual Quality Assurance Assessment (known as an AQAA, pronounced as ‘aqua’) and a range of survey forms for service users, their relatives, carers, advocates and health professionals, prior to my visit. The AQAA was completed and returned together with four surveys. Other sources of evidence have been used as part of the Key Inspection process. These include the Random Inspection of the service we conducted on 21/03/07, which was focused on the Statutory Requirements and Recommendations following the Key Inspection of this service on 01/11/06. I gathered additional information during my visit through informal discussions with the Registered Manager, her Deputy and Support Workers. Interaction and communication between staff and service users was also observed during part of the afternoon. Care plans and associated records were examined together with Risk Assessments, complaints procedures, medication administration, staff personnel and training records and health and safety records. I was also provided with a tour of the communal areas of the home and all of the bedrooms. What the service does well: Each service user who responded by survey said they are treated well by staff who listen to them and act on what they say. Each relative who responded by survey said the home does provide the care and support they expect for their son or daughter. Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 6 The Manager and staff continue to demonstrate a commitment to provide a good quality service and support each service user in a person centred way. Stibbs House provides a valuable respite care service for adults with a learning or physical disability in a supportive, caring and safe environment. Staff have a sound understanding of the diverse needs of service users and support them as individuals. They were observed treating people with dignity and respect. The home works closely with other health care professionals to ensure each individual is provided with any specialist support they may require. The home has adaptations and specialist equipment to ensure the care needs of each individual are well met and their welfare and dignity is promoted. What has improved since the last inspection? A new suction machine is now in use in the home. This helps to ensure each service users needs can be met during their stay in the home. (This improvement was noted during the Random Inspection we conducted in November 2006). Contract arrangements are now in place to service and maintain the boiler and a number of old towels have been replaced. This helps to ensure a clean, homely and safe environment for service users. (These improvements were noted during the Random Inspection we conducted in November 2006). Staff have now been provided with refresher training in responding to behaviour which may be perceived as challenging the service being provided. This promotes the welfare and safety of each person who uses this service. (This improvement was noted during the Random Inspection we conducted in November 2006). The home’s Statement of Purpose has now been reviewed and updated. This ensures any potential users of this service and their relatives are provided with up to date details of the service the home is able to offer. The administration of Controlled Drugs has now been improved. This promotes the welfare and safety of service users. Detailed and accurate financial records are now maintained for each service user. This promotes a safe and accountable service. Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 7 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. Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 8 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 Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 9 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): 1 and 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users and their relatives have access to detailed information in order to make informed choices about whether to use this service. Each service user knows their needs and aspirations will be assessed and met by the home. EVIDENCE: The home has a Statement of Purpose, which contains comprehensive information about the home and service it is able to provide. This was last updated earlier this month and I was provided with a copy on the day of my visit. The home is currently in the process of updating the Service User’s Guide. This is currently available in a written format and also on audiotape. It is hoped that a DVD version can also be produced as part of this updating and review process, as this may be more accessible to some of the people who may wish to use this service. Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 10 I examined four care plans for individuals who have been using this service for varying lengths of time. Each plan contained details of an assessment carried out by the home to ensure they understand and can demonstrate they are able to meet each person’s care and support needs. Some care plans also included assessments carried out by the Funding Authority or other health professionals. The service users who responded by survey said they did receive enough information about this home to decide if it was the right service for them. Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 11 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. The home ensures that the service provided to each individual takes into account their changing needs and personal goals, supported by both written information in care plans and risk assessments which are subject to ongoing review. EVIDENCE: I examined four service user’s care plans during my visit. Each plan had been written in an individual way and covered key areas of support people required, such as communication, personal care, healthcare, eating and drinking and how they wish to spend their leisure time. The Manager told me the care planning system is in a relatively new format and each plan is currently being developed and hopefully improved. Senior members of the staff team are overseeing this process. Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 12 Regular reviews are carried out internally by the home, although staff are not always invited to or are able to attend the formal reviews conducted by the Funding Authority. The Manager told me that it is sometimes difficult to release staff to attend these meetings and there are also occasions when they are not informed that a meeting is taking place. When they are informed of a meeting, but are not able to attend, they will send a written report to be included and discussed as part of the review process. They usually receive a copy of the Funding Authority’s’ review document, although this is not always sent to the home. I did speak with one service user who was able to express they were happy during their stays at the home. I also observed a limited amount of interaction between staff and service users, on their return from day services, which show the staff have a good knowledge of the support needs of service users and how to communicate effectively. Service users appeared to be very relaxed in the company of staff who spoke openly with them. Those individuals who responded by survey said they did make decisions about what they would like to do each day and felt that they generally do the things they choose. There are a small number of person centred Risk Assessments in place for service users, which are currently quite limited in their scope. These are mainly focused upon the risk of falls or potential injury but there are none in place relating to individual’s lifestyles, such as when they access the community. The Manager acknowledged this and feels these can be developed in line with the general improvement of care plans. The Risk Assessments, which are in place, have all been regularly reviewed and updated. Stibbs House DS0000020256.V352025.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, 14, 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. Each individual has opportunities and appropriate support to access leisure and educational facilities. Family and personal relationships are supported during each individual’s stay. A healthy and balanced diet for each individual is promoted. EVIDENCE: Most of the people who have regular respite stays have day care services organised that continue while they are in the home. There remains a close relationship and ongoing communication between the home and each individual’s day service. It was evident from records, discussions with staff and from the observations of the interactions between staff and people using the service that each Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 14 individual continues to be given opportunities and encouragement to develop personally during their stays in the home. Staff spoken with explained that they work hard to ensure each person is provided with opportunities to do things which they enjoy. Each person is seen as an individual and is respected as such. The home’s latest newsletter, produced this month, describes recent trips to see the Moscow State Circus, to ‘Noah’s Ark Farm’, Weston-Super-Mare and to do Christmas shopping. The home also held a ‘fund raising’ Christmas Party, which was attended by staff, service users and their families. Some of the money raised at this event has been used to buy some games, CDs and portable TVs for individuals to use during their stays at the home. The service users who responded by survey said they were able to choose how to spend their time in the home and generally were able to do the things they wished to do. Relatives who responded by survey said the home provides the support and care they expect, although one family felt there could be more activities offered for their relative during their stays. The home have stated in their ‘AQAA’ that one aim is to revise their booking process to help accommodate friendships and shared interests between service users. This may help in improving compatibility and make it easier to plan activities or trips out of the home. The home appears to have a good liaison with family members with regular communication with parents and carers taking place. Staff spoken with feel they provide a valuable service for parents and carers. They are also asked for and provide advice to them, as well as providing respite care for their relatives. The menus show a wide range of food, which provide both a healthy and balanced diet. Each person’s likes, dislikes and cultural needs are known and clearly recorded and they are given a choice of what they would like to eat. The kitchen is clean, tidy and well organised. Service users eat their meals in the dining room on the ground floor, which looks out over the garden area. Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 15 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. Service users are supported in their preferred manner and their personal and healthcare support needs are well met. The policy and procedures relating to administration of medication ensures service users’ welfare and safety. EVIDENCE: The care documentation in place for individuals provided clear guidance for staff on how they should support each person with their health and personal care. People who use Stibbs House retain their own General Practitioner; GPs are requested to visit the Home if needs be though in most situations, a person’s relative or carer could be asked to take that person to their GPs surgery if this was necessary during their stay. Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 16 It is evident from care plans that a number of health care professionals support the people who use this service and their advice or guidance is incorporated into each plan. The records I examined contained reports from Consultant Psychiatrists and Speech and Language Therapists. There is a core of experienced staff who have a good knowledge of service users’ healthcare needs. Any changes, which may cause staff concern, are noted and acted upon. It remains evident that the management and staff spoken with are sensitive to the personal, healthcare and emotional needs of those using the service. On the day of my visit staff were concerned about the health of one service user when they arrived from their regular day service to commence their stay in the home. The staff took immediate action and contacted the GP for an emergency home visit, whilst providing appropriate care and support to this individual. The home now has an effective, efficient system of medication administration and storage. Each person who uses the service will come in with his or her medication. Generally the medication will only be sufficient to cover the length of their stay, although occasionally extra medication may be provided. This is checked and booked in when the person arrives. All medication is stored securely in the medication cabinet, which is in the main office. Medication is only dispensed by trained nurses; this is usually the most senior person working on that shift. When the respite stay comes to an end, the medication records are again checked and any extra medication is booked out and returned to the individual concerned. The home has recently improved their record keeping in relation to controlled drugs, ensuring these are correctly audited and the records are signed by two staff. The home’s policy relating to ‘homely remedies’ (such as painkillers) and maintaining a stock of ‘rescue medication’ (such as epilepsy medication) has been amended after guidance from our Pharmacy Inspector. Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 17 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. Service users are supported to communicate their views and they can be confident that they will be listened to and their views acted on if necessary. Clearer policies and procedures must be put in place in order to protect service users from the likelihood of abuse, neglect and self-harm. EVIDENCE: The home has a formal Complaints Policy, an Adult Protection Policy and a Whistle Blowing Policy, which staff can use in confidence to raise any issue or concern they have regarding the service. The information provided on the home’s AQAA confirmed that there have been some complaints made in the last twelve months. I examined details of each one and found they had been taken seriously, investigated in accordance with the home’s policy and the outcome recorded and explained to the complainant. The service users who responded by survey said they knew who to speak to if they are unhappy, knew how to complain and confirmed that they felt safe during their stays at the home. They felt that staff did listen to them and acted on what they said. Relatives who responded by survey said they knew how to make a complaint. Both relatives and health professionals felt the home had responded Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 18 appropriately if they had raised any concerns about the care provided by the home. Due to the diverse abilities and needs of the people who use Stibbs House, staff would need to advocate for a number of individuals, who would not be easily able to complain or use the formal complaints procedure. Staff spoken with were clear about the advocacy role they have. Due to the vulnerability of some of the people who use the service, they would rely on staff raising concerns on their behalf. Staff spoken with demonstrated a very good knowledge of the action they would take if they suspected or witnessed abuse. They also confirmed that they had received training in the Protection of Vulnerable Adults and were clear in their own views about providing a safe and supportive environment for each individual. The records I examined show staff are provided with training in relation to the Protection of Vulnerable Adults and are subject to ‘enhanced’ Criminal Record Bureau disclosures (known as ‘CRB’s) before they start work in the home. The home has now developed a clearer system to record any monies which service users may have with them during their stay. I examined the records of two people who do usually have money with them during their stays and found these to be clear, correctly recorded and signed by staff. The home does provide a service for individuals who may present behaviours which can be perceived as challenging the service provided by the home. While details of some of the behaviours are described in areas of care plans, such as within communication guideline, these must be developed and formal behavioural plans put in place where this is appropriate. Risk Assessments must also be developed if the home intends to use any restrictive interventions, which would include block and breakaway techniques. Both should be developed as soon as possible and I did share the Department of Health Guidance on Restrictive Physical Interventions, which the home may wish to use to support these developments. Staff receive training in understanding and responding to these behaviours, using ‘Positive Response Techniques’ (known as ‘PRT’). There has been a recent refresher training course which all of the staff team attended. The home maintains clear records of all accidents and incidents and notifies us of any significant event which occurs. Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 19 Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 20 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, 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Stibbs House provides a homely, comfortable and safe environment for service users during their stay. EVIDENCE: Stibbs House is a purpose built property situated in a quiet residential area close to local amenities and bus routes. There is a large car parking area at the front of the house and mature gardens at the side and rear of the home. There are four bedrooms on the ground floor and six on the first floor. There is a lift to support individuals who have mobility problems or use wheelchairs or adapted seating. The communal facilities consist of a kitchen, dining area, two lounges (one on the ground floor and one on the first floor), sensory room, office, laundry, toilets and bathrooms. Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 21 I did view all of the communal areas and each of the bedrooms. Most areas of the home were clean and tidy and furnishings and fittings are of a good quality. The house is tastefully decorated and some areas of the home have been redecorated since our last visit. One member of staff has painted landscape pictures on the walls of the downstairs corridor to add to the homely feel. Some of the bedroom carpets are stained, and although these are to be professionally cleaned shortly, the home should consider including this type of cleaning on a regular schedule to ensure the home remains clean and hygienic. The home has adaptations and specialist equipment to meet the needs of the people who use this service. There are mobile hoists available, adjustable height baths, beds and accessible showers. All areas of the home and garden are accessible to people who use wheelchairs. The garden area is now more secure, with higher fencing being erected, which allows some service users to now use this area independently. It is noted in the home’s ‘AQAA’ that they wish to develop a sensory garden, using some of the money raised from various fundraising activities. The home had a ‘Food Premises Inspection’ carried out by a representative from Bristol County Council. They confirmed that “very good standards are maintained” in the home and it awarded Stibbs House the highest rating of “5 Stars”. Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 22 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): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The clarity of staff roles and responsibilities along with staff meetings, training and supervision helps to provide a consistent approach to the support of staff and service users. The home’s recruitment policy promotes both service users’ rights and their safety. EVIDENCE: There is a core of well-established staff with varying skills and abilities who meet the needs of each individual who uses the service. The staff members I spoke with have a clear understanding of their role and responsibilities within the team and their own personal role and accountability. The home has three separate shifts each day, which provide at least three care staff on duty during the day and two on duty at night. A qualified member of staff is always on duty within the home. Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 23 Staff told me that the staff team was extremely open, honest and supportive. Each commented that it was a nice home to work in. They felt well supported by the manager and were able to discuss issues in an open and honest way. Staff were observed interacting well with service users and those spoken with demonstrated a good understanding of the support needs of each person who stays in the home. Each service user who responded by survey said they are treated well by staff that listen to them and act on what they say. Relatives who responded by survey said they felt the staff did have the right skills and experience to look after people properly. The staff team meets regularly and the way meetings are conducted have recently been improved. The qualified staff and support staff hold separate meetings on the same day, then join together to form one large staff meeting to discuss issues raised at the smaller, separate meetings. The staff I spoke with felt this new system works well and that attendance at the meetings is generally very good. I examined the personnel records of both long-standing and newer staff members. These contained a photograph of each staff member, copies of their Application Form, at least two satisfactory references, documents confirming identity and eligibility to work in the UK, contracts of employment and a record of their induction to working in the home. (The details of Enhanced Disclosures from the Criminal Records Bureau are discussed earlier within this report). Staff are provided with a variety of training opportunities. Training is provided either by the organisation or external training providers. The records I examined show that staff have been provided with mandatory training such as Fire Safety, Safe Manual Handling Techniques, First Aid and Adult Protection. Other more specialist training such as Diabetes and Autism awareness, understanding Dementia and how to safely manage and respond to challenging behaviour (using ‘Positive Response Techniques’, known as ‘PRT’) has also been provided to ensure staff can understand and meet the support needs of people who use this service. A number of service users suffer from epilepsy and some staff members I spoke with told me they have waited for some considerable time, however the training promised to them has not yet been delivered. It appears prudent, due to the high number of people who use this service with this condition, that this training is provided as soon as it can be organised. Each member of staff is provided with regular formal supervision. This is a 1:1 meeting with their supervisor. Staff spoken with felt this was valuable and they were able to have open and honest discussions with their line manager. The Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 24 records I examined show that the frequency of supervision sessions did vary, but these are generally conducted every six to eight weeks. The home also endeavours to annually appraise each member of the staff team. Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 25 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, 38, 39, 40, 41 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well-run and service users benefit from the ongoing development and improvement of the management systems in place. Service users benefit from the ethos, leadership and management approach of the home. Each person’s rights and best interests are promoted by the home’s record keeping and the organisations’ policies and procedures. The health, safety and welfare of people staying in the home is promoted and protected. Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 26 EVIDENCE: The Registered Manager, Miss Anstey, was present throughout my visit and supported the inspection process fully. She has worked in social care for a number of years and has managed this home since September 2006. She qualified as a RMNH in 1991 and is also a qualified NVQ Assessor. She undertakes additional periodic training to maintain her knowledge and update her skills and level of competence. Through my discussions with the Manager and members of the staff team it is clear the management approach remains open and positive, with a clear sense of direction and leadership. The ethos of the service is person centred with the views of service users being sought, as far as possible, as part of this process through their discussions with staff, surveys and regular contact and social events with families who often act as advocates for their relatives. The management structure and lines of accountability within the home are clear and straightforward. The Registered Manager is supported by a Deputy Manager and other qualified members of staff. The Manager is in turn supported by the Trusts’ Area Service Development Manager. There are efficient management systems and structures in place to ensure the home runs effectively. The quality of record keeping in the home is good, with all records required during my visit easy to access and stored securely when not in use. Aspects and Milestones Trust have comprehensive policies and procedures to support the home, which are designed to ensure it complies with the law and remains aware of good practice guidelines. Full details of each policy were provided by the Manager as part of the AQAA she completed for us as part of this Key Inspection process. The registered providers’ representative makes regular visits to the home, and produces a report of their findings. A copy of each report is forwarded to us each month. There are recording systems in place to support Health and Safety within the home, which are being used consistently. Portable electrical appliance safety checks were carried out in June 2007, the safety of gas appliances was checked in May 2007, hoists used in the home were tested in June 2007 and the electrical wiring in the home checked in March 2007. I also examined the home’s Fire Log which shows the fire alarm system is tested each week, emergency lighting is checked monthly and regular fire drills are conducted, the most recent taking place on 27/01/08. Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 27 There are a number of general Risk Assessments in place to ensure the welfare of service users and staff. These have all been recently reviewed. Stibbs House DS0000020256.V352025.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 3 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 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 3 3 3 3 Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO 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 YA9 Regulation 13(4) Requirement All people using the service must have any potential risks to them assessed and recorded. This will promote their welfare and safety. The home must ensure clear reactive strategies and risk assessments are put in place for all service users who present behaviour, which challenges the service. This will promote their welfare and safety. Timescale for action 28/04/08 2. YA23 13(6) 13(7) 28/04/08 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 YA6 YA6 Good Practice Recommendations The home should complete the transfer of all care plans into the new and improved format. This would improve the planning and review of care provided to each person. The home should obtain the latest Funding Authority Care Plan Review Document for each service user. This would improve the planning and review of care provided to each DS0000020256.V352025.R01.S.doc Version 5.2 Page 30 Stibbs House 3. 4. YA30 YA35 person. The home should consider regular, scheduled cleaning of the carpets to ensure a clean and hygienic environment is provided for each person who uses the service. The home should provide epilepsy training to all staff members to ensure they can offer appropriate support to each person who uses this service. Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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. Extracts may not be used or reproduced without the express permission of CSCI Stibbs House DS0000020256.V352025.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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