Random inspection report
Care homes for adults (18-65 years)
Name: Address: Stiperstones Stiperstone Clappers Lane Chobham Surrey GU24 8DD zero star poor service 15/04/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Suzanne Magnier Date: 1 0 0 7 2 0 0 9 Information about the care home
Name of care home: Address: Stiperstones Stiperstone Clappers Lane Chobham Surrey GU24 8DD 01276858440 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Welmede Housing Association Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 8 The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home Stiperstones is a care home for eight adults with learning disabilities and provides personal care only. The property is located in Clappers Lane, Chobham, Surrey and accommodation is provided on two floors accessed by stairs. The home has eight
Care Homes for Adults (18-65 years) Page 2 of 13 1 5 0 4 2 0 0 9 Brief description of the care home single bedrooms and facilities include a kitchen, lounge, dining area, office, laundry, bathrooms and toilets. The property has a private drive and a large garden, which is secure and easily accessible. Private parking is available. Care Homes for Adults (18-65 years) Page 3 of 13 What we found:
The random inspection was carried out by Ms Suzanne Magnier Regulation Inspector on the 10th July 2009 who arrived at the service at 07.30 and left at 12 midday. The reason for the inspection was to follow up the compliance, by the service, following the requirements made at the announced key inspection of the service on the 15th April 2009. The service was represented by the person in charge who is currently employed by Welmede as the homes day to day manager. It was concluded that the registered person is working towards full compliance relating to the requirements detailed within the key inspection report dated 15th April 2009. What the care home does well:
Following the previous key inspection and the requirements made that arrangements must be made to ensure that all care plans and risk assessments for each individual are reviewed and up to date. The manager explained that as part of the updating of care plans the homes staff are continuing to gather information to assist in the updating of the care plans and person centred plans and have been gaining this information from individuals significant others and from other carers. This information will be included within the individuals care plan and also in their person centred plan. There was evidence to support that the homes manager and staff have worked in association with the Surrey Heath and Borders Community Learning Disability Team and the manager explained that as part of the reviewing and updating the care plans each individual, supported at the home, has had a thorough health care check from their newly appointed general practitioner and community nurse. All indivduals have been seen by the dentist and optician appointments have been made for individuals where the need has arisen. As a result of the reviews a variety of health care referrals have been made which include speech and language therapy, continence management, dietician, physiotherapy and occupational therapy. One documented health care action plan was sampled and evidenced that there had been a significant improvement in ensuring the health care needs of the individual were identified and staff were aware of the health care support the individual needed in their daily life. One person centred plan was sampled which was in the process of being developed and would be used as a template for the development of further person centred plans for other individuals. The plan had recent photographs of the individual which positively promoted them, contained information about their life, their likes and dislikes, significant people in their life, ways of communicating and being, the activities they enjoy and take part in, hobbies and interests and past holidays. The plans would assist the reader to have up to date information about the individual in order that they would be able to support and build professional relationships with them and ensure their needs are met. The improvement plan received by the commission indicates that the updating of the care plans has been set as a staff objective as part of their key worker responsibilities and the progress of the work is discussed in individual meetings with the staff with the homes
Care Homes for Adults (18-65 years) Page 4 of 13 manager. One member of staff has recently undertaken training in Person Centred Planning and will be assisting their team colleauges to complete and update the person centred plans. The manager explained that there has been a review of the staffing at the home experienced staff, who have understanding of the person centrted care approach have commenced working at Stiperstones and are working closely with the manager, Surrey Care Association and Surrey Heath and Borders Community Learning Disability Team in order to improve the standards of quality of care in the home. The commission were advised that individuals risk assessments are being reviewed in conjunction with the care plans to reflect genuine hazards identified in individuals daily lives rather than corporate or general risks. In discussion with the manager it remains evident that the manager has a good understanding of the value and importance of risk assessments and is working toward ensuring the safety and well being of all individuals in the home as far as reasonably practicable. Documented evidence of care plans and risk assessments will be more fully assessed at the next key inspection. Following the previous key inspection and the requirements made that arrangements must be made for a planned and consistent activities programme to be introduced in the home the manager advised that with the continued updating of the person centred plans, health care plans and referrals to the Learning Disability Team this has and will continue to determine the social needs and activities which individuals may enjoy and gain meaning from. One staff member has undertaken the responsibility of finding new activities, which could also include evening activities, and co ordinating and planning the activities on a weekly basis taking into account the wishes and needs of the individuals. During the inspection an arts and crafts session was held in the home provided by an organisation recently arranged by the home and individuals art work was displayed in the home. Due to the homes improvement of working with outside agencies the homes staff will be offered further support from speech and language therapists and the challenging behaviour team to support, offer staff training and awareness in supporting individuals who test the service in order that they can better understand the individuals communication style. Documented evidence of planned activities and meaningful engagements will be more fully assessed at the next key inspection. Following the previous key inspection and the requirements made that dining arrangements must be reviewed staff confirmed that the way in which individuals are supported to have their breakfasts are now on an individual basis rather than all individuals having breakfast together. Staff confirmed that they support the person downstairs following providing personal care and the individual has access to the kitchen where they can watch or assist in preparing and choosing their breakfast which they then have at the dining table. On arrival at the inspection it was observed that one staff member was supporting one
Care Homes for Adults (18-65 years) Page 5 of 13 individual to have their breakfast at the dining table and there was positve engagement by the staff member giving the individual quality one to one time with no distractions with the individual appearing content, relaxed and calm during their breakfast. The manager confimed that the dining room furniture will be changed and the large dining table will be replaced with smaller tables to reduce the institutional feel of the dining area. All mealtimes will be staggered to reflect a more person centred approach and continued advice from health care professionals and the use of pictorial prompts and other methods of communication will continue to promote individuals choice and preferences regarding their meals. The menus, which have been updated, will be further improved to offer more flexibility with a healthier, better balanced diet offered and menu choices will be further explored regarding individuals current likes and dislikes. The manager advised that with the changes in the homes routines and the inclusion of more activities it is envisaged that individuals will be supported to have meals out or meals at different times. This arrangement will be monitored by the managers and staff in order to promote a person centred approach and ensure that mealtimes are meaningful and take into account peoples wishes and feelings. Documented evidence of menu planning, meals provided by the home and reviewed dining and support arrangements will be more fully assessed at the next key inspection. Following the previous key inspection and the requirements made that arrangements must be made to ensure that individuals are supported with respect, privacy and dignity at all times the manager has arranged for all staff to attend a course which includes training staff to provide respectful personal care. It was observed that staff interactions with individuals was calm and supportive and all individuals seen during the inspection appeared calm and relaxed. All individuals at home during the inspection looked well groomed and clothes were ironed and clean. The manager explained that individuals clothes have been marked with coloured cotton to ensure that they are easy to identify as belonging to a particular person and staff are aware that to mix these would show disrespect to the individual. Staff have identified that some individuals require new clothes and arrangements have been made that these are purchased with the inclusion of the individual, their significant others and the individuals keyworker. Documented evidence and observation of how individuals are supported with respect, privacy and dignity will be more fully assessed at the next key inspection. Following the previous key inspection and the requirements made that all medication procedures in the home must be strengthened the morning medication routine was observed which indicated there had been a significant improvement by staff in the administration and recording of medicines. The medication procedure was methodical and unrushed and individuals were offered privacy and dignity whilst having their medicines. The manager confirmed that ongoing monitoring in the home regarding medicines will continue on a weekly basis and he will assess all staff after their completion of the care
Care Homes for Adults (18-65 years) Page 6 of 13 and control of medicines training to ensure they are competent and fully aware of their responsibilities. All staff will receive Lloyds pharmacy training as an additional safeguard for individuals receiving medication. The improvement plan states that the managers will check all aspects of the medication procedures on a weekly basis and report in an open and honest way any concerns regarding medication. Any shortfalls will be discussed with staff individually and staff will be given an opportunity to discuss any issues or concerns regarding the safe handling of medicines they have. Any shortfalls will be reported more openly where mistakes are made using the incident reporting procedure and Regulation 37 notfications will be received by the commission without delay. Documented evidence and observation of how individuals are supported with their medication will be more fully assessed at the next key inspection. Following the previous key inspection and the requirements made that arrangements must be made for the control of the spread of infection in the home and satisfactory standards of hygiene and safety must be maintained the general cleanliness and control of infection in the communal and individuals bedrooms home had significantly improved. The improvement plan indicates that all staff comply with the current infection control policy however during the inspection the manager was reminded to ensure that all staff must wear protective clothing for example aprons and gloves when supporting individuals with personal care. Plastic baskets have been purchased to ensure that soiled laundry is not mixed with clean laundry and a cleaning rota has been developed and cleaning records are completed. The cleanliness of the home is monitored daily by the shift leader and the managers and any shortfalls discussed with staff individually or at staff meetings. Documented evidence and observation of sustained improvement regarding infection control in the home will be more fully assessed at the next key inspection. Following the previous key inspection and the requirements made that arrangements must be made for all staff to undertake training necessary for the work they are to perform the homes manager has been proactive in ensuring that all staff are currently booked on or have undertaken mandatory training with Welmede. All staff responsible for the administering of medicines have received medication training. The improvement plan indicates that the managers will continue to offer support, formal supervision and appraisal of staff and if shortfalls are identified further training will be offered or action taken where performance does not improve. The manager demonstrated that he is committed to the ongoing improvement of standards in the home which will benefit the individuals living in the home by delivering respectful and dignified person centred care and support which meets the individuals health and care needs provided by a well trained and skilled staff team. Documented evidence and observation of sustained improvement regarding staff training
Care Homes for Adults (18-65 years) Page 7 of 13 arrangements will be more fully assessed at the next key inspection. The improvement plan was received by the commission within the timescale set and it is concluded that the registered person is working towards full compliance relating to the requirements detailed within the key inspection report dated 15th April 2009 in order to improve the services provided in the care home. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 8 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 6 12 Arrangements must be made 30/09/2009 to ensure that all care plans and risk assessments for each individual are reviewed and up to date. In order to ensure that individuals are provided with the appropriate care, treatment and supervision and to ensure that peoples changing needs are identified to ensure their safety and well being at all times. 2 12 16 Arrangements must be made 30/09/2009 for a planned and consistent activities programme to be introduced in the home in consultation with individuals living in the home. In order that they know what is happening in their daily lives and they have a choice and be supported to make decisions. 3 17 12 Arrangements must be made 30/09/2009 that the dining arrangements be reviewed. In order to offer individuals improved choice and take into account peoples wishes and feelings. Care Homes for Adults (18-65 years) Page 9 of 13 Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 4 18 12 Arrangements must be made 30/09/2009 to ensure that individuals are supported with respect, privacy and dignity at all times. In order to reflect peoples human rights. 5 20 13 Arrangements must be made 30/09/2009 that all medicine procedures in the home must be strengthened. In order to promote the safety and well being of people receiving medicines. 6 30 23 Arrangements must be made 30/09/2009 for the control of the spread of infection in the home and satisfactory standards of hygiene and safety must be maintained in all areas of the home. In order to ensure the safety and well being of all individuals. 7 35 18 Arrangements must be made 30/09/2009 for all staff to undertake training necessary for the work they are to perform. In order to improve staff practice and ensure that staff have the skills and abilities to provide the care and support needed by the individuals living at the home. 8 42 24A Arrangements must be made 30/09/2009
Page 10 of 13 Care Homes for Adults (18-65 years) Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action for an improvement plan to be sent to the commission. Which sets out the methods and timetable by which the registered person intends to improve the services provided in the care home. Care Homes for Adults (18-65 years) Page 11 of 13 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 13 of 13 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
