Inspection on 31/07/07 for Stocksbridge Neuro-Rehabilitation Centre

This inspection was carried out on 31st July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Stocksbridge... 12/08/08

Stocksbridge... 02/08/06

Stocksbridge... 02/02/06

Stocksbridge... 08/07/05

Stocksbridge... 11/01/05

Stocksbridge... 29/06/04

Similar services:

Snydale Care Home

Staveley Birk Leas Nursing Home

Fairmount Nursing Home

Currergate Nursing Home

Brookfield

Castlethorpe Care Home

Elmleigh Convent

Woodlands Respite Care Centre

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

CARE HOME ADULTS 18-65 Stocksbridge Neuro-Rehabilitation Centre 2a Haywood Lane Stocksbridge Sheffield South Yorkshire S36 2QE Lead Inspector Marina Warwicker Key Unannounced Inspection 31st July 2007 10:20 Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.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 Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.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. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stocksbridge Neuro-Rehabilitation Centre Address 2a Haywood Lane Stocksbridge Sheffield South Yorkshire S36 2QE 0114 2837200 0114 2887736 stocksbridge@schealthcare.co.uk Not available Active Care Partnerships Ltd 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) Kathryn Sandra Oakley Care Home 24 Category(ies) of Physical disability (24) registration, with number of places Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The home is for service users who require neurological care. The minimum numbers of staff on duty must comply with the staffing notice dated 6/3/00 and attached (referring to previous name of home; Holly Lodge). One specific service user of the age of 17 years and named on variation dated 5th October 2006, with Physical Disabilities / Neurological needs may reside at the home. One specific service user over the age of 65 years and named on variation (V27411) dated 18th December 2006, with Physical Disabilities/Neurological needs may reside at the home. 2nd August 2006 Date of last inspection Brief Description of the Service: Stocksbridge Neuro-Rehabilitation Centre is a purpose built service offering respite, assessment and rehabilitation to adults aged 18 – 65 years who have an acquired brain injury or neurological condition. The building has therapy rooms, Kitchenettes to facilitate independent living skills, lounges for relaxation and access to paved and lawned gardens. The centre overlooks the village of Stocksbridge. It is near the bus routes and the local shops. It is also within easy reach of Sheffield city centre and the motorway network. The building has two levels, with a passenger lift providing access to both. Rooms and corridors are designed to accommodate wheelchairs. The staffing structure consists of an interdisciplinary team of professionals made up of a consultant neurophysiologist, care manager, service manager, nurses, behavioural technicians, physiotherapist, occupational therapist, speech and language therapist and rehabilitation support workers. The ancillary workers such as the cooks, the domestics and the maintenance persons are also employed to support the service. The basic weekly fee is £2,384.00. This includes, nursing care, therapy input as assessed on admission and on reviews, board, lodging, laundry, house keeping, meals, support when attending out patient appointments and a programme of social and recreational activities to complement therapeutic activities. The fee does not include the cost of hairdressing, chiropody, toiletries, maintenance of private equipment, private telephone, internet access, replacement clothing, footwear and underwear. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 5 Stocksbridge Neuro-Rehabilitation Centre is a part of Active Care Partnerships. At the reception area in the main entrance information is made available about the parent company for visitors and relatives. There is also a folder available with the service user guide specific to Stocksbridge Neuro-Rehabilitation Centre. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced site visit of the Stocksbridge Neuro-Rehabilitation Centre was carried out on 31st July 2007 between 10:40 and 18:10hrs.Ten people who live at the home, five relatives, professional visitors and six staff were consulted. A further seven representatives/relatives were contacted by post to find out their view of the service. On the day of the site visit, time was spent on observing care, interacting with people who lived at the home and the staff. The premise inspection included the bedrooms of people who live at the home (only with the individual’s permission), indoor and outdoor communal areas. The environmental officer inspected the kitchen and the food preparation areas on the same day. His comments have been included in the body of the report. Individual care plans, medication administration sheets, service reports, staff training and recruitment files were some of the records checked during this visit. The managers were present during the day and helped me to access the necessary information. I would like to thank the people who live at the home, the staff, the visitors/families and the visiting professionals for having taken the time to share their experiences about the home and therefore contributing to the inspection process. What the service does well: In the entrance hall there was information about the service made available by the management of Stocksbridge Neuro-Rehabilitation Centre to the visitors so that people were able to make an informed decision. People who use the service were involved in making decisions about their needs. They had an active role in planning the care and support they wish to receive. This gave them the choice and support they needed to work towards achieving an independent life style. The people had their needs assessed before moving into the home. The families or their representatives had the opportunity to visit the home before arranging admission. Terms and conditions of the person’s stay was reviewed at the home’s multidisciplinary team meetings with the person and/or their representatives and agreed on an individual basis. The multidisciplinary staff arranged and supported social, educational, cultural and recreational activities for the people so that they were able to explore and enhance their abilities so that they were able to reach their expectations. The staff encouraged community involvement of the people who live at the home so that the people were prepared to settle in the communities as part of their rehabilitation. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 7 The food served had healthy options and the people were able to change their minds at short notice and receive an alternative. The health and personal care of those people who live at the home was based on their individual needs and this was made available by the staff using the principles of respect, dignity and privacy. The staff helped the people access the appropriate sections of the health service so that they were able to live in a caring and comfortable setting. The people who use the service were able to express their concerns and know that the staff listened to them and took corrective action; therefore they knew that they were protected from abuse or neglect. The physical design and layout of the home enabled people who use the service to live in a safe and comfortable environment, which encouraged independence. The staff employed at the home were trained, skilled and in sufficient numbers to support the people who use the service. The management and administration of the home was based on openness and respect for those who use the service and also those who work at the home. The management team seemed competent and had experience in running the rehabilitation centre. They were able to meet the stated purpose and the home’s aims and objectives. This was backed up by the comments received from the users of the service and the staff. What has improved since the last inspection? What they could do better: The centre should continue to maintain its best practices and high standards of person centred care programmes. The records maintained by the multidisciplinary rehabilitation team should be centralised so that the individuals and their families/representatives at their request are able to see the true picture of their rehabilitation progress. Although staff received regular supervisions, these need to be formalised and evidence of documentation is needed. The management of the home needs to seek regular audits from the supplying pharmacist with regards to medication management and updates. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 8 To maximise the access, support and supervision of the rehabilitation support workers the offices of the therapy staff should be better organised. 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. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 9 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 Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 10 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, 2, 3, 4 and 5. People who use this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The information for those who wish to use the service is readily available so that they are able to make an informed decision. EVIDENCE: In the entrance hall there was information about the service made available by Stocksbridge Neuro-Rehabilitation Centre to the visitors. The staff and the visitors who were spoken to on the day of the site visit knew where they would find the information. A visitor said that the staff gave them copies of different information about the home and also told them that they could have a look at the Commission for Social Care Inspection report if they so wish. An admission took place on the day of the site visit. This gave the inspector the opportunity to follow the admission process and find out about the arrangements made by the staff before accepting the person into their care. Named staff was allocated to the family for support and to gather further information. One of the family members said, “We are very nervous but the nurse is getting a lot of information from us and as long as they take note of our wishes and keep us informed of what is happening we will be satisfied.” The manager said that most people were funded by either the different Primary Care Trusts or part funded by the social services and the health Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 11 service. Therefore the contracts were agreed and reviewed by the agents and not the individual families. However, the Terms and conditions of the person’s stay was reviewed at the home’s internal multidisciplinary team meetings with the person and/or their representatives and agreed on an individual basis. Two relatives confirmed this on the day. The care plans checked demonstrated that the people have had their needs assessed before moving into the home. The families or their representatives have had the opportunity to visit the home before arranging admission. The staff and some of the visitors confirmed this. The care manager said that due to the nature of the service often the Terms & Conditions/contracts were drawn up by the management, at the point of moving into the home and reviewed regularly. One of the relatives said that the contract told them about the service they were to receive and also what their rights were. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 12 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, 8, 9 and 10. People who use this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. People who use the service are involved in making decisions about their needs, and have an active role in planning the care and support they wish to receive. This gives them the choice and support they need to achieve an independent life style. EVIDENCE: Four individuals’ care plans were checked. The relatives and the care staff were consulted. The comments from the surveys were also used to judge this area. The care plans emphasised that the rehabilitation aspects of the care were based on individuals’ daily living activities and the multidisciplinary team focused on the promotion of independence by involving the individuals. During case tracking it was noted that the care plans would be more useful to the person who uses the service and their representatives if the records maintained by the multidisciplinary team were kept centrally to show the full picture of the person’s progress. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 13 These are some of the comments received from the people who live at the home. “Here the staff know what they are doing. I have been in other places.” “ The care staff are helpful but firm. I know they have helped me a lot.” “ I like the routine here. I know what I would be doing next. Sometime I don’t feel like therapy but I know if I get it done; then I can do what I want for the rest of the day.” “I am new here getting used to the routines. Its alright, staff are friendly.” There was documentation in the care plans of risk assessments and how the person had planned to minimise the risk. The people had been encouraged by the staff to participate in activities such as using public transport, going out to the shops, to Church and finding their way around in large shopping centres. During direct observation and whilst speaking to the relatives it was understood that the staff working at the home treated information shared by the people living at the home with utmost discretion. The staff were aware of the home’s policy on confidentiality and the reason for sharing information which had been given in confidence with the manager or a senior member of staff. The following comment was received from a relative. “When we came around to check this place out, although the staff were polite and friendly, they did not allow us into people’s own rooms and avoided communal areas where people were in. We felt that the staff protected the identity of those who lived at the home. We were pleased about this.” Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 14 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): 11, 13, 14, 15, 16 and 17. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The people who use the service are able to make choices about their lifestyle, recreation, their personal preferences and receive support to develop their life skills so that they are able to enjoy life and fulfil their wishes. EVIDENCE: The multidisciplinary staff said that they arranged social, educational, cultural and recreational activities for the people so that they were able to explore and enhance their expectations. There was evidence in the individuals’ record to support this. A family member said that the staff would take them to the local church if the people wanted to. It was noticed on the day of the site visit, that the people living at the home were given encouragement by the care staff to be confident in their achievements and talk about them. The people were encouraged to show the inspector a sensory garden that they had built. One person involved Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 15 said; “We have had great fun. If we win a prize it will be good. We have worked hard.” One of the carers said that the judgement for the garden was to take place the following day and that they were looking forward to it. People living at the home and some of the families said that the staff encouraged community involvement since most of the people living at the home had moved away from their counties and community involvement made them feel that they belonged somewhere. Two family members said that during summer fares and Christmas time the home encouraged community involvement, which they saw as positive. The people were encouraged to have a healthy diet. It was noted that the people were able to eat in the dining room or in their own rooms if they so wished. The Environmental Health Officer inspected the kitchen and the dining areas on the day of the site visit. He reported that on the whole the home complied with their requirements and that the cook was competent and was willing to listen to his suggestions and seek advice when she needed. Two people and one relative said that the food was good and that the people were able to change their minds at short notice and receive an alternative option. Staff said that if there was a need for monitoring fluid or food intake they maintained charts and recorded the intake of the people and monitored them. Monthly weighing of people was also used to monitor those who were at risk of malnutrition. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.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, 20 and 21. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The health and personal care of those people who live at the home is based on their individual needs. This is made available by the staff using the principles of respect, dignity and privacy and help the people access the appropriate sections of the health service; so that the people are able to live in a caring and comfortable setting. EVIDENCE: Four care plans were checked and people living at the home were consulted and observed. Visiting professionals were also consulted. The care plans indicated the preferences of the people such as how they liked to be guided, moved, supported and mobilised. These were risk assessed by the staff to point out why some preferences were not suitable for individuals and alternative methods were agreed. The staff supported and facilitated the people living at the home to take control of and manage their own health care by attending the general practitioner’s surgery, accessing NHS primary care teams such as the opticians, dentists and podiatrists. On the day of the site visit the community dentist team visited the Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 17 home. They were very impressed with the staff attitude and helpfulness. They said that the nurses were open to suggestions and that the staff were very knowledgeable about each individual who lived at the home and this was helpful when attending to the individuals’ dental needs. None of the people living in the home on the day of the visit were able to self medicate and this was documented in their care plans following risk assessment. Four care plans confirmed these decisions. Records were maintained of current medication for each person. The supplying pharmacist had been contacted by the manager to carry out an audit of the medication management within the home. The management said that those people who needed to remain at the home would be able to do so when they grow older. This had been demonstrated by the management requesting variation to registration to accommodate people who were already living at the home. There was evidence that the staff were receiving training on end of life care and also on how to support people when there had been a death of a person living at the home. The staff were able to access palliative care practical assistance and advice. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 18 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. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The people who use the service are able to express their concerns and know that the staff listen to them and the management would take the corrective action on receiving complaints; therefore they know that they are protected from abuse, and have their rights protected by staff adhering to the home’s policies and procedures. EVIDENCE: The management had recorded formal complaint reported since the last inspection. There had been one complaint and it had been investigated and action taken by the manager to resolve it. The staff, the people living at the home and the visitors knew how to make a complaint and what they would expect from the management. One of the staff said, “If someone makes a complaint I feel that we need to listen and then do everything we can to put things right. If it is out our control then we’ll ask the management to deal with it. Usually it is a misunderstanding or anxiety on the part of the person complaining.” Two people living at the home had the following comments to make. “The staff are just like us. They can make mistakes too. But it is how they sort things out what matters. I have been here for sometime and have had my ups and downs and the staff had been very understanding.” “People who work here are like gods. Without them I won’t be alive today. But I have had a few rows when I have been upset and the staff had been smashing.” Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 19 The staff training records showed that most staff have had attended Protection Of Vulnerable Adults training and knew who to contact in the even of an allegation of abuse. The management continue to demonstrate that they were able to take appropriate action when there had been allegations of abuse. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.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, 28, 29 and 30. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The physical design and layout of the home enables people who use the service to live in a safe and comfortable environment, which encourages independence. EVIDENCE: The information gathered through the tour of the premise, consulting the people who live in the home and the visitors; supported that the premises were kept safe, comfortable, bright, airy and free from offensive odours. During the tour it was noted that there was sufficient lighting, heating and ventilation around the home. The areas where the people were allowed to enter had appropriate access facilities and the doors were wide enough to accommodate wheelchairs. Stocksbridge Neuro-Rehabilitation Centre had specialist equipment as needed by individuals. These were environmental control systems such as the lowered light switches, recharging facilities and appropriate bathroom fittings. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 21 It was noted that the soiled clothing was handled correctly by the staff and transported to the laundry. The staff were seen complying with the systems in place to control the spread of infection by removing protective clothing and washing hands as soon as they had finished caring for/supporting each person. The present layout of the home reflects the ethos and the aims of the service. However the multidisciplinary staff offices were spread out and were not easily accessible. It was understood when speaking with the managers and the staff that the plan was to develop the RSW- rehabilitation support workers- to deliver a collaborative care programme. Therefore a better office arrangement would help with supervision and support for staff whilst on duty. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.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 and 35. People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The staff employed at the home are trained, skilled and in sufficient numbers to support the people who use the service. This practice is in line with the Terms & Conditions agreed by the placing authority and the funding levels. EVIDENCE: The staff working at the home said that the management team had given them clear job descriptions, which helped them understand their role as well as the roles of the others. This had helped them develop into a supporting team. Two comments were received with regards to the staff team. “My X knows the key worker and has a special bond. All the staff are very professional and I know that X is in good hands.” “The staff work very hard and I sometimes see them covering for sickness and absenteeism. They can only do this when they are truly committed.” Four staff files were checked and the records kept of the recruitment and selection complied with the Care Homes Regulations 2002 and the relevant schedules. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 23 A further four staff training and development profiles were checked. There was evidence that the staff had received mandatory training and also service specific training such as splinting in neurology, male catheterisation, management of behavioural problems, understanding aphasia and advances in the management of people in a vegetative state. There were some gaps in the training records and the manager showed evidence of forthcoming training to address the gaps. Staff surveys confirmed that they received regular supervision by their senior staff. The manager said that the staff who supervise colleagues were trained and supported by her and the other senior staff. Supervision records were available for inspection. The manager said although all staff had received supervision the frequency needed to be increased. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 24 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 and 42. People who use this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to the service. The management and administration of the home is based on openness and respect for those who use the service and also those who are working at the home. EVIDENCE: The management team seemed competent and had experience in running the rehabilitation centre. They were able to meet the stated purpose and the home’s aims and objectives. This was backed up by the comments received from the users of the service and the staff. It was noted that the management team communicated a clear sense of commitment to the rehabilitation of the people who lived at the home. There Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 25 was also a clear dedication by them to equal opportunity for the people who lived at the home and the staff who worked there. Regular Relatives, ‘Residents’ and staff meetings had taken place and the minutes were available for inspection. It was noted that there had been some care issues raised by the relatives and these had been identified as areas for improvement and staff had been identified to monitor the ongoing improvements. Such practice empowers the staff and therefore leads to lasting changes. There was regular monitoring from the responsible individual and selfmonitoring of documentation. These were carried out to a high standard and there were records to support this. The home’s records confirmed that the management team continued to work towards compliance with relevant moving & handling, health & safety and fire safety legislation. Records were kept of incidents, accidents and injuries. These records were checked on a monthly basis and reported by the managers. The care staff induction and foundation training has been reviewed by the multidisciplinary team leaders to ensure that the training was suitable for the rehabilitation support workers so that they were confident and competent in their roles. Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 26 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 4 2 3 3 3 4 4 5 3 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 3 25 X 26 X 27 X 28 4 29 4 30 3 STAFFING Standard No Score 31 3 32 3 33 4 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 4 4 3 LIFESTYLES Standard No Score 11 3 12 X 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 3 4 4 4 X X 3 X Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations The records maintained by the multidisciplinary rehabilitation team should be centralised so that the individuals and their families/representatives at their request are able to see the true picture of their rehabilitation progress. All staff should have documentary evidence of regular supervision. The management should seek regular audits from the supplying pharmacist with regards to medication management and updates on medication for staff. To maximise the access, support and supervision of the rehabilitation support workers the offices of the therapy staff should be better organised and thereby the therapy staff are within reach. 2. 3. 4. YA36 YA20 YA24 Stocksbridge Neuro-Rehabilitation Centre DS0000048612.V346693.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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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