Inspection on 18/11/05 for Stoke House

This inspection was carried out on 18th November 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stoke House 28/07/08

Stoke House 22/08/06

Stoke House 30/06/05

Stoke House 02/10/04

Stoke House 23/06/04

Stoke House 09/12/03

Stoke House 01/10/03

Stoke House 12/09/02

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

CARE HOME ADULTS 18-65 Stoke House 145 Harborough Road Northampton Northants NN2 8DL Lead Inspector Mrs Moira Mosley Unannounced Inspection 18th November 2005 10:00 Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 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 Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 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. Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Stoke House Address 145 Harborough Road Northampton Northants NN2 8DL 01604 715169 NONE 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) Mentaur Limited Mr Richard O`Neil Care Home 12 Category(ies) of Learning disability (12), Mental disorder, registration, with number excluding learning disability or dementia (12) of places Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. It is a condition of this registration that the home may continue to care for older people who have lived in the home long term, for the duration of their lives, unless the Community Health services can no longer support any health or nursing care needs that the service user may develop. The home will limit its services to the following service user categories: No person falling within the category Learning Disabilities (LD) can be admitted where there are already twelve persons of category LD in the home. No person falling within the category Mental Disorder (MD) can be admitted where there are already twelve persons of category MD in the home The total number of Service Users in the home must not exceed twelve (12) 30th June 2005 2. 3. Date of last inspection Brief Description of the Service: Stoke House is situated in a residential area on the outskirts of Northampton. It is convenient to local facilities including the Kingsthorpe shopping centre, less than ½ a mile away, to a park very close by, and to the local pub. The home offers care to people with Learning Difficulties, some of whom have challenging behaviours. Stoke House is one of three homes in the locality owned by Mentaur. There is a Day centre, run by the organization less than ½ a mile away, which service users have a choice of attending. The house is a large extended terraced property offering shared and single bedrooms on the first floor and a range of communal areas including two lounges on the ground floor. In addition there is a semi-independent unit within the gardens offering accommodation for one service user. There are accessible and secure gardens to the rear of the property for the use of the service users. Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a statutory unannounced inspection; 2 hours were spent gathering information and planning for the inspection and 4 hours were spent in the home. The care of one service user was reviewed and included care plans, medication and other records. All twelve service users were in the home at various points during the inspection. Due to their learning disability some were unable to comment specifically about their care however three spoke to the inspector and gave some comments about their life in the home. Since the last inspection a further monitoring visit was undertaken in October 2005 to review progress towards the requirements made all of which had been met. Further requirements were issued regarding pre admission assessments, staffing levels and the contents of care plans and healthcare assessments. The update of the care plans and healthcare assessments has an agreed timescale of the 25/11/05 and were not fully reviewed during this inspection. What the service does well: What has improved since the last inspection? Requirements made at the last statutory inspection have all been met; these included a review of the complaints procedure, service user involvement in the management of their monies, staff recruitment procedures, and repair of the cooker and the production of a valid insurance certificate. Pre admission assessment showed a comprehensive system with the service user and their family along with the multi disciplinary team being fully involved in assessing the level of need for a service user prior to admission. Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4, 5 The pre admission process is sufficiently detailed to ensure that service users are suitably assessed and an appropriate placement is made. EVIDENCE: A new service user had a very detailed pre admission assessment package and this included input from the family and the multi disciplinary team involved in care. The registered manager visits new referrals and completes an assessment pack. Staff spoken to confirmed they are informed about new admissions prior to them arriving and are is planned to meet needs. The service user reviewed had visited the home on several occasions to meet the staff and fellow service users prior to the move. There was a signed contract in place outlining the agreed terms and conditions of the placement. Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 9 Care plans and risk assessments identify service user needs. Service user rights may not be fully met due to the lack of documented evidence about restrictions made. EVIDENCE: The timescale for the requirement made regarding the content of care plans has been reviewed and a new timescale of the 25/11/05 agreed with the CSCI. The care plans will be reviewed fully at the next inspection in light of this. The registered manager confirmed they are working towards this. Care plans and risk assessments for the new admission were reviewed. Staff confirmed they read the care plans and sign to say they have seen them. In addition staff stated that they are involved in the review of care plans and are encouraged to communicate their observations and ideas into the care planning process. There was evidence of involvement with the multi disciplinary team, including Community Psychiatric Nurse (CPN), care management and psychiatry input. Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 10 The care plans developed were written to a high standard with clear guidance for staff to ensure a consistent approach. The team have developed strategies to manage challenging behaviour and positive results have been seen although the service user continues to have some difficulties that they hope to overcome with their approach. Regular meetings are arranged to keep changes under review and there was an acknowledgement of the impact of this service user on the other service users in the home. The service user had signed agreement for some of the care plans and the care manager had signed others as her representative. Risks assessments showed proactive action with regular reviews as new risks were identified. Restrictions on smoking are in place for this service user and although the rationale was discussed and a cigarette plan in place there was no documented agreement or outline of the plan in place. Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 16. Individual programmes are in place to ensure residents receive a varied opportunity to develop skills and experience a wide range of social opportunities. EVIDENCE: A service user spoke about her daily activities and said she liked going to college and going shopping on a regular basis. Service users all have individualised daily activities and this includes cookery, animal care, drama and art at the local college as well as life skills training and attendance at the day centre run by the company. Staff spoken to confirmed that service users have input into the menu planning and shopping on a weekly basis and a range of evening and weekend activities are arranged both in the local community and in house depending on their likes, dislikes and capabilities. Staff spoke about how they promote individual choices and respect rights on a daily basis and have received training about this. Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 12 The home has a no smoking policy within the building and this is stated in the statement of purpose, however they exact details about the restrictions, for example due to the fire risk no service user is allowed to hold lighters or matches, but this is not clearly identified prior to admission. Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 20 A clear audit trail of all medication entering the home, total stocks and procedures for regular checks are required to ensure medication is being administered as prescribed. EVIDENCE: The timescale for the requirement made regarding healthcare assessments has been reviewed and a new timescale of the 25/11/05 agreed with the CSCI. The registered manager confirmed these have not yet been implemented and they will be reviewed fully at the next inspection in light of this. The new admission to the home had evidence of healthcare review with the GP, psychiatrist and CPN involvement. The medication in the home was reviewed and cross-referenced to the Medication Administration Records (MAR). There were three occasions when the MAR records were signed for medication given when the tablets remained in the monitored dosage system, the registered manager agreed to investigate these further. Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 14 There were 3 boxes of out of date medication in the PRN (as required) cupboard along with an unlabelled tube of daktarin cream. The total amount of stock in the home was not clearly identified and it was not possible to clearly audit if medication especially PRN was being administered as prescribed. Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed on this inspection. EVIDENCE: Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed on this on this inspection. EVIDENCE: Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 35 and 36 There are systems in place to ensure staff are available to meet service user needs. EVIDENCE: The home has employed more staff and has recently promoted two staff to a senior position. Staff spoken to stated they felt they had a good staff team and they supported each other. Service users were observed to be supported to attend a variety of activities and the day-to-day running of the home was being successfully managed. Staff were concerned about the impact of the newest service user to the home on the other service users and were feeling under pressure to meet the needs of this very challenging individual. However they said the plans in place were very clear and they were being supported and felt they had a say in the continued placement. Both stated they receive regular supervision with the manager and have received a range of training including statutory training and others for example advocacy and epilepsy. There are a number of staff registered to commence NVQ training although at present the home does not meet the 50 of staff qualified. Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 18 Concerns were raised at the monitoring inspection in October about the cost of training as it is costed to the individual employee and is payable on a sliding scale for up to 24 months following all training received. The CSCI is discussing this with the registered provider under separate cover. Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39. There is an effective management system in place to give clear guidance and support to the staff team and to the service users. The Quality Assurance system could be improved to evidence action taken as a result of comments raised by staff, service users and their families. EVIDENCE: The manager has been successfully registered with the CSCI as the Registered Manager since the last inspection. Staff spoke highly about the level of support and involvement they are given by the manager. Service users interact positively with the manager and he demonstrates a good understanding of their needs. There is a quality assurance system that includes questionnaires sent to staff, service users and their families, however these are issued from Head Office Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 20 and feedback of the outcomes has not been provided to the home. They are unaware of any positive comments made or of any action plans to address the issues raised. The registered provider conducts the monthly visit to the home to audit systems and the service users have regular meetings within the home to discuss any issues that arise. Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X 3 3 Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 2 17 Standard No 31 32 33 34 35 36 Score X 2 X X 3 3 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Stoke House Score X 2 2 X Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X X X DS0000012930.V266788.R01.S.doc Version 5.0 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement Timescale for action 25/11/05 2. YA19 3 YA6 4 YA20 Care plans must be developed to address all current identified needs and give staff clear direction of required action. Timescale reviewed and date agreed with CSCI – requirement carried forward. 12(1)(a)(b) Healthcare assessments must 13(1)(b) be completed and evidence of referral to healthcare professionals identified where required. Timescale reviewed and date agreed with CSCI – requirement carried forward. 17(1)(a) Individual restrictions on smoking must be agreed and documented with the service user or their representative. 13(2) A clear audit trail for all medication in the home must be available. 25/11/05 01/01/06 01/01/06 Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 23 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 YA16 Good Practice Recommendations The smoking restrictions should be clearly identified within the statement of purpose and service user guide to give information prior to admission. 50 of the staff team should have NVQ at level 2 or above by the end of 2005 The results and development plan to address any issues identified from the service user, staff and family questionnaires should be available to the home and the service users. 2 3 YA32 YA39 Stoke House DS0000012930.V266788.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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