Inspection on 28/07/08 for Stoke House

This inspection was carried out on 28th July 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stoke House 22/08/06

Stoke House 18/11/05

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 08/11/2008.

CARE HOME ADULTS 18-65 Stoke House 145 Harborough Road Northampton Northants NN2 8DL Lead Inspector Stephanie Vaughan Unannounced Inspection 28th July 2008 09:00 Stoke House DS0000012930.V369127.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 Stoke House DS0000012930.V369127.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. Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stoke House Address 145 Harborough Road Northampton Northants NN2 8DL 01604 715169 01604 715169 lchamberlain@mentaurltd.uk www.mentauruk.com Mentaur Limited 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) Vacant 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.V369127.R01.S.doc Version 5.2 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) 22nd August 2006 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 single bedrooms on the first floor and a range of communal areas including two lounges on the ground floor. In addition there is a semiindependent 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. At the time of the inspection, fees ranged from £1003.03 to £1817.73, items that are not included are, some individual activities, hairdressing and personal items such as toiletries and clothing. Information about the services provided by the home was available. Stoke House DS0000012930.V369127.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 0 star. This means the people who use this service experience poor quality outcomes. Prior to this statutory inspection, a period of five hours was spent in preparation. This comprised reviewing the Annual Quality Assurance Assessment, a document sent to us by the provider, the previous inspection reports and associated requirements, the service history and other documentation. A total of 10 Comment cards were sent to people who use the service and 10 comment cards were sent to staff. One Comment card has been received from a resident and one from a staff member. Both indicated satisfaction with the service one resident commented ‘I like living here’. The Commission have received one compliant about this service and this was referred to the provider for investigation. There have been eight Safeguarding Adults allegations about this service since the last inspection; these have been referred to the local adult care team and are subject to independent investigation under the Local Authority Guidelines for the Safeguarding of Adults. Three of these allegations were against staff members, in one circumstance the allegation was not upheld, however following investigation two staff were dismissed and referred to the POVA list held by the Secretary of State. The Commission have a focus on Equality and Diversity and issues relating to this are also included in the main body of the report. This site visit to the home was conducted over a period of eight hours during which the inspectors made observations and spoke to residents and staff. A limited tour of the premises was conducted which involved viewing the communal areas and a selection of the private accommodation. Case tracking is the method used during inspection where a sample of four residents were selected and all aspects of their care and experiences reviewed, including individual plans of care and associated documentation. The service specialise in the care of people who have learning disability and who have limited communication abilities and as such were unable to recollect or to fully express their views about this service. In these circumstances observations are used to inform the inspection activity. There is not a Registered Manager for this service, however an acting manager has recently been appointed but was not present during this inspection. Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 6 What the service does well: People who use the service have the right information so that they can make choices about the service, in their daily lives and have information about how to complain. Most of this information including the individual plans of care are being developed in formats that are easy for people to understand. In general, admissions seem to be managed well and staff make sure that they have the right information to be able to care for people properly. Staff know how the residents need and like to be cared for, their preferences are documented and they are supported to make choices in their daily lives. One resident commented ‘ I like Living at Stoke House’. Others described how they had chosen the décor of the bedroom and had helped to paint it. Residents appear to have a programme of activities, although these are not consistently recorded. People who use the service told us about the activities that they had enjoyed such as attending football matches, holidays, arts and crafts and outings. There were several activities going on during the day of the inspection. People who use the service are able to choose where to spend their time when they are at home and are able to participate in household tasks such as washing up and making drinks, they are also involved in the menu planning and have daily food choice. People who use the service told us that they liked the food that was provided at Stoke House. People who use the service are supported to build relationships and keep in touch with family and friends, one person told us how he was looking forward to an outing with his father the following day. People who use the service have access to all of the right health checks, doctors and other hospital services and specialists. They are supported to maintain their personal care in general by staff of the same gender; a key worker system is in place. Individual plans of care show that staff have good information about the way that residents need to be supported in the management of challenging behaviour. Residents appear well cared for and in general to be well presented and in keeping with their preferences and gender. The staff make sure that the people who use the service receive their medication safely. Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 7 All people who use the service have their own bedrooms and are able to personalise their own space and have their own possessions around them. What has improved since the last inspection? What they could do better: The staff need to make sure that they are clear about their admission criteria and the needs of the people who live there are compatible. Resident’s contracts need to be reviewed to make sure that people who use the service have up to date information. Individual plans of care need to be further reviewed to make sure that staff have up to date information that is easily accessible. Information that is no longer current needs to be archived. Risk assessments need to be reviewed to make sure that they are up to date and that the staff are able to follow them. Management need to conduct an audit into the incidents, which occur when restraint has been used to identify how the number of incidents requiring the use of restraint can be reduced. The storage of medication needs to be reviewed to ensure that it complies with the new guidance issued by the Royal British Pharmaceutical Society Guidelines. Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 8 There have been a high number of notifications about this home since the last inspection, management need to be proactive about the management of these and conduct frequent audits to identify themes and risk factors that could be addressed to prevent further reoccurrence. People who use the service told us that they had been physically assaulted by other residents and that they were worried that it might happen again. One person said ‘ ….keeps punching me and I don’t like it’. There were also incidents that occurred during the inspection and these were brought to the attention of senior management. The management needs to make sure that the people who use the service are safe and free from abuse at all times, including a review of the mix of residents, provision of consistent management, the required level of supervision of residents and staffing levels; also to ensure that staff have the right training and support. They should also consider what improvements they could make to the environment to ensure that people who use the service have more personal space and comfort within the communal areas. Management need to make sure that they have up to date information on the Safeguarding of Adults and that they are familiar with the referral processes to the Adult Care Team and that staff have the right training to ensure that incidents pertaining to the Safeguarding of Adults are dealt with appropriately at all times. The environment is subject to heavy useage and wear and tear, for example one of the fireplaces has broken tiling and one of the doorframes was damaged. The standard of the environment needs to be reviewed to ensure that it meets the needs of those with limited mobility and other disabilities and that it is clean and hygienic throughout. The management need to make sure that the linen cupboard is locked when not in use. The management need to make sure that the right numbers and mix of staff are available on the busy shifts, including appropriate senior staff and gender mix to accommodate the needs of the individual residents. The management of staff training needs to be reviewed to make sure that there is system in place that allows them to identify which staff have had mandatory and other specified training, when it is due for renewal and other staff which are yet to receive it. Management should consider the use of more external trainers particularly in the training of Safeguarding of Adults and the management of challenging behaviour to ensure that staff have access to accurate up to date information. Management need to ensure that all staff have formal documented supervision and support. They should also consider what actions can be taken to reduce Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 9 the level of staff turnover and improve the consistency of care to the people who use the service. The management must ensure that the service is managed in the best interests of the people who use the service at all times including when the Acting manager is on leave. The management should ensure that appropriate quality assurance procedures are in place and that the outcomes are used to inform service development. 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. Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 10 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.V369127.R01.S.doc Version 5.2 Page 11 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, 4, & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Appropriate assessments are undertaken with potential residents prior to admission, conflicting needs for service users due to their complex and changing needs means there are not always fully met. EVIDENCE: A Statement of Purpose and Service User Guide were available within the home. This means that the people who use the service have the right information about the home. Assessments are obtained form the appropriate funding authorities and are held on file. Records also showed that assessment of peoples needs had been undertaken prior to moving into the home to establish whether their needs could be met. Both assessments are used to form the basis of the individual plans of care. There was some evidence that residents are assessed as their health personal and social care needs change. Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 12 The service specialises in the provision of care for people with Learning Disability and Mental Disorder and associated challenging behaviours, however the specific needs of the individuals and the size of the home means that these needs often conflict. For example people with autistic spectrum disorder require organised routines and this impacts on others who live there. Service users spoken to were unable to recall when they moved into the home. Staff spoken to confirmed that pre-admission assessments, including visits took place but that on occasions there were issues with the residents compatibility with each other due to the number of people living there and the level of complex needs and behaviours. A written contract signed by the service user was available in their files for each of the four service users who were case tracked, however these had not all been reviewed. This means that the service users do not have up to date information about the service that they receive and how much it costs them. Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 13 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 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the individual needs and choices are well documented within the individual plans, they are not consistently supported to exercise real choice within their daily lives. EVIDENCE: Each person who uses the service has an individual plan of care and the service is in the process of reviewing the format to make sure that these are person centred. Staff explained that these files were being developed in conjunction with the service users who would then keep the files in their own rooms, with a copy being kept in the office. However, current information within the existing recording systems was not always easy to find, files contained records from previous years and on Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 14 occasions it was unclear which of this was still relevant. This may result in staff not being able to access the information required to meet the needs of the people who live there. Individual plans of care show that there are on going assessments of the needs of people who use the service and these included information about their likes, dislikes and preferences. A key worker system is in place and the home. People who use the service are supported to be involved in decision making and were observed to contribute to the running of the home such as helping to prepare meals and drinks. One resident described how she had chosen the paint for her bedroom and been helped to decorate it. Residents and staff confirmed that residents meetings were held on a weekly basis to discuss menu planning, activities and the running of the home. Risk assessments were available covering areas such as personal care, health and safety, specific health needs and behaviour and support needs. In general these are reviewed and updated on a regular basis, however this is not consistent. Observations made during the visit indicated that service users identified as requiring a certain level of supervision did not always receive that support at all times which put individuals at risk. Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activity and meals are in general managed well, are creative and provide daily interest and variation for the people who use the service EVIDENCE: People who use the service have access to a local college courses. One person described how she had been supported to choose the courses she wanted to start in September. Most residents attend a local day centre run by the provider, Mentaur during the week, however a garden party was planned for the following day, which meant that residents were all at home during the day of inspection. There was evidence that the staff had arranged a variety of outings and activities to engage residents during the day. Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 16 People are supported to access the local community by going out for walks, to local shops, out for drives and to visit friends and family. One person described how much he enjoyed going to football matches “I am going to Northampton football ground tomorrow – I am getting a football shirt”. Another service user said she was looking forward to going on holiday to Butlin’s Holiday Camp. One resident was knitting, another was designing and painting a T-shirt both were clearly proud of their achievements. People are encouraged and supported to maintain relationships with family through visits to Stoke House and relatives homes. One service user spoken to was looking forward to seeing his father at the garden party being held the following day at the day centre. There was also evidence that residents are supported to maintain close personal relationships with other people. Arrangements are in place to ensure that they have access to health promotion agencies and that issues of consent are considered. Residents are able to choose where to spend their time when they are at home; there are two communal lounge areas, one small lounge which is available for quiet activities. However the main lounge was busy, noise levels were at times quite high and at times residents did not appear always relaxed. At lunch time a staff member was observed asking people what they would like in their sandwiches and where they would like to eat lunch. The lunch appeared to be adequately substantial and well balanced; residents said that they were happy with the food provided. There was evidence that specific dietary requirements had been assessed and were being met. Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The resident’s individual needs are known to staff, which enables their health and personal care needs to be met. EVIDENCE: People who use the service told us that they were supported to maintain their personal care. Their personal preferences are documented and known to staff. Routines for personal care are flexible according to varying individual need and planned activities. There is a key worker system in place, which means that residents can, in general, be supported by staff who know their needs and are of the same gender. Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 18 Individual plans of care demonstrated that appropriate information was recorded to support staff in the management of challenging behaviour. People who use the service appeared to be well cared for however their appearance varied from extremely smart to slightly unkempt for example one resident was wearing a T-shirt that was inside out and another had food stains on their shirt when going out. People who use the service have a variety of additional health and complex support needs. Records show evidence of how these have been assessed using a range of multi-agency health and social care professionals. For example consultant psychiatrists, general practitioners, community learning disability team and dieticians. There was also evidence that people who use the service have access to occupational therapists, podiatrists, dentists, opticians and Community Psychiatric Nursing Services. The individual plans of care demonstrated that residents have access to routine health checks and other health services. Medication systems were reviewed and were found to be in good order. Appropriate records are maintained to ensure an accurate audit trail. Medication is stored in a locked facility located within the office, however this needs to be reviewed to ensure that it complies with new guidance issued by the Royal British Pharmaceutical Society Guidelines. There is evidence that people who use the service are assessed for their ability to self medicate and their consent is obtained for staff to do this on their behalf if they are unable or unwilling to do so. Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22& 23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Due to the conflicting demands on staff, the supervision levels of residents are not consistently sustained to ensure that residents are protected and are able to feel safe. EVIDENCE: There is an easy read complaints procedure, which is accessible to the people who use the service. They told us that they could raise their concerns with staff and one person also said he could contact the police or speak to his family. There has been one complaint received about this service, which was referred to the provider for investigation. Although the complaints file was not reviewed during the inspection there was no evidence to support the allegations. The Commission have received a significant number of notifications about this service and include acts of physical aggression between residents and incidents where restraint has been used. Since the last inspection there have been eight referrals to the Local Authority for investigation under the Safeguarding Adults Policy and Procedures. Five of these relate to serious incidents between residents. Three related to allegations against staff, all of the allegations have been sent to the Safeguarding Adults Team and as a Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 20 result of investigations two staff members have been dismissed and referred to the POVA list held by the Secretary of State. Some staff have received training in the management of challenging behaviour including de-escalation and restraint techniques and on the Safeguarding of Adults. Staff demonstrated a varied understanding of their responsibilities in the Safeguarding of adults. One service user spoken to said that someone “..kept punching me all the time – I don’t like it.” A number of other residents also complained of incidents where their had been assaulted and demonstrated an anxiety about further incidents. A number of physical assaults by residents on other residents were witnessed during the visit including people being pushed, slapped on the head and hair pulling. The people involved were clearly distressed by the assaults. Some of these assaults occurred whilst the staff were out of the room despite the fact that at least one of the residents there required constant supervision. Also a number of incidents occurred whilst staff were in the room in these circumstances staff intervened to limit the aggressors actions however there was no support offered to the injured party or no immediate action appeared to be taken to prevent further acts of aggression or document these occurrences. These incidents were brought to the attention of the staff on duty and also to the Responsible Individual who has agreed to ensure that the appropriate action is taken. Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area adequate. This judgement has been made using available evidence including a visit to this service. The standard of the environment is safe and meets the basic needs of the residents. EVIDENCE: The property consists of a large period house within a residential area. It is on a main road and close to the shops and amenities in Kingsthorpe. The property is not suitable for wheelchair users due to there being a step to the front door and narrow corridors and doorways. The majority of bedrooms are on the first floor and there is no lift available. The communal areas comprise of one large sitting room, one small sitting room and a dining room. The layout of environment appears to have a Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 22 significant impact on the psychological wellbeing of the existing residents. The limited personal space means that the challenging behaviours of some residents have a significant impact on the others. The dining facilities are limited in size and the current practice of organising a structured programme for meals and snacks means that most of the residents have to use the dining room at the same time. This also has the potential to adversely affect the enjoyment of meal times. The interior of the property shows signs of heavy usage, wear and tear and in some areas are in need of cleaning. In addition to their care duties staff also have some responsibilities for cleaning and other household duties. The service does have access to maintenance staff who are responsible for maintaining the fabric of the building. The communal areas were basically furnished and had been personalised to some extent with pictures and ornaments. These are secured for health and safety reasons. Each resident had their own bedroom with a lockable door for which they are able to hold a key. Resident’s bedrooms are personalised to varying degrees. There was evidence that residents were consulted over the décor and furnishings of their bedrooms. Specific fixtures and fittings are available according to the resident’s individual needs and there are also fixtures and fittings in place to maintain the health and safety of residents. There was a large linen cupboard situated on the first floor and although latches had been fitted there were no locks. This was discussed with the Responsible Individual who agreed to ensure that appropriate were obtained for use within the next 24 hours. Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels are unstable at Stoke House which means that the people who use the service are placed at possible risk. EVIDENCE: The service aims to ensure that there seven staff on shift during peak periods throughout the day and two waking night staff. However on the day of inspection both the manager and deputy were not on duty, meaning that only six staff were working on the early shift. Staff also confirmed that they had been short staffed over the weekend and that all residents were at home. This combination of factors appears to have had resulted in a number of incidents involving assaults to both residents and staff some of which required police involvement. In general the staff group reflects the age and gender of the people who live at Stoke House. All of the residents are white British and the management are mindful of the need to reflect this within the staff team. Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 24 There is evidence that the staff are undertaking training in National Vocational Qualification in Care level 2 and at least 50 have achieved this. Senior staff demonstrated a high level of competence and commitment when dealing with residents with challenging behaviour, nevertheless people told us that staff turnover is high this means that it is difficult to maintain a consistent highly skilled and trained staff team required for the care of the existing residents. The individual plans of care showed that the service aims to provide person centred care however the staff have limited ability in achieving this due to the unstable staffing levels and the ability to maintain a highly trained and skilled staff team. Staff files were in good order and evidenced robust recruitment procedures. Staff files showed that the service provides induction training however this is limited in content and needs to be reviewed to ensure that it reflects the needs of the residents and the service. There was no evidence that staff have opportunities to take other training specific to the needs of people with learning disability such as the Learning Disability Award Framework qualifications. There is evidence that the service has a programme of staff training and that this reflects the mandatory training needs of the service however there was no system in place to identify which members of staff had had which training and when it was due for renewal and which staff were yet to receive training in specific subjects. Most of the training appears to be “in house”, there would be a distinct advantage to all concerned for the staff to receive training from external providers particularly in the Safeguarding of Adults, management of challenging behaviour and training specific to the needs of specific residents such as Autistic Spectrum Disorder. There was some evidence that staff receive supervision, however this had not yet been conducted for the two most recent employees and there was little evidence of support and debriefing for staff after incidents such as physical assaults. Stoke House DS0000012930.V369127.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): 37,39 & 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of the home has been unstable for an lengthy period of time and puts the people who use the service and staff at risk. EVIDENCE: It is of serious concern to the Commission for Social Care Inspection that there have been eight changes to the management for Stoke House since November 2003 and no Registered Manager since July 2006. This instability has meant that the service has struggled to achieve consistency and a proactive approach to management. This appears to have had an adverse effect on the staff team in terms of their morale, retention, staffing numbers, safety and training which Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 26 impacts on the level of care that the staff are able to provide for the people who use the service. However the Commission have now received an application from the recently appointed acting manager for registration. The registration process is ongoing at the present time. Neither the acting manager or the deputy were present during the inspection although the provider had arranged for a staff member to cover these absences however the Commission views these arrangements as inappropriate. These concerns have been raised with both the Acting Responsible Individual and the Provider and have received assurances that the arrangements are being urgently reviewed. The senior member of staff on duty was unable to confirm whether there were any quality assurance activities conducted within the home. Individual plans of care showed that in general residents appropriate risk assessments are in place for their individual needs. The service has a high level of notifications many of which involve acts of aggression between residents and assaults on staff. There has been one concern raised about this service and eight Safeguarding Adults allegations, five of these were serious incidents between residents, three were against staff. The laundry cupboard on the first floor was not locked and the Responsible Individual confirmed that this would be addressed within the next 24 hours. No other hazards were identified. Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 27 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 2 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 1 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 1 X 2 X X 2 X Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 28 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 YA2 Regulation 14 Requirement Admission procedures must be reviewed to take into account the varying needs of the people who use the service and the impact that these needs have on others who live in the home. To ensure the health, safety and well being of residents. The management must arrange for all residents to have a care management review to ensure that the individual and collective needs of the residents can continue to be met at Stoke House. To ensure that Stoke House is able to meet the individual and collective needs of the people who use the service. Risk assessments must be kept under regular review to ensure that they contain accurate and up to date information and reflect the specific and changing needs of the individual To ensure the health, safety and well being of residents. Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 29 Timescale for action 30/09/08 2. YA2 14 30/09/08 3. YA9 13 30/09/08 4. YA9 13. Residents who are assessed as requiring continuous or one to one supervision must receive this at all times. To ensure the Safeguarding of Adults Arrangements to ensure the Safeguarding of Adults must be reviewed to ensure that they comply with the current guidance issued by the Local Authority. To ensure the Safeguarding of Adults. Accidents and incidents must be reviewed to ensure that management are able to identify risk factors and to take appropriate actions to prevent reoccurrence. To ensure the health, safety, well being and of Safeguarding Adults Action must be taken to ensure use of restraint is used only as a last resort and that there is consistent recording and reporting of these incidents. To ensure the Safeguarding of Adults Records of incidents where restraint has been used must be monitored and interventions put in place to reduce the number of incidents. To ensure the Safeguarding of Adults Further external staff training must be arranged in the Safeguarding Adults, including the recognition, prevention and referral procedures relating to the current Local Authority DS0000012930.V369127.R01.S.doc 01/08/08 5. YA23 13 30/09/08 6. YA23 13 30/09/08 7. YA23 13 30/09/08 8. YA23 13 30/09/08 9. YA23 13 30/09/08 Stoke House Version 5.2 Page 30 Guidelines. To ensure the Safeguarding of Adults Further external staff training must be arranged in the management of challenging behaviour. To ensure the Safeguarding Adults All Safeguarding Adults incidents must be appropriately documented and submitted to the appropriate authorities. To ensure the Safeguarding Adults The laundry cupboard must be kept locked when not in use to ensure the health and safety of residents Staffing levels must be reviewed to ensure that there are appropriate numbers of suitably qualified and experienced staff on duty at all times. To ensure the Safeguarding of Adults. Action must be taken to stabilise the management of the home and to provide an acceptable level of consistency for residents and staff. To ensure the health, well being and the Safeguarding of Adults. The management must ensure that the service is managed by a competent and experienced person at all times. To ensure the health, well being and the Safeguarding of Adults. 10. YA23 13 30/09/08 11. YA23 13 01/08/08 12. YA24 23 01/08/08 13. YA32 18 01/08/08 14. YA37 8 30/09/08 15. YA37 9 01/08/08 Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 31 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. 3. 4. 5. 6. Refer to Standard YA5 YA6 YA6 YA20 YA24 YA24 Good Practice Recommendations Resident’s contracts should be reviewed to ensure that residents have up to date and accurate information. Individual plans of care should be further reviewed to ensure that they contain up to date and accurate information Individual plans of care should be further reviewed to ensure that outdated information is archived The storage of medication should be reviewed to ensure that it complies with new guidance issued by the Royal British Pharmaceutical Society. The layout of the environment should be reviewed to ensure that it is accessible to those with physical and other disabilities. The lay out and usage of the communal areas should be reviewed to ensure that it provides residents with adequate safe personal space and that it is a safe and comfortable place to live The environment should be reviewed to ensure that it is well maintained, clean and hygienic. The management should conduct an investigation into the high level of staff turnover and find ways to address this and ensure stability within the staff team The content of the induction training should be reviewed to ensure that it complies with the guidance issued by Skills for Care. Staff training should be reviewed to ensure that staff have more access to external accredited training such as LDAF and other training specific to the needs of the people who use the service The management of staff training should be reviewed to ensure that there is a system such as a training matrix to organise staff training, show who has had training in mandatory subjects and topics relating to the needs of the people who use the service, when this is due to be renewed and what training remains outstanding for individual members of staff. Regular staff supervision should be provided for all staff, this should be done more frequently to support new staff and those who are involved in the management of DS0000012930.V369127.R01.S.doc Version 5.2 Page 32 7. 8. 9. 10 YA24 YA34 YA34 YA35 11 YA35 12 YA36 Stoke House 13 YA39 resident’s physical aggression. Arrangements should be made to ensure that there is a quality Assurance programme specific to the service and that this is used to inform service development Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Stoke House DS0000012930.V369127.R01.S.doc Version 5.2 Page 34 - 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. 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