CARE HOME ADULTS 18-65
Stoke House 145 Harborough Road Northampton Northants NN2 8DL Lead Inspector
Moira Mosley Unannounced 30 June 2005 @ 08.30 A.M.
th 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 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 Stationary 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 C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Stoke House Address 145 Harborough Road Northampton Northants NN2 8DL 01604 715169 Telephone number Fax number Email 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 Vacant Care Home 12 Category(ies) of LD Learning Disability (12) registration, with number MD Mental Disorder (12) of places Stoke House C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 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. Date of last inspection 2nd October 2004 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 shred 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 accomodation 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 C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 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 4.5 hours were spent in the home. The care of two service users was reviewed to include their care plans and other records. All twelve service users were in the home until 10am when many left to attend day placements or for outings and appointments. Due to their learning disability some were unable to comment on their care however a period of observation and discussion with four of the service users was undertaken to find out how they felt about living in the home. Service user questionnaires were returned to the Commission for Social Care Inspection from eight service users and comments received from six service user relatives. What the service does well: What has improved since the last inspection?
The arrangements for night-time cover have improved with two waking night staff now on duty. Dining facilities and provision of crockery and utensils have been improved with service users stating they enjoy the meals within the home. Stoke House C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 Page 6 The healthcare provision for service users has improved and there was evidence of input from a range of specialists including learning disability and psychiatric services. 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 C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Stoke House C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 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 standard(s) These standards were not assessed on this inspection. EVIDENCE: Stoke House C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 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 standard(s) 6, 7, 8 and 9. Care plans and risk assessments identify service user needs but the overall care planning system prevents a consistent approach. Service user rights are not being met due to the lack of documented evidence about restrictions made including financial management. EVIDENCE: Care plans were available for assessed needs however the format of the files made it difficult to identify key areas of need; one service user had 24 care plans. They were not generally numbered dated or signed; however there was review documents evidencing when they were in place and regular reviews undertaken. There were some plans with evidence of service users agreement. One service user spoken to had restrictions in place in regard to her bedroom key and times for getting up in the morning, the records did not fully reflect the reasons for restrictions or any agreement. One of the service users spoken to was very positive about their involvement with decisions made and said they speak to their keyworker and the manager
Stoke House C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 Page 10 about their needs. He knew he had care plans and had the opportunity to discuss the content and reasons for them. One service user was concerned about the management of his money, he has his own bank account but has to transfer funds to his account held by the company who then pay him a weekly personal allowance; there was no documentation available in regard to this arrangement. The service users spoke about the regular meetings they have in the home and a forum meeting when service users from different homes owned by the company meet with one of the directors to discuss issues. Risk assessments were cross-referenced to care plans and highlighted action to be taken by staff to minimise the risks. Stoke House C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 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 standard(s) 11, 14, 15 and 17. The provision of day placement, activities and community access meet the social needs of the service users, however the staffing issues are impacting on service user activities, education and holidays. EVIDENCE: Service users spoke about their daily activities and several really enjoyed the opportunity to attend college and other placements to develop new skills and experiences. Two spoken to were concerned that due to staff shortages that these were sometimes cancelled at short notice and affected their progression. These issues are discussed further within the standards for staffing. The home has access to two vehicles for transporting service users to placements, however one of these belongs to a named service user within their mobility allowance and there was no clear evidence of how this was managed as it appeared to be relied upon for other service users use. Stoke House C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 Page 12 Staffing permitting they enjoy a wide range of social and educative activities and leisure pursuits include swimming, pub visits, meals out and in house activities including a monthly pottery session. One service user raised concern that there was not going to be an annual holiday this year, again due to staffing difficulties and they all spoke highly about last years holiday. Families and friends are encouraged to visit the home and many spoke about home visits that help maintain family contact. The menus are chosen with assistance from the service users and all service users spoken to and those who returned questionnaires were very positive about the meals. One service user stated that there were two choices and staff would provide alternatives if necessary. The dining facilities have been altered to provide more space with a table in one of the lounges to allow a small group of service users to eat in a more relaxed environment. Stoke House C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 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 standard(s) 18 and 19 The healthcare and physical needs service users are being met. EVIDENCE: There were records to show input from a range of healthcare specialists including the GP, community nurses for learning disability services and psychiatrists along with dental and optical services. The service users spoken to said they were happy with how staff treat them and were able to say how they make choices in their daily activities and routines. Interactions observed between staff and service users were appropriate. Service users are very aware of who their key worker is and they liked being able to link with an identified person. Stoke House C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 Page 14 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 standard(s) 22 and 23 The lack of documentation to support investigation of complaints puts the service users at risk of not having their concerns fully addressed. EVIDENCE: One service user spoke about a missing item and he was unhappy with the outcome, discussion with the manager showed that it had been investigated and discussed with the service user, however this was not logged as a complaint and there was no evidence to support the outcome or any measures to prevent reoccurrence. The service users were aware of how to complain and the complaints procedure was on communal notice boards. There is an effective system to protect the service users from abuse and the protection of vulnerable adults procedure is implemented for any concerns. Stoke House C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 Page 15 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 standard(s) 24, 26, 28 and 30 The home provides a safe environment for the service users although maintenance records need to be maintained to show evidence of timely repairs. EVIDENCE: The home was clean and tidy and provided a range of communal space including a safe garden area for the use of the service users. Bedrooms were personalised and decorated with service user involvement, two of the service users spoken to said they were happy and were very proud of their rooms. Maintenance records are not retained within the home although it was reported that a weekly maintenance form is sent to head office however there was no evidence of action taken in response to repairs, for example the cooker in the kitchen is reported to not be working effectively and one of the boilers for the central heating system is also broken, this is not directly affecting the service users at present due to it being summer.
Stoke House C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 Page 16 The fire officer has visited in April 2005 and records showed compliance with fire and health and safety requirements. Laundry facilities are within the basement area and procedures are in place for infection control including the provision of gloves and aprons. Stoke House C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 and 36 The needs of the service users are not being fully met due to the lack of suitably qualified and experienced staff. EVIDENCE: Service users and the rotas seen confirmed that at times the home is understaffed due to sickness, annual leave or other shortages. The service users said this meant that at times they could not attend college or it restricted outings and activities. Staff frequently work overtime to cover shifts and some are working excessive hours. This has an impact on staff turnover and sickness levels. There have been a number of new staff employed and these are being given training and support to enable them to meet service user needs, however there is concern that there is a lack of experienced staff available and at times the home has no senior person in charge. On review of the incident notifications it is apparent that there are higher levels of aggression and the need for restraint when key senior figures are not on shift.
Stoke House C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 Page 18 The majority of staff files are not available in the home and the manager is not directly involved in the recruitment process or ensuring that staff have the skills, experience, and other recruitment checks necessary, for example references and Criminal record checks. The service users spoken to also confirmed they don’t have the opportunity to meet staff prior to their employment in the home. There are two staff with a NVQ (National Vocational Qualification) and this does not meet the 50 of the staff qualified by 2005. Staff supervision is not occurring at least 6 times per year for all staff due to the lack of senior staff to undertake this duty. Stoke House C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 42 and 43 The health and safety of the service users is being maintained. The management of the home is being compromised due to the staffing issues. EVIDENCE: There is an acting manager in post who is being registered with the CSCI. Due to the difficulties in recruiting staff in sufficient numbers with the necessary skills and experience to meet service user needs, the acting manager is covering a large number of shifts, including weekends and the on call system is such that there is an expectation to cover any shortages due to sickness. This is impacting on supernumerary time to complete managerial expectations. The feedback from both service users and their relatives was very positive about the home and the manager. Comments included “the manager and his team have worked very hard to restore the family atmosphere” and “we are
Stoke House C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 Page 20 very please with the care [service user] gets from the manager and the staff.” The overall control of the homes budget, procedures and contracts with service users is held by the head office of the company however it would be expected that on registration the manager would retain overall decision making processes. There was evidence of statutory training including fire, health and safety and food hygiene. Fire records showed evidence of regular maintenance and checks on equipment. External maintenance records for utilities were also available. Issues of day-to-day maintenance of the home are discussed within the environment standards, as there are no records to show routine and timely maintenance. The insurance certificate was not available at the time of the inspection. The certificate on display expired 22nd May 2005; the manager stated that head office have sent a memo to say that the new certificate is at head office. Stoke House C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 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 x x x x Standard No 22 23
ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 2 3 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 2 x 3 x 3 x 3 Standard No 11 12 13 14 15 16 17 3 x x 2 3 x 3 Standard No 31 32 33 34 35 36 Score x 2 2 2 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Stoke House Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 2 3 x x x 2 2 C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 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 7 Regulation 17(1)(a) schedule( 3)(3)(q) 12(2) 12(3) 18(1)(a) Requirement Any restrictions on service users must be fully documented and agreed by the service user and/or their representative. There must be evidence of service user input into decisions made about the management of their money. There must be suitably qualfied experienced and competent staff on duty to meet planned service user activities and placements. Complaints raised by service users must be fully documented and investigated. An action plan identifying how the repair/replacement of the broken cooker and boiler must be submitted to the CSCI Evidence of the recruitment procedure for staff must be available for inspection. A copy of the insurance certificate for the home must be submitted to the CSCI Timescale for action 14/08/05 2. 7 14/08/05 3. 14 30/08/05 4. 5. 22 24 12(1)(a) 22(3) 12(1)(a) and 23(2)(c) 19(5) 25(2)(e) 14/08/05 14/08/05 6. 7. 8. 9. 34 43 14/08/05 14/08/05 Stoke House C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 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. 2. 3. 4. 5. 6. Refer to Standard 6 24 32 34 33 36 Good Practice Recommendations Care plans should be dated, signed and orgainised into a system to aid staff in providing consistent care. Maintenance records should be available in the home. 50 of the staff team shoould have NVQ at level 2 or above by the end of 2005. The manager and the service users should be involved in the recruitment of staff for the home. The retention of staff should be explored to ensure there are sufficient suitably qualfied and experienced staff available to meet service user needs. Staff should receive formal supervision at least 6 times per year Stoke House C51 C08 S12930 Stoke House V236097 Stage 4 300605.doc Version 1.40 Page 24 Commission for Social Care Inspection 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
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