Inspection on 14/03/08 for Stonecroft House Care Home

This inspection was carried out on 14th March 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stonecroft House Care Home 06/01/09

Stonecroft House Care Home 05/10/06

Stonecroft House Care Home 14/02/06

Stonecroft House Care Home 15/11/05

Stonecroft House Care Home 03/03/05

Stonecroft House Care Home 23/11/04

Similar services:

Snydale Care Home

Staveley Birk Leas Nursing Home

Fairmount Nursing Home

Currergate Nursing Home

Brookfield

Castlethorpe Care Home

Elmleigh Convent

Woodlands Respite Care Centre

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

CARE HOME ADULTS 18-65 Stonecroft House Care Home Barnetby North Lincolnshire DN38 6DY Lead Inspector Mrs Jane Lyons Key Unannounced Inspection 14th March 2008 09:00 Stonecroft House Care Home DS0000002805.V360855.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 Stonecroft House Care Home DS0000002805.V360855.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. Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stonecroft House Care Home Address Barnetby North Lincolnshire DN38 6DY 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) 01652 688344 01652 688594 margaret.soulby@lc-uk.org www.leonard-cheshire.org.uk Leonard Cheshire Disability Position Vacant Care Home 29 Category(ies) of Physical disability (29), Physical disability over registration, with number 65 years of age (29) of places Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th October 2006 Brief Description of the Service: Stonecroft Care Home is situated in a rural position close to the small village of Barnetby and the M180 motorway. The main house is Victorian in style, with a modern extension and set in extensive grounds overlooking the Lincolnshire Wolds. All rooms have views of open countryside and are styled for the individual person; bedrooms are for single occupancy and eight have en-suite facilities. The home is designed for easy access for those in wheelchairs. There are a number of different sitting rooms within the home, plus a very large dining area and separate activities room. A range of aids, adaptations and equipment are provided throughout the home. The gardens are well maintained and offer a variety of settings to sit and walk in and people are encouraged to take part in their maintenance. Parking space is provided at the front of the home. The home provides care for those people with a physical disability from residential category through to those with more complex nursing needs. Stonecroft is owned by Leonard Cheshire Disability and the local team of Manager, professionally trained nurses, carers and other ancillary staff are supported by a regional and head office team. As at 14th March 2008 the weekly fees ranged from £ 450 to £4500 per week. People who use the service will pay additional costs for optional extras such as hairdressing, private chiropody treatment, toiletries and newspapers/magazines. Information on the specific charges for these can be obtained from the manager. Information on the service is made available to prospective and current individuals via the home’s statement of purpose, service user guide and inspection report. Copies of these documents can be obtained from the home. Stonecroft House Care Home DS0000002805.V360855.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 1 star. This means that the people who use this service experience adequate quality outcomes. The site visit took place over one day in March 2008. Surveys were posted out prior to inspection; twenty were returned from people who use the service, two from relatives, and five from health/social care professionals. Some of their comments have been included in this report. Mrs Jane Lyons carried out the visit. During the site visit we spoke to the manager, deputy manager, five care staff, three qualified staff, the cook, seven people who use the service and one relative to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. We also looked around the home and looked at lots of records, for example; people’s care plans and risk assessments, daily records, supervision schedules, menus, and other records relating to the running of the home. Information received by the Commission over the last few months was also considered in forming a judgement about the overall standards of care within the home. Prior to the visit the inspector referred to notifications sent to the Commission for Social Care Inspection, the event history for the home over the past year and the completed Annual Quality Assurance Assessment document (preinspection questionnaire), all of which forms part of this inspection. There had been an unstable period of management since the last inspection which had impacted the extensive work completed by the previous manager to improve standards of care. An experienced new manager has been in post since June 2007 whose consistent approach is moving the service forward. What the service does well: There was a very relaxed and homely atmosphere in the home, people were observed to be very settled and comfortable in their surroundings. The home is always welcoming to visitors. Care is taken to ensure that the views of people living in the home are listened to and that they not only have a voice as to their own care, but also of the communal running of the home as a whole. There was a core group of staff that had worked at the home for several years and knew the people who use the service well, this means individuals are able Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 6 to receive care and support from people they are familiar with. People were very happy with the standards of care provided, lots of very positive written and verbal comments were received about the staff, some of these include; “The carers provide a superb care regime, they treat ……with dignity and respect, also humour there is so much laughter and happiness.” “ The staff are lovely and kind” and “All the staff at the home are excellent”. Meals are well presented and offer people at the home a choice and variety of different foods. The manager had made sure that people living in the home would be safe with the staff employed in the home by obtaining criminal record checks and references before new staff started work. People knew how to complain and any complaints were taken seriously and investigated thoroughly. They had procedures and staff training in place to protect people from abuse. What has improved since the last inspection? What they could do better: They must look at care plans in more detail on a regular monthly basis to check that the care plan is still relevant and up date the care plans when required. They must ensure that activities meet individual’s interests and expectations and that staff are proactive in encouraging and enabling people to take part in activities that interest them. Medication recording must be improved to ensure medication charts detail all information from the prescription and signatures are in place for medications Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 7 administered by the staff, so that there is no mishandling of medication and the individual’s health is looked after. The home needs to make sure there are enough staff on duty so the people who use the service are looked after properly. The supervisory arrangements for the home must improve to provide all the care staff with the necessary guidance, leadership and support to ensure people living in the home are safe and well cared for. Generally the home has good safety measures in place however staff need to carry out more regular checks and keep more detailed records on bed rails provided to individuals to protect their safety. 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. Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 8 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 Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 9 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 and 5. People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. The people who use the service were provided with basic information to assist them to make an informed choice to live at the home and they were provided with a written contract. Admitting individuals to the home whose needs are not included in the registration category could potentially place those individuals at risk of not receiving the care support they need and has caused some discontent amongst existing people who use the service. EVIDENCE: The home had a statement of purpose and a service user guide, which gave current information about the home. Whilst these covered the points required to meet the regulations and the standards, the documents were limited to some basic statements about the service and could be further developed to give more information about the location of the home and life style individuals could expect if they lived in the home. For example people commented in surveys that from the information they received prior to moving in they thought the home was located more centrally in the village and would have liked more information about the activities. Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 10 There had been a number of new admissions to the service since the previous inspection visit. The admission procedure was sufficient to guide staff on the actions to be taken to ensure prospective people’s needs are properly assessed and planned for. The manager liaises with the relevant care management teams, visits prospective individuals and an assessment is completed. A decision is then made as to whether the individual’s needs can be met and the person is invited to visit the home with their family, this gives the individual the opportunity to see what they think about the home, before committing to a decision. Most individuals spoken to stated that they had been given the opportunity to visit the home before they were admitted to it. One individual wrote describing how her husband had visited the home a number of times, had chosen the décor for the room and had taken photographs to show her as she had been unable to visit. Two individuals said that the Multiple Sclerosis Society had recommended the home. The care files of four people who use the service were examined. These contained copies of the Local Authority community care assessment, care plan and a range of assessments carried out by a variety of professionals. The care files contained evidence that people’s needs had been assessed before they were admitted into the home. People who use the service were provided with written contracts, which set out the terms and conditions of occupancy and included the room the individuals would be occupying. Individuals at the home who received nursing care had had an assessment by a NHS registered nurse from the local Primary Care Trust, to determine the level of nursing input required by each individual and to determine the amount of financial support they would receive. Three individuals with complex needs associated with learning disability and physical disability had been admitted to the home in December 2007, the placement is funded by North Lincolnshire Primary Care Trust. Although the homes current registration does not include a learning disability category, the PCT is funding support for some extra nursing and care support from staff with learning disability qualifications and experience to provide direct care to the individuals and provide support to the home’s staff. Concerns were raised by a number of the people who use the service during the visit around this placement and the home has also received a formal complaint, which the manager is currently addressing. The management must ensure that the statement of purpose is updated to reflect the change of criteria for admitting people who have needs associated with learning disability whose primary needs are associated with physical disability. People who use the service are able to have a choice of staff gender when receiving personal care as far as practicable, as the home employs both male and female staff at the present time. Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. People using the service are supported to make decisions and everyday choices to promote an independent lifestyle as far as practicable. Most of the individuals had a range of care plans in place, which were supported by written risk assessments, in some cases records had not been updated to reflect changes in need which potentially puts those individuals at risk of harm. EVIDENCE: All people that live in the home have care files; due to the amount of documentation in each individuals file a decision had been made to separate the files into a working file and supporting file however the files seen were very disorganised and did not consistently contain the same information and therefore not give a clear picture of people’s planned care and areas of risk. Four care files were examined as part of the inspection process. One file belonged to an individual admitted for respite care, who was well known to the Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 12 home; the care file did not contain any care plans although the individual has complex health needs and requires significant support from staff. Plans looked at in other files were found to be detailed and generally gave good information about the identified needs of the individual together with clear information about what care was needed to be given by staff in most cases. Some information about the persons social interests, likes/ dislikes, spiritual needs were also included within the individuals care plan. The use of risk assessment documentation to form a basis for care was generally consistent with the exception of the individual recently admitted for respite support; there were no risk assessments in place for nutrition or tissue viability even though daily records detailed the provision of a high risk pressure relieving mattress and issues around pressure damage had been identified. All files contained up to date moving/ handling risk assessments. There was evidence in the individual plans to show relevant health care professionals had been consulted regarding specific care regimes; all files seen contained detailed physiotherapy assessments and there was good evidence of detailed records in place to support the exercise programmes delivered to those individuals. Some people who use the service had signed agreements to their plans, but this was not happening in the majority of cases. There was limited evidence of the involvement of individuals or their representatives in the development of their plans other than at the reviews held with the funding authority. One relative said that she had never seen her son’s care plan. All people who use the service had a key worker. In one of the files a small number of the care plans had been written in the “first person” however none of the current care plans clearly reflect the principles of person centred planning which would be a positive move forward in developing the documentation systems. Comments received from health care professionals, relatives and people who use the service indicated that everyone was very satisfied with the standards of care in the home. The home accesses support for individuals from local advocacy agencies when required. A number of the people who use the service attend regular unit meetings in the home and also attend (Leonard Cheshire) forum meetings at regional and national level. There was good evidence that individuals were supported to participate in activities which enabled them to influence key decisions in the home such as redecoration and staff selection. Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 13 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, 14, 15, 16 and 17. People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. People are enabled to keep in contact with family and friends; they receive a healthy, varied diet according to their assessed needs and choices however they had limited opportunities for social stimulation and participation in activities. EVIDENCE: Staff said that the routines of the home were planned around the individual’s needs and wishes. Observations indicated that staff members interacted very well with the people that lived in the home. There was a warm, friendly and relaxed atmosphere in the house during the course of the visit. Discussion with staff and relatives indicated that family and friends were able to visit the home and see people in private if required. They can use any of the communal facilities and there was no restriction on visiting times. Written Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 14 comments from relatives included “All family and friends are made very welcome. We are able to have time with ……in a relaxed atmosphere. There are no restrictions on visiting times; the staff are very friendly and family and friends are encouraged to be a part of … care needs.” The people that live in the home have their own TV, computer systems, music systems and personal items in their bedrooms. A number of individuals have assisted technological systems in place to support environmental controls in their rooms. In discussion staff displayed good knowledge of individual people’s needs, likes/ dislikes and family support. People spoken with stated that there was very little social stimulation at present, comments included “ Although I decide what to do each day I don’t feel there are a lot of activities to do” and “There isn’t very much to do in the home, I do get quite bored” and one relative wrote “ I think my only concerns are what activities are on offer and how often ….. can get out”. ‘It’s very limited for activities, I get bored sometimes’. This was confirmed in discussions with the manager and staff, and in surveys received. Staff felt that their time was taken up caring for people and there was little time to sit and talk to people. The home employs an activity coordinator and also a volunteers coordinator; activities were provided within a group or one- to one basis, a weekly programme was in place which included games, crafts, outings etc . Records showed that some individuals accessed activities and support such as art classes, adult education and visits to the local day hospice however the majority of individuals were not accessing regular activities with many people only having one or two entries per month. Little information was documented in the care plans about individual wishes and needs regarding social and emotional care. Examination of a number of files established that social profiles had been completed however in some cases these were not detailed. This together with information from discussions with people showed there is a need to look in more detail at people’s social stimulation needs in order to better tailor daily activities to the individual wishes, needs and capabilities of some people who use the service. The manager was aware of the need to improve this area of practice. All the comments received from surveys and during the visit confirmed that the home provided a high standard of meals, which people really enjoyed. The menus are reviewed regularly in consultation with the people who use the service. Comments included “the food is very good” and “the home provides a good nutritional diet.” The meal served during the visit looked tasty and well presented, a choice of meal is always provided. Many of the people use the dining room and the Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 15 mealtime was seen to be a relaxed occasion with people choosing when they wanted to have their meal. Aids were provided to encourage people to maintain independence where possible and staff assisted individuals where required in a sensitive and discreet manner. The kitchen was clean and there were good stocks of food in the fridge, freezers and stores. There were no special diets required by people at the time of the inspection except low sugar diets. Discussions with the cook identified that she had the knowledge of how to access any special dietary needs that were required by individuals. A number of pureed diets are provided and the home should consider the use of food moulds to improve presentation in this area. Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use this service experience adequate outcomes in this area. We have made this judgement using available evidence including a visit to this service. People’s health and personal care needs were met at the home, however the very limited evaluation of the care provided would not ensure timely and appropriate interventions if there were changes in health or care needs. Some deficiencies in the transcribing and recording of medicines could place people at risk of not having their health needs met. EVIDENCE: Care files for four of the people living at the home were examined. There was no indication during the site visit that people’s health needs were not being met however the lack of care plans in place for one individual and the absence of regular evaluation or updating of many of the care plans could mean individuals were at risk of not receiving the care they needed. There was little evidence that the majority of care plans had been evaluated and updated since 2006; although one file seen contained one revised care plan for an individuals’ mobility needs which had been updated in November 2007. Changes in people’s health were not always identified and plans had not been updated to reflect these changes for example one individual’s daily records Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 17 detailed recent problems with high blood glucose levels, leg swelling and the urinary catheter however there were no evaluation records in place nor had the care plans been updated to reflect any changes in care support needed. A number of gaps were identified with the recording of daily records of care; in one file there were no records for six dates in February. All individuals were registered with a local G.P. who visits the home weekly and carries out a regular “surgery” at the home; he commented on a survey “The staff are very caring and the new manager has already taken steps to improve the standards of care and other areas of the home.” Records of visits by health care professionals were maintained. There was good evidence at this visit that the home has continued to work closely and develop positive relations with a range of specialist health care professionals such as the speech and language therapy team, physiotherapy team and dieticians. Many of the individuals had exercise programmes and daily records showed these were being followed. At the last visit a recommendation to record more of the discussions around emotional support/ counselling for individuals was made yet there was little evidence of any improvements in the recording of such discussions and support which clearly is being provided by the staff on a regular basis. One relative wrote “I think the staff have very good skills, it is not just the physical side of caring, it is also the emotional side and this I believe is their strong point.” There were risk assessment tools for mobility, tissue viability, bed rail provision, medication, nutrition and general issues; high risk areas had been identified and care plans were in place to support appropriate care provision with the exception of one care file. Two of the surveys received from care management detailed some concerns regarding the staff needing to develop their skills in enabling and encouraging people to maintain and gain skills / independence during short term placements at the home so they can return to the community. This issue was passed on to the manager. The majority of individuals living in the home had significant mobility problems. Evidence from discussion with staff and observation showed people’s personal aids were well maintained and the home provided the necessary aids and equipment to support both staff and individuals in daily living. The manager confirmed that the home’s medication policies were currently under review and would be issued in the near future. Only the qualified nursing staff administer the medications in the home. The home receives medication from the local G.P. dispensing practice via a “Venelink” medication system. Computer generated medication administration records were not provided with Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 18 this system therefore staff have to write all the medications on the charts by hand; the standard of the transcribing was found to be very poor with many dosages and dates not recorded, there were no running totals of medications detailed. A number of gaps were identified on the medication administration charts, where staff had not signed for the medication or not used the appropriate code to support why the medication had not been administered. Recent guidance issued by the Royal Pharmaceutical Society, Nursing and Midwifery Council and the Commission details that all prescription dose changes of Warfarin must now be supported by written confirmation from the G.P.; this guidance now needs to be put in place. Medication in the home was appropriately stored. Records of room and fridge temperatures were maintained and satisfactory. Administration records and storage of controlled medication was checked and found to be satisfactory. Stonecroft House Care Home DS0000002805.V360855.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 and 23 People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People are aware of how they can make complaints and expressed confidence in the home’s approach to responding to them. Discussion with staff indicated that recent training has improved awareness of adult abuse (safeguarding) issues. This supports the home’s stance on management of instances of alleged abuse. EVIDENCE: A complaints procedure was available. The Commission had not received any complaints since the last key inspection carried out in October 2006. At this visit the manager reported that he had dealt with one complaint which had been received recently, the issues had been upheld. Examination of the records evidenced that the process of reporting, investigation and outcome management of complaints was robust. The manager had maintained detailed records to support the process. People are aware of how they can make complaints and expressed confidence in the home’s approach to responding to them. They all said that the manager goes round and speaks to everyone and that they are able to go to his office to discuss issues if they want to. One relative wrote, “ There have been occasions when there have been concerns and without exception we have been given reasons and answers.” Information provided to the commission prior to the visit and discussion with the manager indicated the home had policies and procedures to cover adult Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 20 protection and prevention of abuse, whistle blowing, management of challenging behaviours and management of people’s money and financial affairs. One referral to the safeguarding team had been made by the home since the last inspection; the matter had been fully investigated and appropriate action taken. Comments from professionals in surveys received detailed that the management of the home had dealt with the issues very effectively. Policies and procedures were in place to support the management of people’s finances. The home manages a number of pocket money accounts for individuals; records to support the management of three accounts were checked. The cash balance in all accounts seen corresponded to the records and receipts were in place for all transactions. There was evidence from the home’s recruitment and selection processes, staff training records, financial management, complaints log and the use of risk assessments that the manager ensured that people who use the service were protected and safeguarded from harm. Training records evidenced that the majority of all existing staff had now received training on the protection of vulnerable adults and the manager confirmed that new staff recruited to the home would access this course. Stonecroft House Care Home DS0000002805.V360855.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, 29 and 30. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People felt at home at Stonecroft, they were provided with a warm, comfortable and safe environment suitable to their needs. EVIDENCE: All areas of the home were decorated and furbished to a good standard; several bedrooms and the dining room had recently been redecorated. The home benefits from having a number of lounges in which the people who use the service could choose to socialise, or have some private time in. There is also a dedicated smoking room, an activities room and a snoozellum. The toilets and bathrooms were all close to the communal and bedroom areas. The communal areas were all well utilised during the visit; people who use the service commented on how happy and settled they were at the home. The manager was currently developing this year’s maintenance and renewal plan; he confirmed that he was looking to provide some robust protection for Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 22 the woodwork and walls in the form of Perspex covers to better protect those areas from the constant wheelchair damage and that the corridor carpets would be replaced. All of the rooms in the home had a call bell system in them. People who use the service confirmed to the inspector that when the call bell was activated the staff were generally quick to respond. The bedrooms were all decorated and furbished to a good standard with evidence that the rooms were personalised to the extent the chosen by the individual. One person moved back into their room during the visit following the fitting of a new carpet, which they confirmed was “absolutely perfect just what they wanted.” The home was seen to be clean and tidy and free from any offensive smells. Positive comments were received during the visit and from surveys returned regarding the facilities, these included “ Provides a very homely environment for people with complex needs” and “It provides a happy, safe environment with the emphasis being on the safety aspect”. Discussion with the staff indicated that there is a wide range of equipment provided to help with the moving and handling of the people who use the service and to encourage their independence within the home. The exterior of the building has been well maintained. The grounds of the home were large and well maintained; people who use the service stated they had a lot of pleasure from sitting in the grounds and looking at the views. Stonecroft House Care Home DS0000002805.V360855.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): 31 32, 33, 34, 35 and 36. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. People felt that staffing levels were appropriately maintained to meet their needs however some staff have felt overstretched in recent months which the manager is addressing through further recruitment. Staff are generally well trained and competent in their roles. Recruitment practices afford sufficient protection for people who use the service. EVIDENCE: The roles and responsibilities of staff were clearly defined and in discussion staff demonstrated understanding of the management and reporting structures for the home. Twenty four individuals were residing at the home at the time of the visit. Written and verbal feedback from the people who use the service and relatives stated that they felt there was generally adequate staff available to support individual needs. Staff felt that the dependency levels in the home had increased since the three people with complex needs regarding learning disabilities had been admitted; they said they felt overstretched at times on Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 24 the morning shifts in meeting the personal care needs of all the individuals and this left little quality time to spend with them. The manager confirmed that he was in the process of recruiting more care staff to increase the staffing levels to meet the current dependency. The home does not formally monitor dependency levels which now needs to take place to determine the number of staff that were required for each shift at the home. New staff access a corporate two day induction programme. Following this staff complete the Skills for Care Common Induction Standards; new staff interviewed stated that they had been made to feel very welcome at the home and one staff member said that his induction had been “good”. The home currently has 69 of the care staff trained to level 2 NVQ or above which is a significant improvement since the last inspection visit. Training statistics were looked at which evidenced that staff were generally up to date with mandatory courses in fire safety, moving/ handling, first aid and food hygiene. Other courses such as infection control, safeguarding adults, equality and diversity, health and safety had also been provided to many of the staff. The manager confirmed that staff had accessed some service specific courses such as multiple sclerosis, gastrostomy feeds and male catheterisation however he was looking to provide more service specific courses and specialist training for staff in working with people with multiple disabilities within next years training programme. Discussion with the staff revealed that they were positive about the learning and development they had been able to access. The home had a recruitment and selection policy and procedure that the manager understood and uses when appointing new members of staff. Checks of four staff files showed that Protection of Vulnerable Adult register checks, police (Criminal Records Bureau) checks, written references, health checks and past work histories are all obtained and satisfactory before the individual started work. The home had an equal opportunities policy and procedure. Feedback from the manager, staff and information in personnel and training records showed the procedure is followed when employing new staff and throughout the homes working practices and staffs access to training. There is a staff supervision programme in place, although records to support the recent sessions held were not available during the visit due to some administrative problems, the manager has since provided evidence. The management have been carrying out appraisal sessions with staff and so far 80 of staff have completed this session this year. Stonecroft House Care Home DS0000002805.V360855.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, 38, 39, 42 and 43. People who use this service experience good outcomes in this area. We have made this judgement using available evidence including a visit to this service. An experienced manager runs the home. Quality monitoring systems allow individuals and their families to comment on and in part affect the way in which the service is operated. The safety of people who use the service and the staff at the home is generally well promoted and protected. EVIDENCE: The manager of the service has a wide range of experience in managing services for people and has been in post for about a year. He has completed the registered managers award and is awaiting registration with the CSCI. Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 26 Comments from staff and relatives during the visit and feedback from health professionals identify that the manager is very popular and well respected; they recognise that his management style and commitment is improving the quality of the service at Stonecroft. One relative told the inspector “The home is really improving since Mike started working here, the staff work as more of a team and there has been lots more decoration carried out.” Other comments from people and who use the service and staff include “He’s the best manager we’ve had” and “Mike sorts things out properly”. Comments during discussions indicate that staff are able to express their views openly, and the manager and deputy manager listen and offer help where needed. Staff said they are treated with respect and there was evidence of improved teamwork between the manager, nurses and staff. Staff reported that moral was generally very good however at the time of the visit the manager was holding a number of consultation meetings about changes to shift patterns which some of the staff were duly concerned about. The manager confirmed that when he had taken over from the previous manager there were significant areas for improvement identified within the home, it was clear from discussions during the visit that he is putting measures in place to improve many of the management and administration systems but is also looking to take the home forward to meet the future longer term demands of the service. Stonecroft has a formal quality assurance system, which includes audits and monitoring of the service and consulting with people who service, relatives and stakeholders and culminating in an annual review; this took place in August 2007.The home produces an development plan. regular use the service annual Formal meetings with staff, people who use the service and relatives have been held regularly; all people spoken to were very positive about the standards of communication in the home. The area manager undertakes regulation 26 visits, reports of these visits were available for April and July 2007 and January 2008. General health and safety was maintained via adherence to policies and procedures, risk management, staff training and the maintenance of equipment. Examination of maintenance records identified that checks and certificates were in place for installations and equipment. The fire safety equipment, checks and risk assessment were all in place and up to date; the fire safety officer had visited the home in December 2007 and made six requirements which the manager was currently addressing within the timescales given. Training records show that staff have attended safe working practice up dates. Information examined in the home corresponded to that provided in the AQAA. Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 27 Accident records were completed and in place; these were audited by the manager to review action taken to reduce reoccurrence. A number of individuals had bed rails fitted. Two of the bed rails in use did not have protectors in place; the manager confirmed that this was the decision of the individual however this must be recorded as it contravenes guidance issued. Records evidenced that the staff completed risk assessments to support the use of bed rails and that the maintenance man checks the rails on a regular basis. Guidance issued by the Medical Devices Agency details that the risk assessments should be detailed and cover areas of assessment such as: type of rail used, height of bed, distance from the headboard to the rail, height of mattress etc. The manager should review the homes’ risk assessments for use of bed rails in line with the current guidance. Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 28 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 2 2 3 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 3 3 X X 2 3 Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES 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 YA1 Regulation 4 Requirement The statement of purpose must be updated to reflect the change in admission criteria to describe how the needs of people with learning disability whose primary needs are physical disability will be met in the home. The registered person must ensure that all people admitted for respite support have care plans in place to support their needs. The registered person must ensure that all people’s personal and health care needs and associated care plans are fully evaluated taking into account any incidents or changes over the previous month to ensure timely and appropriate interventions. The registered person must provide evidence that people who use the service or their representative have had the opportunity to see and agree their plan of care so that people DS0000002805.V360855.R01.S.doc Timescale for action 30/06/08 2. YA6 15 05/06/08 3. YA6 YA18 15 30/06/08 4. YA6 15 12(2) and (3) 15/07/08 Stonecroft House Care Home Version 5.2 Page 30 who use the service are enabled to make decisions about the care they are to receive. 5. YA9 YA19 13 and 17 The registered person must ensure that risk assessments are developed to cover all areas that pose risk to the people that live in the home and reviewed to ensure people are protected from the risk of harm. The registered person must ensure all people who use the service have opportunities for personal development and have access to appropriate and stimulating leisure activities linked to an assessment of their individual needs. Timescale of 20/02/07 not met. 7. YA20 13(2) The registered person must ensure that the transcribing records on medication administration accurately reflect the individual’s prescription and that the medication records are completed appropriately to ensure the individuals health needs are safely met. 20/06/08 30/06/08 6. YA13 YA14 16(m) 20/07/08 8. YA33 18(1) a 9. YA42 23(4) The registered person must 20/06/08 ensure that adequate numbers of staff are employed and rostered to meet the dependency needs of the service users. This will better protect the health and welfare of the people who use the service. The registered person must 30/09/08 ensure that all action is taken to comply with the requirements made by the fire safety department within the given timescales of their report. This will better ensure the safety of DS0000002805.V360855.R01.S.doc Version 5.2 Page 31 Stonecroft House Care Home those who live and work at the home. Stonecroft House Care Home DS0000002805.V360855.R01.S.doc Version 5.2 Page 32 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 OP1 Good Practice Recommendations The registered person should further develop the statement of purpose and service users guide to give more information about the location and life style people could expect if they lived in the home. The registered person should review the organisation of the care files to provide a working file which contains all the appropriate documentation such as assessment, care plans, risk assessments, individual activity programmes, exercise programmes, daily records, evaluation notes, supplementary communication records and multidisciplinary records. The registered person should develop care documentation which reflects the principles of person centred planning. The registered person should ensure that daily records of care are maintained. The registered person should consider the use of food moulds to improve the presentation of pureed diets in the home. The registered person should implement a formal dependency tool to support effective staff rostering in the home. The manager should apply to the commission for registration. The registered person must ensure that risk assessments accurately determine whether an individual initially requires bed rail provision and evaluations must determine the continued need for them. Bed rails and protectors must be fitted and checked in line with manufacturers instructions and Medical and Healthcare products Regulatory Agency (MHRA) guidelines. DS0000002805.V360855.R01.S.doc Version 5.2 Page 33 2. YA6 3. 4. 5. YA6 YA6 YA17 6. YA33 7. 8. YA37 YA42 Stonecroft House Care Home Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Stonecroft House Care Home DS0000002805.V360855.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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