Inspection on 06/01/09 for Stonecroft House Care Home

This inspection was carried out on 6th January 2009.

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

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

Other inspections for this house

Stonecroft House Care Home 14/03/08

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 13/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Stonecroft House Care Home Stonecroft House Care Home Barnetby North Lincolnshire DN38 6DY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jane Lyons     Date: 0 6 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Stonecroft House Care Home Stonecroft House Care Home Barnetby North Lincolnshire DN38 6DY 01652688344 01652688594 mike.day@LCDisability.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Leonard Cheshire Disability Name of registered manager (if applicable) Michael John Thomas Day Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: 5 day care places available in addition to the above Date of last inspection Brief description of the care home 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 multi- media 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 Care Homes for Adults (18-65 years) Page 4 of 32 care home 29 Over 65 29 29 Brief description of the care home 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 6th January 2009 the weekly fees ranged from six hundred and thirty pounds to three thousand, five hundred pounds 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 homes statement of purpose, service user guide and inspection report. Copies of these documents can be obtained from the home. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We have reviewed our practice when making requirements , to improve national consistency.Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations- but only when it is considered that people who use this services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This inspection included an unannounced site visit carried out by Mrs Jane Lyons on the 6th January 2009. During the visit we spoke with some of the people who live at the home, care staff, Care Homes for Adults (18-65 years) Page 6 of 32 qualified staff, a kitchen assistant, activity co-ordinator, physiotherapy assistant, the local vicar, a G.P. the deputy manager and the manager. We looked around the home to see if it was kept clean and tidy. Some of the records kept in the home were checked. This was to see how the people who live in the home were being cared for, that staff were safe to work in the home and that they had been trained to do their job safely. We also checked records to make sure that the home and the things used in it were safe and were checked regularly. The manager at the home also completed an annual quality assurance assessment that was requested by CSCI(Commission for Social Care Inspection), which includes information about people who live at the home, the staff that work there, the service provided, complaints and any incidents or accidents that have occurred. Prior to this visit, surveys were sent out to obtain the views of people who live at the home, staff who work there and health/ social care professionals who have recently been involved with the service. Seven surveys were returned from people who live at the home, three from staff and five from visiting professionals. The feedback was generally very positive. Comments from surveys have been included in the main body of this report. We would like to take this opportunity to thank everyone who participated in the inspection process. What the care home does well: What has improved since the last inspection? There has been positive action on the requirements listed within the last inspection report. All the requirements and the majority of recommendations have been acted upon and met, this shows the homes commitment to improving the services provided and working with the CSCI. The rotas show that the home is now staffed more efficiently, some of the shift patterns have been altered to better support individuals with their daily living choices. Observations on the day found that there were sufficient numbers of staff on duty that were able to meet the the needs of the people living in the home. Peoples care plans have been improved upon. They are much more person focused and contain more information about their wishes and interests so that staff are clearer about what care is needed and how it should be provided. This also helps the people using the service to have a choice in how they are cared for and helps them stay as independent as possible. Care Homes for Adults (18-65 years) Page 8 of 32 People have had their individual risks in carrying out aspects of their daily living and their health needs better assessed, which means that their health and welfare is better promoted and protected and this allows more individuals to develop and maintain some independence. A number of rooms have been redecorated and refurbished including bedrooms and the new multi- media room; with further work planned for the future this means people live in more pleasant, better maintained surroundings which meet their changing needs. The homes physical fire safety measures have all been upgraded which means that people who live and work in the service will be safer. Staff have accessed more specific training related to the complex needs of the people ho use the service and the number of staff who have gained National Vocational Qualification at level 2 or above has continued to increase which means that more staff are skilled and competent to carry out their work. Improvements have been made to the way staff record the medication administration, this will make sure that people receive the right medication at the right time. People have accessed a much wider range of activities and trips out which enables them to pursue their interests, have more access to the local community and occupy their time in a more meaningful way. More detailed records have been kept to support the provision of bed rails for people, this will better protect their safety. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with detailed information about the home to assist them to make an informed choice about the service. People had had their needs properly assessed before moving into the home. Evidence: The home has a detailed statement of purpose and service user guide, which gives information about services provided. They have reviewed these documents to make sure they are up to date in respect of any changes which have taken place within the home and also included more information about the homes location and services available. The admission procedure is sufficient to guide staff on the actions to be taken to ensure prospective peoples 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 individuals needs can be met and the person is invited to visit the home with their Care Homes for Adults (18-65 years) Page 11 of 32 Evidence: family, this gives the individual the opportunity to see what they think about the home, before committing to a decision. All those who completed a survey as part of this inspection, indicated that they were given sufficient information about the home before they moved in to help them t decide if it was the right place for them. The care files of three people who use the service were looked at. 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 peoples needs had been properly assessed before they were admitted to the home. Individuals at the home who receive nursing care have 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. Care Homes for Adults (18-65 years) Page 12 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have been made to care plans to provide staff with sufficient information to meet the needs of the people who use the service. People are assisted and supported by staff to make decisions and choices about all daily living needs where possible. Evidence: Three peoples care plans were looked at in order to obtain a picture of what their needs are and how staff support them. Significant improvements have been made to the quality of the recording in the care plans and they provide a good level of detail and enable staff to deliver the right level of care to each person. The care plans contain a lot more information about peoples personal goals, preferred routines and how they like to spend their time, this helps in making sure that the care is more person centred to suit the persons individual needs. The files are now well laid out and all information is easily accessible.Evidence from discussions and audit records show that the manager and deputy manager have been instrumental in the production and Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: overseeing the development of the new documentation system. Qualified and care staff have received specific support and training in this area and have received ongoing individual support from the management, audit records demonstrate that all the plans are being checked through to ensure they have been completed appropriately, are accurate and being updated. The care plans are now regularly reviewed and evaluated to keep the information up to date.There was good evidence of the involvement of individuals or their representatives in the development of their care plans, one person said The staff sit with me and discuss my care, my new support plan is much better as it tells them just how I like things done and what I can do for myself. Risk management strategies are in place for all areas of need and cover health needs and some daily living skills. The documentation is detailed and has been reviewed regularly; there was good evidence to demonstrate that they were being followed by staff to minimise risk thereby promoting the individuals health, welfare and in some cases allowing individuals to develop and maintain some independence. There was evidence in the individual plans to show relevant health care professionals have 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. All people who use the service have a key worker, people spoken to knew who their key worker is and said that they have regular one-to -one sessions with them which they enjoy. Comments from health care professionals and people who use the service indicated that everyone was very satisfied with the standards of care in the home. Discussions with a G.P. during the visit confirmed that he was very satisfied with the standards of care and communications with the service, he went on to say how he felt the service had improved with the changes made to the recoding in care and medication records. 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. One person told us how she liked to go to all the meetings and meet people from other homes. 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. Care Homes for Adults (18-65 years) Page 14 of 32 Care Homes for Adults (18-65 years) Page 15 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home now provides, promotes and encourages more development of social and practical skills. This ensures that people have the opportunity to participate in leisure activities which better suit them and live as part of the community. People are given the opportunity to exercise their right of choice regarding their daily lives. Evidence: Daily routines within the home are flexible and individual for each person who uses the service. Observations indicated that staff members interact very well with the people who live at the home and that people spend their time how and where they want to. There was a warm, friendly and relaxed atmosphere at home during the course of the visit. Discussion with staff and individuals indicate that family and friends are able to visit the home and see people in private if required.They can use any of the communal Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: facilities and there is no restriction on visiting times. The people that live in the home have their own T.V, computer systems and personal items in their bedrooms. A number of individuals have assisted technological systems to support environmental controls in their rooms. In discussions staff displayed good knowledge of individual peoples needs, likes/ dislikes and family support. Peoples religious needs are identified in their records. During the visit we spoke to the local vicar who visits the home regularly, he told us that he spends time chatting to people and one individual likes him to play his guitar and have a sing a long. He confirmed that none of the current individuals residing at the home choose to attend the local church services in the village however most people had attended the carol service at Christmas which they had enjoyed. Many of the people who use the service have complex or significant needs and require a high level of support from the staff team, therefore few of the individuals would be able to participate in work/ college placements; one individual is currently accessing a computer course at a local college and another person attends a local art class. Examination of records and discussions with staff and individuals evidenced that there has been some significant improvements in the provision of activities in the home since the last inspection. Detailed activity programmes have been developed which are structured and cover sessions throughout the day including weekends. The home now employs two activity co-ordinators who work with people to help them develop their independence, occupy their time in a meaningful way and try to live a fulfilling life. The people who use the service are accessing a much wider range of activities both in the home and in the local community; some of these include sensory time in the Snoozelum, water skiing, cinema, theatre, visits to local places of interest, meals out at local pubs and restaurants and shopping trips. One person said how much she enjoys the pampering sessions, where staff giver her a manicure and help her choose make- up. Activities that take place in the home are much more structured which was observed during the visit, individuals were seen to be enjoying a variety of sessions such as card making, music, sensory support, model making, game of dominoes and watching films. Many of the individuals are supported to use the wide range of communal areas in the home at different times of the day; staff interaction was observed to be very positive. The home has re- decorated and refurbished one of the recreational rooms to provide a new multi- media room which contains new equipment such as computer, home cinema and interactive games such as a Wii. This has been a very positive improvement to the facilities at the home and people said how they had been consulted on the refurbishment programme and how much they enjoy using the room. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: Many people told us that they had enjoyed all the activities and entertainment over Christmas, this has included a magic show performed by one of the local G.Ps with assistance provided by care staff from the home and a staff performance of their show Grease Frightening. Records and discussions with staff and the manager identified that people who wanted to go on holiday last year were supported to do so. One person told us how she had really enjoyed her holiday to Blackpool and that it had been so good to get away from the home for a bit and that she had had a lot of fun. All the comments received from surveys and during the visit confirmed that the home provides a high standard of meals, which people really enjoy. The menus are reviewed regularly in consultation with the people who use the service. Comments included I really like the meals, there is always a good choice and The food is great here. The meal served during the day looked tasty and well presented, a choice of meal is always provided. Many of the people use the dining room and the meal time was seen to be a relaxed occasion with people choosing when they wanted to have their meal.Aids are provided to encourage people to maintain their independence where possible and staff assist individuals where required in a sensitive and discreet manner. One person told us that they had enjoyed a Chinese take- away meal at the home recently and this was now going to be arranged monthly as it was so popular. Discussions with the kitchen assistant confirmed that the cook is informed of peoples individual nutritional needs and specialist diets are provided when needed. The home is currently providing one pureed diet, the provision of food molds would improve presentation in this area.The cook regularly meets with individuals to discuss menu choices and particular requests. Care Homes for Adults (18-65 years) Page 18 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and personal needs are well met by staff at the home, and each person has a more detailed plan of care that they or someone close to them has been involved in making. Improvements have been made to the recording of medication administration to ensure the systems are safer. Evidence: The information in care plans show that people living in the home have their own preferred routines and discussions with staff and records show that people are assisted and supported by staff to make decisions and choices about all daily living needs.This was also confirmed in feedback from professional surveys. Each individuals care plan documents the visits made and input each person receives from outside professionals for example GPs, chiropodist, physiotherapist, dentist, optician, speech and language therapist and out patient appointments. Comments received from a health professional included The staff have always been friendly and happy to implement recommendations, the physical care is very good, clients have Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: always been clean, well dressed etc. There as 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. As recorded in a previous section of the report the G.P. spoken to during the visit expressed his satisfaction with the care support at the home and considered peoples health care needs were well met. There are risk assessments in place for mobility, tissue viability, medication, nutrition, bed rail provision and general issues; high risk areas have been identified and care plans are in place to support appropriate care provision. The majority of individuals living in the home have significant mobility problems. Evidence from discussion with staff and observation show peoples personal aids are well maintained and that the home provides the necessary aids and equipment to support both staff and individuals in daily living. A sample of three peoples medication records were checked during the visit. This showed significant improvements in the standard of recording. The local dispensing practice now provides the home with pre- printed labels for each medication prescribed which are put onto the MAR sheet. The administration charts were well maintained with all signatures/ codes in place. Staff said that the home supports one individual to access separate pharmacy services which includes the re- ordering of medication each month. 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. There was evidence that the manager was auditing the medication systems regularly with positive results. A local community pharmacist visits the home periodically to provide advice and support with the medication systems in place. Care Homes for Adults (18-65 years) Page 20 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples concerns are listened to and acted on. Systems are in place to safeguard people from abuse. Evidence: People and their representatives have been provided with a copy of the homes complaints procedure, which is also on display in the entrance hall. This contains details of who to speak to at the home and who to contact outside of the home to make a complaint should they wish to do so, the procedure is clear and user- friendly. People who completed surveys responded yes when asked if they knew how to make a complaint. Those people spoken with during the day said that they felt very comfortable in going to the manager and staff knowing that any concerns they may have would be addressed, two people told us that the manager listened to them and always made time to discuss any issues. Information provided prior to the visit indicated that the home had received two complaints since the previous inspection. The manager has systems in place to support the investigation and management of complaints. Examination of the records evidenced that the process of reporting, investigation and outcome management of complaints was robust. The manager has maintained detailed records to support the process. Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: Staff confirmed they were aware of protection policies and procedures, they were able to describe the action they would take on receiving any allegations. Records were seen of recent adult safeguarding training people had undertaken. Policies and procedures were in place to support the management of peoples finances. The home manages a number of pocket money accounts for individuals; records to support the management of one account was checked. The cash balance in the account seen corresponded to the records;signatures and receipts were in place for all transactions. There was evidence from the homes recruitment and selection processes, staff training records, financial management, complaints log and the use of risk assessments that the manager ensures that people who use the service are protected and safeguarded from harm. Care Homes for Adults (18-65 years) Page 22 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel at home at Stonecroft, they are provided with a warm, comfortable and safe environment suitable to their needs. Evidence: The home is very clean, tidy, well maintained and has a good friendly atmosphere. People said they liked their bedrooms, which are personalised to suit their individual tastes. The home benefits from having a number of lounges in which the people who use the service can choose to socialise or have some private time in. There is also a dedicated smoking room, a new multi- media room, therapy room and snoozelum. 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. Since the previous inspection visit some of the bedrooms, bathrooms and corridors have been redecorated, the multi- media room has been provided and the homes fire safety systems have been upgraded which includes new fire doors, alarm system and panel. The bathrooms and toilets are fitted with appropriate aids and adaptions to meet the needs of people at the home. A shower room has been refitted and decorated in a Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: contemporary style. Staff have also made some positive changes to room layout such as dividing part of the large dining room to make the space more inclusive for people, which is working well. Comments from a professionals survey were passed on to the manager which detailed concerns that there was no reception area in the home, the manager confirmed that this issue is currently being looked into and consideration given to the use of a call bell in this area. All surveys received indicate that the home is always clean and fresh, some comments were received about the improvements made to the decor of the home which include The manager has made sure that more of the rooms have been redecorated and The new media room is fantastic. Discussion with 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. Comments from a visiting professionals survey were passed on to the manager, these detailed a concern that staff needed to ensure all the mobility equipment issued to individuals was used as directed; the manager confirmed that he was aware of these concerns and that a number of individuals in the home had their own views about how they wanted to use their equipment and that the staff tried to support them accordingly. The exterior of the building has been well maintained. The grounds of the home are large, well maintained and look attractive with mature trees and shrubs, people who use the service said that enjoy sitting in the grounds and looking at the views when the weather is nice. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have safe and appropriate support as thee are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their manager. Evidence: The staff duty rota shows that there are sufficient numbers of staff on duty at all times to meet peoples needs. Surveys returned by people living at the home all commented that they thought there were always enough staff on duty and that staff were always available when needed. Observation during the visit confirmed this, staff appeared calm and unrushed and had time to spend sitting talking to people. Comments from staff received in surveys and during the visit confirmed that they had enough time to carry out their tasks and spend time with people, and that they enjoyed their work at the home. At the previous visit staff had commented that they had felt overstretched at times due to workload pressures however due to a reduction in occupancy levels over recent months, this had settled completely. The staff confirmed that the manager reviews the staffing levels regularly to ensure they meet dependency and the levels would be increased if necessary; it remains valid though that the management should Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: consider introducing a formal dependency tool which would support effective rostering of staff as the occupancy increases. New staff access a corporate two day induction programme. Following this, staff complete the Skills for Care Common Induction Standards, records were in place to support this. The home currently has 80 of the care staff trained to level 2 NVQ or above and the remaining care staff are currently working towards qualification, this helps to ensure that people are receiving care from staff with the right skills and knowledge. The home has a training matrix, which identifies mandatory, general and service specific courses for staff. The home employs a training co-ordinator and a number of staff have gained their training for trainers qualification and provide in- house courses for moving and handling. A training room room is provided for staff at the home. Staff records confirmed they were up to date with moving/ handling, fire safety, first aid and food hygiene courses. Records also showed that staff had completed courses in equality and diversity, I.T. Mental Capacity Act, medication, safeguarding, multiple sclerosis and mental health awareness. The manager confirmed that a number of the qualified staff had recently accessed a five day High Dependencycourse run by the local hospital, which had been very beneficial and that the remainder of the nursing staff would also access this course. Discussion with staff revealed that they were positive about the learning and development they had been able to access. Three staff recruitment files were checked at this visit.The files contained a range of information including application form, to written references, declaration of health and identification. The staff had undertaken a criminal bureau check(CRB) at the enhanced level. This confirmed that thorough recruitment practices were in place at the home, which was sufficient to safeguard people. All staff said that they receive regular supervision and regularly meet up with their manager to discuss ways of working, checks of records confirmed this. Appraisals are carried out yearly to assess the individual staff members performance and to identify training needs. Staff meetings take place to enable staff to voice their views and opinions and to discuss any issues in the home. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have confidence in the management of 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 environment is safe for people and staff because appropriate health and safety practices are carried out. Evidence: The registered manager is Mike Day, he is a qualified general and mental health nurse, he has completed the Registered Managers Award and has considerable experience in managing care services. Comments from staff 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. Comments from surveys and during the visit include Mike has made a real change to the home and The home is better organised and run, we have more things to do and the place looks lots better. It is clear from this inspection visit that the Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: manager and deputy manager have worked hard to improve many of the management and administration systems in the home with very positive results in areas such as the care records, activity programmes, medication records and staff supervision. The manager is committed to ensuring that people staying in the home are consistently well cared for, safe and happy but is also looking at how the home can progress to meet the demand of people in the longer term. 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 continued improved teamwork between the manager, nurses and staff. Staff said that moral was very good which was supported by comments from health professionals. Stonecroft has a formal quality assurance system, which includes some regular audits and monitoring of the service. Surveys are issued to [people who use the service via head office. There was good evidence at this visit that the home continues to consult regularly with individuals and that they have good opportunities to affect service delivery. Areas that have been closely audited such as care records and medication systems have seen significant and maintained improvement. The home produces an annual development plan, this could be improved upon with the inclusion of findings from the previous years findings from the previous years programme and surveys should be issued to stakeholders to obtain their views on the service. The responsible individual visits the home on a regular basis , a report is written following the visits. 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 returned CSCI surveys show that people are more than happy with the service. To keep people safe the information provided before the inspection visit shows there are regular health and safety checks carried out throughout the home including fire and emergency equipment. The fire safety equipment, checks and risk assessment wee all in place and up to date; significant upgrading of the homes physical fire safety measures had recently taken place and the manager confirmed that all requirements issued in the fire officers report of December 2007 had now been fully actioned. Training records show that staff have attended safe working practice up dates. Information examined in the home corresponded to that provided in the AQQA. There is good evidence that the home is working with local agencies to introduce new initiatives and improve the safety of the service. One of the staff represents the home at the local Primary Care Trust meetings around infection control and the management Care Homes for Adults (18-65 years) Page 28 of 32 Evidence: have recently obtained the more comprehensive food safety management records which they said will be introduced shortly. Discussions with the manager and records evidenced that the home now has safer systems in place to support the use of bed rails. Care Homes for Adults (18-65 years) Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 33 The registered person should consider implementing a formal dependency tool to ensure appropriate rostering of staff. The registered person should further develop the quality assurance programme to include a wider range of audits, consultation with stakeholders and the annual development plan should include detail of improvements made to the service through the quality assurance systems. 2 39 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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