Inspection on 01/08/06 for Strafford House

This inspection was carried out on 1st August 2006.

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

The inspector found 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Strafford House 02/03/06

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 Strafford House Off Doncaster Road Hooton Roberts Rotherham South Yorkshire S65 4PF Lead Inspector Ms Stephanie Kenning Unannounced Inspection 1 and 8 August 2006 10:30 st th Strafford House DS0000065108.V304454.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 Strafford House DS0000065108.V304454.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. Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Strafford House Address Off Doncaster Road Hooton Roberts Rotherham South Yorkshire S65 4PF 01709 855796 NONE NONE Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Voyage Limited Post Vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One specific service user under the age of 18, named on variation dated 26th January 2006 may reside at the home. 2nd March 2006 Date of last inspection Brief Description of the Service: Strafford House is a care home for up to six adults aged 18 to 65 with learning disabilities. It is owned by the Voyage Group, that has many care homes in the UK. It is located in a small village near to the town of Rotherham, in a converted building behind the Earl of Strafford public house. There are not many facilities in the village of Hooten Roberts, though there is a bus service to Rotherham and to Doncaster. The home overlooks farmland and has its own private garden. Each of the 6 service user rooms is spacious and has an ensuite bathroom. They are located on the first and second floors of the house. There is a communal lounge, a large kitchen dining room and a games room. A small laundry room is available for service users if appropriate. The home was registered in August 2005 and was finished to a high standard. Since registration 4 male and 2 female residents, all under the age of 33, occupy the rooms. The service users have some challenging behaviours and are relatively able. A new manager has been appointed and will need to be registered with CSCI. A minibus is available for service user transport. Fees range from £1100 to £2200 each week and depend on the amount of staffing required. Information about the home is available from the home in the form of a service user guide. Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There were two visits to the home to look at the key standards. They took place on the 1st and the 8th of August 2006. The inspector was Stephanie Kenning and she had met 5 of the residents at the inspection in March. Not all the residents were at home during these visits. One person was visiting a relative, and on the second visit some of the residents were on holiday at the coast in a caravan. Stephanie talked to the residents that were at home, including the person who had moved into the home since her last visit. She also talked to all of the staff on duty, and had telephone conversations with some social workers and doctors about their views of the home. She looked around the home, and checked that some of the problems she had found last time had been put right. Some of the residents let her look at their files and showed her records of their meetings. There were also some surveys that the residents had asked the staff to complete. Stephanie was at the home when meals were being prepared and served, and she was able to look at the different choices that residents had made. The manager had returned the preinspection questionnaire and supplied menus and staff rotas to the inspector. The home had made a lot of improvements since the last visit, and only one person was unhappy with some of the changes. The residents were mainly positive about all aspects of the home and were pleased with how their lives were developing. There were only a few requirements and recommendations from this visit. What the service does well: The majority of the service users like living at the home and feel very well supported and safe. They are supported to live a fulfilled life involving working towards independence, and have individual programs to achieve this. The service users take an active role in some of the daily running of the home such as deciding the menus and helping with shopping, and have devised surveys that help to influence how the home develops. Their health needs are looked after with medical help arranged when needed. The home has met the majority of a large number of requirements and recommendations from the previous inspection showing that they are keen to improve and develop the service. Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5. Prospective service users have information about the home and opportunities to visit before they make a choice about where to live. Their individual needs are assessed before they are resident to ensure that the home is confident about meeting them. Quality in this outcome area is good. This judgement is based on evidence gathered during and prior to the visits to this service. EVIDENCE: The service users felt that the information given to them before admission was adequate, but that visiting was more important because of meeting the other service users and staff. The information was in a written format and some photographs. With some assistance the current service users could probably produce a video or similar showing life at Strafford House. Information written in picture formats would not be appropriate for these service users. Since the previous inspection there has been an admission to Strafford House, and the service user is pleased with the placement. A thorough assessment was made and is on file, and there are care plans in place to meet the specific needs identified. There were opportunities to visit and discuss the placement, and they involved relatives and a social worker. The service user moved a long way from home because this was felt to be the most suitable placement. So far the experience has been positive and they feel settled. There was a contract on file regarding the service they will receive. Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 9 Generally the service users felt that they got on with each other and that the age range was appropriate. One person did have some concerns about another service user, and there were some recorded incidents between the two. Care plans and monitoring were in place for their behaviour management. The person at the home that was under 18, for which a variation to the registration was granted, is now 18 and the provider should apply to CSCI to remove this variation. Therefore the supplementary standards were not assessed at this inspection and the documentation such as the statement of purpose will need to be amended to reflect the current service. Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 and 10. Individuals are involved in decisions about their lives, and play an active role in planning the care and support they need. Quality in this outcome area is good. This judgement is based on evidence gathered both during and before the visit to this service. EVIDENCE: During the two visits five of the six service users were present and were involved in the inspection. They all spoke to the inspector individually and commented on life at the home. Three people were case tracked, and views were sought about the home from social workers and GPs and other health care workers. All service users are white British people with two of them female and four males. Their ages range from 18 to 33. Service user files were kept locked away though the service users were familiar with their own files and care plans, and some were signed. Of those files seen all contained assessments including areas of risk and areas for development. There was evidence of review involving the service user and others, and changes to care plans from these reviews. The files were still bulky and contained a lot of relevant information though they had been reorganised so that it was easier to find the information. Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 11 Some plans described restrictions agreed by service users, for example, abusive behaviours or racism, to enable them to live in the home and in society. One person was not happy about these restrictions despite having agreed and signed the care plan, and this was being reviewed. The service users are relatively able and have some literacy skills, however it may be useful to create a summary of the care plan for the individual service user that they can keep and refer to, or that they can write in their own way. Overall service users were very happy about the care and support they received, with many positive comments about the manager and the staff team. One person that had previously been unhappy with the new manager because ‘he is strict’, was now very happy, realising that there needed to be boundaries, and the incidences of challenging behaviour were much reduced, showing that the interventions were appropriate. A letter on file from the social worker was also very complementary about the progress of the service user and the management of the home. Another social worker commented that their client ‘was more confident and talkative and had a higher level of functioning since being at the home’. The service users already hold weekly meetings that they minute themselves and have created records with photographs of outings and holidays, and have devised surveys for staff, showing that they are involved in decision making and the development of the home. The meals are planned for the following week at the weekly meeting, and each service user gets to choose the meals for a day, though alternatives are available. During the inspection visit one service user did the shopping for the home with a development worker, both developing skills and participating in the running of the home. Since the previous inspection there has been a financial review on all the service users and the issues raised are being addressed. Not all the service users have welcomed this as it has sometimes involved paying arrears and therefore they have less disposable income. A report of the audit was seen and it shows that two service users are their own appointees, though there are written procedures in place for the management of their monies, that are signed as agreed by them, and they confirmed that they are in agreement during the visit. The company is appointee to one person, and this is now managed by the home, with records of all income and expenditure and receipts kept. Parents and local authorities are the appointees for the other service users, each with different arrangements, and the audit made some recommendations for these different circumstances. Risk taking is managed through care plans and is reviewed. Evidence through notifications to CSCI demonstrate that the home responds promptly to unexplained absences, and have revised a care plan in order to try to address this for one individual. Service users felt that information about them was handled appropriately and that their confidences were kept. Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. People who use this service are able to make some choices about their lifestyle, and are supported to develop their life skills. Quality in this outcome area is good. This judgement is based on evidence gathered both before and during the visits to this service EVIDENCE: Activity plans are recorded in individual files and they show a range of activities are undertaken, for example, shopping, college, pool, table football, football nets, house-hold tasks. Some people also have work placements at farms or garden centres, or at the organisations’ birds of prey centre. Some additional equipment has been provided at the home such as an exerciser, and the pool and football tables. Service users were asking for improved computing facilities that the manager stated would be purchased soon. Finding appropriate opportunities for personal development for some of the service users has been difficult, and work, college or placements have ended because the service user will not get up in the morning or just not turn up, or have been disruptive, despite attempts by staff to support them in this. Alternatives are being pursued that are of more interest to those individuals. Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 13 The service users are supported to identify their goals and work to achieve them. Three of the service users have college courses and one has a work placement at a garden centre, all of which were stated to be satisfactory or good by the service user. One of the service users records the social events and activities including holidays, and has taken photographs, and the minutes of their meetings show that they collectively choose some outings. Relationships with others including family members were apparent, with many references to visits and outings mentioned in conversation with service users. No visitors were seen during this visit so their views could not be obtained. One person was not happy with others, (staff and other service users), going into their bedroom, including at times without knocking on the door, as it was an invasion of their privacy, and will need to be addressed. Service users enjoyed meal times, with comments such as ‘I like the food here as I can choose what I have’, and ‘I am helped to do the cooking which I love, and we can do cakes or healthy things’. The weekly menus were agreed at the weekly service user meetings though it was obvious that two or three alternatives were available, as observed at mealtimes. Two people were successfully losing weight at a steady rate that they were pleased with, and felt supported by staff in this. Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19, and 20. Service users receive individual health and personal care support that promotes their independence and responsibility. Medication is managed well with safe systems for storage and administration, and good record keeping. Quality in this outcome area is good. This judgement is based on evidence gathered during the visit to this service. EVIDENCE: Staff members understood the individual requirements of the service users in relation to personal and health care support, and there was evidence in the care plans of treatment and interventions, involving doctors or nurses. Through the case tracking of three of the service users it was established that appropriate advice or action had been taken for some previously identified medical problems. The service users confirmed this, and were happy about the ways they were supported regarding health and personal care. They felt that they could choose their own routines such as what time they got up, when they bathed, or what clothes to buy. It was observed that service users were taking more pride in their appearance than previously, and one social worker giving feedback also commented on this as a positive. Attention to the emotional needs created by a move to a new home was noted and service users felt that they had settled in well. Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 15 Specialist support was provided as necessary, for example through a psychologist, and behaviour management techniques have been changed to address some challenging behaviour. Each person has a designated key worker that provides a consistent link to work with the service user. The medication appeared well organised with safe storage provided. One service user manages their medication and has a risk assessment relating to this. All staff members that administer medication have had training, and the records were completed properly, and have links to the care plans. A new medication refrigerator was in place and in use. Each service user file has a section for medication including the side effects. These were also linked to the care plans, for example, a medication to calm behaviour had a care plan specifying types of behaviour where it would be appropriate to administer it. There was then a procedure for how to give it, ensuring the safety of the service user. The supplying pharmacist has not yet audited the medication at the home. Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. There was clear information about how to make a complaint that was understood by the service users, however, the less confident service users had not raised some issues that concerned them. There are policies and procedures in place for the protection of individuals, and the staff members were clear about the actions they would take. Quality in this outcome area is good. This judgement is based on evidence gathered both during and before the visit to this service. EVIDENCE: There was one record in the complaints log, which was about the actions of another service user. The way it was recorded showed the action taken and the outcome. Service users did know how to raise a concern, and most felt that they could approach members of staff and the manager. The new service user also felt confident of raising concerns with staff or the manager. Service users also felt that they had opportunities to raise concerns in their weekly meetings. One service user did not always feel listened to, although they had not raised the concerns with either the manager or other staff members. They intended to raise the issues with their key worker the following week. Another service user raised the concern about others coming into their room without permission, but had not raised this with the home staff. This indicated that the less vocal service users may not feel as able to raise concerns as the others, and may need staff to be more proactive in seeking out their views. Discussions with the staff included what actions they would take if they suspected that abuse had taken place. They showed a good understanding of the issues and referred to training that they had received, showing that the rights of the service user are promoted and protected. Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 17 The local adult and child protection procedures had been obtained and were available for staff to follow if required. Training in appropriate physical interventions had also been given to staff and these appeared to be applied appropriately from evidence in service users files. There have been a number of improvements made to the practices involving how monies are managed at the home, following an audit by the company. This includes written guidelines, ensuring receipts are kept with clear information written about their content, implementing checks, and other ways of ensuring that the monies are safe and accurate for the home and service users. Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,30. The home is a nice environment internally and externally and is now being maintained properly for the comfort and safety of the service users. There are two outstanding requirements that need to be addressed before the winter, and a new one relating to the problem with flies inside the house. Quality in this outcome area is good. This judgement is based on evidence gathered both during and before the visit to this service. EVIDENCE: At the previous key inspection a number of problems were identified to do with the environment and were sufficiently serious to issue an immediate requirement notice in order to resolve them quickly. There was a prompt response with some problems being addressed before the end of the inspection. A random inspection took place on the 13th April 2006 and confirmed that the work had been completed or was in progress, with the exception of the provision of heating in the en-suite bathrooms. This was not an issue at that time as the weather had improved and service users were no longer complaining about it. The heating in the adjoining bedrooms had been installed to include the bathroom areas, but cannot warm them if the door between them is closed. It was agreed that over the summer the company would look at providing heat safely to these rooms, and monitor the temperatures during any cold spells. This remains a requirement. Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 19 Shower curtains were provided for service users and they were pleased about this. The lighting improvements from the car park had not yet been improved due to the building work next door, and will need to be done before the winter. Smoking arrangements have been agreed and an external area is designated for service users. The main building concern, raised by everybody at the home, was the amount of flies in the home, particularly in the kitchen/ dining room and the living room. The kitchen had an executor machine installed that appeared to be operating, but not dealing with the number of flies around. Service users and staff were constantly waving flies off their food at mealtimes and food preparation was difficult because of this. Additional measures to resolve this should be taken. The cleanliness of the home was good, and routine maintenance including decoration was evident, providing a good environment for service users. Some new equipment had been installed such as a fan and a condenser in the laundry, and new garden swings and football net in the garden. Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36. People at the home are supported and protected by the homes recruitment practices. Staff are being developed into their roles and responsibilities, and are liked by service users. Quality in this outcome area is good. This judgement is based on evidence gathered both during and before the visits to this service. EVIDENCE: The rota varies according to the day and the activities of the service users, but was said to meet the needs of service users and the requirements of the placing authorities. During daytime hours there are a minimum of three staff plus the manager on weekdays, and at night there are two people one awake and one sleeping. There was evidence of more staff at certain times, ensuring that activities could take place. Some new staff had been recruited to vacant posts and the correct procedures and checks were followed helping to protect service users. All of the staff on duty during the visits were clear about their roles and felt well supported by the manager. The team leaders were taking on more responsibilities, such as monitoring care plans, and auditing medications, and this helped them to be more effective. Staff were observed to handover the significant information to the next shift, including those people that started at different times, ensuring that they are up to date to deal with the service users. Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 21 The manager had identified gaps in training and knowledge of the staff team and a plan was displayed showing how this will be achieved. More staff members are to be registered with a training provider to do a NVQ in care, which will increase the current percentage of 24 of staff with NVQ2 or above. Training in a specific area had been done to meet the needs of a service user, and that service user has settled well. The arrangements for formal supervision with each staff member were also displayed and records were seen in the files that were sampled. One comment about the staff from a visiting professional was that ‘there is a lack of experience of the staff in the absence of the manager, though this is improving’. The manager commented that he had seen a big improvement in the staff since they had been given areas of responsibility, and that they were keen to develop their skills. Other comments about staff from professionals were very positive, such as ‘they are good at communicating with me’, ‘they are forthcoming with information’, and ‘they provide a good stable environment’. Service users also praised the staff, saying they liked them and they got on well with them. One exception to this was a service user that did not like the restrictions imposed as reported earlier. These included not being racist, including to the two black members of staff, and not being abusive to others including service users and staff. Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42, 43. The service is managed well, with many improvements being implemented since the previous visit. Their practice follows policies and procedures, and is monitored in a number of ways to safeguard the service users. There was a great deal of praise and support for the new manager. The quality in this outcome area is good. This judgement is based on evidence gathered both during and before the visit to this service. EVIDENCE: The manager had tried to submit his application to CSCI, but was unable to, as his CRB check had not been returned. Despite not being registered the manager, John Egbury, has implemented many changes at the home and there was an overwhelming support from service users, staff and visiting professionals about the improvements made. One staff member commented ‘ the home is more settled, service users are happier, and staff now want to stay’. Another said ‘it is much more organised and a nicer atmosphere. I get the support to do my job.’ A team leader said, ‘John is a good manager, he sorts things out and shows us what to do. I feel that the home is well managed now and service users are much more settled.’ Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 23 Many of the systems and practices at the home have been reviewed and changes implemented, such as the way accidents were recorded, monies handled, or routine checks carried out, therefore improving the safety for people in the home. Some auditing has been implemented, such as medication and care plans, which will monitor problems in these areas and safeguard service users. Service users have input into the running of the home from their weekly meetings, whose minutes are recorded by a service user. Surveys devised by service users have been done and have influenced changes at the home. Meetings are also held for the whole staff team and for the senior team, and staff members seem able to raise issues and get agreements about how to progress. Throughout all this change, in the relatively short time of four months, they have not had the time to take stock of how far they have come and do a collective development plan for the future. Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 24 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 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 3 28 X 29 X 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X 3 3 3 Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 25 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4 (1)b Requirement Information in the service user guide now needs to be up-dated as all the service users are 18 or older. The home should apply to remove the variation now that the service user is 18. No one should enter a service users room without permission or just cause. Ensure that all service users have the opportunity to raise concerns in a safe environment. Provide adequate heating to the bathrooms. This is an outstanding requirement from the previous inspection 2nd March 2006 Install lighting to improve safety from the car park to the home. This is an outstanding requirement with timescale of 01/07/06 not met. Provide additional measures to reduce the number of flies in the home. The manager should apply for registration with CSCI as soon as possible. This is an outstanding DS0000065108.V304454.R01.S.doc Timescale for action 31/10/06 2. 3. 4. 5. YA1 YA16 YA22 YA24 4(1)b 12(4)a 22(2) 13, 16, 23(2p) 01/10/06 18/09/06 01/10/06 31/10/06 6. YA24 23(2p) 01/10/06 7. 8. YA30 YA37 23 (2) 8, 9 31/10/06 01/10/06 Strafford House Version 5.2 Page 26 requirement with the timescale of 01/07/06 not met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard YA1 YA6 YA39 YA42 Good Practice Recommendations Information about the home could be provided in a different format that shows life at the home more clearly. Consider creating a care plan summary for each individual. Consult with service users, staff and visitors and produce a development plan for the home. The manager could implement an analysis of the accidents. Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Doncaster Area Office 1st Floor, Barclay Court Heavens Walk Doncaster Carr Doncaster DN4 5HZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Strafford House DS0000065108.V304454.R01.S.doc Version 5.2 Page 28 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!