Inspection on 28/11/07 for Stratford Lodge

This inspection was carried out on 28th November 2007.

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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Stratford Lodge 4 Park Lane Castle Road Salisbury Wiltshire SP1 3NP Lead Inspector Tim Goadby Unannounced Inspection 26th & 29th November 2007 16:45 Stratford Lodge DS0000070168.V355026.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 Stratford Lodge DS0000070168.V355026.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. Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stratford Lodge Address 4 Park Lane Castle Road Salisbury Wiltshire SP1 3NP 01722 421504 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) eva.spratt@cambiangroup.com Cambian Education Services Limited Miss Eva Jane Spratt Care Home 9 Category(ies) of Learning disability (9) registration, with number of places Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 9. Date of last inspection Not applicable Brief Description of the Service: Stratford Lodge is a service which provides term-time accommodation for up to nine students aged 16 and above. It is part of the post-16 provision linked to Grateley House School. Both are operated by Cambian Education Services, part of a group which provides specialist healthcare and education services to children and adults with learning disabilities in the United Kingdom. The home is in a quiet residential street a short distance from the centre of Salisbury. A number of students at Stratford Lodge are supported to attend the local college. They are also able to make use of the city’s amenities, including shops, pubs and restaurants and a range of leisure facilities. The property itself was formerly a hotel. It has been converted and refurbished to provide comfortable modern accommodation. Each student has a single bedroom. These vary in size, with some falling below the usual minimum requirements of care home standards. Information is available about this and all students are able to make a choice about which room they prefer. All bedrooms have an en-suite shower and toilet. In addition, there are two bathrooms for general use, equipped with spa baths. Communal areas include two lounges, kitchen, dining room, games room and computer suite. Information about the service is available from Stratford Lodge itself, and via the organisation’s website at www.cambianeducation.com. Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was completed in November 2007. It is the first inspection of this new service, which was registered in June 2007 and admitted its first students in August. For this inspection we asked the home to complete an Annual Quality Assurance Assessment (the AQAA). This document contains information about the service, as well as their own judgements and evidence about how well they are doing in all areas of service delivery. We also looked at other evidence, such as information provided during the registration process and reports which the service has sent us since it opened. We made two visits to the home. The first of these was unannounced, lasting just over three hours, and took place in the evening to enable us to meet with students. A return visit took place by appointment later in the same week, to meet with the registered manager, conclude the inspection and give feedback. The fieldwork at the visits included sampling records, checking medication systems, sampling a meal, discussions with people using the service and staff on duty, and a tour of the home. The judgements in this report are based on all the above sources of evidence. What the service does well: Students can be confident that a thorough assessment and admission process ensures a suitable decision about whether Stratford Lodge can meet their needs. The service gathers all relevant information about prospective students. Individuals and their families are fully involved in this process and have time and opportunity to make their own decision. Information about the process is detailed and is readily available to interested people. Students are supported with all their health care needs. Cambian Education Services has its own team of therapists who are available to offer support on a range of topics. These include physical health and also psychological aspects, such as counselling. Students also receive all relevant help to access any medical support they require. Individual records contain suitable information and guidance about students’ health needs and how to support them. Students benefit from living in an environment which is clean, comfortable, safe and suitable to their needs. Stratford Lodge has been redeveloped to a high standard to provide stylish modern accommodation. The tastes and preferences of its young adult occupants are reflected in the décor and the facilities, such as the games room and computer suite. Each service user also Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 6 benefits from opportunities for privacy by having an individual en-suite bedroom, and a range of communal areas to choose from. Staffing levels are suitable to meet the needs of students. Cover is provided at all times to ensure that students are able to undertake their preferred activities, including at evenings and weekends. Rotas are organised so that there is always a senior person present who is responsible for that shift. Systems for quality assurance ensure that the service is audited regularly. This includes visits from independent persons. Students can air their views or concerns to such visitors, as well as within their individual reviews of care and education, and in weekly student meetings. Families of students also have regular opportunities to communicate with the service and advocate on behalf of their children. The service is totally geared towards promoting students gaining independence and skills, which will help them towards their future goals for adult life. The curriculum encompasses everything that students to, including attendance on courses, developing essential life skills, building relationships and enjoying social and leisure opportunities. Each student has an individual plan, which they are fully involved in developing and reviewing. The service also has overall development targets to help it continue to meet its students’ needs. The ethos of the service means that there is a positive focus on achievements. Students are supported in ways that enable them to make progress, and to have tangible results, such as access to new experiences and the ability to do more independent of support. Records highlight examples when students have had notable achievements. Students appear positive about the service and the opportunities it provides them. One told us that they think Stratford Lodge is “brilliant”. Others were less enthusiastic in their verbal comments, but all were seen to be relaxed and confident in the surroundings. They enjoy friendly and natural interactions amongst themselves and with the staff on duty. They choose where to be within the home and how to occupy themselves. They make full use of all the facilities on offer, such as the games room and computer suite. What has improved since the last inspection? What they could do better: Support to students with their medication needs to ensure that there are safe systems of administration for all medicines, so that students are not placed at Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 7 risk. We found one example of a practice which was risky, and which the service has now agreed to amend. Students have extensive care records. Systems for these are under review. Improvements could include ensuring that different documents which relate to the same topics are properly updated and cross-referenced, to avoid conflicting or out of date information being present. The practice of making records about more than one student within the same document should also be reviewed, as this makes keeping a full separate record for each individual more difficult. Information about the service would benefit from more detail about the varying size of bedrooms at Stratford Lodge, and the arrangements for students to choose which room they prefer. Procedures for safeguarding vulnerable adults are present in the home. But the service could make clearer the link between Cambian Education Services’ own policies and the requirement to make alerts under Wiltshire’s multi-agency procedures. The information available about the latter process should be distributed to staff to promote their awareness. A number of senior staff have relevant National Vocational Qualifications (NVQs) relating to their work with students. But the service is below the overall percentage target set within care homes standards, due to the large number of new staff employed recently. Plans are in place for all staff to have access to NVQ training as soon as possible. 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. Stratford Lodge DS0000070168.V355026.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 Stratford Lodge DS0000070168.V355026.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 Quality in this outcome area is good overall, and quality in the area of needs assessment is excellent. This judgement has been made using available evidence including a visit to this service. Students have their needs assessed and have information to make a choice about the services provided. EVIDENCE: Stratford Lodge is registered to provide for up to nine students, although ordinarily there will probably be a maximum of eight. One room is designated as a ‘transition room’, which will be used for prospective students to stay in whilst they are trying out the service. The service admitted its first students in August 2007. The group know each other and some of the staff team, as they were previously at Grateley House School. Stratford Lodge is a new post-16 extension of this facility, offering further education opportunities for students unable to access mainstream education independently. Students may be referred from anywhere within the United Kingdom. They therefore need the option of a residential facility. There were seven students living at the home when this inspection took place. Another young person was making some visits to the service as part of the process of considering a more permanent move. Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 10 Students’ folders show that there is a thorough assessment of their needs before they are offered a place at Stratford Lodge. There is detailed information about their life histories and their needs relating to education, behaviour and essential life skills. All students have received a multi-disciplinary assessment under the requirements of education legislation and have a Statement of Special Educational Need, issued by their own local education authority. Prospective students are fully involved in the assessment process as well. They are interviewed and encouraged to ask questions themselves. People being actively considered as prospective students visit Stratford Lodge, including for overnight stays. New students have a two week induction period involving assessments, education and relaxation time. Fuller assessments are carried out by various professionals over the first three months. There is then a review of the placement at the end of this period. Assuming the placement is confirmed, students move on to a cycle of annual review. There is detailed information for prospective students and their families about the assessment and admission process in Stratford Lodge’s prospectus. Information for students includes an ‘All you need to know’ folder which they are given to keep in their own rooms. Rules of residence are set out. These include areas such as agreements on behaviour and the right of staff to search students’ rooms, in their presence, in certain circumstances. Each student also has a contract, with terms and conditions for use of the service. The service’s Statement of Purpose includes the required range of information. Details about contacting the Commission need updating, following closure of our Chippenham office in October 2007. The Statement explains that three bedrooms are below the usual minimum size set out in care homes standards, but does not make clear which ones these are, or the arrangements for students to choose the room they prefer. Stratford Lodge DS0000070168.V355026.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 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Students have their abilities, needs and goals reflected in their individual plans. Students can make choices and decisions in their daily lives, and about the conduct of the service. Students are supported to take positive risks and access new opportunities, as part of an independent lifestyle. EVIDENCE: We checked three sets of student records. Each individual has a range of documentation which is stored in various files and folders. All records were in the process of being reviewed and updated when we visited, including the completion of new style ‘Placement Plans’ for each Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 12 student. A few forms were incomplete or undated. However, the majority of the information that we saw was clear and up to date. Students are closely involved in all aspects of planning and reviewing their own care and education. Files show that they sign up to agreed targets and frameworks. All students have a personal tutor who spends one-to-one time with them to extend their learning and skills. Each individual has a transition planner which sets out goals for the period between the ages of 16 and 19 and for beyond that. Staff work with students to help them identify realistic goals. We spoke with a number of students, and what they told us about their own hopes and ambitions was reflected in the written information we saw about them. Students are involved each week in reviewing how they are getting on. They are enabled to reflect on any issues that are of concern to them. They are also encouraged to focus positively on recognising when they have made achievements by overcoming any anxieties or barriers. Each student’s progress is also discussed and reviewed in weekly staff meetings. Ongoing records of care are completed through detailed daily notes, which use a set format to include information on topics such as personal care, diet, mood and motivation, activity and sleep pattern. Some student records are held in forms where there is personal information about more than one individual on the same document. For instance, handover information in a ‘Daily Schedule Folder’; and notes about each student within a ‘Night Schedule Folder’. This makes it more difficult to extract a full and separate care record for each individual. Student meetings are held regularly. They enable each individual to have a say about how the service is running. They are also used to negotiate solutions for communal living. Positive risk taking is promoted through a detailed process of assessment and guidance. Each individual is observed and assessed for their ability to manage certain tasks, such as travelling independently on public transport. They are signed off as competent once they have demonstrated this enough times. Such records provide evidence of genuine achievements by students. Parental consent is also obtained where necessary. Risk assessments are kept under review at set frequencies, or when circumstances change. Students may have levels of independence reduced for a time if there is sufficient concern, and will have to go through a further assessment process to demonstrate competence again. Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 13 Some of the risk assessment documentation we saw was not fully up to date and properly cross referenced. For one individual, some of the assessments still related to when they were living in accommodation at Grateley House School. Two separate forms also contradicted each other about the student’s agreed level of independence. Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Students are provided with full and active lifestyles, offering them full engagement with the local community. Students are supported to maintain and develop relationships. Students’ rights and responsibilities are upheld, balanced with appropriate steps to safeguard their welfare. Students are offered healthy, nutritious and enjoyable meals, in line with individual needs and preferences. EVIDENCE: The programme at Stratford Lodge offers students further educational opportunities and the chance to develop essential life skills. Students receive individually tailored courses and activities. They are supported to access Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 15 college, develop independence at home and in the community, attend work experience and enjoy a range of leisure opportunities. All students at Stratford Lodge are in full time education. They attend some teaching sessions at Grateley House School, and also access mainstream college courses in Salisbury. Other parts of the curriculum can be delivered at home, as part of the overall aim of developing students’ independence. Students told us about the various areas they are studying. Each individual is following options that they hope will lead on to future employment. Some have part-time employment outside school and college hours. Students enjoy living in Salisbury and the chance this gives them to access a range of community amenities. They told us about the various facilities they make use of. One person is keen on sport and was on their way out to a local athletics club on the first evening we visited. Another is a musician and spoke about the various local gigs they attend. Another had enjoyed a visit from family the previous weekend and the chance to do lots of Christmas shopping. Students’ records include information about their key relationships, including family and friends. Students are also able to form close personal relationships. Staff and other professionals will offer support if necessary, particularly where there are any concerns about the vulnerability of a student. Systems are in place to ensure effective communication between Stratford Lodge and students’ family homes. Many students see relatives regularly at weekends, and may choose to go and spend time with them. The home itself remains open for anyone who wishes to stay. Whilst at Stratford Lodge, students are positively encouraged to maintain contact with their families. This is done through a mixture of phone calls, emails and letters. Whenever possible, the staff keyworker for each student will make weekly telephone contact with their parents. A housekeeper is employed during the day. Part of her duties is to prepare the main meals for the home. A number of students have expressed some concern over the standard of food. The service has noted these and taken actions to respond. For instance, menu ideas were discussed in a recent student meeting. The quality of food we saw being prepared was good. A menu is displayed. Choices are always available within this. Students can decide whether to opt in or out. Some choose on occasions to purchase and prepare their own meals. Students are encouraged to eat the main meal of the day together in the dining room, to promote social interaction. There was initial reluctance about this, but it is now reported to be working well. On the evening that we visited Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 16 all students ate in the dining room, although at various times, depending on their other commitments and what meals they had chosen to eat. Any issues with diet and nutrition for individual students are recognised within their care records. There are suitable guidelines in place to help them try and manage these. Advice and support is available from relevant professionals via the therapeutic services team which Cambian Education Services has. Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good overall, although quality in the area of medication is only adequate. This judgement has been made using available evidence including a visit to this service. Students are supported to address their personal and health care needs effectively. Students are not fully protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Students at Stratford Lodge are generally independent in personal care. They receive support or advice as necessary. The staff team includes people of different genders and with a range of backgrounds and experience, giving students access to diverse support. Students have records relating to health kept in designated files, as part of their overall records. These files include information about any known health issues, immunisation records and details of contacts with health professionals. Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 18 Students may choose to register with a GP in Salisbury or to remain registered with the GP near their family home. Cambian Education Services have a range of professionals who can offer various forms of therapy to students. These options cover a range of health issues and psychological support, such as counselling. Information about the therapy services is on display in the home. Students can fill in a form indicating if they would like to meet with one of the therapists. Students can be responsible for their own medication if they are assessed as capable of doing so. They sign up to protocols which set out how they will manage their medicines. They are provided with suitable lockable storage in their own bedrooms. There are systems to check and review how they are coping. One student showed us how they are managing their own medication and explained how the system works. Other students are supported with their medication. Mostly, there are appropriate arrangements for storage and recording. This includes taking additional measures for some drugs which have extra controls required by law. One such drug was being dispensed in two stages. Firstly it was taken from the packaging the pharmacy supplied it in and placed into a box which holds medication as a week’s supply, divided according to the time that the doses are due. No record was being kept for this stage, and the box was also being stored less securely than required. The second stage of dispensing was then to give medication from this box to the student at the relevant time. We discussed risks arising from this approach during the inspection. Our pharmacist inspector then gave further advice which we relayed to the registered manager following the inspection. The service has now told us that they are changing this practice. Staff who are involved in supporting students with medication receive training. Each student has guidelines within their individual plans about how they are supported. There is also information available about all the drugs used in the home. This includes medicines which are prescribed to students, and an approved list of non-prescription items which may be taken. Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Students are safeguarded by the home’s policies and procedures for protection. Students benefit from an effective and appropriate approach to the management of behavioural needs. EVIDENCE: The information given to students includes the various routes open to them for raising any concerns. This includes a range of possible internal and independent contacts. The service has not received any formal complaints as yet. Students have raised some minor concerns. These have been recorded and addressed. Students told us that they do not have any real concerns, but that they would feel able to raise them with staff if necessary. The service has suitable policies and procedures relating to safeguarding vulnerable people. Because of the age range of the students at Stratford Lodge, these cover both child and adult protection. Cambian Education Services has a local child protection lead person who is based at Grateley House School. They are the key person to co-ordinate any response to issues of concern about students under the age of 18. Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 20 The service has one student aged 18 and more who will become so shortly. As yet, there has been no need to consider alerts under procedures for safeguarding vulnerable adults. Information about the multi-agency process for Wiltshire is available within the home. It is not yet clearly linked to the service’s own procedure. Information has been obtained for staff about the process, but had not been distributed when we visited. Cambian Education Services has suitable policies relating to staff conduct. This includes a procedure for staff who wish to raise any concerns about practice. Stratford Lodge supports some students who may present behavioural challenges. There is clear information about this in individual records. This explains the possible issues, strategies to minimise risks, and management approaches to take if a difficult situation does arise. These guidelines are kept under regular review, at least once every three months. All staff of the service are trained in the use of strategies to manage challenging behaviour. This includes learning some techniques for physical interventions. These would only be used as a last resort and they have not yet had to be carried out. The service has clear anti-bullying policies. These are made clear to all students, so that they are aware of the possible consequences of any breach. Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Students live in a comfortable, clean and safe environment, suitable to their needs. EVIDENCE: Each student has an individual bedroom. These have en-suite showers and toilets. Students are able to personalise their rooms. We saw one occupied room, with the permission of the student concerned. They told us how much they enjoy spending time in their room, and being able to bring in items which help to make it feel more homely. Bedrooms vary in size. Three of them are below the usual minimum size set out in care home standards. Greater flexibility is permitted in the accommodation offered, because the service is for term-time use only. Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 22 Two rooms at the top of the house are particularly affected by sloping ceilings which impact on useable floor space. However, some students have expressed a preference for these rooms. As well as the en-suite facilities, the home also has two bathrooms for general use. These have spa baths. There are a range of communal areas. There are two lounges and a dining room. A games room has various equipment, including a games console linked to a large screen and tables for pool and air hockey. An IT suite contains a number of computers for student use, all of which have internet access. Staff facilities include two offices and a meeting room. Occasionally one staff member may sleep in overnight, and a vacant student bedroom is used when necessary. The home was clean and hygienic in all the areas seen during our visits. Students are expected to participate in all household tasks, as part of their overall programme of developing skills for independent living. A utility room with washing machine and tumble drier is on the first floor. Each student is supported to do their own laundry. Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Students are supported by suitable numbers of staff who are receiving appropriate training. Students are protected by effective practices in staff recruitment. EVIDENCE: The staff team includes the registered manager, a team manager and three assistant team managers. There are also learning support workers, some at senior level. There is a separate team of night staff with their own manager. Some of the staff team at Stratford Lodge are based with the service. Others work flexibly between this home and the student accommodation on-site at Grateley House School. Having this larger pool of staff helps with covering absences such as holidays or sickness. Cover on the rota is a minimum of two staff for all shifts. Often there are three or four staff on duty. Cover is adjusted to meet the needs of students. There are always sufficient staff to enable students to undertake their Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 24 preferred activities. A number of students have evening and weekend activities that they enjoy and staff rotas reflect this. Night time cover is provided by two or three staff, usually all waking. Occasionally one staff member will sleep in, if there is difficulty in getting two waking staff. The service had some staff vacancies when these inspection visits took place. But as there were only seven students in residence the planned ratios of staff to students were still being maintained. Staff work with students includes supporting them outside Stratford Lodge if they need this. Each individual has support tailored to their assessed needs. For instance, support to a student at college may mean that a staff member is available, but does not need to be with the student all the time. We checked two sets of records for recently appointed staff. These show that all the required recruitment checks are completed before new employees begin working with students. New staff are initially on a six month probation period. They need to complete a satisfactory induction process within this time. Training records show that the service has a policy on learning and development and a detailed ongoing training programme for all staff. Training that has taken place in 2007 includes behaviour management, health and safety, awareness of abuse and ‘Valuing People’, about the principles of support to people with a learning disability. There is also a full training plan in place for 2008. Each staff member has their own personal development folder, from induction onwards. This includes their curriculum vitae (CV), which has details of any relevant experience and training before they joined the service. It contains records of any training undertaken in post, and of all individual supervision meetings and appraisals. Staff have supervision once a month during their probationary period. After this, meetings take place every six weeks. Appraisals are annual. Staff meetings take place once a week. Stratford Lodge has a lot of staff who are new to care work. The service is currently below the targets in national standards for the percentage of staff working with students who have a relevant National Vocational Qualification (NVQ). There are plans in place to address this, with all staff expected to move on to study for NVQs at Level 3 when they have completed inductions. Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 25 Cambian Education Services has its own NVQ assessment centre which enables it to support all its staff through this training. The manager and other senior staff at Stratford Lodge are qualified NVQ assessors. Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Students benefit from a well run service. Quality assurance measures underpin service developments, and include actions based on the views of students. Students’ health and safety are protected by the systems in place. EVIDENCE: The registered manager for Stratford Lodge is Miss Eva Spratt. She has a National Vocational Qualification (NVQ) Level 4 in management and has also gained the Registered Manager’s Award. Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 27 The manager is supported by a number of other senior staff, three of whom have achieved NVQ Level 3 awards. There are two appointed independent people who carry out regular unannounced visits to the service. They meet with students and report back to Cambian Education Services on the operation of the home. Their visits are an opportunity for students to make comments and raise concerns. These are then taken back to Cambian for their response. The service is also checked every month by independent school visitors, who produce detailed reports on all aspects of the service. These reports are being copied to the Commission as evidence that the company is meeting the requirements of Care Homes Regulations. Senior staff of Cambian Education Services, who are not directly employed at Stratford Lodge, also carry out visits. Student meetings are used to discuss ways in which the service can improve. The sessions are their chance to contribute their own ideas to overall development plans. At regular intervals, they are also sent questionnaires to get their views on aspects of the service. Students’ families can give feedback as well. They attend review meetings about the care and support of individual students. There are link diaries between family homes and Stratford Lodge which enable two way information and communication. The service is regularly audited in a number of ways on a range of topics. Internal audits generate reports which include any identified actions that the manager must address. Stratford Lodge is included in the overall service development plan for Grateley House School’s post 16 provision. Targets for 2008 include improving awareness of particular needs, such as Asperger’s syndrome; developing communication with students’ families; and improving the transition process for students deciding what to do at age 16. Health and safety is addressed by a wide range of risk assessments, for general topics and for issues relating to particular students. Each student has an individual risk profile which summarises all the issues relevant to that person. Particularly significant risks are highlighted. Possible triggers are explained, along with strategies to try and prevent these or respond to them if they occur. An overall judgement is recorded about the level of risk associated with the student. Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 28 Stratford Lodge employs a maintenance man who attends to various jobs and also carries out a number of regular health and safety checks. Potentially hazardous materials such as cleaning chemicals are stored safely when not in use. Some other items are also locked away and only used with students when they are under supervision. All staff receive training in relevant health and safety topics. These include fire safety, first aid and food hygiene. Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 4 3 X 4 X 5 X 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 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 30 Not applicable 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 YA20 Regulation 13-2 Requirement The persons registered must establish a safe system of administration for all medication. Timescale for action 31/12/07 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 YA1 Good Practice Recommendations The service’s Statement of Purpose should contain more detail about sizes of small bedrooms and the arrangements for students to choose the room they prefer. Detailed records relating to individual students should be entered in separate care records and not made alongside similar information about other students. There should be updating and cross-referencing for all records about risk assessment and management. If medicines are dispensed from pharmacy packaging into another container before being administered to students, a record should be kept of this additional stage in the handling process. DS0000070168.V355026.R01.S.doc Version 5.2 Page 31 2 YA6 3 4 YA9 YA20 Stratford Lodge 5 YA23 The service’s own procedures for safeguarding vulnerable people should be more clearly linked to Wiltshire’s multiagency procedures. The service needs to ensure progress on reaching the target for 80 of care staff working with students to achieve a National Vocational Qualification relevant to their work. 6 YA32 Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Stratford Lodge DS0000070168.V355026.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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