Inspection on 08/05/06 for Strathmore House

This inspection was carried out on 8th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 24 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Strathmore House 25/11/08

Strathmore House 28/11/07

Strathmore House 12/12/06

Strathmore House 31/01/06

Strathmore House 30/07/05

Strathmore House 25/01/05

Strathmore House 21/07/04

Strathmore House 11/02/04

Strathmore House 02/12/03

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Strathmore House 27 Queen’s Park Avenue Dresden Stoke-on-Trent Staffordshire ST3 4AU Lead Inspector Mrs Sue Mullin additional inspector Norma Welsby Key Announced Inspection 8 May 2006 09:30 Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 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 Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 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. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Strathmore House Address 27 Queen’s Park Avenue Dresden Stoke-on-Trent Staffordshire ST3 4AU 01782 596849 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) Strathmore Care Services Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st January 2006 Brief Description of the Service: Strathmore Hs is part of Strathmore Care Services which is part of the Craegmoor group. Primarily, it provides long term care for up to 15 younger adults who have learning disabilities. During the week, there is a day care service for up to three people. Currently the age range is 21 to 37 years. The home is centrally located in a suburban area close to local amenities and with easy access to the city. It is also opposite a park. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two officers undertook this announced key inspection on the first day and one officer on the second day. 24 of the 43 National minimum standards were assessed in detail on this occasion and the remaining standards will be checked on the next follow up inspection. There were 15 residents in the home on the day of the inspection with one vacancy. In January 2006 the previous care manager resigned her post and now several months later is disappointing to note that there is still no designated registered care manager in post. However another registered care manager (Mrs Barbara McBride) from a nearby sister home has been put forward by the Company to manage the home on a full time supernumerary basis, for a minimum of three months. During that time the company hope to recruit another care manager and put him/her through a full induction course. Mrs McBride was present during the two day inspection and knows Strathmore House very well, as she was the care manager there some ten years or so ago. Although, the inspectors felt that there was some degree of negativity towards her from both staff and residents during the course of the inspection, it was pleasing to note that parents engaged in conversation, felt more positive towards her and glad of someone whom they hoped would improve standards. Mrs McBride was present through both days of the inspection and actively took part in the inspection process. The area manager Ms Tina Morten was present on the second day of the inspection and made a positive contribution to the inspection. Both managers were present during the feedback session at the end of each inspection day. The general staffing of the home was a concern as the turnover in recent weeks was relatively high, including two staff that resigned on the first day of the inspection. Another care worker was on suspension; one other was due to leave in the next few weeks and another due to go on maternity leave. However, there was one person who had been off work on long term sick and had subsequently resigned but informed the interim care manager that she may be returning. It was determined that due to this shortfall, the home relied on regular staff cover from the sister home High Cross. One inspector was informed that this was only a short-term measure. On a more positive note, it was determined that three care staff recently interviewed were in the process of being offered employment. Progress on this will be assessed on the next follow up inspection. Generally, during the inspection, it was noted that the staff team appeared low in mood and conversations with them identified that they felt demoralised and undervalued. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 6 This was discussed at length and while everyone involved in the inspection process agreed it was imperative to improve standards, particularly staff practices, it was felt that this needs to be done by harnessing staff and resident support and dissolving the degree of hostility and uncertainty that was evident during the inspection. Staff supervision and leading by example must be implemented immediately to improve practice, support staff so that all parties can regain confidence in care provision at Strathmore House. Serious concerns were discussed with the interim care manager and area manager at the time of the inspection about the lack of recording and storage of resident’s monies. A large number of other concerns about this service were also identified and there are still some outstanding requirements from the last inspection that have not been satisfactorily dealt with by the Company. The Department of Health’s guidance ‘No Secrets’ that outlines people’s responsibilities regarding adult protection was seen in the home but training in this regard had not been cascaded down to all care staff. All staff must receive adult protection training. There is the need for good risk assessments to be in place, and to ensure that the standard of staff record keeping is improved. Complaints procedures must be reviewed and be in line with National Minimum Standards. Pre admission assessments were inconsistent and varied from resident to resident. There was outdated information and gaps in assessments and care planning systems. There was no evidence that care plans are monitored regularly or reviewed and therefore it was difficult to see where or if residents had made progress. All the residents care plans need to be re written to meet the National Minimum Standards. Staff must accurately record the current physical, mental and social needs of each individual. All care plans must be reviewed monthly or more frequently if required. All entries must be legible, completed in black ink, signed and dated. Appropriate current risk assessments must be implemented and kept under review Only competent members of staff, who understands the principles of record keeping, should complete care plan documentation. The telephone in the home is sited in the main hallway making it impossible for staff or residents to receive calls in private. This needs to be addressed. The independence and rights of residents must be promoted and their views listened to and acted upon. There needs to be more choice about the foods purchased and the meals offered. The home must review all recent changes in the home to ensure that residents are properly consulted, that their rights are upheld and are enabled to participate in decision-making processes. The daily living skills and rights of all the residents in the home must be promoted and their views listened to unless there are valid reasons not to do so, which have been recorded and shared with the residents and their representatives Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 7 There were some repair issues within the home these were discussed during the inspection. There needs to be clear maintenance recording when repairs are identified and when they are carried out. The interim care manager must provide the CSCI with weekly written reports outlining how the home is meeting the outstanding National Minimum Standards. The home will be monitored closely and follow up inspections will be undertaken until the home meets all the National Minimum Standards. What the service does well: What has improved since the last inspection? What they could do better: Of the 24 National Minimum Standards assessed on this two-day inspection only two were met. The remaining 22 fell well below the acceptable level. This has caused great concern to the CSCI and weekly monitoring of the service will continue, followed up with frequent unannounced inspections. The home must meet all of the National Minimum Standards to continue to be registered. Sustained failure to meet the National Minimum Standards is a breach of registration and may subsequently incur enforcement action. Staff could not demonstrate that they possessed the level of skill and experience necessary in communicating with others or when dealing with anticipated behaviours. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 8 The registered person must ensure that the workforce is adequately trained and has the required experience and knowledge when dealing with young adults with learning disabilities. No observations of acting manager on the floor/interactions with staff or service users. Effective communication in the home is poor and regular meeting with relatives must be implemented so that all parties are fully aware of any organisational issues that may affect resident’s well being. 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. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 9 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 Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 10 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. The home does not provide sufficient information to enable residents or their representatives to make informed decisions of the service. Assessments do not provide adequate information to ensure that resident’s needs are identified. EVIDENCE: There was no available copy of the Statement of Purpose and only an outdated version of a Service users guide, which was not service specific. A current Statement of Purpose and a Service Users Guide pertinent to Strathmore House must be compiled, sent to the CSCI and be available in the home at all times when required by inspectors, residents and their representatives. Pre admission assessment carried out prior to admission varied from resident to resident. The home need to use an acceptable assessment tool which thoroughly assesses all physical, psychological and social needs. There was little evidence that the staff in the home have the skills and experience to deliver care that meets the identified needs of the residents on a sustained basis. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 11 Care plans inspected during the inspection indicated that some residents had been at the home for some years and there was evidence that ‘in house’ assessments had been completed, however these were not comprehensive and did not provide a clear picture of individual needs and history. Information within these assessments was vague. Not all admissions were accompanied by the required care management assessment from the placing authority. This information is needed to ensure that the home is able to meet the needs of the resident and is able to support them effectively and residents must not be admitted without this information. One file did contain a profile of the resident, which staff stated had compiled with the help of the resident and her mother. However, following discussions with the parent not all the information contained in the records was pertinent or current. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 12 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. There is no clear or consistent care planning system in place to adequately provide staff with the information they need to satisfactorily meet resident’s needs. There are serious inconsistent practices in areas of monitoring records, which could potentially put young people at risk. The systems for resident’s consultation in this home are very poor with little evidence that indicates resident’s views are both sought and acted upon EVIDENCE: Care plans in the home did not reflect current individual needs and not all staff had the necessary knowledge to meet newly identified needs. Care plans had been linked to risk assessments with files containing more care planning information than others but generally there was no clear care planning system in place. There was no evidence that the care plans are monitored or evaluated. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 13 A parent engaged in conversation during the inspection stated that she had never been approached to be involved in the planning of her daughters care. On no occasion had a member of staff discussed her daughters care plan with her. Some risk assessments were in place. However, clear risk management strategies were not in place. The information and detail within the risk assessments was not consistent. There were gaps where risk assessments had been started but not completed and there were some areas where risk assessments were in place but the reason for it was not recorded. Choice and participation were not actively encouraged and not all residents had control over their lives or were involved in aspects of running the home. Evidence for this was found in consultation with residents about recent changes in the provision of meals and specifically the withdrawal of provision of certain snack items such as crisps, pop and pot noodles. Residents felt that they had not been properly consulted and their right to make decisions and exercise personal choice had been denied them. While the Inspectors fully understood that there was a need to improve menus and the arrangements for mealtimes, in order to provide a healthier and balanced diet, the Inspectors felt that this had been introduced too quickly and residents had not had an opportunity to fully consider the situation or look at options available to them. Several residents also referred to new ‘rules’ that had been introduced at the home, with which they did not agree, such as the new expectation that residents remain at the dining table once they had eaten their meal until everyone had finished. While the Inspectors acknowledged the need for improvements in the provision of meals and mealtime arrangements, such changes must be achieved in consultation with residents. There was evidence that residents had not been properly consulted about changes in the home and the introduction of new policies that affected their day-to-day life. For example one resident complained that he had been told that he could no longer carry about in the home and use a particular soft toy as a means of communication at times of personal stress. The Inspector’s enquiries into this arrangement with a parent, established this method had been successfully used for more than 8 years and had worked well and had previously been discussed with a Psychologist. She was concerned about this new ‘rule’ and felt anxious that problems would occur. These decisions had not been recorded within the care plan and there was no evidence of consultation with placing authorities. The home must review all recent changes in the home to ensure that residents are properly consulted, that their rights are upheld and are enabled to participate in decision-making processes. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 14 The daily living skills and rights of all the residents in the home must be promoted and their views listened to unless there are valid reasons not to do so, which have been recorded and shared with the residents and their representatives. The telephone in the home is sited in the main hallway making it impossible for staff or residents to receive calls in private. This needs to be addressed. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 15 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): 12,17 Generally residents take part in appropriate activities but communication with families in this regard was poor and at best inconsistent. Not all residents were supported to help plan and prepare their meals. There was no structure evident in the planning of meals and mealtimes and not all residents could exercise choice and control over their diet or what they eat EVIDENCE: Most service users are able to access the local community independently whilst others require support with transportation. A small number of residents also require staff support whilst in the community this was recorded within the sample of files inspected. The parents of one resident expressed concern that their son thoroughly enjoys attending a farm work placement twice each week. The inspector was informed that this is a subsidised activity, which they thought cost £15 per day. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 16 However, they had concerns that as part of Craegmore’s review of budgets that this activity might have to be stopped and a cheaper alternative found. Both parents were very worried about the negative affect it might have on their son should this placement be cancelled. Another parent was surprised to find out whilst visiting her daughter that she had been working for two hours in a local supermarket the previous Saturday. No one in the home had consulted her on this matter and the acting care manager explained to the inspector that she had not been informed of this matter by staff either. This highlights to the inspector that effective communication in the home is poor and regular meeting with relatives must be implemented so that all parties are fully aware of any organisational issues that may affect resident’s well being. While there was evidence that the menus had recently been reviewed to provide a more nutritious, varied and balanced diet, several residents expressed concern that they had not been properly consulted about such changes and felt aggrieved that their long-term habits were now being denied. While on the first day of the key inspection a cooked meal was being prepared for the evening, the lunchtime arrangements seemed haphazard with little discussion about choices or encouragement given to residents to prepare their own meal. One resident opened a tin of soup for himself while another decided to go to the chip shop, paying for this himself and another told the Inspector he was not going to have anything. There were several expressions of discontent in respect of the new house rule about residents sitting at the dining table until everyone finished their meal. Some felt they would not be prepared to do this and that it would cause problems. Staff also felt it was likely to cause unnecessary anxieties. One resident was preparing his own meals three times each week and he spoke very positively about this and felt that he had developed skills which had improved his independence. Most other residents were involved in menu planning and meal preparation to a much lesser degree and this is an area that should be further encouraged. Food stock was examined and found to be satisfactory. Food labelling in the fridge of items opened was not consistently done. For example several jars of jams, sauces and relishes were not labelled when they had been opened. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Personal support in this home is not offered in such a way as to promote and protect resident’s privacy, dignity and independence EVIDENCE: Personal hygiene routines were sporadic and not always recorded. Residents must receive more support from care staff in particular so that all residents are able to meet identified personal hygiene requirements appropriately, including adequate oral and foot care. The rooms of some residents seen on the day of the announced inspection fell well below acceptable levels of cleanliness. Some washing baskets were overflowing with personal clothing items. Staff must support residents to undertake household tasks such as cleaning rooms and washing personal clothing. Generally, there was evidence that health care professionals are involved where necessary. There was information relating to health care issues within care plans. There were letters, which indicated that appointments were made with the relevant bodies to address health issues. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 18 In discussion with a relative about a residents health needs it was determined that adequate sexual education had not been sought despite concern about a developing relationship. This should be addressed properly to ensure that staff within the home are aware of, and able to meet any health care support needs, which have been identified. One file identified that the resident suffered with epileptic fits, which could occur at any time. Very little scant information was recorded which was not consistent with identified health needs. The homes response to this was ‘ She goes straight to hospital following a fit, we have always done that for her’. Discussions took place on these two issues and the interim manager confirmed to the inspectors that these would be resolved. This will be checked on the follow up inspection. Observations of interactions between service users and staff were limited. The overall impression of the inspectors was that residents were ‘hanging around’ staff members, but interactions were not of a positive or meaningful nature. However, there were a few examples of an established rapport and light banter. Medication was examined on this inspection and the home have recently moved over to Boots Chemist implementing a monitored dosage system. All care staff had received training in the administration and disposal of medication and the MAR sheets were completed correctly. However the whole medication unit was stored at the top of the home in a cupboard on the top of the stairs. It was recommended that this should be moved to a more suitable site, so that and PRN medication can be given quickly on the event of a resident becoming unwell. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The complaints process in the home is very poor with little information available to residents and no evidence that their views are listened to or acted upon. Arrangements for protecting residents are not satisfactory placing them at possible risk of harm or abuse. EVIDENCE: The home has a history of poor handling of complaints and in particular a lack of effective input from senior managers over a recent serious complaint. This complaint remains ongoing at the present time. Two other complaints about poor care practices are also ongoing. Any complaints made to the home must be acted upon in line with the homes procedures. These must be recorded and available for inspection when required. The home must produce robust policies and procedures to the CSCI in regard to how the home intends to manage the resident’s personal monies safely. This must include reference as to how money/valuables are stored in the home and how staff and residents access personal monies from a bank or building society. The home does not have a clear system for recording and storage of service users’ monies. A random sample of two service user’s monies were checked and showed that that the policy had not been followed. Discrepancies were identified in the recording of monies for one service user. This was discussed with the senior member of staff and with the manager. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 20 There must always be a record of all monies or valuables and a record of the purpose for which the money or valuables have been used. Adult protection issues were checked and it was determined that staff training is still required in this area. This was discussed with the manager and must be addressed in the very near future. There are two adult protection investigations ongoing at the present time. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,30 There has been no change to the décor or the furnishings for some considerable time and although this does not pose a risk to residents it does not create a pleasing and pleasant environment to live in. Not all residents had suitable bedroom furniture or fixtures and fittings. Some areas of the home require a more structured cleaning programme. EVIDENCE: The home is a large Victorian detached house and all areas of the home were fully inspected on this visit. The home was very cold on the first day of the key inspection and it was only when raised by the Inspectors was the heating was eventually put on. The registered person must ensure that residents have suitable bedroom furniture, fixtures and fittings that meet the requirements in standard 26.2. One relative had been told that she had to provide bedroom furniture. The bedroom were personalised but the level of cleanliness in resident’s bedrooms must be improved. The communal areas of the home had a ‘homely’ feel and were reasonably furnished. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 22 There were some areas of the home, which required general maintenance. A maintenance recording system also needs to be set up which identifies when issues were raised and when repairs have taken place. The registered person must undertake all remedial repairs to home outlined at the inspection feedback. And included;• Decoration required to several walls where wallpaper is peeling off • Many light bulbs not working - overhead pull cord lights also not working • Dripping taps and hand wash basins in rooms heavily stained and scoured with lime scale • No thermometer in the home to test hot water prior to bathing • Kitchen cooker needs repairing An audit of the home must be undertaken regularly and the home must provide the CSCI with a planned maintenance and renewal programme for fabric and decoration of the premises and a record kept in the home. There was only one master key to all the rooms which resulted in staff searching for the member of staff who held the key to gain entry to rooms to undertake cleaning or returning washing to the rooms (where permission has been sought from residents). Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,36 Staff morale is extremely low resulting in a high turn over of staff and poor attendance that in turn results in residents receiving an inconsistent and unsatisfactory service EVIDENCE: Early shift 8am – 4pm 1 manager and 3 care staff Late shift 4pm – 10pm 3 care staff Night shift 10pm – 8am 1 sleep in and 1 waking staff Night staff cleans the homes communal areas as all the residents in the home at the present time sleep well. All care staff undertake, cleaning, cooking and domestic duties. The interim manager is fully supernumerary 9 – 5 Mon – Friday and is on call 24 hours a day at the present time. Administration is undertaken mainly by head office. The care manager prepares time sheets. There is one resident in the home at the moment who requires 2 to one care during the day. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 24 The roles of care staff was difficult to determine, evidently there were two senior care staff and the remainder of staff were care workers. There were no routines, regimes or duties allocated to each particular level of care staff. The registered person must supply job descriptions for all staff and daily shift routines for the early, late and night shifts. Staff could not demonstrate that they possessed the level of skill and experience necessary in communicating with others or when dealing with anticipated behaviours. The registered person must ensure that the workforce is adequately trained and has the required experience and knowledge when dealing with young adults with learning disabilities. Regular staff meetings must be held, recorded and available to all other staff and inspectors from the CSCI when required. The registered person must ensure all staff are appropriately trained in line with the duties they are expected to undertake, which includes; • • • • • • Manual handling Basic Food hygiene First aid POVA Challenging and aggressive behaviour Accident and incident recording The appraisal/supervision records seen on the inspection were very poor, records evidenced that the former care manager who resigned in January 2006had her last appraisal in December 2003. The area manager Ms Tina Morten undertook her last three supervision sessions of 15/7/03, 19/1/04 and 9/6/05. This level of supervision, direction and support is unacceptable. Care staff must be supervised every two months and this should be recorded and available to inspectors when required. Recruitment procedures will be checked on the next follow up inspection. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,42,43 The Conduct and management of the home has not resulted in a well run home. Not all health and safety practices protect resident’s well being. There were no clear lines of accountability within the home, which is understood by staff, residents and other representatives. EVIDENCE: A certificate of registration was displayed. A twice-yearly service report for the Fire alarm system and the emergency lighting was seen dated 22/06/05 and found to be all in order. Fire Extinguishers were checked on 21/01/06. However weekly fire alarm checks were very sporadic and staff did not know which part of the home was outlined in which designated fire Zone. Documentation was confusing and the file contained a lot of outdated information. The inspection officer contacted the Fire Safety Officer who advised he would undertake an inspection in this regard. The registered person must ensure fire alarms are tested weekly and that all staff are familiar with this procedure. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 26 Not all staff have received adequate fire drills. Two a year for day staff and four a year for night staff. All staff must have adequate and appropriate fire drills. Other training requirements have been outlined in another section. The interim manager stated that there were some ‘panic’ buttons throughout the home but could not be sure where each one was and if they were all in working order. This will be determined and CSCI informed out the outcome. During the inspection it was noted that there were no towels within some of the toilet areas for hand washing. There were very small slivers of cheap soap bars. This is not good infection control practice for staff or and potentially leaves both at risk of infection. The home should be using soap dispensed from a plunger bottle and towels must always be available and changed regularly. Not all radiators have been adequately covered to protect residents from injury. Previous requirements were still not met. The interim care manager must provide the CSCI with weekly written reports outlining how the home is meeting the outstanding National Minimum Standards. A representative of the company must produce monthly written reports to the CSCI, which meet all the criteria outlined in this regulation. (26) Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 27 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 1 2 2 3 1 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 1 1 1 1 X X LIFESTYLES Standard No Score 11 X 12 2 13 X 14 X 15 X 16 X 17 1 1 X 1 1 1 1 X 1 1 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X X X X 1 1 1 X X X X 1 1 Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 28 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)(2) 5(1)(a,b,c,d,e,f) 5(2)(3) Requirement Timescale for action 08/05/06 2 YA2 3 YA3 4 YA6 A current Statement of Purpose and a Service Users Guide pertinent to Strathmore House must be compiled, sent to the CSCI and be available in the home at all times when required by inspectors, residents and their representatives. 14(1)(a,b,c,d) All residents must have a 08/05/06 pre admission assessment carried out prior to admission. This must meet the criteria laid down in standard 2.3 18(1)(a) Staff in the home must 08/05/06 have the skills and experience to deliver care that meets the needs of resident client group. 14(2)(a)(b) All the residents care plans 08/06/06 15(1)(2)(a,b,c,d) must be re written to meet the National Minimum Standards. They must • Accurately record the current physical, mental and social needs of each DS0000008255.V294862.R01.S.doc Version 5.1 Page 29 Strathmore House 5 YA7 12 (2)(4)(a) 6 YA8 12(3) 7 YA12 15(1)(2)(c) 22 8 YA17 16 (2) (i) 9 YA18 18(1)(a) individual • Be reviewed monthly or more frequently if required • Completed by a competent member of staff who understands the principles of record keeping and meeting residents identified needs • Be legible, completed in black ink, signed and dated • Appropriate current risk assessments must be implemented and kept under review. Residents must be actively encouraged and supported to make their own decisions where possible and these must be recorded. Residents must be properly consulted about changes in the home and the introduction of new policies that affects their day-to-day life. Relatives must be consulted when there is any change or revision of the care plan that affects the wellbeing of residents. Any concerns from relatives must be listened to and acted upon. Residents must be supported to enjoy foodstuffs of their choice in conjunction with a healthy nutritious balanced diet. Residents must receive more support from care staff • To meet identified personal hygiene requirements DS0000008255.V294862.R01.S.doc 08/05/06 08/05/06 08/05/06 08/05/06 08/05/06 Strathmore House Version 5.1 Page 30 10 YA22 22(3)(4)(5)(8) 11 YA23 13(6) 12 YA24 13(4)(a) 23(2)(b)(d) 13 YA26 16(2)(c) 14 YA30 23(2)(d) appropriately, including adequate oral and foot care. • To undertake household tasks such as cleaning rooms and washing personal clothing. Any complaints made to the home must be acted upon in line with the homes procedures. These must be recorded and available for inspection when required. The home must produce robust policies and procedures to the CSCI in regard to how the home intends to manage the resident’s personal monies safely. This must include reference as to how money/valuables are stored in the home and how staff and residents access personal monies from a bank or building society. The registered person must undertake all remedial repairs to home outlined in the report. An audit of the home must be undertaken regularly and the home must provide the CSCI with a planned maintenance and renewal programme for fabric and decoration of the premises and a record kept in the home. The registered person must ensure that residents have suitable bedroom furniture, fixtures and fittings that meet the requirements in standard 26.2 The level of cleanliness in resident’s bedrooms must be improved. 08/05/06 08/05/06 08/06/06 08/07/06 08/05/06 Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 31 15 YA31 18(1)(a) 16 YA32 18(1)(a)(i)(ii) 17 YA33 21(1)(2) 18 YA35 18(1)(a)(c)(i) The registered person must supply job descriptions for staff and daily shift routines for the early, late and night shifts. Staff must have the skills and experience necessary in communication and in dealing with anticipated behaviours. Regular staff meetings must be held. These must be recorded and available to all other staff and inspectors from the CSCI when required. The registered person must ensure all staff are appropriately trained in line with the duties they are expected to undertake, which includes; • • • • • • Manual handling Basic Food hygiene First aid POVA Challenging and aggressive behaviour Accident and incident recording 08/05/06 08/06/06 08/05/06 08/06/06 19 YA36 18(2) 20 YA37 9 (1) (2)(b)(i) 21 YA42 23 (4)(c)(v)(e) The registered person must ensure all care staff are appropriately supervised every two months. This must be recorded and available for inspection when required. The acting care manager must provide the CSCI with weekly written reports outlining how the home is meeting the outstanding National Minimum Standards. The registered person must ensure fire alarms are 08/05/06 08/05/06 08/05/06 Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 32 20 YA42 13(4)(c) tested weekly and that all staff are familiar with this procedure. All staff must have adequate and appropriate fire drills. Not all radiators have been adequately covered to protect residents from injury. Previous requirements not met. A representative of the company must produce monthly written reports to the CSCI, which meet all the criteria outlined in this regulation. There must be clear lines of accountability within the home, which is clearly understood by staff, residents and other representatives. 08/09/06 22 YA43 26(2)(3) (4)(a)(b)(c) (5)(a) 08/05/06 23 YA43 18(1)(a) 08/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard YA14 YA36 YA41 YA42 YA20 Good Practice Recommendations More detailed daily activities sheets are necessary to reflect activities particularly for residents with specific needs. Previous recommendation not met. Training matrix recommended to easily identify individual team member training needs. Previous recommendation not met. Accident/incident matrix is recommended to record any trends or patterns. Previous recommendation not met. Accident sheets should be filed and a log created for auditing purposes. Previous recommendation not met. It was recommended that all medication should be stored in a more appropriate site in the home. Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 33 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Strathmore House DS0000008255.V294862.R01.S.doc Version 5.1 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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