Inspection on 13/11/06 for Stratton Road (20)

This inspection was carried out on 13th November 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stratton Road (20) 11/09/07

Stratton Road (20) 10/11/05

Stratton Road (20) 22/06/05

Stratton Road (20) 26/02/05

Stratton Road (20) 16/11/04

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 Stratton Road (20) 20 Stratton Road Pewsey Wiltshire SN9 5DY Lead Inspector Alison Duffy Key Unannounced Inspection 13th November 2006 4:00pm Stratton Road (20) DS0000028314.V302185.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 Stratton Road (20) DS0000028314.V302185.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. Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stratton Road (20) Address 20 Stratton Road Pewsey Wiltshire SN9 5DY 01672 564957 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) Landlace Care Homes Ltd Miss Beverley Britten Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th November 2005 Brief Description of the Service: 20 Stratton Road is a residential care home, which accommodates three service users with a learning disability. The home is one of three residential care homes owned by Landlace Care Homes Ltd. Miss Bev Britten is the Registered Manager and Mrs Nan Lance is the responsible individual. Mrs Angie McGrorty has recently been employed as service manager. The home is located within a residential area of Pewsey and is within walking distance of local amenities. The property is semi detached and furnished to a good standard. Service users have single room accommodation, either on the ground or first floor. The home has one member of staff on duty throughout the waking day and sleeping in cover is provided at night. Fees for living in the home are based on individual need and range from £594.00 to £629.00 a week. Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place initially on 13th November 2006 between the hours of 4pm and 7pm. Mrs Sandie Benford, a support worker was on duty and assisted throughout. Within this time, discussion took place with service users both in private and within the kitchen. The inspector also viewed care planning information and daily records. A second day was arranged to complete the inspection. This took place on 22nd November commencing at 9am. One service user was at home and Mrs Benford was on duty again. The medication systems and the management of service users’ personal monies were examined. Menus, fire safety and risk assessments were also viewed. Once these areas were completed, the inspector went to another of the organisation’s care homes where Mrs McGrorty, service manager, is based. Discussion took place with Mrs McGrorty regarding recent developments and further planned improvement. Documentation including staff training and recruitment were also viewed. Miss Britten was off duty yet visited to offer assistance with the inspection. Miss Britten spoke of the positive aims for the future of service provision. These are detailed within the main sections of this report. Service users gave positive feedback about the home and spoke of important aspects of their lives. The inspector was invited to view one service user’s room. Another service user showed photographs of a recent holiday to Spain. Interactions between Mrs Benford and service users were attentive and animated throughout. Service users chose to be involved in the preparation of the evening meal. This was seen to be productive yet also a time to talk about the day’s events. As part of the inspection process, surveys were sent to service users and their primary relative. Surveys were also sent to each service user’s GP and social worker. Feedback included ‘we are very impressed with the care that XX is given. The care home has a very warm and friendly atmosphere and XX is very happy there. It is a real home from home for XX.’ All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. What the service does well: The environment is comfortable, homely and well maintained. Service users bedrooms demonstrate individuality and personal interests. Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 6 Day service provision is supported and high levels of opportunity and friendships are promoted through this. Important relationships are promoted and service users are able to assist with housekeeping responsibilities, as they wish. Service users are able to choose and plan a holiday of their choice, which may include a trip to another country. Meal arrangements are based on fresh produce and service users’ preferences. What has improved since the last inspection? What they could do better: Staffing levels continue to be maintained at the minimum of one member of staff. This significantly restricts individual activity and service users being able to make decisions about what they wish to do. Due to existing staffing levels, one service user, when not at day service, has to spend time in other care homes within the organisation. While it is noted that these areas are being addressed through the recruitment of staff, there must be flexibility within staff deployment to address such shortfalls. Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 7 Mrs McGrorty is currently overseeing the day-to-day management of the home although Miss Britten is the registered manager. Consideration must therefore be given to individual management responsibilities. If Miss Britten is to continue with the role of registered manager, she must have the designated time to undertake her responsibilities. This will involve, being removed from the staffing roster in the other care home, where she is also the registered manager. Not all care plans were up to date and did not reflect changing need. While it is acknowledged that the newly introduced key worker meetings will assist this, greater monitoring is needed. Staff should also be more aware of service users’ rights to privacy when recording personal information within the communication book. All medication, when received must be receipted within the medication administration record. Another member of staff should also countersign all handwritten medication instructions on the record, to avoid the risk of error. Risk assessments currently give insufficient clarity within control measures. Some incidents have also occurred but a risk assessment has not been undertaken. Mrs McGrorty has acknowledged this and reported that risk will be the next targeted area. While various systems such as service user satisfaction surveys have been developed, there is not an implemented quality assurance system. Mrs McGrorty reported that she is planning to address the shortfall when other identified matters, which need greater priority, have been completed. 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. Stratton Road (20) DS0000028314.V302185.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 Stratton Road (20) DS0000028314.V302185.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 5 Due to the long-term nature of the service, it was not appropriate to fully address the above standards. Service users reported being happy with the service received. Consideration is being given to realistic fee levels, which in turn will enable the further development of service provision. Contracts are out of date, yet this is being addressed. EVIDENCE: All service users have lived at the home for many years. Placements remain appropriate and therefore, any changes are not expected. It is anticipated that service users will live at the home on a long-term basis. This is unless individual needs change significantly and cannot be met within the existing environment. Due to this, the above standards in relation to choice of placement were not assessed. Within discussion with Mrs Benford it was evident that the level of service users’ needs are increasing. Mrs McGrorty also confirmed this and reported that consideration is being given to ways in which service provision will need to change. Mrs McGrorty is currently in the process of re-costing the service. A review of all fees is being requesting from all placing authorities. All service users have a contract yet these have not been reviewed for a number of years. Mrs McGrorty is aiming to address all such areas, within formal meetings with individual care managers and the contracting department. Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Care planning gives an overview of care required yet not all documentation is up to date. While decision-making is encouraged, consideration is being given to ways in which this can be further developed. Service users are encouraged to be independent yet greater focus on the formal assessment process would enhance individual safety. EVIDENCE: Mrs McGrorty reported that she is intending to develop the existing care plan format. This will incorporate a more person-centred plan, which will enable full involvement of service users. Mrs McGrorty is aiming to involve social workers and any others, who service users may wish to be involved. Mrs McGrorty showed some examples of documentation. These were positive and will be an invaluable tool if completed efficiently. At present all service users have a care plan, which details guidelines of care provision. The information is detailed and reflects individuality. However there is some information within other areas of the file, which is not addressed Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 11 within the care plan. This includes for example, recommended foods following a consultation with a dietician. The plans do not evidence the service users involvement. Regular review is also not evidenced. One plan has not been updated in relation to changing need. Mrs McGrorty reported that she is aiming to develop monthly key worker meetings. This will enable the service user and key worker to reflect on the month’s events. A summary will then form part of the plan. Within one plan there was evidence that this system had commenced. The service user and the member of staff had both signed the document. One service user had not had a formal review for a number of years. Mrs Benford reported that the service user does not have an allocated social worker although a request has been made for intervention. Mrs McGrorty confirmed this, yet reported progress had been minimal. The plans also contained previous care plans and therefore varying amounts of out of date information. Mrs Benford was advised to file any information, no longer required. In addition to care planning information, all service users have a daily diary. Entries within these are detailed and provide information about ill health, food consumed and activities undertaken. At the last and subsequent inspection, it was noted that personal information regarding service users had also been recorded within the staff communication book. Despite recommendations to avoid this, the practice is still continuing. It was agreed that reference could be made within the communication book, yet all other information, to promote service users rights to privacy, should not be included. Mrs McGrorty reported that she would discuss this with the staff team accordingly. Within discussion with service users it was evident that on a general basis, service users are able to chose what they want to do. For example, attending day services, watching television in their own room, assisting with housekeeping tasks and meal preparation were aspects that were undertaken through choice. One service user also reported enjoyment from staying at home over the weekend due to being out all day during the week. There continues to be examples however, whereby service users are restricted through existing staffing levels. In particular, one service user likes shopping yet due to there being only one member of staff on duty, they are not able to go when they wish. Activity therefore, has an implication for the others living within the home. On previous inspections, it has been highlighted, when not at day services during the week, service users go to other homes within the organisation. This is due to the existing insufficient staffing structure. It was noted that this practice continues, which does not promote service users right to decision making. Mrs McGrorty reported that she had identified this and on recruitment of further staff, the situation would be addressed. Mrs McGrorty confirmed that she wanted to build on responsibilities and decision-making. For example, service users are now being encouraged to answer the phone and the front door. Arrangements are being made for service users to purchase their own personal shopping and choose their own hairdresser. Internet food shopping by staff is also being discouraged so that service users can be more Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 12 involved in going to the shops. Mrs McGrorty reported that consideration is being given to communication training for staff and the involvement of a speech and language therapist. Both are intended to assist staff within enabling service users to express their views. Service users are very involved in maintaining the standard of their environment and undertaking various housekeeping tasks. This includes polishing, vacuuming and individual laundry. Within the inspection two service users helped prepare the evening meal and also laid the table. One service user confirmed that they were not expected to help, but they enjoyed doing so. Service users are encouraged to take reasonable risks in relation to individual ability. This may include making a hot drink, meal preparation or cooking. A number of risk assessments are in place yet these do not give detailed information. It was also identified that greater focus is needed when considering risk. For example, one service user’s deterioration in mobility had not been sufficiently addressed. Also an incident identified within a daily diary, had not been identified within a risk assessment. Some risks are now being monitored more regularly. This includes road safety awareness. Mrs McGrorty confirmed that the risk assessment process is an area requiring further attention. A new risk assessment format has been developed and all are in the process of being reviewed. Mrs McGrorty confirmed that she is also intending to work with staff to enable risk to be risk-aware rather than risk-adverse. Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users have access to a wide range of opportunities within their day services, yet individuality within the homes’ activities is restricted through minimal staffing levels. Positive focus is given to matters such as holidays, which significantly improve quality of life. Important relationships are promoted and service users are encouraged to be involved with daily housekeeping tasks. Meal arrangements are based on service users’ preferences, with an emphasis on fresh produce and home cooking. EVIDENCE: Mrs McGrorty confirmed that she is aiming to improve the focus of what service users would like to achieve within their future. Within this, is an emphasis on individual wishes and developing new experiences. Mrs McGrorty confirmed that networking and finding out what is actually available, within the vicinity of the home, is an integral part of offering such experience. All service users have public transport (bus) passes. It is therefore the intention to develop the use of these, in order to initiate further opportunity. Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 14 Two service users spoke with enthusiasm regarding their day service activity. Both attend five days a week, Monday to Friday. Activities such as drama, cooking, communication, swimming, card making and ‘out and about’ are undertaken. One service user confirmed that they are very busy and go to lots of places. As stated earlier in this report, one service user attends their day service on a sessional basis. When not undertaking sessions, time is spent in other homes within the organisation. With the further deployment of staff, it is intended that this practice will cease. Mrs McGrorty reported also, with the anticipated withdrawal of some day care placements, further consideration would be given to staff deployment. This would also address limitations currently in place, regarding service users not having one-to-one support from staff to follow preferred individual activity. Service users reported that they continue to attend various clubs such as Gateway and Open Minds. One service user has also recently started at college. Another service user also commenced attendance yet chose not to continue. When at home, service users are able to follow their preferred interests. This was demonstrated when two service users went off to watch their television in their room. Another service user completed a jigsaw puzzle in the kitchen with staff assistance. One service user spoke with enthusiasm about a recent holiday to Spain. Photographs were shared and it was reported that next year’s holiday would be given consideration shortly. Service users are able to have visitors as they wish. Within comment cards, relatives reported that the owners/staff always make them feel welcome in the home. This was evidenced within the inspection when hospitality was clearly evident. Relatives stated that they could meet with their relative in private. They also confirmed they are kept informed of important matters. As stated earlier in this report, service users are encouraged to be involved in various housekeeping responsibilities. Service users also prepare their own lunchboxes and choose preferred meal arrangements. Mrs McGrorty reported that she is aiming to further develop this area of the service. A new phone with larger numbers has recently been purchased to enable service users to use the phone more easily. Service users do not have locks or keys to their bedrooms although this may be something that will be considered in the future. Service users are given assistance as required, to read mail and also keep in contact with important people in their lives. Additional one-to-one time with staff would however, assist service users to exercise their rights further. Mrs Benford reported that progress had been made within the key worker system, as individual Christmas shopping trips have been arranged. Mrs McGrorty reported that it is her aim that individuality will be significantly developed over time. To promote service users’ own space, Mrs McGrorty has informed staff that they must knock on the front door and wait to be invited in. They must not just walk at the start of their shift. Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 15 Mrs Benford confirmed, that at the beginning of the week, service users sit down over a coffee and plan the weeks’ menu. All meal arrangements are therefore devised through service users’ choice. The menu is informal and can be changed at any point. The main meal in the week is undertaken in the evening. A packed lunch or a snack is taken for lunch. At weekends, meal arrangements are arranged according to individual wishes. Service users assist with meal preparation if they wish. Service users spoke positively about the food stating Sandie (Benford) is a good cook. Service users have access to fresh fruit as they wish. Fresh vegetables are an integral part of each evening meal. Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users receive varying levels of support according to their level of ability. Current levels of monitoring ensure service users’ health care needs are met. Additional measures would ensure medication systems provide greater protection. EVIDENCE: Service users receive varying levels of support with daily living skills. The assistance required is clearly stated within care planning information. A record of all health care appointments is maintained. This includes intervention from various health care professionals such as the GP, District Nurse, Physiotherapist and Occupational Therapist. All service users are registered at the same practice although has appointments with different GPs. Within a daily record it was noted that a service user had fallen. An accident record had been completed yet medical intervention was not accessed. Mrs McGrorty had identified this. In response, she had forwarded a memo to all staff, identifying the need and reasons for medical input, after any such incident. Within a comment card, a health care professional reported that staff are kind and caring yet there is sometimes a lack of understanding regarding the Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 17 service users’ needs. There are also some difficulties with communication. Another comment card also stated that staff sometimes do not have a clear understanding of the care needs of service users. Mrs McGrorty reported that she was aware of these concerns and was addressing all areas through discussion with staff and further monitoring. Service users do not administer their own medication. The staff member on duty administers such via a monitored dosage system. All medication is stored securely within a locked cupboard that is attached to the wall. Although the amount of medication is minimal, the cupboard is very small. It is not conducive to the monitored dosage system. Mrs Benford reported that consideration is being given to a replacement within an alternative location. Within the cupboard there was a box of paracetamol and cod liver oil tablets without a name. Mrs Benford confirmed that she would label the cod liver oil tablets although only staff use the paracetamol. There were a number of creams, which stated ‘as directed’ on the label. Mrs Benford reported that this had been addressed with the surgery yet changes had not been made. Within the administration record there was one instruction that had been hand written. The instruction was not clear and Mrs Benford had written over the directions to minimise the risk of error. Mrs Benford was advised to ensure countersigning hand written instruction occurs as standard practice. All medication must also be receipted. Mrs Benford reported that the home has a homely remedies policy that a GP has been signed. At the time however, the policy could not be located. Information from the Internet is available regarding currently used medication. Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 18 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 and 23 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are clear regarding who they need to speak to if they are unhappy. The development of pictorial complaint formats will further enhance this. Systems to increase awareness of adult protection have been developed. The arranged training will further ensure service users’ protection. EVIDENCE: The home has a complaints procedure that contains the required information in relation to regulation. A copy of the procedure is displayed in the kitchen. Through discussion with Mrs Benford however, it was agreed that the procedure is not service user focused. Service users confirmed that they would speak to Sandie or Ann (support workers) if they had a problem. It was recommended therefore that the complaints procedure should be simplified and be displayed on the notice board. Mrs Benford agreed that pictorial formats or photographs would be much more beneficial. It was noted that service users are encouraged through daily communication to express their views. For example, Mrs Benford asked specific questions regarding the day’s events and how they managed certain activities. It was also reported that general mood levels and body language give indications of wellbeing. Within comments cards, service users confirmed that they could speak with their key worker or ‘Bev who is the boss.’ In addition, further comments included ‘Bev will sort things out for me’ and ‘I can tell Angie, Bev and Sandie. I know I can speak to Alison.’ Relatives reported that they are aware of the home’s complaint procedure. Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 19 Mrs McGrorty has now devised complaint reporting forms and a complaint log. Within discussion, Mrs McGrorty also confirmed that she intends to further develop communication systems. These will particularly address those service users who have more limited communication skills. Mrs McGrorty confirmed that she intends to review all policies with Mrs Lance on her return from annual leave. This will include the adult protection policy, as at the last inspection, the document was unclear. All staff have been given a copy of the ‘No Secrets’ documentation. Mrs McGrorty confirmed that the home has an adult protection-training package in the home. External training, taking into account local policies has been arranged for all staff in January 2007. Service users do not manage their financial affairs and all have appointees with their placing authorities. Some small amounts of money are kept securely on behalf of service users. These were examined and all were found to correspond with balance sheets. All receipts are now attached on a monthly basis giving greater organisation. A regular audit is also now in place. A managing finances policy has been developed and all staff have been given a copy. Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 20 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 and 30 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The environment continues to be comfortable, clean, homely and well maintained. Service users’ bedrooms demonstrate individuality and reflect individual interests. Laundry facilities continue to meet existing needs. EVIDENCE: All service users have a single room on either the ground or first floor. Rooms are individual in style and have been personalised to varying degrees. All have a range of personal entertainment equipment that is regularly used. One service user has recently purchased a new plasma television. Another service user said they were also awaiting a similar television. The home has a large kitchen with dining area and a separate lounge. The lounge has patio doors leading to an outside seating area. The room is comfortable, has a large television and magazines on the coffee table. Current service users do not smoke so the home operates a non-smoking policy. The hot water is centrally regulated and since the last inspection, hot water temperatures are monitored and recorded appropriately. Radiators are at this time uncovered and risk assessments are in place. Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 21 On the day of the inspection, the hallway and the kitchen were being decorated. Mrs Benford confirmed all areas are in the process of being refurbished. The environment was noted to be clean and odour free. There have been no changes to the laundry facilities. Current arrangements were reported to meet existing need. Due to the location of the utility room, soiled linen must be carried through the kitchen. One service user confirmed they carried their laundry down in a basket. Staff gave assistance to use the washing machine. Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 22 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): 32, 34, 35 and 36 Quality in this outcome area is adequate yet flexibility and individual opportunities to service users are significantly restricted through minimum staffing levels. This judgement has been made from evidence gathered both during and before the visit to this service. While in line with the previous registration authority, only having one member of staff on duty, significantly restricts individual needs of service users. Service users are assured greater protection through significant developments within staff supervision, recruitment and staff training. EVIDENCE: Within previous inspections, insufficient staffing levels have been identified. A requirement was made at the last and subsequent inspection to address this. Although not as yet achieved in practice, a weekly roster has been devised for all staff across the three services. Rather than each home having key staff, Mrs McGrorty is aiming to use the whole staff team to create greater flexibility. However, until more staff are recruited, staff continue to work on their own, while service users are at home. Staff commence their shift at 4pm until 10pm and undertake sleeping in provision between the hours of 10pm and 7am. Staff then work until 9am when service users go off to their day services. One service user has sessional day care. When not at the day service, between Monday and Friday, this service user needs to spend time in either of the other two care homes within the organisation. This was also raised within a comment Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 23 card. This practice, compromises the service user’s right to make decisions. It also creates a service, which is not entirely service user focused. Within discussion, it was agreed that service users’ needs are increasing. This places additional demands on staffing. Mrs McGrorty confirmed that additional staff are required and expressed commitment to addressing the shortfalls. Mrs McGrorty also confirmed that consideration is being given to additional staff at a weekend so that service users may develop their individual interests. Since Mrs McGrorty has been in post, formal staff supervision has been instigated. All staff have now had two supervision sessions. It was reported that these have worked well although time is needed to fully reach the potential of the sessions. To date, discussions have centred on service users and service provision. Particular attention has been given to the key worker role. Mrs McGrorty is also aiming to develop the responsibilities of staff. Key aspects, such as fire safety, have been delegated to specific members of staff. Mrs McGrorty has recently completed a training review and has identified her findings within a training matrix. In order to enable service users, with more specialised communication needs, to express their views, Mrs McGrorty believes that training in communication skills is paramount. She has therefore requested the input of a speech and language therapist. Signing courses are also being investigated. Mrs McGrorty reported that further areas of required development are risk assessments. Risk management training is therefore being investigated. The majority of staff are up to date with mandatory training. Topics regarding first aid and manual handling are currently being arranged in order to ensure all staff are fully up to date. Challenging behaviour refresher courses are also being arranged. All staff have completed epilepsy and medication training. Within the whole staff team, three staff have completed NVQ level 2. Two are currently undertaking level 2 and a number of others are in the process of being enrolled. Mrs McGrorty is aiming to raise this number so that the majority have the qualification. Mrs Benford confirmed that regular staff meetings are now in place. Staff are given an agenda and all receive a copy of the minutes. The meetings are held away from the care home so they are not interrupted. Mrs Benford confirmed this to be a good opportunity for the team to get together and share ideas. Staff are also given their own copy of memos. All are asked to sign a copy, which is kept on file. Recent matters have included the disciplinary procedure and imposing restrictions. As stated earlier in this report, the home is actively recruiting, in order to increase staffing levels. Recruitment documentation has been significantly developed enabling greater organisation and efficiency. A checklist has been developed and all information is now ordered, within individual files, to demonstrate a robust process. Documentation of the two most recent members of staff were viewed. The application forms were detailed and references were in place. Copies of letters demonstrated an invitation to an Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 24 interview and confirmation of gaining the post subject to a successful CRB disclosure and references. Mrs McGrorty confirmed that the most recent applicant was awaiting her disclosure so a start date had not been confirmed. Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Since commencing her post as service manager, Mrs McGrorty has made significant developments to service provision. However, further consideration of roles and responsibilities will assist with the clarity of the home’s leadership. Service users are encouraged to give their views, yet a formal quality assurance system will enable further development of provision. While health and safety is given consideration, the development of some areas would assure further protection. EVIDENCE: At the last and previous inspection, it was highlighted that, due to other commitments, Miss Britten had spent limited time within the home. This meant management responsibilities were being unfulfilled and leadership was poor. Although aware of this, Miss Britten was sole working in another home within the organisation and therefore time was restricted. Requirements were made to address management responsibilities, yet progress was minimal. Mrs Lance Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 26 has since given consideration to the management systems within the organisation. Mrs Lance has employed McGrorty as service manager. This is mainly to address shortfalls and focus on meeting outstanding requirements. At present, Miss Britten continues to operate as the registered manager yet Mrs McGrorty is overseeing matters on a daily basis. Both are working together to implement systems. However, Miss Britten continues to remain on the working roster of the other care home. Mrs McGrorty reported that consideration is currently being given to the continued management framework. Once decided upon, applications to register would be undertaken as required. Mrs McGrorty agreed to keep CSCI informed of this process. Miss Britten has NVQ level 3 although has not as yet registered to undertake her Registered Manager’s Award. Mrs McGrorty reported that this would be addressed when the management arrangements of the home are identified. Since her time within the organisation, Mrs McGrorty has made significant progress. This includes staff supervision, arrangement of training, staff meetings and more efficient systems such as staff recruitment. Mrs McGrorty has a clear focus regarding further development and is motivated to achieve. At the last inspection, a requirement was made to develop a quality assurance system. Mrs McGrorty reported that she is planning work for this but has not, understandably, had time to implement a great deal. User-friendly service user satisfaction surveys are in place and other questionnaires have been developed. An auditing system is planned. The requirement has therefore been repeated although Mrs McGrorty confirmed the system would be in operation shortly. Health and safety is given consideration yet some systems require further attention. For example, as stated earlier within this report, Mrs McGrorty has identified the need for greater clarity within risk assessments. This was confirmed, within one assessment, where it was stated a service user is able to run a bath unsupervised as the water is regulated. Additional factors such as, mixing temperatures or timescales for being in the bath unattended are not identified. This was identified at the last inspection although to date has not been addressed. Mrs McGrorty confirmed that this would be addressed when reviewing the whole risk assessment process. At the last inspection, a requirement was made to ensure that fire doors are not propped open. This matter has been addressed, with a self-closing mechanical device that can be activated by the fire alarm. Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 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 X 2 X 3 X 4 X 5 2 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 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 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 2 X 1 X X 2 X Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 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 YA6 Regulation 15 Timescale for action Unless it is impracticable to carry 28/02/07 out such consultation, the registered person shall after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan) as to how the service user’s needs in respect of his health and welfare are to be met. (All plans must be kept up to date and reflect any change in need) The registered person shall 28/02/07 ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. (Potential risks to service users must be considered within the risk assessment process. These must be documented accordingly and regularly reviewed.) The registered person shall 28/02/07 having regard to the size of the care home and the number and needs of service users – consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for DS0000028314.V302185.R01.S.doc Version 5.2 Page 29 Requirement 2 YA9 13(4)(c) 3 YA14 16(2)(n) Stratton Road (20) recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. (Staffing levels must enable all service users to have opportunities for individual leisure activities in and outside of the home.) This has been repeatedly identified. While in practise, staffing levels remain the same, additional staff are being recruited, draft staffing rosters have been compiled and Mrs McGrorty expressed commitment to address the shortfalls. The registered person shall make 22/11/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (All medication must be documented within the medication administration record when received.) The registered person shall make 31/01/07 arrangements, by training or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. (Staff must receive adult protection training, which takes into account local reporting procedures.) This was identified at the last inspection. Training has been arranged to take place in January 2007. The registered person shall 31/01/07 establish a system for evaluating the quality of the services provided at the care home. (A quality assurance system, which takes into account service user and other interested parties DS0000028314.V302185.R01.S.doc Version 5.2 Page 30 4 YA20 13(2) 5 YA23 13(6) 6 YA39 24 Stratton Road (20) views, must be implemented.) 7 YA41 12(1)(a) The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. (All policies and procedures must be specifically related to service provision.) This was identified at the last inspection. Although this has not been fully addressed, Mrs McGrorty has arranged a meeting in January 2007 with Mrs Lance to review all policies. The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. (Further clarification is required to the risk assessments relating to bathing and radiators.) This was identified at the last inspection. Mrs McGrorty has developed a new format for risk assessments and is in the process of reviewing all. 31/01/07 8 YA42 13(4)(c) 28/02/07 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 2 Refer to Standard YA5 YA6 Good Practice Recommendations The Registered Person should ensure that each service user has a reviewed contract identifying the terms and conditions of living within the home. The Registered Person should ensure that the communication book is not used to record information about service users. This was identified at the last inspection and has not been addressed. DS0000028314.V302185.R01.S.doc Version 5.2 Page 31 Stratton Road (20) 3 4 5 6 YA6 YA20 YA20 YA32 7 YA37 The Registered Person should ensure that all out of date information is removed from service users’ care plans and is then stored appropriately. The Registered Person should ensure that another member of staff countersigns all hand written instructions within the medication administration record. The Registered Persons should ensure that all medications are clearly labelled and instructions including ‘as directed’ are discouraged. The Registered Person should ensure that there is flexibility within staff deployment so that service users, do not need to spend time within other homes in the organisation, when not attending a day service. The Registered Person should ensure that clarity is given to the roles and responsibilities of the management team. Stratton Road (20) DS0000028314.V302185.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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. 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