Inspection on 11/06/07 for Stratton Road (27)

This inspection was carried out on 11th June 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stratton Road (27) 28/06/06

Stratton Road (27) 02/11/05

Stratton Road (27) 21/06/05

Stratton Road (27) 04/01/05

Stratton Road (27) 15/11/04

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 (27) 27 Stratton Road Pewsey Wiltshire SN9 5DY Lead Inspector Roy Gregory Unannounced Inspection 11th June 2007 02:15 Stratton Road (27) DS0000028213.V337441.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 (27) DS0000028213.V337441.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 (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stratton Road (27) Address 27 Stratton Road Pewsey Wiltshire SN9 5DY 01672 562691 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 4 Category(ies) of Learning disability (4) registration, with number of places Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th June 2006 Brief Description of the Service: 27 Stratton Road is a semi-detached house with single bedrooms for four people with learning disabilities. Two bedrooms are upstairs, with a bathroom and toilet nearby. The other two bedrooms are downstairs, close to a shower room with toilet. One upstairs room had been empty for a long time, so there were three people living in the home. People share a living/dining room, kitchen and enclosed garden. Landlace Care Homes Ltd. have just changed their name to Innovations Wiltshire. The company owns two similar care homes on the same estate as 27 Stratton Road. The company’s office is in the grounds of 27 Stratton Road. Two company vehicles are available for use by the three homes, and there is some sharing of staff between them. Miss Bev Britten is the Registered Manager of 27 and 20 Stratton Road and her mother Mrs Nan Lance is the responsible individual. Mrs Lance, Miss Britten and the service manager Mrs Angela McGrorty work closely together. The home is in a residential area of Pewsey. Within walking distance is the village centre, with shops, doctor’s surgery, bus stops and a railway station. It is possible to park in the road outside the home. Weekly fees are set in accordance with the Wiltshire County Council “fair pricing tool”. For people currently living there, fees vary between £770 and £1100 per week. Fees do not include items such as toiletries, clothes and social outings. Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place between 2:15 p.m. and 6:30 p.m. on Monday 11th June 2007. The inspector met with the registered manager, Miss Bev Britten, and later the provider, Mrs Nan Lance, as well as a member of support staff on duty at the time. Initially two of the three people living at the home were present. The third person returned from attending a day service during the afternoon. The inspector was able to observe and interact with all three service users, singly and as a group, sometimes with the assistance of staff present. The inspector saw preparations being made for an evening meal. He looked at how medication was used and how the home links up with health professionals and other community resources. As the home had recently conducted a questionnaire exercise with external professionals, reference was made to responses that had been received. All areas of the home were seen, including the bedrooms. People’s agreement to this was obtained first. Records that were read included care records and support plans, and proof of monitoring health and safety matters, including risk assessments and fire precautions. The inspector returned to the home, by arrangement, on Tuesday 19th June 2007, to look at staff records, including those about training, supervision and recruitment. This visit also enabled an in-depth discussion with Mrs Lance and Mrs Angela McGrorty. Since the previous inspection, Angela McGrorty has been appointed as service manager for all the services offered by the provider company. Between the two visits, the inspector made telephone contact with the near relatives of two people. One of them decided to visit their relative at the home at the same time as the inspector’s second visit, when it was possible to meet and talk further. The judgements contained in this report have been made from evidence gathered during the inspection, which included the visit to the service and taking into account the experiences of people using the service. What the service does well: Each person had a support plan. These used standard sections and were easy to follow. They made sure people’s needs were understood. Relatives spoken to confirmed they were invited to care reviews, and able to talk about care needs at any other time. A standard section of support plans concerned provisions for people’s privacy. Two people were seen at different times choosing to go to their bedrooms to Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 6 do things on their own. People got up and went to bed when they chose. People living in the home helped to answer the front door. Care plans emphasised a person-centred approach, to include respect for diverse needs. There were photographs that showed people’s involvement in various activities. All three people had bus passes and had used them. They also shared use of a car and a minibus with people from two nearby homes. They went on a variety of trips out. Two people had recently been to a wildlife park. Food shopping was done when there were two members of staff on duty, so people could choose whether to join in the shopping. The people living in the home had been together a long time. Staff had a good understanding of the close friendships between them. Relatives that the inspector spoke to said the home had always communicated well with them and been open to suggestions and comment. They were very pleased with the standard of care provided. Daily diaries showed that care and support were offered in line with support plans. The community learning disabilities nurse and a physiotherapist had written about the staff working well with them to make sure people stayed in good health. The three bedrooms in use reflected the personalities and interests of the people living there. A visitor said they were very pleased with their relative’s room and obvious enjoyment of it. People seemed proud of their rooms. Standards of cleanliness were high, including in toilets and the kitchen. What has improved since the last inspection? As well as adding Mrs McGrorty to the management, the company has also appointed an administrator. These appointments have enabled more consistent liaison between the company and placing authorities. It was clear that considerable effort has been put to overhauling systems of working, training and recording. Policies and procedures have been put in place, and old ones updated. Mrs McGrorty has adopted a mentoring approach to Miss Britten’s role as registered manager. The main improvement in the home has been an increase in staff availability. Where previously the home had relied on staff working alone, there were now two staff on duty on four days per week, including one day each weekend. This meant activities could be actively promoted. A community learning disabilities nurse noted in her response to the home’s quality assurance questionnaire that people had become more involved in the running of the home as a result. A day resource manager saw that increased staffing had led to more activity for the people who lived at the home. The domestic nature of every day life in the home means that sole staffing is appropriate at times. Staff are supported by on-call arrangements and by the availability of transport and escort staff shared with two nearby homes run by the same company. There were no Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 7 longer any times when people from one home spent time in another because of inadequate staffing, which had been a concern at previous inspections. Recommendations made at the previous inspection, to improve the safety of practice and recording in administering medicines, had been followed. An external trainer for abuse awareness training for all staff had been found and provided training to all staff. The nature and recording of staff supervision were much improved, as were staff records generally. Recruitment was in line with the checks and timescales that have to be followed by all providers, which was not the case at the previous inspection. Quality assurance methods had been researched, as recommended, and a system put in place to obtain information from external health and social care professionals, care managers and relatives. This was to help guide future development of the service. At the previous inspection the home had presented as poor in terms of cleanliness and décor. It had now been redecorated throughout, and was clean to a high standard. Department of Health cleaning guidelines were followed. Monthly monitoring ensured shortfalls were identified and corrected. What they could do better: None of the people living in the home were able sign the care plans to show their agreement with them. If care managers or relatives were invited to do so, this would demonstrate the home working in partnership with those who are significant to the people living there. Another improvement to support plans would be to set goals with people. When someone lives in one place for a long time it is easy to settle into a routine without learning many new things. If people were helped to concentrate on particular life skills or interests for a period of time, they could get a sense of achievement and progress. One person had been supported to bake cakes, but this had been just once, a few months previously. If it was planned because of a goal, such pieces of work might be more regular. Induction records for recently recruited staff did not provide evidence that recognised essential elements of induction were provided. There was an urgent need to set up a structured induction for new staff. At the previous inspection, there was a requirement to bring the home’s Statement of Purpose up to date, so that it reflects the service provided. This piece of work was almost completed. There is a new requirement to complete the document quickly, and supply copies to the Commission for Social Care Inspection and to relatives of the people in the home. This will enable people to judge how well the home meets its own aims. Another related requirement is for the home to finalise its admissions policy, including devising a form of assessment. This will mean that when they are in a position to fill the vacant room, they can prove how they may meet the needs of anyone referred. Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 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 Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 2. Quality in this outcome area is adequate. Full information and assessment procedures are not available to prospective users of the service, although admission of any person is not likely before these shortfalls can be made good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a requirement at the previous inspection to keep the home’s statement of purpose up to date. A draft document showed this requirement was being met, alongside improving the statement of purpose generally. All essential items were included, although the ways the home upholds people’s privacy and dignity needed to be described. It was agreed that copies of the completed document would be sent to relatives and care managers of all people living there, as well as being supplied to anyone making a referral to the home. The document was prepared in a way to make it easy to read. Supporters of people living there need it to be able to understand the home’s aims and to judge how well the home is meeting them. The home had a vacant room, but there were no plans to fill this place in the near future, because of the needs presented by a person currently living there. A longer-term intention in the service was to develop an improved pictorial guide for prospective residents. Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 11 There was a recently developed policy for admissions. This relied too much on using assessments by other professionals, rather than giving guidance on an assessment process by the service. There was a need for an assessment tool that would demonstrate what needs were identified, and how the home would meet them or why they could not meet them. The policy also did not spell out the stated commitment to offer trial visits and stays as part of an assessment process. Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is good. People’s assessed needs are reflected in care and support plans, which are reviewed and changed as necessary. People are supported in making decisions about their everyday lives. Setting of longer-term goals could help give a sense of achievement and progress. Risks are identified, and assessed in such a way as to encourage safe participation in a range of activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person had a support plan. These used standard sections and were easy to follow. For two of the people in the home, care review dates had been set with their care managers for 2007. The manager was trying to establish a review date for the third. Relatives spoken to confirmed they were invited to care reviews, and able to talk about care needs at any other time. None of the people living in the home were able sign the care plans to show their agreement with them. If care managers and/or relatives were invited to do so, this would demonstrate the home working in partnership with those who are significant to the people living there. Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 13 Another improvement to support plans would be to set goals with people. When someone lives in one place for a long time it is easy to settle into a routine without learning many new things. One person had been supported to bake cakes, but this had been just once, a few months previously. If it was planned because of a goal, such pieces of work might be more regular. A new, brief care plan format was shown. This was not intended to replace the full support plans but was especially to guide new and relief staff on essential routines and personal care needs. This could also be used as a “grab sheet” in an emergency, such as a hospital admission, to share information with others. One of the standard sections of support plans was a person’s communication needs. A speech and language therapist was working actively with two people. Another standard section concerned provisions for people’s privacy. For one person, for example, it was explained by reference to a risk assessment, why there was no lock fitted to their bedroom door. To compensate, there were directions to knock before entering, and to leave their door closed at night. Two people were seen at different times choosing to go to their bedrooms to do things on their own. People got up and went to bed when they chose. People living in the home were involved in answering the front door, with support. Care plans emphasised a person-centred approach, to include respect for diverse needs. The people working in the office at the rear were expected to use the side path for access, and not to go into the house. Miss Britten had requested a screen to be put up so that the office would not overlook the back of the house. The company planned to move the office elsewhere. There was a new policy on risk taking and risk management. The statement of purpose described the service as “risk aware but not risk averse”. Risk assessments seen were of good quality. Some had been amended, showing they were working documents that were reviewed. They were checked as part of monthly management audits. A recent audit had found that a person’s risk assessments were overdue for review, and directed this to be corrected. A good example of active risk assessment was seen in action. A person wished to accompany a member of staff as they went to collect another person from a day activity. Staff on duty discussed how to use the vehicle’s seating in the safest way to meet the person’s wish to go. The decisions reached were later seen to fit with a written risk assessment to cover these situations, which had been reviewed in recent weeks. Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17. Quality in this outcome area is good. Varied activities give people access to the community and opportunities to maintain leisure interests. Relationships with families and friends are encouraged. People participate in everyday tasks and their rights are respected. A healthy diet is offered, and mealtimes are conducted as people want. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People had a range of things they enjoyed doing in the home, such as jigsaws, in their rooms and in the sitting room. One person got a box of their things from the dresser without help and occupied themselves at the dining table. A television was left on in the sitting room, which was said to be the choice of the people who live there. Two people joined in an exchange with a member of staff about favourite TV programmes. In their own rooms, people had audiovisual equipment and sensory items like lights, which they clearly used when they wished. Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 15 Support plans showed how people were involved in daily and weekly tasks in the home. For one person it was noted they were unable to be involved in cleaning, but they could assist with sorting their washing. Another was directly involved in cleaning their own room and communal rooms. A community learning disabilities nurse noted in her response to the home’s quality assurance questionnaire that people had become more involved in the running of the home over preceding months. Two people attended a resource centre in Marlborough for one or more sessions a week. In her response to the quality questionnaire, the manager of the resource centre said the people often referred to things they had done with home staff. She described the home as a “client-led service”. She saw evidence of increased staffing, which had led to more activity for the people who lived there. She also commented on good handover of information from the home, and joint review sessions. The future of day resource provision was uncertain and so Miss Britten and Mrs McGrorty were considering alternative ways of providing activity and stimulation. Now that the rota provided more than one member of staff on four days a week, community access had become regular. People were supported to go out on foot or by wheelchair into the village or further afield by car or minibus. All three people had bus passes and had used them. There was an intention to try going out by train. There was evidence of a variety of trips out. Two people had recently been to a wildlife park. Food shopping was done when there were two members of staff on duty, so people could choose whether to join in the shopping. There were photographs that showed people’s involvement in various activities. Two people chose to go regularly to a local club for people with learning difficulties. Staff from the nearby homes were able to assist with transport to day resources and the club, using the company’s transport, which took pressure off staff in the home. There were no longer any instances of people from one home spending time in another because of inadequate staffing. One person was due to go on holiday to the Canaries with people they knew from other houses in the company. Two staff, whose costs were covered by the company, were to support them. Experience had shown the other people in the home preferred to have lots of day trips rather than go away on holiday. The people living in the home had been together a long time. Staff had a good understanding of the close friendships between them. The home also had a dog that was clearly valued by all. Relationships with families were encouraged. A visitor said he had been pleased to receive a father’s day card that their relative had been supported to send. He felt welcome to contact the home in any way, at any time, and described a good exchange of information. Another parent said the home helped them to have as much contact as they and their relative could manage. They said “we can look at his room and his finances any time”. They appreciated that their relative had a wide choice of Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 16 clothes that reflected their age and personality and were well looked after. They were kept informed quickly of anything affecting their relative. There was a planned menu that ensured a balance of the main food groups. It could be easily varied to take account of things like exceptional weather. Care plans showed food preferences. Drinks were regularly offered. During the inspection visit a person particularly asked for baked beans with their evening meal and they were provided. The dining area was homely and looked out through patio doors to the garden. Another table and chairs on the patio, under a parasol, provided an alternative place to eat in good weather. Miss Britten said it was usual then for two people to eat outside, while the other chose to stay at the inside table with the doors open. Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is good. The home provides personal support in line with people’s preferences and needs. There are good links and systems to ensure physical and emotional health needs are met. People are protected by the home’s medication procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was good written guidance about how people liked to be supported with their personal care needs. Times for meals and baths, and getting up and going to bed, were flexible to fit with people’s choices and activities. People were allocated a “key worker”, who was responsible for maintaining routine health appointments and checking on clothing needs. Otherwise, all staff knew the people well and were able to care and support in a consistent way. Daily diaries were kept for each person. These contained good records to show that care and support were offered in line with support plans. For one person, an additional diary was kept to monitor particular issues, at the request of a consultant. There was evidence of close liaison in both directions between home staff and the consultant, including quarterly home visits, to the benefit of the person concerned. Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 18 The community learning disabilities nurse had undertaken “OK Health Checks” for all people in the home, and had produced an epilepsy profile for one person. In her response to the home’s quality assurance questionnaire in May 2007, she noted that health and incident recording had shown improvements over preceding months. She recognised “good staff attitudes” and wrote: “Requests for information or to carry out guidelines are met.” Another response was from a physiotherapist: “Staff are receptive to advice and positively working in partnership in promotion of health preventative working.” All staff had received update training about epilepsy in April 2007. Miss Britten had been trained in use of a standing aid provided to a person, and was able to share this training with the other staff. One person’s weight recording had lapsed in December 2006. Miss Britten arranged to restart this, because any changes noted can act as a warning of a change in health. Following a requirement at the previous inspection, there had been some improvement to care planning for the same person’s pressure area care. However, it was necessary to advise further improvements for clarity and to ensure all pressure area risks for the person are recognised. The home had developed a general risk assessment concerning pressure area care needs, which also required some changes for clarification. The storage and recording of use of medicines were very orderly and safe. Miss Britten said she checks the medicines administration charts every time she is in the home. There were records of staff training in the administration system used by the supplying pharmacist. The company had a medications policy that ensured safe practice. Recommendations made at the previous inspection, to improve the safety of practice and recording in administering medicines, had been followed. Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. There are appropriate procedures, including staff training, to protect people from harm, and to receive and act on complaints. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints information provided to people’s representatives was satisfactory. Relatives who were spoken to considered the home and provider to be approachable and had experience of satisfactory responses to queries raised. No formal complaints had been received since the previous inspection. In line with a recommendation made at the previous inspection, an external trainer for abuse awareness training for all staff had been found and provided training to all staff. There was provision for updating this every two years. Staff had been issued with the latest version of the “No Secrets” brief guidance to local inter-agency safeguarding procedures. A draft policy on abuse, which included “whistle blowing” provision, was not fully compliant with these procedures, but was corrected during the inspection. There was an effective policy and procedure covering any incident of a person going missing. An event in another of the company’s homes has enabled Mrs McGrorty to demonstrate compliance with local safeguarding procedures, showing people are protected in this service. Earlier in 2007, Mrs McGrorty took and acted on advice about a potentially difficult matter in the home, from both the Commission and the community team for people with learning disabilities. Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 20 None of the people living in the home were able to understand use of money. A County Council appointee protected their interests. There was evidence of positive links between the home and the appointee, who visited the home twice a year. Internal monthly monitoring also included checks on accuracy of records of handling of people’s money. Log sheets were kept of all movements of money between the appointee, residents’ cash accounts, money tins and spending, with receipts kept for all but the most minor spending. Staff saw most user-focused spending as mundane, on items like toiletries and clothes. So if a person showed interest in something that might enhance everyday experience, such as a pot plant, or a souvenir from an outing, such a purchase would be supported. This approach was guided by a policy on management of people’s money, and helped to add to the homeliness of the home. There was work in progress, including obtaining appointee advice, on ensuring people received full entitlement to mobility allowances. Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 & 30. Quality in this outcome area is excellent. 27 Stratton Road provides a homely environment, maintained and kept clean to a high standard. Individual bedrooms reflect people’s needs and lifestyles. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is an “ordinary” domestic property on an estate of similar houses. It had been redecorated since the previous inspection, when it was described as “deteriorated … with some areas needing a good clean”. Now it was clean and homely throughout. Furniture was good quality. There was a maintenance plan. However, staff commented that tasks such as hedge cutting and lawn mowing could take them away from direct care and support tasks. The three bedrooms in use reflected the personalities and interests of the people living there. A visitor said they were very pleased with their relative’s room and obvious enjoyment of it. People seemed proud of their rooms. Diaries showed they made daily choices of when and how to use their own and the communal rooms. Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 22 There was a recently developed policy on infection control. This was based on Department of Health “Essential Steps” guidance. Standards of cleanliness were high, including in toilets and the kitchen. Staff said they saw routine cleaning as an integral part of the overall care task. Individuals’ toiletries were kept in separate boxes in the wet room, labelled with their names, to ensure they could not be used by each other. There were appropriate procedures for disposal of soiled waste. There was a well-planned utility room with washing machine and drier. There were hand-washing sinks in there and in the kitchen. Staff had ready access to protective clothing, with guidance on those tasks where this was to be used. Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36. Quality in this outcome area is good. People are supported by competent, trained staff, who experience regular supervision and are supported by an employer committed to staff development. Recruitment practices ensure people are protected from being cared for by unsuitable staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Personnel information was kept efficiently, in line with a recommendation made at the previous inspection. In the office there was a training matrix showing what training each member of staff in the company had achieved, and when renewals were due. Copies of certificates were held in individual staff files. The administrator had a meeting arranged with a new training provider, with a view to buying in a number of courses. This might include an induction course. There was an urgent need to set up a structured induction for new staff. Induction records for recently recruited staff did not provide evidence that recognised essential elements of induction were provided. Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 24 Some members of staff had been affected by the collapse of a firm that provided training for National Vocational Qualification (NVQ) in care. However, arrangements were in hand to support staff to achieve NVQ to level 2 at least, which is an expectation of the company for all support staff. The company employed 14 support staff across the three homes. Of these, five had achieved NVQ level 2, and three were currently working towards it. At various times, staff have to work alone, including when sleeping-in overnight. There was a lone working policy. An on-call manager was always available. Staff operated a handover of information each morning between shifts. All interactions seen between staff and people in the home were positive and focused on individuals’ needs. The community learning disabilities nurse who responded to the service’s quality questionnaire noted, “Feedback, continuity and consistency have improved. Verbal & written feedback are thoroughly carried out as agreed. Staff are willing to take on and complete pieces of work. Staff attitudes to individuals are overall more positive, reflected in the words they choose to use.” The company had been in a position to recruit additional staff, including two relief staff. Records for the most recently recruited staff showed they were interviewed by two of the company management team, with notes kept of the content of interview. In one case, a person living at one of the other homes took part in the interview, something Mrs McGrorty hopes to develop further. At the previous inspection, there was a requirement that the completion of checks, before people began work, was fully documented. On this occasion it could be easily seen that new staff did not start working for the company until after the company had received disclosures from the Criminal Records Bureau (CRB) and confirmation that the individuals were not listed on the Protection of Vulnerable Adults (POVA) list. Two references were obtained for each person recruited. There were photographs of all members of staff. Identity cards were being developed, so that in any situation outside the home, staff could prove to others their duty of care. One staff member in each of the company’s homes is being made a “senior support worker”. They will have responsibility for regular formal supervision of support workers, whilst being supervised themselves by the home manager. Records showed that Miss Britten and Mrs McGrorty have maintained supervision of all staff. This occurred every four to six weeks, each session ending with setting a date for the next one. There was recent experience within the company of supervising individuals more frequently for particular reasons. Supervisions were recorded on a standard format, which proved them to be a meaningful exercise. Improvements were in line with previous recommendations. Mrs McGrorty considered the system well enough established for annual appraisals to be started. Stratton Road (27) DS0000028213.V337441.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. Quality in this outcome area is good. The management team provides leadership and direction so people benefit from a well run home. Quality assurance systems include obtaining the views of service users’ supporters to monitor and improve the service. There are systems in place to identify and promote the health and safety needs of residents and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the previous inspection, the company has appointed Mrs McGrorty as service manager, and there is also now an administrator. These appointments have enabled more consistent liaison between the company and placing authorities. It was clear that considerable effort has been put to improving systems of working, training and recording. New policies and procedures have been put in place and old ones updated. Miss Britten, meanwhile, has continued to play a significant part on the staffing rota in 27 Stratton Road. Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 26 Mrs McGrorty described a mentoring role towards Miss Britten. It was planned to pass manager responsibilities increasingly back to Miss Britten; the greater staff availability enables her to work less as part of the support staffing rota. The two women plan to complete the Registered Managers Award together. Following a recommendation at the previous inspection, an annual quality assurance exercise has been put in place, including a feedback tool to be used with people living in the home. Questionnaires were sent to a range of professionals in May 2007 and a number of full responses had been received. There was also a staff questionnaire that was beginning to yield responses. A questionnaire for people’s near relatives was about to be sent out. The purpose of the whole exercise was to identify areas for development. Health and social care professionals who responded identified management changes as having been effective. One said changes had been “not too fast for service users to understand.” Relatives that the inspector spoke to said the home had always communicated well with them and been open to suggestions and comment. Reviews of people’s needs, and how the home meets them, were seen as thorough and brought about changes. Another source of monitoring was a recorded monthly provider visit, which included observing and interacting with the people living in the home. The monthly monitoring visits also acted as an audit of health and safety measures, including fire precautions and drills. Records were sampled. Action points were indicated where any shortfall or developmental need was found. The records of these visits would be improved by showing who was responsible for any task identified. They could then be signed off when the required actions had been taken. There were arrangements for the training of staff in moving and handling, fire safety, first aid, food hygiene and infection control. Stratton Road (27) DS0000028213.V337441.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 2 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 4 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO 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) Requirement The revised statement of purpose must be completed, ensuring full compliance with Schedule 1. Copies must be provided to the Commission and to a representative of each service user. The home’s admissions policy and assessment tool must enable the registered person to confirm in writing whether the home can meet the person’s needs in respect of their health and welfare. All staff must be provided with structured induction training. Timescale for action 01/08/07 2. YA2 14 (1) (c,d) 01/08/07 3. YA35 18 (1)(c)(i) (2)(b) 01/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 29 1. 2. 3. 4. YA6 YA7 YA6 YA24 YA31 YA37 YA42 Invite care managers and significant relatives or advocates to sign agreement to support plans. Aim to set goals as part of the care planning process. Support staff time should not be taken up by property maintenance tasks such as lawn mowing. Monthly audit records should show to whom identified actions have been delegated, and when they have been completed. Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Stratton Road (27) DS0000028213.V337441.R01.S.doc Version 5.2 Page 31 - 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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