Inspection on 21/06/05 for Stratton Road (27)

This inspection was carried out on 21st June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Stratton Road (27) 11/06/07

Stratton Road (27) 28/06/06

Stratton Road (27) 02/11/05

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 Alison Duffy Announced 21 June 2005 st 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 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 Stationary 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) D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 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 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 LD Learning Disability (4) registration, with number of places Stratton Road (27) D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th January 2005 Brief Description of the Service: 27 Stratton Road has recently increased its registration from three people with a learning disability to four. The additional vacancy has not however been filled and therefore three service users continue to live within the home at this time. 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 Lance works closely with her daughter, Miss Britten. 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 on either the ground or first floor. Service users require a high level of staff assistance and communication is limited. The home has one member of staff on duty throughout the waking day and sleeping in cover is provided at night. Stratton Road (27) D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 27 Stratton Road is one of three care homes owned by Landlace Care Homes Limited. As all homes are similar in nature it was agreed to undertake the announced inspections of all services over a period of three days. This inspection was scheduled and took place on the 21st June 2005. The inspection commenced at 9.45am and was completed at 5pm. Miss Britten was the sole member of staff on duty and therefore available throughout the inspection. The inspector discussed current arrangements within the home with Miss Britten. Time was also spent viewing care planning information and daily records, personnel and training records, policies and procedures and health and safety information. Time was spent with a service user in her room, looking at recent holiday photographs. Due to complex need and communication difficulties however, feedback regarding the service was limited. Much of the inspection was therefore based on observation and interactions with Miss Britten. As part of the announced inspection process, four comment cards were received. One was from a service user and three were from family members. The service user identified being happy within the home and three family members were satisfied with the care provided. Three were not aware of the home’s complaint procedure and two were not aware of forthcoming inspections. One highlighted that there were not always sufficient staff on duty and two reported that they were not always kept informed of important matters. One highlighted that they were not consulted regarding the service user’s care and another reported that they could not visit their relative in private. These matters were discussed with Miss Britten and will be addressed as required. What the service does well: What has improved since the last inspection? All care planning information and risk assessments have recently been reviewed. The documentation identifies detail and individual need. All documents now also correspond and follow through, rather than showing some conflicting information. Stratton Road (27) D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 Page 6 Policies and procedures have also received significant attention. Despite some aspects requiring clarity, all are well written, detailed and easy to read. At the last and subsequent inspection, a requirement was made for all staff to have up to date food hygiene training. This has been undertaken. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Stratton Road (27) D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Stratton Road (27) D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 and 4 There is an established admission policy, yet staffing levels are insufficient at this time, to meet the needs of an additional service user. EVIDENCE: 27 Stratton Road has recently been registered for an additional room enabling the home to accommodate four service users. A prospective service user has visited the home for a look around, has had lunch and attended a bar-b-que. The visit however was not entirely successful and the need for one-to-one staff support was identified. Miss Britten reported that this was not appropriate and therefore the home could not meet the person’s needs at this time. Miss Britten believed that a further visit or a possible overnight stay had been arranged. This was discussed and it was agreed that this would not be appropriate, as the admission must not take place without additional staffing and confirmation that the person’s needs would be met within the home. Stratton Road (27) D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 Page 9 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 standard(s) 6, 7 and 9 Care planning is up to date and of a good standard enabling service users’ needs to be met. Residents’ safety is safeguarded through appropriate risk taking and decision-making is satisfactorily undertaken in relation to need. EVIDENCE: Since the last inspection, all care plans have been updated. All contain detailed information and are well written. Certain matters identified within plans were addressed within risk assessments as appropriate. Instructions such as monitoring a services user’s weight were also followed through. Clear behavioural management guidelines were available for one service user. Due to varying levels of communication and understanding the decision making process is limited. However, staff promote choices and decision making in relation to ability. There were examples throughout the inspection of positive interaction and staff asking closed questions in order to gain involvement. All service users require full support, do not go out unattended and have limited involvement with housekeeping tasks. Risk taking is generally related to maintaining a condition such as epilepsy within daily routines and activity. The home has a new ‘absent without leave policy.’ This would benefit from clarity with particular attention to police involvement. Developing the policy on an individual basis would also be of benefit. Stratton Road (27) D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 Page 10 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 standard(s) 12, 13, 14, 15, 16 and 17 The home is relaxed with positive relationships and hospitality evident. While service users have some opportunities for external activity, current staffing levels give restriction. EVIDENCE: The home is located within a residential area close to the main amenities of the village. Service users sometimes visit the local shops or make use of the local bus service with staff assistance. On many occasions however these take place with staff covering within off duty time. Activities are tailored to individual needs. One service user recently enjoyed a very successful holiday to Lanzarote with other service users and staff from within Landlace Care Homes. One service user attends a day service four days a week, another has one session and the third service user chooses not to attend. The service user attending for one session does so with a member of staff. It was highlighted within a recent review record that staffing shortages have restricted such attendance and have also limited activities such as swimming. This was discussed with Miss Britten who reported that unfortunately this is sometimes the case. Such information was confirmed on the day of the inspection as although it was a sunny day, external activity was not available due to there Stratton Road (27) D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 Page 11 only being one member of staff on duty. Due to individual circumstances, visits from friends and family are infrequent. Visits are however encouraged and transport can be provided if required. Hospitality was evident throughout the inspection. Various interactions and discussions demonstrated that service users’ rights are fully promoted and respected. The home has a menu, which is generally developed according to service users’ likes. A snack is provided at lunchtime and on the day of the inspection, service users were asked what they wanted. The main meal of the day is taken at teatime. All meals are taken at the table in the lounge/dining room. Stratton Road (27) D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 Page 12 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 standard(s) 18, 19 and 20 Service users’ health care is well managed. Well-organised medication systems minimise the risk of errors to service users. EVIDENCE: All service users require a high level of staff assistance with all daily living tasks and routines. This is fully documented within care planning information. Very clear epilepsy management guidelines, developed with specialist input, are in place. Daily records demonstrated recognition of ill health and appropriate follow up action. Input from other professional services was evident. Service users do not have the ability to self medicate. All medication was stored securely in a locked cupboard. Records demonstrated receipt, disposal and appropriate administration of medication. A GP has signed a homely remedies policy and information sheets are available for each medication used. Information from the internet has also been gained. There is a clear medication policy in place. Miss Britten reported that she is currently making arrangements for the medication to be transferred to a monitored dosage system. Stratton Road (27) D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 Page 13 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 standard(s) 22 and 23 Information regarding the complaint procedure is not freely available to individuals who may act on behalf of service users. The home’s adult protection systems are insufficient at this time to fully protect service users. EVIDENCE: Each service user has a copy of the complaints procedure within their file. However due to limited comprehension, service users would not be able to use this. It was noted within comment cards that some family members were not aware of the home’s complaint procedure. Miss Britten was informed of the need to forward the procedure to them, especially as service users are unable to make a complaint themselves. There have been no formal complaints reported to the CSCI. The home’s adult protection policy has been updated and gives a line of command for reporting a suspicion or allegation of abuse. At the last inspection a requirement was made to ensure all staff were aware of their responsibilities by undertaking specific training. However due to restrictions with Miss Britten’s time, this requirement remains outstanding. It was noted within daily notes and body maps that staff had recognised some bruising on one service user. It was not immediately apparent how this had been sustained. In this event Miss Britten was informed of the need to investigate such by gaining information from day services as appropriate. Service users do not manage their financial affairs and all have appointees with their placing authorities. The home has an unwritten policy for transport, contributing to gifts and subsidising staff when out. Miss Britten was informed however of the need to formalise such within a written policy. Stratton Road (27) D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 Page 14 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 standard(s) 26 and 28 The home is comfortable, homely and well maintained. All areas are furnished to a good standard and meet service users’ needs. EVIDENCE: All service users have a single room on either the ground or first floor. One service user enjoys listening to music and viewing photographs within her room when not at her day service. Two other service users do not use their rooms during the day. Rooms are comfortable and linked to individual need. The home has a pleasant lounge/dining room which opens on to a patio area. There is an unused summerhouse in the garden, which Miss Britten hopes to turn into an activity area for service users. Stratton Road (27) D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35 and 36 Staffing arrangements at this time are restricting opportunities to service users and not enabling individual needs to be met. Staff supervision is given insufficient priority, which compromises the development of the home and of care provision. EVIDENCE: The home operates at one member of staff on duty throughout the waking day. At night a member of staff provides sleeping in cover. The home has a small team of two staff and Miss Britten. This does not enable any flexibility and external activities are usually facilitated by staff in their off duty time. Miss Britten undertakes a high level of shifts as part of the working roster, which restricts the completion of management responsibilities. In the event of an additional service user, staffing levels must be increased to two staff during the waking day. At present, one service user is not sleeping. This means that the sleeping in member of staff often has a very disturbed night. In the event of this situation continuing, consideration must be given to replacing the sleeping in role with a waking night. On the day of the inspection staff were undertaking food hygiene training. Both members have an up to date first aid certificate and have undertaken matters related to service users such as epilepsy. One member of staff has recently completed NVQ level 2. Adult protection training however, as stated earlier in Stratton Road (27) D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 Page 16 this report is required. The staff team works well together and Miss Britten regularly meets with staff on an informal basis. Despite a requirement being made at the last inspection, formal supervision has not been instigated due to time restrictions. The requirement is therefore repeated. There have been no new staff within the home. It was noted however that references and a POVAFirst check were not undertaken in another of the care homes within the organisation. Discussion took place with Miss Britten regarding recruitment and it was reported that the necessary checks would be followed. Stratton Road (27) D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 41 and 42 The home is enthusiastically managed with the well being of service users at the centre of interactions. Health and safety systems generally promote service users’ wellbeing although fire safety requires further attention. EVIDENCE: Miss Britten has almost completed NVQ level 3 and is then intending to register for NVQ level 4. Miss Britten has a strong value base and has built excellent relationships with service users. She is totally committed, enthusiastic and demonstrates a clear awareness of service users’ needs. Miss Britten works a high level of care shifts as part of the working roster, which means she generally sole works. Although positive for service users, this is restrictive in relation to management responsibilities and must be addressed. The home is well maintained. Low surface temperatures are in place and hot water, although regulated centrally is regularly monitored and recorded appropriately. Documentation demonstrates the testing of the portable electrical appliances. Staff are up to date with their mandatory training and Stratton Road (27) D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 Page 18 policies as required from the last inspection have been undertaken. These include lone working and driving the home’s vehicle. Mrs Lance has given significant effort to developing policies and procedures since the last inspection. All are well written, informative and easy to read. Some policies however require clarity for the service. For example, within the management of aggression policy, information is given regarding panic alarms, which is not relevant to the home. Others recognise matters such as the need for annual training yet there is no evidence of such training, taking place. There is a copy of the General Social Care Council’s Code of Conduct within the policies and procedures file. Risk assessments have recently been reviewed and are therefore all up to date. One assessment however relating to hand washing needs to be clarified. The fire risk assessment, as identified at the last inspection also remains outstanding. The fire log book was generally well maintained. All systems except the emergency lighting had been tested as required. Stratton Road (27) D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 2 3 x Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x 3 x 3 x x Standard No 11 12 13 14 15 16 17 x 2 3 2 3 3 3 Standard No 31 32 33 34 35 36 Score x x 2 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Stratton Road (27) Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 3 x x 2 2 x D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 Page 20 No 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 3 Regulation 18(1)(a) Requirement The Registered Person must ensure that the prospective service users needs will be met within the home and staffing levels will be increased to two members of staff throughout the waking day at the time of admission. The Registered Person must ensure that staffing levels enable all service users to have opportunities for leisure activities in and outside of the home. The Registered Person must ensure that all family members are aware of the homes complaint proceedure. The Registered Person must ensure that all staff receive adult protection training. This was identified at the last inspection. The Registered Person must ensure that any bruising identified on service users is fully investigated. The Registered Person must ensure that a policy is devised regarding payment of transport and staffing costs when out. The Registered Person must ensure that night disturbance Timescale for action At the time of the next admission. 2. 12 and 14 16(2)(n) 30th September 2005 31st July 2005 30th September 2005 From 21st June 2005 31st July 2005 31st August Page 21 3. 22 22 4. 23 13(6) 5. 23 13(6) 6. 23 13(6) 7. 33 18(1)(a) Stratton Road (27) D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 8. 36 18(2) 9. 37 18 10. 41 12(1)(a) 11. 42 23(4) within the sleeping in provision continues to be monitored and is replaced with a waking night, as approriate. The Registered Person must ensure that a formal system of recorded staff supervision is developed and maintained. This was identified at the last inspection. The Registered Person must ensure that the Registered Manager is not an integral part of the working roster. This was identified at the last inspection. The Registered Person must ensure that all policies and procedures are specifically related to service provision. The Registered Person must ensure that a fire risk assessment is carried out. This was identified at the last inpection. 2005 30th September 2005 31st October 2005 31st August 2005 31st August 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 9 42 42 Good Practice Recommendations The Registered Person should ensure that the missing person procedure is developed on an individual basis and police involvement is clarified. The Registered Person should ensure that the risk assessment involving hand washing is clarified. The Registered Person should ensure that the emergency lighting is tested on a monthly basis and documented within the fire log book. Stratton Road (27) D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI Stratton Road (27) D51_D01_S28213_STRATTONRD(27)_v205760_210605Stage4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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