Inspection on 28/06/06 for Stratton Road (27)

This inspection was carried out on 28th June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stratton Road (27) 11/06/07

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 Alison Duffy Key Inspection 28th June 2006 09:30 Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 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.V291632.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd November 2005 Brief Description of the Service: 27 Stratton Road is registered to care for four people with a learning disability. The additional vacancy however has never been filled and therefore three service users continue to live at the home. 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 domestic in style. 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) DS0000028213.V291632.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place initially on June 28th 2006 between the hours of 9.30am and 2.45pm. On arrival at the home Miss Britten was on duty after completing sleeping in provision. Her shift was due to finish at 10am but due to the inspection, she left at 12.15pm. Ms Anita Ellis, support worker then continued to assist as required. A second day to complete the inspection took place between 11.30am and 4.30pm on the 3rd August 2006. Miss Britten was available throughout, yet was the sole member of staff on duty. At the end of the inspection, Miss Britten contacted Mrs Lance to request her presence for the feedback. Discussion therefore took place with Mrs Lance and Miss Britten. At the beginning of the inspection, two service users were in the home. At lunchtime, another service user from another of the care homes within the organisation arrived for the afternoon. Interactions were generally positive although activity was minimal due to staffing levels. The inspector met with the third service user of the home on their return from their day service. Current care provision was discussed with Miss Britten. Miss Britten also highlighted various developments, which had taken place since the last inspection. Restrictions, including the difficulties of recruiting staff were also raised. The inspector then viewed documentation including care planning information, health and safety material and staffing records. A tour of the accommodation was made and discussion took place with Ms Ellis. Service users’ monies held for safekeeping and the medication systems were also viewed. Due to complex disabilities, service users were unable to give substantial feedback, about the service received. Views of service users’ experiences were assessed through observations, discussions with staff and viewing various documentations. Comment cards were also forwarded to each service user’s primary relative and a number of health and social care professionals. All comment cards from relatives were returned and all were satisfied with the overall care provided within the home. Specific comments included ‘I could not wish for a better place for my XX. The standard of care and professionalism of the staff is excellent.’ Another stated ‘the home has always looked after XX very well with no problems.’ Comment cards sent to placing authorities were not returned. The inspector received verbal feedback from one care manager, which was of a positive nature. The care manager reported that they were impressed with the homely feel to the service and the care provided. It is of serious concern to the inspector however that despite being identified on many inspections, back as far as November 2004, Miss Britten remains an integral part of the care staff roster. Mrs Lance has assured the CSCI on various occasions that other arrangements would be made so that Miss Britten could fulfil her management responsibilities. Miss Britten was removed for a period of two days a week earlier in the year, yet has resorted back to being Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 6 on the roster on a full time basis. This, combined with inadequate staffing levels which cannot facilitate leisure opportunities to service users, is totally unacceptable. Mrs Lance has assured the Inspector that this time, by the end of October 2006, the matter will be finally sorted. A random inspection will be completed after this timescale. If satisfactory arrangements are not in place, enforcement action will be taken. 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 the visit to the service and takes into account the views raised on behalf of service users. What the service does well: What has improved since the last inspection? What they could do better: Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 7 Current staffing levels remain at one member of staff throughout the day and night. Miss Britten also continues to be an integral part of the working roster. These issues have been raised on many occasions and despite a temporary improvement, the situation remains unchanged. Such staffing arrangements are having a significant detrimental effect on service users’ quality of life and the general environment. Social opportunities available to service users are extremely limited. For one service user in particular, much of the day is spent in the lounge, unoccupied. This area must be addressed. It is clearly evident, that due to the dependency of service users, one member of staff is insufficient. The environment in some areas is need of a good clean as staff do not have the time to undertake certain areas. It would also not be appropriate for a member of staff to be cleaning an upstairs room while service users are downstairs on their own. Due to insufficient management time, the storage of information is disorganised. New policies need to be put into place and staffing information needs to be sorted into some form of order. Documents such as the current Statement of Purpose also need to be readily available. A complaints log is required and greater attention must be given to fire safety. This must include fire drills, staff instruction and implications of lone working within the fire procedure. 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) DS0000028213.V291632.R01.S.doc Version 5.1 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 (27) DS0000028213.V291632.R01.S.doc Version 5.1 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): 1 and 2 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 current admission process ensures that potential needs will be met and the needs of existing service users are taken into account. The Statement of Purpose although well written, does not give enquirers an accurate reflection of service provision. EVIDENCE: 27 Stratton Road continues to have a vacancy that has never been filled. This is mainly due to Mrs Lance and Miss Britten being selective within their assessment criteria, which in time will assure an appropriate placement. For example, existing service users have a high level of need and therefore the placement needs to facilitate similar dependency in order to be successful. Miss Britten also commented that referrals often require a ground floor room, which cannot at this time, be accommodated. As existing service users have lived at the home for a long period of time, the admission procedure could not be examined in practice. It was evident however, that clear criteria is in place and a formalised process would be followed as required. This includes visiting the prospective service user in their existing environment and undertaking a full assessment. Various visits to the home would be facilitated. All would be varied in length in order to gain sufficient information to ensure that the home could meet the individual’s Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 10 needs. Communication with relatives and associated care professionals is viewed as an integral part of the process. It was noted that there are various versions of the Statement of Purpose. This is confusing and therefore out of date information needs to be filed appropriately. Although additions were made to the Statement of Purpose in April 2006 a number of aspects need review. These include details of staff and their qualifications. The document also states that regular trips to the cinema, restaurants and coach trips are provided and regular outings at weekends are arranged. In practice however, there is little evidence to demonstrate this and therefore documentation should be developed accordingly or the Statement of Purpose should be changed. Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected 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 good. This judgement has been made from evidence gathered both during and before the visit to this service. Care planning is of a good standard and gives staff sufficient detail to meet individual need. Although restrictive due to individual health conditions, staff encourage service users to be involved in decision-making. Service users’ safety is given priority. EVIDENCE: Each service user has a care plan that gives specific information on required care provision. For example detailed information highlights personal care routines such as dressing, bathing and eating. Interests, social skills and family links are also identified. There is a clear section on health. Required health care checks are fully recorded. One plan also demonstrates clear behavioural management guidelines. Discussion took place with Miss Britten regarding various systems to assist with the reviewing process. At present additional sheets have been added to the plan for changes as required. Miss Britten is also replacing parts of the care plan. It was agreed that the system of review could be flexible. The most important factor was to ensure that all plans were up to date and identified an accurate account of need and care provision. Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 12 Within the plans it was evident that specific instructions had been followed through. For example one service user needed to be weighed weekly. This was undertaken and recorded within a weight chart. It was identified that another service user was sometimes reluctant to get out of a vehicle. This was observed later in the inspection and the member of staff appropriately followed the documented guidelines. Within correspondence however, physiotherapy guidelines were identified, which had not been incorporated in detail within the plan. There was also no evidence that the proposed exercises had been undertaken. Due to abilities, service users are generally unable to make decisions about their life and how they wish their care to be delivered. Within care planning information, matters such as assisting service users to choose their clothing on a daily basis is encouraged. In some instances however, such decisions need to be made by staff. Miss Britten spoke of pictorial formats, which have been developed to assist service users with choosing their food. During the inspection, service users were also shown items of fruit so they could choose what they wanted. Other interactions encouraged a response through the use of short, concise questions. Within documentation it was noted that one service user has a limited understanding of makaton. This has been identified as an area for staff development. To date however there has not been any further progress. Within daily diary entries, particular incidents between service users were often resolved by one service user being asked to go to their room. Miss Britten reported, rather than giving an instruction to leave the room, staff always encourage an activity such as listening to music. Through discussion it was agreed that this could be seen as a form of restriction. The strategy should therefore be fully documented and be agreed with the service user’s care manager. Service users do not have the capacity to manage their financial affairs. All have appointees with their placing authorities. A small amount of personal money is kept within the home. Records are maintained and receipts demonstrate expenditure. Service users are unable to give their consent to how their money is spent. Items such as hanging baskets should therefore not be purchased with service users’ money without the agreement of the service user’s care manager or other representative. Participation within the home is limited due to the ability of service users. In some instances activity such as folding laundry, vacuuming and dusting may be undertaken in a restricted manner. Staff however undertake the main responsibility for all tasks. A staff photograph board has recently been developed in order to enable service users to know who is on duty. This is incomplete at present, as not all photographs have been taken. The board would also benefit from being bigger and therefore more conspicuous. Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 13 All service users need assistance and supervision with all daily living tasks. Personal safety is given careful consideration and therefore matters such as being in the bath unattended is not permitted. Service users do not go out unattended or use the kitchen when staff are preparing meals. A number of risk assessments have been developed and these take into account matters such as shopping, eating and using the stairs. It was agreed that consideration should be given to service users travelling without an escort in the home’s transport. This must also apply to other forms of transport without the accompaniment of a member of the home’s staff. Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Opportunities for social activity both inside and outside of the home are limited. This is restrictive and significantly reduces some service users’ quality of life. Service users are assisted to maintain important relationships. Catering arrangements appear satisfactory with variety offered within the evening meal. EVIDENCE: One service user continues to attend a day service four days a week and another attends for one session. Another service user chooses not to attend any day service. Miss Britten reported that this service user now visits another home within the organisation. This is generally for additional stimulation and to give other service users some space. While it is noted that the service user enjoys this time, the inspector was of the opinion that sufficient arrangements should be available within 27 Stratton Road. It should not be necessary for the service user to go to another home with additional staffing in order to meet individual need. Within the record of personal expenditures, it was noted that this service user often travels to collect service users from their day service. Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 15 While it is noted that the service user enjoys this, consideration should be given to the personal cost, in monetary terms, of this. Such expenditure should also be agreed with the service user’s care manager. Within daily diaries it was evident that one service user likes puzzles and DVDS. Such activity was generally undertaken in the evenings and at weekends. Other service users did not appear to have any particular interests that were undertaken in the home. On the first day of the inspection the television was on. Music was playing on the second day. There were no other forms of activity. One service user remained in their armchair throughout the inspection and only moved to the dining room table for lunch. Another service user, from another home within the organisation was also unoccupied. Such inactivity was raised at the last inspection and a requirement was made. The area has not been addressed. Limitations on social activity have also been raised within a formal review setting yet again changes have not been made. At the last inspection, Miss Britten reported that the summerhouse in the garden was being developed in order to become an activity centre. Progress however is slow and the area remains unfinished. Trips into the village are undertaken if a member of staff can stay on after their shift. Due to lone working, spontaneous trips out are not possible. While it is noted that visits to the cinema for example are not appropriate, other opportunities are limited. Within discussion, Ms Ellis reported that a trip had been made to the Cotswold Wildlife Centre. This was very successful and service users were attentive and interested in their surroundings. This appeared a contrast to the way one service user generally presents and therefore such trips should be regularly repeated. The home has its own transport and a new vehicle with a tail lift is planned. One service user enjoys a ride around the area on the local bus. To enable this however, a member of staff needs to undertake this on a voluntary basis or provide cover for the home. There are occasions when service users need to go to other homes within the organisation or go with staff to collect, for example a service user from their day service. In such instances, insufficient staffing clearly places limitations on service users’ choice. Routines within the home are flexible. Due to health conditions however, service users are unable to express their wishes regarding routines. Staff use observational skills to identify need. Privacy is respected yet keys to individual rooms are not appropriate. Staff were observed to be attentive and positive relationships were noted. Miss Britten reported that service users continue to be given assistance to maintain contact with their families. A list of special occasions is located within individual files and staff ensure family birthdays etc are not forgotten. Within comment cards, all relatives reported that they are welcomed into the home. They also commented that they could visit their relative in private. All except Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 16 one are kept informed of important matters although one relative reported that information is only exchanged on a visit. The catering arrangements within the home reflect those of a domestic setting. Service users generally have a snack such as sandwiches and fruit at lunchtime. The main cooked meal is provided in the evening. Staff, through experience, have identified service users’ preferences although Miss Britten reported that very few foods are disliked. A record of food is maintained. The record demonstrated greater variety with the evening meal although lunch is often similar. Miss Britten reported that she continues to undertake all food ordering. Staff on duty undertake full responsibility of meal preparation. During the inspection, service users were asked what they wanted in their sandwiches and were able to visually choose the fruit they preferred. Ms Ellis reported that staff always give assistance during meal times to ensure service users’ safety. The lunchtime period was observed to be pleasant and interactive. Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 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’ personal and health care are well managed yet pressure care management needs to be considered to minimise the risk of pressure damage. Clear medication systems are in place, which minimise the risk of error. EVIDENCE: Service users receive a high level of support with all aspects of daily living. Such routines are stated within care planning information although service users are unable, due to their level of disability, to express their views of how they wish their care to be provided. Care during the inspection, such as being assisted to the toilet was performed discreetly in a sensitive manner. The timings of daily living, including getting up and going to bed are flexible although are generally governed by observations of tiredness. Mealtimes are generally taken at similar times although are relaxed and informal. All service users have a daily diary which is used to detail matters such as ill health, activity and general well being. Within one diary, soreness was reported upon and a cream was applied. Miss Britten is therefore advised to address pressure care management within the service user’s care plan. It was also identified that another service user received soreness through prescribed Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 18 footwear. Again, the need for staff to observe such should be highlighted within the service user’s care plan. This should also include what staff should look for and the management of such. Within documentation and discussion with Ms Ellis it was evident that staff are attentive and identify any signs of ill health at an early stage. All service users are registered with the same GP practice and visit the surgery as required. One service user has recently received hospital treatment. Appropriate follow up care from the staff including pain relief was provided. Service users have access to other health care provision as required although regular appointments to the optician for example, are not undertaken due to levels of understanding and possible anxiety. A record of health care intervention is maintained. Documentation also demonstrates intervention from professionals such as the consultant psychiatrist. One service who suffers with epilepsy has a detailed epilepsy profile in place. The information was however completed in 2004 and therefore would benefit from review. Miss Britten confirmed arrangements are in place for this. Service users, due to their level of disability, are not able to 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. The pharmacy that provides the medication undertakes regular audits. Within a recent visit, the pharmacist advised that the existing cabinet is moved and replaced with a metal unit. It was agreed that this was not necessary although moving the cabinet to a less conspicuous position would be good practice. The pharmacist also raised the need for a separate fridge and identified that staff were not receipting medication on arrival. It was agreed that a fridge would only be necessary if the home had regular medication that needed to be stored at a certain temperature. Miss Britten agreed that she would monitor the temperature of the existing cabinet. Staff are now receipting medication. Medication procedures are readily accessible and arrangements are in place for all staff to receive medication training. Patient information leaflets are placed in each service user’s care plan. Additional information from the Internet has been printed off for staff reference. Service users have limited medication, which is documented in care planning information. The need for supervision when taking medication is also clearly recorded. The medication administration records were satisfactorily signed yet Miss Britten was advised to ensure another member of staff countersigns any written medication instruction. It is also advised that the pharmacy provides appropriate labelling which identifies clear details of administration. Labels such as ‘as directed’ should be replaced with specific instructions. The home has a homely remedy policy signed by the GP. This was undertaken in 2004 and therefore would benefit from review. Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Systems are in place to enable representatives to raise concerns on behalf of service users. The risk of abuse to service users is minimised through the recent adult protection training. Further protection will be assured when staff receive their formal training. EVIDENCE: Service users, due to their level of disability, rely on staff or family members to recognise their discontentment. In some instances, determining the reasons may be difficult to ascertain. It was evident within discussion with Ms Ellis, that gestures such as pushing something away may demonstrate discontentment. Facial expressions and repetitive movements may also be identifiable factors. At the last announced inspection, through comment cards it was apparent that not all relatives were aware of the complaints procedure. A requirement was therefore made to ensure that all key stakeholders were sent a copy. Miss Britten reported that this had been undertaken. This was confirmed within comments cards at this inspection. Since the last inspection, two concerns have been reported to CSCI. Mrs Lance and Miss Britten addressed both, yet there were no records of such. A complaint log is therefore required. Within a service user’s review it was identified that limited activity was a concern. Documentation regarding the response to this was not available and therefore Miss Britten was informed of the need to address this matter further. Within the policies and procedures file, there is information about adult protection including signs of abuse and reporting procedures. A flow chart identifying the alert process is also available although this is located in another Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 20 part of the file. It is therefore recommended that all such information is coordinated. Within the information it is stated that initially, any such incident, must be reported to Mrs Lance. Miss Britten is therefore advised to alter this in the event of management being unattainable. In the management of finances policy it was stated that the manager would investigate a theft. This needs to be changed to incorporate the Police. Within documentation it was noted that the ‘No Secrets’ documentation was available. Miss Britten was advised however to ensure the up to date version is in place. At the last inspection a requirement was made to ensure all staff have adult protection training. Miss Britten has arranged for all staff to watch a video and undertake accompanying questionnaires. A formal session, with an external facilitator is planned although a date has not as yet, been arranged. As stated earlier in this report, service users do not manage their financial affairs. A small amount of money is kept within the home for safekeeping. At the last inspection a transaction had not been recorded and therefore the amount of cash was incorrect. All balances were checked on this occasion and all were accurate. Mrs Lance reported that she has also written a policy regarding costs to service users in respect of transport and activities when out. Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The standard of the accommodation has deteriorated since the last inspection with some areas needing a good clean. Risks to service users are minimised through attention to health and safety matters such as low surface radiators. EVIDENCE: 27 Stratton Road is a semi-detached property within a residential area of Pewsey. The home is within walking distance of local amenities and the local bus service is easily accessible. Communal areas consist of a lounge with dining area, a large kitchen and separate utility room. There is an upstairs bathroom and a downstairs shower room. Private accommodation consists of single rooms, which are located on the ground and first floor. There is a small garden to the rear of the property. This can be accessed via patio doors from the dining area or through the utility room. The garden contains a patio area, with seating and a summerhouse. It is planned for the summerhouse to utilised, as an activity centre. New wooden flooring has been applied and electricity is awaited. Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 22 The accommodation was toured and it was noted that private accommodation varied in the level of comfort and individuality. For example, one room contained a high level of personal belongings and another, was sparser due to the service user’s need. To minimise the risk of injury through self-harm, the bed had been moved to the middle of the room. This had exposed a gap in the carpet and highlighted that the room was in need of a clean. There was a high level of dust for example on the skirting board and on the lampshade. The room appeared ‘tired’, was uninviting and in need of redecoration. Communal areas, in particular the lounge, were also showing signs of wear. There were marks over the walls and tea stains over the radiator. The toilet was in need of a clean and the toilet roll holder had come off the wall and was therefore in need of replacement. Mrs Lance raised surprise of the condition of the home and agreed such areas would be given attention. Low surface temperature radiators are in place and the hot water is controlled centrally. Samples of hot water outlets are regularly checked and a record is maintained. All windows on the first floor have restricted openings. Due to the level of service users’ disabilities, locks have not been fitted to private accommodation. The utility room is located on the ground floor and consists of a washing machine and tumble drier. This area was observed to be clean and ordered. The route however to the utility room from some private accommodation is through the kitchen. Miss Britten reported that staff manage this by carrying laundry in enclosed containers. Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Quality in this outcome area is adequate yet opportunities available to service users are significantly restricted through insufficient staffing levels. This judgement has been made from evidence gathered both during and before the visit to this service. Training has increased since the last inspection, yet Miss Britten is still restricted in her time to facilitate various opportunities to staff. Recruitment procedures require better organisation in order to enable service users’ greater protection. EVIDENCE: Since the last inspection there has been one new member of staff. Miss Britten confirmed recruitment is difficult and limited application forms are returned. The home therefore continues to have a staffing team of three members consisting of Miss Britten and two support workers. This gives little flexibility. The staff continue to sole work at all times. This appears to be a contributory factor to the current poor standard of cleanliness within the home. Service users’ social needs are also not being addressed. For example, all service users need one-to-one support, when out, so with only one member of staff on the premises, external activity is minimal. Spontaneous activity such as going out for a walk is also not possible. Within the home, social activity and stimulation are also minimal. Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 24 Inadequate staffing levels have been highlighted within previous inspections and requirements have been made. These have not been addressed. Such shortfalls have also been identified within a review setting whereby comments include ‘unable to access XX due to staffing levels at Stratton Road limitations on XX’s social opportunities remain a concern.’ This again, has not been addressed. It is of great concern that service users’ quality of life is being reduced, through the lack of attention to this matter. Requirements have also been made to remove Miss Britten from an integral part of the staffing roster. This had been achieved in part for a short while, although due to a member of staff leaving, Miss Britten has since returned to providing full care provision. Clearly this continues to be unsatisfactory and does not give Miss Britten the opportunity to fulfil her responsibilities. This matter was again discussed with Mrs Lance and Miss Britten during the feedback of this inspection. Miss Britten confirmed that she did not want to leave the roster but agreed there was a need for her to do so. Mrs Lance was informed that changes must be made and the staffing arrangements could not continue as at present. Mrs Lance agreed to reorganise the deployment of staff and a timescale was agreed. This would enable Miss Britten to spend some time with service users but not as an integral part of the roster. Mrs Lance was informed that a random inspection would be undertaken to ensure compliance. The recruitment documentation of the new member of staff was viewed. The organisation of these records was poor and therefore it was difficult to ascertain the process and specific timescales. Attention is required to ensure clear systems. Miss Britten was advised to file each individual’s records separately in date order and have a checklist, on the front of the file, identifying each stage of the recruitment process. Such records must include the member of staff’s commencement date. The new member of staff had completed an application form although the post applied for had not been filled in. One written reference was available. Miss Britten reported that the second had been received but could not be located. A CRB disclosure had been undertaken yet there was no evidence of a POVAFirst check. There was also no evidence of a start date. It was therefore not possible to clarify the sequence of events within the recruitment procedure. Miss Britten is required to address this area. Since the last inspection, food hygiene training has been undertaken. Adult protection has also been covered through in house videos and questionnaires. All staff have up to date first aid training. There was no evidence of any induction documentation in relation to the new member of staff. One member of staff has NVQ level 2 and is hoping to commence level 3. Miss Britten reported that it is anticipated that the newest member of staff will undertake such training. Within discussion it was evident that staff are clearly aware of service users’ needs and have built positive relationships. Miss Britten has commenced a system of formal staff supervision. Due to meeting with the staff team on a regular daily basis however, the format and Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 25 content of the sessions has proved difficult. Miss Britten was advised to expand on the existing content and discuss matters such as service users’ needs and possible developments to service provision. Miss Britten has planned regular sessions although also has the challenge of making the system both purposeful and productive. Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected 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. Removing Miss Britten from being an integral part of the working roster continues to be essential to ensure that management responsibilities are fulfilled. While interactions with service users are positive, the home is not being run, at present, in the best interests of service users. Greater attention to fire safety is required in order to ensure the well being of service users in the event of fire. EVIDENCE: Miss Britten has experience of working with adults with a learning disability and has NVQ level 3. Miss Britten has previously spoken of undertaking the Registered Manager’s Award although has not registered for the course. Attention must be given to this as a matter of priority. As stated in the staffing section of this report, Miss Britten remains an integral part of the staffing roster on a sole working basis. This is to the detriment of Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 27 the home as standards are lowering due to the limited time available to undertake all tasks. Progress to address shortfalls within management systems and administration is also slow. At the last inspection Mrs Lance assured CSCI that the matter would be addressed and Miss Britten would come off the roster, initially for two days a week commencing in November 2005. This was addressed temporarily but staffing levels and Miss Britten’s preference, have contributed to the original situation of Miss Britten being on the roster. The home has a number of well-written policies and procedures. At the last inspection however many were in need of review to ensure they reflected actual practice. Within the file given to the inspector, it was evident that no changes had been made. A further file was then located which highlighted various changes. Mrs Lance confirmed that the work had been undertaken although it appeared they had not been filed accordingly. Miss Britten must ensure there is only one set of up to date policies and procedures in place. There was no evidence of any attention being given to quality assurance within the home. As service users are unable to give specific feedback, Miss Britten was advised to gain opinions from relatives and their representatives. As a starting point it was agreed that service users’ next of kin should be involved in the development of care plans. Records demonstrated the satisfactory testing of the fire alarm systems. This also included the fire extinguishers. There was no evidence of a fire drill or staff fire instruction. This was identified as a requirement at the last inspection and therefore remains outstanding. Miss Britten reported that such procedures had taken place but were not clearly documented. Since the last inspection a door guard has been fitted to a service user’s room to enable easier access. Miss Britten reported that further door guards are due to be fitted so that all doors on the ground floor can be propped open safely. The implications of lone working and fire safety were discussed. Miss Britten was advised to address this area within the home’s fire procedure. There were a number of individual risk assessments within service users’ files. These included matters such as shopping, using the stairs, choking and selfharm. Through viewing care-planning information, certain situations, such as refusing to use the shower chair, portrayed potential risks. Miss Britten was advised to address these within the risk assessment process. Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 28 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 3 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 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 1 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 1 13 2 14 1 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 1 X 1 X X 2 X Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 29 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4 Requirement The Registered Person must ensure that the Statement of Purpose is kept up to date therefore ensuring an accurate reflection of service provision. The Registered Person must ensure that the management of the prevention of pressure sores is documented within the identified service user’s care plan and staff are aware of their responsibilities. The Registered Person must ensure that any restriction, such as service users being asked to go to their room, is fully documented and agreed with individual care managers. The Registered Person must ensure that service users’ personal money is not used on items for the home such as hanging baskets, unless agreed with service users’ care managers or other representatives. The Registered Person must ensure that service users travelling unattended or without a designated escort is addressed DS0000028213.V291632.R01.S.doc Timescale for action 30/09/06 2. YA6 12(1)(a) 30/09/06 3. OP7 12(1)(a) 30/09/06 4. OP7 13(6) 03/08/06 5. YA9 13(4)(c) 30/09/06 Stratton Road (27) Version 5.1 Page 30 6. YA12 16(2)(n) within the risk assessment process. The Registered Person must ensure that consideration is given to how opportunities for leisure activities in and outside of the home can be provided in relation to staff sole working. This was identified in June 2005 and has not been addressed. The Registered Person must ensure that a record of all complaints is maintained. This must include details of the investigation, its conclusion and the response given to the complainant. The Registered Person must ensure that all areas of the home are cleaned to a satisfactory standard and the toilet roll holder is replaced on the wall of the upstairs bathroom. The Registered Person must ensure that all recruitment documentation clearly demonstrates that the required checks have been undertaken. This must include two written references. The date the member of staff commenced employment must also be stated. The Registered Person must ensure that the Registered Manager is not an integral part of the working roster. This was identified in November 2004. Miss Britten was removed from the roster temporarily for two days a week at the beginning of this year but has resorted back to spending all her time as part of the working roster. The timescale has 31/10/06 7. YA22 17 Schedule 4,11 03/08/06 8. YA30 23(2)(d) 03/08/06 9. YA34 17 Schedule 4,6 30/09/06 10. YA37 18 31/10/06 Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 31 11. YA42 23(4) (d)(e) therefore been extended but must be adhered to. If the timescale is not met, enforcement action will follow. The Registered Person must ensure fire drills and fire instruction are undertaken as required and documented in the fire log book. 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA7 Good Practice Recommendations The Registered Person should ensure that the cost to the service user when accompanying staff to collect service users from their day service is agreed with their care manager. The Registered Person should ensure that the practice of service users spending time in other homes within the organisation is reviewed. The reason for the visit should not be dependent on insufficient staffing or activity. The Registered Person should ensure that service users’ understanding of makaton is established and staff receive training in this area. The Registered Person should ensure that another member of staff countersigns any hand written medication instruction. The Registered Person should ensure that the homely remedies policy is up dated. The Registered Person should ensure that the pharmacy provides medication that is clearly labelled with a specific instruction of administration. The Registered Person should ensure that all adult protection material is stored in one place. The Registered Person should ensure that the identified policy is reviewed to ensure that any theft is reported to the Police and CSCI. The Registered Person should ensure that an external trainer facilitates the further planned adult protection training. The Registered Person should ensure that all DS0000028213.V291632.R01.S.doc Version 5.1 Page 32 2. YA7 3. 4. 5. 6. 7. 8. 9. 10. YA7 YA20 YA20 YA20 YA23 YA23 YA23 YA34 Stratton Road (27) 11. 12. 13. YA36 YA40 YA39 14. 15. YA39 YA42 documentation regarding each member of staff is separately filed. A checklist identifying the recruitment process should also be in place. The Registered Person should ensure that the content of supervision sessions is developed in order to develop the performance of the staff member and service provision. The Registered Person should ensure that up to date policies and procedures are easily accessible to staff. The Registered Person should ensure that the topic of quality assurance is researched in order to assist with the implementation of the home’s individual system. This was identified at the last inspection. The Registered Person should ensure that service users’ next of kin and other representatives are involved in the development of care plans. The Registered Person should ensure that lone working is addressed within the home’s fire procedure. Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 33 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. Extracts may not be used or reproduced without the express permission of CSCI Stratton Road (27) DS0000028213.V291632.R01.S.doc Version 5.1 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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