Inspection on 15/12/05 for Stroud Court

This inspection was carried out on 15th December 2005.

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 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stroud Court 19/02/07

Stroud Court 06/07/05

Stroud Court 23/02/05

Stroud Court 20/07/04

Stroud Court 17/02/04

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 Stroud Court Longfords Minchinhampton Glos GL6 9AN Lead Inspector Ms Tanya Harding Unannounced Inspection 15th December 2005 11:00 Stroud Court DS0000016591.V283276.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 Stroud Court DS0000016591.V283276.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. Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Stroud Court Address Longfords Minchinhampton Glos GL6 9AN 01453 834020 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) Stroud Court Community Trust Mrs Sharon Barnard Care Home 39 Category(ies) of Learning disability (39), Learning disability over registration, with number 65 years of age (1) of places Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. LD(E) Category for one named service user only Date of last inspection 6th July 2005 Brief Description of the Service: Stroud Court provides care for up to 39 adults with learning disabilities who have been diagnosed with an Autistic Spectrum disorder. Service users accommodated have high dependency and supervision needs. The home consists of seven separate units each with a dedicated staff team and a team leader. Two of the units, Rosemary Heights and Magnolia Heights are located in the main building, which also houses the central kitchen, activity rooms and offices. The other five units, Court View, Dobson House, Sycamore House, Gateway House and Westbank are all individual houses within walking distance of the main house. Also on site there is a day centre for Stroud Court residents and a swimming pool. All individual units have a domestic type self contained accommodation and all service users have single rooms. The home is set in extensive grounds and the site is within short driving distance of Nailsworth and Minchinhampton towns. The home provides own transport for accessing community facilities as it is not located on the main public transport route. A variety of local amenities including a bus station, post office, shops and banks can be found approximately a mile away in Nailsworth. Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit lasted over three hours and was supported by the registered manager as well as staff in the individual units. Court View and Dobson Houses were visited and time was spent in Dobson House talking to staff and service users and examining records. Many of the key standards were assessed at previous inspection in July 2005 and the main purpose of this visit was to assess progress made with meeting the requirements made following that inspection. This report provides evidence that the home continues to offer a high standard of care and support to the service users. What the service does well: What has improved since the last inspection? The requirements made in the last inspection with regards to the storage and administration of medication have been addressed with progress on these issues ongoing. Further investment in staff training and better pay and conditions has resulted in a more stable and resourceful staff team. Progress was evident with the environmental issues and health and safety matters that were highlighted in the last report. Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 Page 6 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. Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 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 the following standard(s): 2 and 4 Comprehensive admission procedures should ensure that a placement is only offered to those service users whose needs can be met. Opportunity to visit the home prior to moving in should help the prospective residents to make a more informed choice about the move. EVIDENCE: A new admission was discussed with the registered manager. The home has followed an established admission process, which involves obtaining all relevant information about the prospective service user from relatives, involved professionals and the current placement. The service user was offered a chance to ‘test drive’ the home before moving in and this is good practice. The inspector was able to talk to the new service user, who commented positively about the care they were receiving and opportunities for social activities they had access to. Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 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 the following standard(s): 9 and 10 A comprehensive approach to risk assessing should enable service users to enjoy activities of their choice without compromising their safety and wellbeing. Storage of confidential information should be improved to protect service users’ personal data. EVIDENCE: Further progress was evident with completion of comprehensive risk assessments for service users. These look at behaviour challenges in different settings and vulnerability and support requirements, such as how many staff are needed to enable the person to access the community. Information was seen in Dobson House alerting staff about an identified risk for one person when travelling in vehicles. There was also a hand written addition to the main risk assessment about this dated September 2005, although this was not signed. It was not possible to establish whether the additional part of the risk assessment was prompted by an incident / incidents. Staff were not sure why there appeared to be a heightened focus on this issue and could not recall any significant events which may have promoted the risk Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 Page 10 assessment review. This should be clarified. Any additions or amendments to agreed care plans and risk assessments need to be signed as well as dated and incorporated into the main plan as soon as practical. In Dobson House it was noted that some service users’ files were not locked away. Staff said that generally these are kept securely, although there did not appear to be sufficient secure storage available. Information containing personal details about service users must be kept securely at all times. Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 Page 11 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): 16 Practices in the home promote independence and look at minimising restrictions for service users, in order to promote choice and autonomy. EVIDENCE: During the visit to Dobson House several service users returned from a swimming activity at the local pool. One service user was involved in preparing lunch. Service users at Court View were observed getting ready to go out for an activity in the afternoon of the visit. Total communication resources were seen in use in Dobson House. There was a staff board with information on which staff were present or expected on each shift. There was also a board showing the weekly schedule of planned activities. Service users were talking about the Christmas party which was being planned for the forthcoming weekend. Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 Page 12 Some restrictions are in place for service users in different units. There are records which identify these and detail the reasons for the restrictions being in place. Observations provided evidence of service users being offered choices and people were seen moving freely about the home and area immediately outside of the home. The service users in the home have high dependency and require close supervision. In Dobson House this was done as discretely as possible by staff to minimise any intrusion on service users’ privacy. The manager advised of a recent incident where a restriction was used by staff inappropriately. Action has been taken to address this. Food was found to be stored appropriately in Dobson House. Food stores were not examined at Court View, but is was noted that kitchens in both units were clean and well equipped. Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 Page 13 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): Not assessed. EVIDENCE: Records of incidents which take place in the home are duly recorded. The home has responded to the requirements and recommendations made following the specialist pharmacy inspection in July 2005 as detailed below. Where requirements have not been met, the manager advised of what progress was made in achieving the required standards. For example, the use of medicine compliance boxes has been reviewed, and as a result it has been decided to purchase individual boxes so that these can be labelled and used only by named individuals. Three staff have commenced the accredited course in safe handling of medicines at Cirencester College. In addition to this training the home has an established system for training staff and assessing the level of competency with regards to administering of medication. Storage of medication keys has now been resolved following further consultation with the pharmacy inspector. The temperature of the medication cabinet in the office is now monitored to ensure this does not exceed 25 Degrees Celsius. Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 Page 14 A proforma has been developed for signing out medication when service users go on home visits. Protocols for recording receipt and administration of medication in individual units are being reviewed to incorporate a system of monitoring to identify any errors and correct mistakes. The manager advised that after due consideration it is likely that both MAR charts and in-house charts will remain in use. There was evidence of progress in meeting the requirement to produce individual protocols for ‘as required’ medication. These will be linked to ‘traffic light’ behaviour guidance for service users who may present challenges. An example of this guidance was seen for one person. This provides staff with a detailed overview of what to look out for at different stages of behaviour and what responsive action needs to be taken to help the service user to deescalate. Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 Page 15 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 There are transparent systems in place for communicating with significant people who could advocate on behalf of service users. Measures for dealing with poor practice are effective and protect service users from potential abuse, although some improvements are recommended to make the system more robust. EVIDENCE: The registered manager provided an update about the concerns which have been raised by relatives. Examination of records around this issue provided evidence that these concerns have been taken seriously by the home and responded to as necessary. The placing authority has been kept informed. The manager advised that a review is being planned for the service user to discuss any outstanding matters in an open forum. Records provided evidence that agreements have been reached with relatives about what they want to be informed about with regards to service users. This is a good step towards establishing communication links with families and other significant people and promotes transparency of the service. Incident and restraint records were examined for two service users. The home has an established system for recording and reporting of incidents. However, one incident which took place in a public place on 1/10/05 was not reported to the Commission. There was evidence that staff attempted to use physical intervention to manage the situation and had to apologise to the members of the public who witnessed the event. Systems for monitoring the incidents and making a decision of what is reportable should be further clarified by the home manager to ensure appropriate notifications are made. Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 Page 16 The home has developed robust systems for responding to allegations of abuse and the manager provided an update on a recent matter of poor conduct by staff which was being addressed. Appropriate notification has been provided to the Commission. Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 Page 17 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 Service users live in homes which are well maintained and offer a homely feel. Some improvements are needed to ensure known hazards are removed and correct hygiene practices are observed. EVIDENCE: Two units were visited during this inspection. Both Dobson House and Court View were noted to be clean and warm with a Christmas feel. The grounds around the home are well maintained and safety signs are provided to reduce risks to service users from vehicles which may be travelling to and from the home. Maintenance issues which were highlighted in the last report have been addressed in part. The patio at Westbank has been made safe, but more permanent repairs will be carried out before the summer. The kitchen in Dobson House has been redecorated. The repairs to the concrete path by Gatehouse were still to be addressed. There is an ongoing programme of redecoration and systems are in place to ensure maintenance jobs are reported by each unit and addressed by the premises manager. Laundry facilities in Dobson House and Court View were assessed. Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 Page 18 The laundry in Dobson House was undergoing redecoration. Hand washing facilities must be improved in Dobson House through provision of soap and disposable towels as well as in other units where these may not be in place. It was noted that the fridge and freezer were being stored in the laundry room. The home should consult about appropriateness of this with the Environmental Health Department. Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 Page 19 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 Service users in the home benefit from a dedicated and competent staff team, who treat people with respect and have the necessary skills and training to provide the required support. EVIDENCE: A number of very positive interactions were observed between staff and service users in Dobson House and in Court View. There was evidence of inclusive practice and service users being addressed respectfully. Staff spoken with felt that they had the required level of skill and knowledge about the service users to provide the required level of support. The manager advised that the home was fully staffed. The home has not needed to employ staff from abroad. Improved pay and conditions have been agreed and the training budget has been increased to offer more comprehensive opportunities for all staff to achieve the required level of skill and knowledge. There is a team of relief staff, who are called upon in cases of sickness and holidays. There are additional day care staff, including the Total Communication team and craft centre instructors. The home employs dedicated staff to oversee cleaning of the main building, food preparation in the central kitchen, administrative tasks and the management of the premises. A music therapist and an aromatherapist are also employed. Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 Page 20 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): Not assessed. EVIDENCE: The premises manager advised that since the last inspection window restrictors in all units have been checked and where necessary an individual risk assessment has been carried out for service users who may not have a restrictor. There are regular premises inspections and evidence of these was available for inspection. Food hygiene and storage practices were assessed to be satisfactory in Dobson House. Staff record fridge and freezer temperatures as necessary. Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 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 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X 3 2 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X X X X X X X X Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 Page 22 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 YA10 Regulation 17 Requirement Information containing personal details about service users must be kept securely. Plans for use of any medicine prescribed as required to be written for each resident. (Progress made. To be assessed at the next visit). Medication administration procedures to be reviewed to ensure the best practice in the Royal Pharmaceutical Society of Great Britain guidelines is always followed. (Progress made). The use of medicine compliance boxes to be reviewed and where risk assessments indicate use, safe practices to be in place with written procedures and training of staff. (Progress made). Repair concrete path by Gatehouse. (Timescale of 01/12/05 not met). Ensure soap and disposable hand towels are provided in laundry areas. Timescale for action 31/03/06 2. YA20 17(1) 31/03/06 3. YA20 13(2) 31/03/06 4. YA20 13(2) 31/03/06 5. 6. YA24 YA30 13(4) and 23 13(3) 31/03/06 31/03/06 Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA9 Good Practice Recommendations Any additions or amendments to agreed care plans and risk assessments should be signed as well as dated and incorporated into the main plan as soon as practical. Clarify the origin of the handwritten additions to the risk assessment about travelling in vehicles for one service user at Dobson House. Residents consent to medication to be recorded. Systems for monitoring the incidents and making a decision of what is reportable should be further clarified by the home manager to ensure appropriate notifications are made. Lockable storage should be provided for people to keep valuables / money in their rooms (clarification on this recommendation has now been provided to the home). The home should consult with the Environmental Health Department about appropriateness of the fridge and freezer being stored in the laundry room. 3. 4. YA20 YA23 5. 6. YA26 YA30 Stroud Court DS0000016591.V283276.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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