Inspection on 06/07/05 for Stroud Court

This inspection was carried out on 6th July 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 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

Stroud Court 19/02/07

Stroud Court 15/12/05

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 Gloucestershire GL6 9AN Lead Inspector Tanya Harding 6 Th Announced and 8 July 2005 09:30 th 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. Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Stroud Court Address Longfords Minhinhampton Gloucestershire GL6 9AN 01453 834020 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) Stroud Court Community Trust Mrs Sharon Barnard Care Home 39 Category(ies) of LD Learning Disabilities Both (39) registration, with number LD(E) Learning Disabilities Over 65 yrs Male (1) of places Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: LD(E) Category for one named service user only Date of last inspection 23rd February 2005 Brief Description of the Service: Stroud Court provides care for up to 39 adults with learning disabilities who have been diagnosed with an Autisitc Spectrum disorder. Service users accomodated 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 a 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 accomodation 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 D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 5 SUMMARY This announced inspection began at 9.30 in the morning on 6th July and was carried out over two days. The lead inspector was accompanied by three other inspectors on the first day, including the pharmacy inspector, who undertook a specialist audit of the medication administration systems in the home. The registered manager was present throughout the inspection. The management and the administrative team were available and consulted on matters around management of finances and health and safety procedures. Service users in four of the units were met with along with several staff members. Some service users were able to comment on the care they receive and said that they were happy with the activities they are able to do and how staff support them. A range of records were checked including care plans, healthcare notes and staffing files. In addition a number of comment cards were received from people living in the home (completed with assistance from staff), family members and others involved in the service users’ care. A pharmacist inspector carried out a specialist inspection of all issues connected with medication. There were discussions with the care managers and inspection of arrangements for medicines in three of the seven houses. Stocks and storage arrangements, medication records, policies and procedures were inspected. Four members of staff were spoken to in the houses. The issues raised from the inspection of the three houses must also be cascaded and addressed if indicated in the other houses. It must be noted that the large number of requirements have primarily resulted from the specialist pharmacy inspection as this is the first of its kind carried out in the home. The home has continued to maintain a good standard of service and systems for monitoring all aspects of the service provided have become more robust. This is very positive and reflects the hard work by the staff as well as the management team. What the service does well: The home has an established communication centre on site where Total Communication and self-advocacy work is carried out. The use of Total Communication is being successfully integrated into the day-to-day function of each unit and is having a positive impact on the lives of the service users. The home is supported by a cohesive and well-established management team which includes the registered manager. The team identifies areas for improvement through self-audit and implements strategies to improve quality of the service. In the past 12 months the team has taken prompt and decisive action against poor practices in line with the Department of Health Guidance on Protection of Vulnerable Adults. The management of the home have a good understanding of their roles and legal responsibilities and demonstrate ongoing Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 6 commitment to make things better for people who live and work at Stroud Court. Care plans and risk assessments are of good quality and are kept up to date. There are some sound arrangements in place to help ensure residents always receive the medicines prescribed for them and that these are recorded and stored safely. Staff have received some training to help them understand about medicines. Service users are given choices in their daily lives and are encouraged to air their views. They are offered a range of activities to suit their needs and interests and are supported to become part of the local community. Staff give service users the support they need with personal care. They also help service users to access appropriate healthcare services. Individual units are made as homely as possible and most are attractively decorated. Bedrooms are personalised. Staff have confidence in the manager and feel that the home is well run. There is a well-organised induction and training for staff. What has improved since the last inspection? What they could do better: Key holding arrangements for some medicine cupboards could be improved. Medicines or vitamin products must be stored in the containers in which supplied. Better procedures to be in place for use of medicine compliance boxes when residents are away from the home. Medicine recording systems need clarification and could be simplified. Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 7 Maintenance issues which could compromise the safety of the service users need to be attended to promptly. 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 D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 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 standard(s) These standards were not assessed on this occasion. EVIDENCE: There is an established Admissions procedure to the home and although there were no new admissions since the last inspection, several referrals are being considered. The registered manager demonstrated a good understanding of the complexities around admission especially with regard to compatibility with existing service users. At the time of the inspection there were 34 service users accommodated. Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,and 9 Care plans and risk assessments on the whole are comprehensive and provide staff with guidance on how to best support the service users. However, there are some omissions (as detailed below) and these may compromise the safety and wellbeing of the individuals. Service users are supported by staff who are more proficient in communicating with them in ways which are meaningful to the residents and give service users control and voice. EVIDENCE: Care plans showed that people’s needs were being reviewed and where necessary changes to care plans were implemented. Some hand written entries on care plans were not signed and dated and this would make it difficult to trace the origin of the changes. Some care plans may be missing out important details about individual’s behaviour. One example of this was found in Westbank, where information about ritualistic behaviours for one person were not identified in the care plan. It was clear that staff new the person well, but a written reference would be useful for any staff who may not know the person so well but also so that it is possible to monitor any changes which may be significant for that person. Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 11 The home has an established communication and self-advocacy unit located on site. This provides support to each unit in respect of assessing communication methods used by individual service users. In addition to this, guidance is given to staff who support the service users to develop and implement the use of communication aids, such as photographic timetables, picture activity cards, picture diaries and so on. Assessments were seen on files of service users’ language and communication skills and communication aids were developed based on this information. Comprehensive risk assessments have been developed and on the day of the inspection almost all units visited were implementing these. In Dobson House there were no risk assessments in the new format. These were still being checked and proof read by the management team. In this instance staff at Dobson House would be relying on the old risk assessments which are significantly out of date and could compromise the safety of the service users as well as staff. The new formats must be implemented as soon as possible. Missing person’s information is provided for each service user and can be accessed quickly in an emergency. Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 12 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, 15 and 17 Service users are supported to develop emotionally, establish community links and take part in meaningful activities. Good food storage practices are not always followed in individual units and may compromise the health of the service users. EVIDENCE: One service user said that they were happy with the activities provided and another person talked about their hobbies and how they were supported to pursue these. Opportunities are offered on site for more formal work activities such as being part of the catering team and undertaking grounds maintenance. There are a number of recreational and leisure activities which service users can access on site, including a day centre, a swimming pool, trampoline, sensory room and a gardening / maintenance group. Service users access courses at the local college and a community centre for cookery. The home has provided extra activities for the summer when the college is closed. Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 13 The communication centre produces a regular newsletter which is then forwarded to each unit. This provides information about changes to staff, comments on events and holidays and talks about activities and individual achievements. The newsletter is in an accessible format. This promotes a community spirit and relationships between the individual units. Relatives can visit service users in their homes and people are supported to maintain contact with their families and supporters by phone and by writing letters. Service users are consulted about what they would like to have on the menu. Food is prepared in the main kitchen as well as in the individual units on site. Service users who were able to comment on the service in the home said they liked the food provided. People can get involved in food preparation and cooking formally in the main kitchen, where they can function as part of the catering team or more informally such as making own snacks. Observations were made that food was not always covered when opened and returned to the fridge. Some foodstuffs were seen as past their best (lettuce turned brown in Dobson House). Attention should be given to food storage and food rotation systems in the units. Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 14 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’ changing needs are monitored and referrals for additional support are made to external professionals in order promote service users’ emotional and physical wellbeing. Medicines are generally safely managed but the detailed inspection indicated some areas where changes or more attention to detail is indicated to ensure best practice advice is followed to help ensure residents are always treated with the correct medicines that have been properly stored and that recording systems demonstrate this. EVIDENCE: Records of health appointments are kept and people’s medical needs are closely monitored and responded to as necessary. This includes seeking medical advise from GP’s and from Community Learning Disabilities Team. There is in-house training and assessment of staff in handling of medicines. Some staff have commenced or completed an accredited college course in the Safe Handling of Medicines. All staff involved with medication should complete this, which is the intention of the home. Medicines are stored in dedicated medicine cupboards. Keys must be held securely on all units and not left unsecured adjacent to cupboards. One Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 15 medicine cupboard was found not secured to the wall. Medicines for internal use are not always stored segregated from those for external use. A monitored dose system (MDS) provided by the pharmacy forms the basis of medicine supply wherever possible and with associated printed records. Medicine receipt records are available but must be dated and signed by authorised staff. Any container of medicine not supplied in the monitored dose system (MDS) packs should be dated when first opened for use to allow for correct stock rotation and audits to confirm correct medicine use to take place. This could be included in the monthly audits. Information about ‘in-use’ expiry dates was provided. The temperature of the medicine cupboard in the care manager’s office must be monitored, as there is a risk of excessive heat gain from sunshine. Printed Medication Administration Record (MAR) charts are supplied by the pharmacy. Arrangements must be made to ensure medicine details are clarified where these are obscured by holes punched in the charts. The allergy box at the top of the chart is always to be completed. The recording of medicine administration on two charts (printed MAR chart and record of medication chart) is confusing with lack of clarity about the role and status of the entries and signatures on each chart. The present system requires the retention of both documents to ensure a complete medicine administration history is available if needed for future reference. It is best if one record is used containing details of all medicines administered, including vitamins and homely remedies, to provide a unified record. All medicine administration records must be fully dated. Written confirmation from the surgery of warfarin dose changes is not available. Prescriptions (FP10s) are not generally checked in the home before being sent to the pharmacy. It is good practice to perform this check. Stock charts are available for ‘as required’ medication but not consistently used. A plan for each person for use of any medicine prescribed ‘as required’ must be in place. Some such plans are available but not for all. Medicines including vitamin preparations and food supplements must be retained in the containers in which supplied to minimise risk of errors, ensure their stability and retain full labelling and batch details. Purchase of bulk containers to break down into smaller bottles within the home is not good practice. Policies and procedures are available for the home and each unit. The document “The Administration and Control of Medicines in Care Homes and Children’s Services” published by the Royal Pharmaceutical Society of Great Britain should be obtained and used as a reference to ensure comprehensive policies and procedures are written and as an audit tool for good practice. Procedures for the actual administration of medicines must always follow the good practice contained in paragraph 6.2.3. There is evidence that this may not always be the case if medicines are taken to individual rooms or are administered away from the medicine storage areas. Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 16 Medicine compliance boxes are sometimes used but are not always fully labelled. The use of these boxes or any secondary transfer of medication must be minimised as it can present a risk to residents of receiving incorrect medication. A risk assessment for the use of these boxes for each circumstance must be made. When boxes are used in the home the same standard of practice as would be expected if a pharmacist filled the box must be followed. Boxes must be fully labelled and filled by staff specifically trained for this task. Training and monitoring procedures of competence must be in place. Records for leave medication taken out of the home must also specify what has been taken and returned including quantities. Residents’ consent to medication should be obtained and recorded. This may be difficult to obtain so a plan for medicine administration should be in place documenting the manner in which residents are willing (or otherwise) to accept medication from care staff. Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 17 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 Service users have opportunities to express their views and those who cannot do this verbally are supported to communicate their concerns and needs in ways meaningful to that person. Procedures for responding to allegations of abuse and poor practices are in place and staff are aware of the whistle blowing policy. Incidents of poor practice are investigated and dealt with decisively. Systems are in place for protecting service users from financial abuse and mismanagement. EVIDENCE: Care plans and behaviour management plans provide staff with guidance on how to monitor and respond to service users when they are anxious or upset. Staff are supported to develop Total communication skills aids to establish a more meaningful methods of interacting with the service users. Importance of individual rights and autonomy of choice is emphasised during induction and staff meetings. Staff are given information about recognising and reporting abuse and poor practice. There have been several examples in the past 12 months when the management team had to respond to allegations of poor / abusive practice. The agreed procedures were followed in each case and comprehensive records were kept. The Commission has been kept informed and updated as necessary. There are robust systems for managing service users finances in the way that any discrepancies can be identified and traced promptly. This is in recognition that service users residing at Stroud Court are particularly vulnerable to financial misuse and need ongoing support to manage their finances to their benefit. Mobility charges are made for those service users who are in receipt of mobility allowance. Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 18 The home notifies the Commission of events and incidents which may have a detrimental affect on service users as required under Regulation 37. Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 19 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) 24, 25, 26 and 27 The home offers comfortable areas for service users to spend in company or on their own. Parts of the environment are hazardous to people who live in the home as well as to staff and limit opportunities for using some outdoor spaces. EVIDENCE: Four units were visited on the first day of the inspection, Westbank, Gatehouse, Dobson House and Sycamore House. Service users have single rooms, which on the whole are furnished and decorated to suit people’s needs and tastes. Some rooms are quite sparse as some service users find it difficult to tolerate certain furnishings. Some bedrooms are lockable, but some are not. Suitable locks should be provided in all cases, although it is accepted that some service users would not be able to manage a key or indeed may not want to lock their room. In any case, consideration should be given to whether people’s belongings and privacy are suitably protected. Where necessary service users should also have lockable storage in their rooms, for any valuables they may wish to keep themselves. Any decisions or observations about availability / lack of locks and lockable storage should be clearly identified in individual care plans. Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 20 There is a maintenance team and a system of reporting items which need repair or attention. However, it was observed that some obvious hazards have not been put right and this needs to be done. For example, in Wesbank, the patio area has deteriorated to such an extent that people can no longer use it safely. There are loose paving slabs, uneven surfaces and moss, which becomes slippery when wet. There were plans to sort these problems out some time ago with the project group, which consists of service users who have an interest in maintenance, but nothing has happened to date. Another hazard is the broken concrete in the path leading up to the Gateway House. This too needs repair. In Dobson House some maintenance work is necessary in the kitchen as well as general re-decoration. Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 21 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) 34 and 35 Ongoing management support and commitment to staff development is beneficial to the team and coupled with the necessary training should result in a competent and skilled team. Recruitment policy and practice protects service users from unsuitable carers being employed. Staff receive appropriate training for the work they perform. EVIDENCE: Several files for new and existing staff were examined and found to contain the necessary information and recruitment checks. A training matrix has been produced, providing evidence of all training undertaken by care staff. This includes NVQ courses and shows that 27 residential care and day care staff have achieved NVQ2, 10 staff have enrolled onto the NVQ2 programme and additional 13 staff have achieved NVQ3. Several of the team leaders have also obtained NVQ3 in management. Staff undergo induction and foundation training, which incorporates LDaf units (Learning Disabilities Award Framework). Several staff in different units have completed an infection control course. Other training provided includes Autism Awareness, Studio 111, First Aid, manual Handling, Food Hygiene, Abuse Awareness, Safe Handling of Medicines, Epilepsy, Incontinence, Confidentiality and Supporting Older People with Learning Disabilities. Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 22 The registered manager is looking at accessing refresher training in deescalation and physical intervention, which will be incorporated into the training programme for care staff. Comments have been received in Regulation 26 reports that increased training has reduced staff turnover and this has been of benefit to the service users as a more consistent approach has been maintained in supporting them. Relief staff are employed to provide additional cover where necessary. There are also indications that although agency staff continue to be used to cover sickness and holidays, the reliance on occasional staff has reduced. From discussions with staff at Dobson House it was evident that on occasion there are no female staff on duty and this can present difficulties in providing personal care support to female service users. This issue should be discusses with the management team and rectified as necessary. Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 23 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, 39 and 42 People living in the home benefit from the confident and competent management approach, which promotes service users’ rights and expectations to have good quality care. Quality assurance and health and safety monitoring systems are in place for the benefit of the service users although some deficiencies can compromise the safety of the service users. EVIDENCE: Staff felt that the registered manager as well as the whole management team at Stroud Court are approachable and supportive. Regular supervision meetings are taking place with team leaders, who have attended the required supervisory training. The home has a premises manager with responsibilities for overseeing all maintenance and health and safety issues. Staff induction includes health and safety awareness and efforts have been made to provide each unit with a concise pack of health and safety information to serve as reference for agency Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 24 / bank staff but also for the benefit of permanent staff. Team leaders in each unit are expected to complete a monthly health and safety checklist. This is then returned to the premises manager, who in addition undertakes an inspection of the units himself every 2-3 months. A visit by the Environmental Health Department took place in January 2005 and the report was satisfactory. A full asbestos survey and necessary actions following this have been done. An inspection by the Fire Officer took place in April 2005 and this report was still being awaited with no major requirements anticipated. Checks such as fridge temperatures, fire alarms and emergency lighting are being carried out regularly. Although according to records in Gatehouse there is no emergency lighting in that unit. It was noted that some upstairs bedrooms do not have window restrictors in place. This may be appropriate for some service users in which case a risk assessment which clearly identifies reasons for not having a restrictor must be in place. Some doors do not have self-closing devices and on the day of the inspection were propped open. This too would need risk assessing as it could potentially compromise people’s safety in the event of a fire. Where it is assessed that self-closures are necessary, these must be fitted. Further advice may need to be sought from the Fire Authority. Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 25 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 x x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x 3 3 x 3 x 2 Standard No 31 32 33 34 35 36 Score x x x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Stroud Court Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 x x 2 x D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 26 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. 2. 3. Standard 9 17 20 Regulation 13(4) 13(3) 18(1) Requirement Updated risk assessments must be implemented for all service users Good food storage practices must be maintined at all times All staff handling and administering medication to study the additional accredited training in the safe handling of medicines. Medicine storage arrangements to ensure: · Medicine cupboard keys always to be held securely by authorised staff. · All medicine cupboards to be securely fixed to the wall. · Medicines for internal use to be segregated from those for external use. The temperature of the medicine cupboard in the care manager’s office to monitored and action taken to ensure storage does not exceed 25°C. Use of MAR charts to be reviewed to ensure that: · All entries are clear and allergy boxes completed. · Written confirmation of Timescale for action 30th September 2005 30th September 2005 1st December 2005 1st September 2005 4. 20 13(2) 5. 20 13(2) 17(1) 1st September 2005 Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 27 6. 7. 8. 20 20 20 17(1) 13(2) 13(2) 9. 20 13(2) 10. 24 13(4) and 23 11. 42 23 and 13(4) verbal dose changes is obtained. · Full records to be kept of medicines taken and returned to the home during periods of leave. The use of two charts to record medicine administration to be reviewed. A protocol defining the status of each document to be in place if both charts continue in use. Plans for use of any medicine prescribed ‘as required’ to be written for each resident. Medicines and vitamin products to be retained in the containers in which supplied. Medication administration procedures to be reviewed to ensure the best practice in the Royal Pharmaceutical Society of Great Britain guidelines is always followed. 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. Address maitenance issues as listed: repair concrete path by Gatehouse; repair patio at Westbank; carry out necessary maitenance on the kitchen in Dobson House; Carry out an audit to determine if all necessary window restrictors, self closing devices and emergency lighting are present in each unit, provide evidence of this audit for future inspections 1st September 2005 1st September 2005 1st September 2005 1st September 2005 1st December 2005 1st December 2005 Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 28 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. 4. 5. 6. 7. 8. Refer to Standard 6 6 20 20 20 26 26 33 Good Practice Recommendations When reviewing care plans for service users details about behaviours should be revisited to determine whether additions or amendments may be necessary Hadn written entries on care plans / risk assessments should be signed and dated bythe person amending the record All containers of medicines (other than those supplied in the MDS blisters) to be dated on opening to allow correct stock rotation and audits to be completed. All FP10 prescriptions to be checked by authorised home staff before being sent to the pharmacy. Residents’ consent to medication to be recorded. All service users should have an option of locking their bedroom, and reasons for not providing a lock / key should be recorded in individual care plans. Lockable storage should be provided for people to keep valuables / money in their rooms Review availability of appropriate gender support at Dobson House (and other units as necessary) Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 29 Commission for Social Care Inspection 1210 Lansdowne Court Gloucester Business Park Brockworth Goucester 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. Extracts may not be used or reproduced without the express permission of CSCI Stroud Court D51_D03_S16591_StroudCourt_V198329_060705_Stage4_A.doc Version 1.40 Page 30 - 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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