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Inspection on 02/03/06 for The Steppes Residential Care Home

Also see our care home review for The Steppes Residential Care Home for more information

This inspection was carried out on 2nd March 2006.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

This is a home that is achieving a high level of satisfaction from service users. The inspector met with all service users who spoke positively about the care they receive. No negative comments were received. There is a good admission procedure that ensures no one is admitted without an assessment of need. Service users can also visit the home to "try it out" before moving. There is a committed and enthusiastic staff team that understands the needs of service user. Comments from service users describe staff as "wonderful", "good" and "very nice". Accommodation is of a good standard, comfortable and homely.

What has improved since the last inspection?

Improvements have been made to the recording of service users care plans to make them more personal and clearer to follow. Improvements have also been made to the recording of meals served at the home, which provides a clear record to demonstrate service users receive a varied and nutritious diet.Parts of the home have been redecorated and one service users bedroom was having a new carpet fitted on the day of the inspection, which demonstrates the homes commitment to improving the environment for service users.

What the care home could do better:

This inspection has identified three requirements and six recommendations on areas that can be improved. The home needs to ensure care plans are kept under review to reflect service users changing needs. More attention needs to be given to health and safety at the home. In particular risk assessments must be completed on the use of portable heaters and the practice of wedging open fire doors must stop. Recruitment procedures could be improved by ensuring any gaps in an applicants CV is explored and recorded as part of the interview process. In addition a reference from an applicants last employer should be always obtained. The home needs to expand their quality audit to include the views of stakeholders and staff on the service provided. Outcomes of the quality audit should be made available to the participants of the review in the form of an action plan detailing how improvements will be made to the service.

CARE HOMES FOR OLDER PEOPLE The Steppes Residential Care Home Cossack Square Nailsworth Glos GL6 0DB Lead Inspector Bernard McDonald Unannounced Inspection 2nd March 2006 09:00 X10015.doc Version 1.40 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 The Steppes Residential Care Home DS0000016361.V281894.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 Older People. 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. The Steppes Residential Care Home DS0000016361.V281894.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Steppes Residential Care Home Address Cossack Square Nailsworth Glos GL6 0DB 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) 01453 832406 steppescure@aol.com The Steppes Care Limited Mrs Joanne Kim Smith Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places The Steppes Residential Care Home DS0000016361.V281894.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th July 2005 Brief Description of the Service: The Steppes is a care home registered to provide personal care for twenty-one older people. The home is an older style property that has been extended over time and adapted for its current purpose and accommodates fifteen service users. Adjacent to the main house is a smaller and more recently constructed house with six service users accommodated there. Both parts of the home provide a domestic style environment and easy access with a stair lift in the small house and a shaft lift in the main house. The main house has a small communal lounge and dining room on the ground floor. Service users accommodation is provided on the ground and first floor. All service users accommodation is provided in single rooms, most have en-suite facilities. A communal bathroom providing an assisted bathing facility is situated in each house. The amenities of the local town are in close proximity. The Steppes Residential Care Home DS0000016361.V281894.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection, which was unannounced, lasted approximately 7 and half hours. Its purpose was to focus on those NMS (National Minimum Standards) not inspected at the inspection carried out in July 2005 and to follow up the requirements and recommendations made. The inspector met with all service users to obtain their views on the care they receive. The inspector spent time with the home manager as well as some of the staff who were on duty. The inspector viewed all communal living areas and service users bedrooms. In addition four service users care plans were examined together with staff recruitment records and various paperwork including the medication policy. In total 17 NMS were inspected out of a total of 38, in line with the Commission’s methodology for this service. At the end of the inspection feedback on the preliminary findings of the inspection were given to the manager and registered provider. What the service does well: What has improved since the last inspection? Improvements have been made to the recording of service users care plans to make them more personal and clearer to follow. Improvements have also been made to the recording of meals served at the home, which provides a clear record to demonstrate service users receive a varied and nutritious diet. The Steppes Residential Care Home DS0000016361.V281894.R01.S.doc Version 5.1 Page 6 Parts of the home have been redecorated and one service users bedroom was having a new carpet fitted on the day of the inspection, which demonstrates the homes commitment to improving the environment for service users. 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. The Steppes Residential Care Home DS0000016361.V281894.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Steppes Residential Care Home DS0000016361.V281894.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5. The admission procedure is being safely managed and ensures service users have opportunity to “try out” the home before moving. EVIDENCE: The inspector examined the community care assessments of two service users recently admitted to the home. To ensure the home can safely meet the needs of service users being referred the manager completed a pre admission assessment form which covers service users personal details, risks, likes, dislikes, general health, social and personal care needs. In addition a summary of the assessment is completed to enable the home to determine the risk and personal care needs of service users. Following admission to the home an interim care plan is developed. The manager confirmed service users have opportunity to visit the home prior to making a decision to move in. One service user stated they had visited on two occasions before making a decision to move. The Steppes Residential Care Home DS0000016361.V281894.R01.S.doc Version 5.1 Page 9 The manager confirmed all service users are offered a three-month trial period before making a decision to permanently move to the home and to ensure the home can safely meet the needs of service users. The Steppes Residential Care Home DS0000016361.V281894.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9, 10 Service users care needs are set out in their care plan, however more attention needs to be given to reviewing the care plan to ensure it accurately reflects the needs of service users. The administration of medication is being safely managed. The home is ensuring service users are treated with respect. EVIDENCE: The inspector examined the care plans of four service users. Following a requirement made at the last inspection the home has improved the format of service users care plans. Discussion with staff confirmed care plans are now easier to follow and provide clarity and the action required from staff to meet the needs of service users. In addition the home keeps only one copy of the care plan. However examination of the care plans found the needs of service users were not being reviewed as often as they should. It is a requirement that care plans are reviewed a minimum of once a month to ensure care plans accurately reflect the needs of service users. The Steppes Residential Care Home DS0000016361.V281894.R01.S.doc Version 5.1 Page 11 The inspector met with majority of service users all of whom spoke positively about the attributes of staff. One service user stated, “staff are wonderful”. Another said, staff “can’t do enough for you”. Another service users stated they were “very happy and could not be better looked after”. Service users confirmed staff are respectful and that they knock before entering their room. Following a recommendation at the last inspection the home has updated their policy on the administration of medication. Discussion with the manager confirmed all staff responsible for administering medication has received training in the safe handling of medication. In addition a number of staff are also completing a distance learning medication course to improve practice and knowledge. Examination of medication records demonstrated medication was being accurately recorded. A separate record is kept of medication received at the home. The Steppes Residential Care Home DS0000016361.V281894.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15. The home is making every effort to ensure service users benefit from a varied and nutritious diet. EVIDENCE: Following a requirement at the last inspection the home is now clearly recording all meals served. Discussion with service users confirmed they are offered a choice at meal times. Service users commented the meals are “wonderful”. Service users can chose where to eat their meals either in the dining room or in the privacy of their rooms. The inspector observed part of the lunchtime meal. The mealtime was relaxed and unhurried. Where service users required assistance with their meal this was provided in a discreet and sensitive manner. Examination of the menu showed a varied and nutritious diet was being provided. Discussion with the cook confirmed the menu is developed in consultation with service users and any special requests are catered for. The Steppes Residential Care Home DS0000016361.V281894.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 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, 18. The home is striving to ensure service users views are listened to and they are protected from abuse. EVIDENCE: The manager confirmed all service users have been given a copy of the homes complaints procedure. The procedure includes details of how to contact the Commission’s office in Gloucester. Examination of the complaints log shows no complaints have been received about the service since the last inspection. Discussion with service users confirmed they were happy living at the home. When asked whom they would speak to if they were unhappy a number of service users said their relatives while others said the staff or the manager. Discussion with staff demonstrated a commitment to ensuring the safety of service users. Staff confirmed they would have no hesitation reporting any concerns affecting the welfare of service users. One member of staff was aware of the whistle blowing policy, which supports staff in raising concerns. The home has a copy of the Department of Health “no secrets guidance” and the manager confirmed in house abuse awareness training is provided as part of the induction process. The Steppes Residential Care Home DS0000016361.V281894.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24, 26. The home provides a good standard of accommodation that is safe, clean, comfortable and well maintained. EVIDENCE: The home is situated close to Nailsworth town centre. Accommodation is divided over two sites. The main home provides accommodation for 15 service users and the adjacent house provides accommodation for six service users. The inspector viewed all communal accommodation and all service users bedrooms. The inspector found the home was clean, tidy and free from any odour. Furniture, décor and fittings were of a good standard. Service users benefit from single bedroom accommodation and all but three bedrooms have en suite facilities. Discussion with service users confirmed they were very happy with standard of accommodation. Several service users confirmed they had been able to bring small items of personal furnishing and all service users bedrooms had been personalised to reflect individual taste. The Steppes Residential Care Home DS0000016361.V281894.R01.S.doc Version 5.1 Page 15 The laundry room is sited on the first floor well away from any food preparation area. Laundry floors and walls were easily cleanable to help to reduce the risk of infection. To further improve infection control measures at the home it is recommended that “red alginate” bags are purchased so that soiled or infected washing placed in the bags can be put directly into the washing machine. Service users were satisfied with the current laundry arrangements and confirmed their washing is promptly returned. The Steppes Residential Care Home DS0000016361.V281894.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29, 30. The home is ensuring staff are trained for the work they do, but need to pay more attention to the recruitment of staff to ensure the process is sufficiently robust to protect service users. EVIDENCE: The inspector examined a sample of three staff recruitment files. Records show that the home had obtained a satisfactory criminal records bureau check prior to staff commencing work. In addition two written references and documentation to confirm identity had been obtained. The inspector found the home was not always obtaining a reference from the prospective member of staff last employer. It is recommended that these be obtained for all new appointments. Discussion with the manager confirmed any gaps in employment records are discussed at interview. As a matter of good practice it recommended the outcome is recorded. Discussion with one member of staff recently appointed to the home confirmed they were able to shadow more senior staff as part of the induction process. In addition staff also work through accredited induction training. Discussion with staff confirmed they were generally satisfied with the level of training provided at the home. Staff have access to National Vocational Training and dementia care. In addition to all mandatory training courses such as moving and handling, infection control and fire safety. The Steppes Residential Care Home DS0000016361.V281894.R01.S.doc Version 5.1 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 37, 38. The manager is making every effort to ensure the home is run in the best interest of service users. However more attention needs to be given to identifying and reducing risks at the home. EVIDENCE: Since the last inspection the manager has attended a “fit person” interview and has been registered by the Commission as the manager for the home. The manager confirmed she has registered to complete a National Vocational Qualification in management and care, which she hopes to complete over the coming year. The manager is in the process of updating policies and procedures as part of the homes quality audit. In addition the views of service users and their families are being sought. Consideration now needs to be given to extend the The Steppes Residential Care Home DS0000016361.V281894.R01.S.doc Version 5.1 Page 18 quality review to seek the views of stakeholders and staff. Examination of a sample of the surveys already completed show the home has received a good to excellent in the feedback it has received. The home now needs to look at ways of publishing the outcomes of the quality review. Following a requirement at the last inspection improvements have been made to the safekeeping of records at the home. These improvements do not prevent service users from having access to their records when they wish. Discussion with staff demonstrated an awareness of what action to take in the event of a fire. Fire safety drills are held every three months. However the inspector found a number of fire doors were being wedged open, an action that puts service users at risk in the event of a fire. Radiators are guarded and hot water regulated close to 43c to reduce the risk of scalding or burns from hot surfaces. However the inspector found some bedrooms and the communal lounge had portable heaters to provide additional heat. It is a requirement that the use of these heaters are fully risk assessed to reduce any risk of injury to service users The Steppes Residential Care Home DS0000016361.V281894.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 2 STAFFING Standard No Score 27 X 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X 3 2 The Steppes Residential Care Home DS0000016361.V281894.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2)(b) Requirement The registered person must ensure service users care plans are reviewed a minimum of once a month or earlier if the needs of the service user change. The registered person must risk assess the use of portable heaters. If a risk to service users is identified then action must be taken to reduce the risk. The registered person must ensure fire doors are not wedged open. Timescale for action 01/04/06 2. OP38 13(4)(c) 01/04/06 3. OP38 23(4)(a) 02/03/06 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. 2. Refer to Standard OP26 OP29 Good Practice Recommendations The registered person should purchase “red alginate” bags for soiled or infected laundry. The registered person should ensure a written reference is obtained from a prospective member of staff’s last employer. DS0000016361.V281894.R01.S.doc Version 5.1 Page 21 The Steppes Residential Care Home 3. OP29 4. 5. 6. OP33 OP33 OP38 The registered person should ensure any gaps in an applicants employment history is fully explored at interview and the outcome recorded as part of the interview process. The registered person should ensure the quality audit seeks the views of stakeholders and staff. The registered person should ensure feedback is given to participants on the outcome of the quality review. The registered person should ensure staff sign risk assessments to demonstrate they have read and understood the contents. The Steppes Residential Care Home DS0000016361.V281894.R01.S.doc Version 5.1 Page 22 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. Extracts may not be used or reproduced without the express permission of CSCI The Steppes Residential Care Home DS0000016361.V281894.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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