Care Home: Cornerstone

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Cornerstone 51 Pease Street Darlington Durham DL1 4EX one star adequate service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Tanya Newton Date: 1 7 0 6 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Cornerstone 51 Pease Street Darlington Durham DL1 4EX 01325261658 08717142628 rich@cornerstonecare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Cornerstone Care (Durham) Ltd care home 12 Number of places (if applicable): Under 65 Over 65 12 0 learning disability Additional conditions: Date of last inspection A bit about the care home Cornerstone is a residential care home providing residential care services for up to 12 adults in the Category of Learning Disability (LD). Cornerstone is owned and managed by Cornerstone Care (Durham) Ltd. Cornerstone is located in a residential part of Darlington and within walking distance of the town centre and all of its amenities. Cornerstone is a large end terrace house that has been extended to provide suitable living accommodation for the residents. The accommodation comprises 10 single and one double bedroom along with a range of communal spaces and garden areas. Cornerstone has its own separate day centre called the Ruby Centre within its grounds. Weekly fees vary between £408 and £458 plus top-up fees for additional inputs where appropriate. The actual amount payable will depend on individual circumstances. The weekly fee covers all accommodation, personal care and meals and drinks. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home An inspection was carried out at the home on the 17th June 2008 between the hours of 10 AM and 3 PM. A second inspector attended for part of the inspection. During the inspection, a tour of the building took place, records were looked at and people who live at the home, the manager and staff on duty were spoken too. In addition the inspector also attended a meeting with staff from both Darlington and Durham Council prior to visiting the home. What the care home does well What has got better from the last inspection Support plans have been updated and contain detailed information about how peoples needs should be met. One of the bathrooms has been updated following a previous requirement made in the last inspection report for the home. What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Tanya Newton Ground Floor Unit 3 Waterside Court Bold Street Sheffield S9 2LR 011 4256 4530 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Although a service users guide, assessment and contract is provided, some of the information needs to be updated. Evidence: Although people admitted to the home have an assessment in place from the local authority, the home should also carry out its own assessments. The manager said that the home would not admit a person whose needs could not be met. The contracts need updating to reflect the change in CSCI contact details, the level of fees and the room number. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Individuals are involved in decisions about their lives, and play an active role in planning the care and support they receive. Evidence: Support plans for each individual were detailed and provided information about how their needs should be met. They are reviewed regularly. Support plans covered areas such as dignity, choice and respect as well as peoples health and personal care needs. People living at the home are encouraged to discuss their needs and personal goals with staff. Feedback from them included I can make choices and decisions, things like what time I get up and go to bed and what I want to do. The home carries out a range of risk assessments so that people can be supported in taking reasonable risks with support from staff. Advice from other health professionals is sought where this is required. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are able to make choices about their lifestyle and are supported in developing their life skills. Social, educational, cultural and recreational activities meet individuals expectations. Evidence: People take part in a range of activities, including outings to places of interest, holidays, parties, social clubs and day placements. There are good links with the local community, with people attending pub outings and shopping trips. One person living at the home said, I go out shopping for new clothes and i enjoy spending time in my room, my family take me out. Visitors are encouraged and visiting arrangements are flexible. The home has a four weekly menu plan, breakfast consists of cereal and toast during the week, with a cooked breakfast being available at weekends. Lunch is a light meal with pasties, or soup and sandwiches. The evening meal is the main meal which is a cooked dinner. The menus did not seem to be based on healthy options and did not show that people were getting the recommended 5 portions of fruit and veg each day although a check of the freezer did show that lots of frozen vegetables were available. The fridge was empty on the day of the visit and contained only milk, the manager said that he was due to be doing a shopping trip that day. One of the people accomodated said that they liked the meals. Evidence: Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The health and personal care that people receive is based on their individual needs. Better systems are required to store medication safely. Evidence: Peoples health and personal care needs were well documented within their individual care plans. Advice is sought from other health care professionals where this is required. Staff said that people were well cared for. Medication systems were viewed. In the main systems to administer, record and store medication were safe, although there were some gaps in the recording of creams and lotions. The basket which was used to store creams was dirty and these were not being stored in a locked cuboard. Medication storage systmes need to be improved to safeguard people living at the home. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who use the service are able to express their concerns, and have access to an effective complaints procedure. Evidence: There are clear complaints and adult protection procedures in place. Some concerns were raised with CSCI prior to the inspection from the Local Authority. These matters are being looked into via their contractual visits. The home has received one complaint since the last inspection. Pre-employment checks are carried out on staff, including enhanced checks with the Criminal Record Bureau plus Protection of Vulnerable Adult checks. Also, two references are obtained in respect of each new employee, with special attention given to the last employment. This is to ensure that unsuitable people are not employed to care for vulnerable adults. All staff spoken with during the inspection said they would have no hesitation in reporting any suspected abuse or neglect. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The physical design and layout of the home enables people who use the service to live in a reasonably safe, well-maintained and comfortable environment, which encourages independence, although some improvements are required. Evidence: A tour of the environment was taken. All of the downstairs toilets were smelly. One had a patch of damp running along the bottom of the wall. There is no call bell fitted in the home, so people have to shout to attract the staffs attention. Some of the bedrooms had no lockable space. The lighting was very poor in the assisted bathroom on the ground floor, with no natural light. The ground floor toilet extractor fan not working and the toilet floor was stained and smelly. The toilet flush was very noisy. Tiles at the back of the toilet looked as if they have been removed and not replaced properly. Staff said they have had trouble with the plumbing in this bathroom. One of the bedroom carpets had a rip in it, which was a trip hazard. This needs replacing. The front lounge had an unguarded gas fire which was on. This poses a risk to people, if they fall against fire. Coffee tables need re-polishing as there was no varnish left on them. The upstairs bathroom had broken chipped tiles and enamel missing from the bath. There was no toilet roll, soap, disposable towels or sink plug. The dead lock on the door needs removing in the refurbishment which is planned for this room. A second bathroom had recently been refurbished, although the carpet in front of the toilet was stained. One of the bedrooms contained old shabby furniture and was smelly. Bathroom doors did not have locks to ensure peoples privacy when they were being used. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Staff in the home are in the main well trained, skilled and in sufficient numbers to support people living at the home. Evidence: The home employs twelve care staff. Nine of the twelve staff have an NVQ at level 2 or above. The remaining three members are working towards this award. The homes recruitment system is robust and includes police checks and references . Staff files contained the required information. New staff members go through induction and foundation training so that they have the right knowledge and skills to do their jobs competently. People said that they were well cared for and that they got on well with each member of staff and felt they could confide in them. Staff training includes first aid, manual handling, safe handling of medicines, food hygiene and protection of vulnerable adults. Fire training is required for all staff. Staff supervision is now provided for all staff. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The homes quality assurance, management arrangements and health and safety systems need to be improved. Evidence: The current registered manager informed us during the inspection that he plans to resign from his position as registered manager in October 2008. Some concerns about the management arrangements had been bought to CSCIs attention by the local authority. Quality Aassurance systems were looked at, the home seeks feedback from staff and carries out audits which are based on national minimum standards (NMS). Monthly staff meetings are held with minutes displayed in the office. An audit had been carried out on the premises but it was not dated, nor did it look finished. The manager said that he had tried to hold relative meetings but that the attendance was very low. Health and safety records were checked, the home was asked to send a copy of the gas safety certificate within 7 days, as this was unavailable. The home was also asked to send a copy of the PAT testing report as this was also unavailable. At the time of this report being made available in draft format, this information had not been received. All other health and safety records which were checked were sufficient. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 1 27 23 (2) (c) (j)13 (3) The bathroom and toilet 31/01/2008 facilities on the first floor must be brought up to a good standard, especially the toilets, in the interest of privacy, dignity and choice (mainly for the benefit of service users on the first floor). Liquid soap and paper towels must be provided in each toilet and bathroom in the interest of hygiene. Not completed Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 20 13 Systems to store medication 18/11/2008 safely must be implemented, the advice from a recent PCT visit must be followed. Medication not being stored safely whioch poses a risk to service users. 2 24 23 One of the bedroom carpets 30/10/2008 needs to be replaced as it has a hole in it which may be a trip hazard. Some of the furniture in bedrooms and communal areas of the home needs to be replaced as it is shabby and in a poor state of repair. Furniture needs replacing in some areas this includes bedroom furniture, tables and a carpet in one of the bedrooms. 3 24 23 The bathroom and toilet facilities must be bought up to a good standard. Liquid 30/11/2008 soap and paper towels must be provided in each toilet and bathroom in the interests of hygiene. Outstanding from last inspection report, although some work has been done it has not been completed. 4 35 23 All staff must receive regular 22/11/2008 fire training. Fire training must be kept up to date for all staff and must be based on the fire officers recommended timescales. 5 42 23 Copies of health and safety certificates requested by CSCI must be made available. 31/10/2009 The home were requested to send copies of their portable appliance testing and gas safety certificate following the inspection. 6 42 13 The gas fire in the lounge must be guarded to ensure that risks to people living at the home are as far as possible eliminated. 31/10/2008 The gas fire in the lounge was unguarded which poses a risk to people living in the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 1 2 The service users guide should be kept up to date and include the name of the registered manager. Assessments should be completed by the home for all people admitted. 3 5 The contract should be reguarly reviewed and updated. It should contain information regarding the level of fees and CSCI contact details. The room number occupied should also be included. Advice should be sought from a dietician so that meals are nutritious, balanced and healthy. The home should consider purchasing a nurse call type of communication aid for people living at the home so that they do not have to shout for staff from their bedrooms. CSCI need to be kept informed regarding the future management arrangments of the home. Quality assurance systems should be further developed and should include feedback from relatives. The homes internal quality assurance sytems should be dated and show any action that is to be taken as a result of an audit. 4 5 17 24 6 7 37 39 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web:www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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