Care Home: High Street (10)

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What the care home does well People`s care and support needs are generally well documented in their care plans. Members of staff carry out monthly and six monthly reviews of people`s care and support needs. Relatives are kept up to date with people`s progress. People choose the gender of staff who will provide intimate personal care.People have good access to healthcare professionals. Contact with healthcare professionals is well documented. Rationales for when people take medicines that are prescribed to be taken only when required are well documented. Risks are regularly assessed and strategies for risk management are generally well documented. The environment is homely and the providers are updating the services with a new wet room, laundry room and storage. People`s bedrooms are decorated and furnished to suit their personalities. People have a sensory room where they can relax and use different sensory equipment. People benefit from having staff available at the times when they need them. Staff have good access to mandatory training. What the care home could do better: People`s files should be reviewed so that only current information is available and any duplication is avoided. People`s individual communication methods should be set out in more detail in their care plans. Daily records should report people`s decision making or communication. Risk assessments which conclude that restrictions apply, for example, access to a person`s wardrobe, should be more explanatory. The home must have suitable safe storage for people`s medicines. Decisions and discussions about appointment of anyone with a caution or conviction must be recorded. This is so that people are protected from anyone who is unsuitable to work with people who may be vulnerable. Random inspection report Care homes for adults (18-65 years) Name: Address: High Street (10) High Street (10) Semington Trowbridge Wiltshire BA14 6JR one star adequate service 29/04/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Sally Walker Date: 0 1 0 6 2 0 1 0 Information about the care home Name of care home: Address: High Street (10) High Street (10) Semington Trowbridge Wiltshire BA14 6JR 01380870061 01672569477 semington@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr John Sinclair Type of registration: Number of places registered: Conditions of registration: Category(ies) : Cornerstones (UK) Ltd care home 8 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 8 Any placement for short-term care or for an emergency placement must be agreed with the Commission before the placement commences. For the purpose of this condition, short-term is defined as a placement that is expected not to last longer than 3 months. An emergency admission is defined as an admission whereby someone is likely to be placed at short notice without an up-to-date assessment of needs having been carried out and the person has not had the opportunity to visit the home prior to placement. Date of last inspection Brief description of the care home 10 High Street is one of five care homes in Wiltshire that are run by Cornerstones (UK) Ltd. 10 High Street is a detached property in Semington, a village between Melksham Care Homes for Adults (18-65 years) Page 2 of 11 2 9 0 4 2 0 0 9 Brief description of the care home and Trowbridge. Each person at the home has their own bedroom. There are two bedrooms on the ground floor and the others are on the first floor. Some of the bedrooms have en-suite facilities. The communal rooms include an open plan sitting room and dining area. There is another sitting room that is also used as a sensory room. On the first floor there is an office and sleeping-in room for staff use. There is a domestic type kitchen and a separate laundry room. At the rear of the property there is a large garden with a patio and a car parking area. People who use the service receive support from a manager, deputy manager and a team of support workers. The weekly fee is 1385 pounds per week. Inspection reports can be obtained from the home and are also available through the Commissions website at www.cqc.org.uk Care Homes for Adults (18-65 years) Page 3 of 11 What we found: This unannounced Random inspection took place on 1st June 2010 between 9.05am and 1.00pm. Mr John Sinclair, registered manager, visited during the inspection. He told us that he had stopped managing the home and Mrs Pascale Orban, currently registered to another of the companys services, had taken over managing the home in April 2010. Mrs Orban had applied to be the registered manager. Mrs Orban told us that the deputy manager had also left and she hoped that the post would soon be filled. Some people were getting ready to go to the companys day service, accompanied by members of staff. We looked at two peoples care plans, daily records and medication. We made a brief tour of the building and one person showed us their bedroom. We looked at two staff records, staff training and the staffing rota. We looked at the accident records. Before we visited we asked the home to complete an Annual Quality Assurance Assessment (known as the AQAA). This was their own assessment of how they were performing. It told us about what has happened during the last year and about their plans for the future. As part of the inspection process we sent survey forms to the home for people who use the service, staff, relatives and healthcare professionals to tell us about the service. Comments are included in this report. The last Key inspection was on 29th April 2009. Following that inspection Mr Sinclair wrote to us to tell us what he was doing to address the three requirements and 10 recommendations that we made. We did not look at all the previous requirements at this inspection. People had lived at the home for more than three years. In surveys three people told us they liked to cook. One person told us they liked cleaning. One person told us, in answer to the question about what the home could do better told us: day care. We were not able to purse this further with the person as they did not tell us their name. A member of staff told us that some people did not have speech and their individual methods of communicating were well known to all staff. One persons care plan identified that they did not use speech but would communicate with signs and gestures. There was no record of which signs and gestures the person used to express themselves. Another persons care plan had a pictorial record of a review of their goals and aspirations. There was a pictorial menu in the dining area. Mrs Orban told us that all staff had attended a course on interactive communication. She said that she intended to do the course too. In the AQAA Mr Sinclair told us that each person now had a one page profile. This was a list of things which were important to individuals, positive statements about people and how they preferred to be supported. Care Homes for Adults (18-65 years) Page 4 of 11 Different care planning formats were being used with some people. Some of the documentation was not completed in full. Mr Sinclair told us that this was because new documentation was being introduced for care planning and health action planning. The daily reports were recorded on a pre-printed sheet which identified most areas of need. These records were not as detailed as would be expected for people with often complex care needs. There were records of what people had done and what they had eaten. There was little written about communication and decision making. Mr Sinclair told us that the printed sheet had been introduced because members of staff had written too much in the past. In the AQAA Mr Sinclair told us that he planned to improve recording the choices people made. Separate records were kept when people displayed behaviours. Peoples appointments with their GP, district nurse, chiropodist and healthcare professionals were recorded in good detail. Peoples weight was regularly monitored. Mrs Orban told us that everyone had recently had an annual health check with their GP. One person told us that they had really enjoyed a holiday the previous week. We looked at the records that members of staff had written whilst the person was on holiday. It was clear that the person had enjoyed the week away but this was not evident from the records which stated where they had been each day and what they had eaten. Care plans and health action plans were reviewed every month and six monthly. Copies of the reviews were sent to peoples families. People were generally supported with intimate personal care by a member of staff of the same gender. One persons family had signed a statement giving their permission for a member of staff of the opposite gender to support the person with bathing in exceptional circumstances as the person could not be consulted themselves. Bathing risk assessments were on file and it was clearly stated when people should never be alone when bathing. Risk assessments had been completed for other aspects of peoples daily lives, for example, using the kitchen, eating, going out, swimming, using the homes vehicle and fire safety. The risk assessments were cross referenced with peoples care plans. Members of staff were required to sign up to the risk assessments. Mrs Orban showed us the storage arrangements for peoples medicines. As a result of the refurbishments, the storage arrangements had changed. Medicines were no longer stored behind two locked doors. Peoples medicines were kept in plastic trays in a locked cupboard. In his response to the last inspection report, Mr Sinclair told us that the company directors had decided that space and finances do not warrant installing a controlled drugs cabinet whilst we do not have any controlled drugs...there is however a guarantee that the resources will be made available immediately should the need arise. The supplying pharmacy put up medicines in individual monitored dosage systems for each week. People who were prescribed medicine to be taken only when required, had clear written guidance from the GP or specialist on their files. Mrs Orban showed us the changes being made to the environment. The kitchen had been extended, a new wet room with shower and toilet was being installed and the old shower room was being turned into a laundry room. One person had a padlock and chain on their wardrobe in their bedroom. They had free Care Homes for Adults (18-65 years) Page 5 of 11 access to their box of shoes and their ensuite shower room. Mrs Orban told us that the persons access to the wardrobe was restricted due to behaviour and health and safety reasons. This was not included in any detail in the persons care plan. Mrs Orban told us that she would complete a more detailed risk assessment. People had the use of a sensory room. There was different equipment for them to use. Mrs Orban told us that some things were currently stored to one side of the room because of the building work being carried out in the home. There was a star lock on this room. Mrs Orban told us that this was not used and could be removed. The staffing rota showed that there was a minimum of three members of staff on duty during waking hours throughout the week. At night a member of staff slept on the premises. There had been no recent appointment of members of staff. We looked at two members of staffs files. All of the documents and information required by regulation were on file. Prospective members of staff were required to state whether they had any convictions on the homes application form. We said that if anyone with a conviction or caution had been appointed, there must be a record of any discussion with the person and reasons why the decision to appoint had been made and by whom. Mrs Orban told us her personnel records remained at the other home she managed. She told us she held the Registered Managers Award and NVQ Level 4 in management and care. Mr Sinclair told us that the company training manager recorded the training that each member of staff was expected to attend, together with when updates were needed. Mr Sinclair showed us his copy on the computer. Training needs were identified at supervision and passed on to the training manager. Compulsory training included: Learning Disability Qualification, NVQ, epilepsy, first aid, moving and handling, medicines, health and safety, managing behaviour, food hygiene and fire safety. Mrs Orban told us the training was a range of internal and external courses and e-learning. In surveys two members of staff said that the staff team worked well together. We looked at the accident records. There had been few accidents and incidents; the last one recorded in December 2009. Body maps identified details of marks or wounds in good detail. Mrs Orban showed us the arrangements for people to hold small amounts of cash at the home. Records of each transaction and numbered receipts meant that there was a good audit trail of peoples money. There were also records of transactions of peoples savings and bank accounts. Mrs Orban told us that the companys accountant audited the records every six months. What the care home does well: Peoples care and support needs are generally well documented in their care plans. Members of staff carry out monthly and six monthly reviews of peoples care and support needs. Relatives are kept up to date with peoples progress. People choose the gender of staff who will provide intimate personal care. Care Homes for Adults (18-65 years) Page 6 of 11 People have good access to healthcare professionals. Contact with healthcare professionals is well documented. Rationales for when people take medicines that are prescribed to be taken only when required are well documented. Risks are regularly assessed and strategies for risk management are generally well documented. The environment is homely and the providers are updating the services with a new wet room, laundry room and storage. Peoples bedrooms are decorated and furnished to suit their personalities. People have a sensory room where they can relax and use different sensory equipment. People benefit from having staff available at the times when they need them. Staff have good access to mandatory training. What they could do better: 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 2. Care Homes for Adults (18-65 years) Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes R 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 39 26 Cornerstones (UK) must 31/05/2009 ensure that reports of all visits that are made to the home in accordance with Regulation 26 of the Care Homes Regulations 2001, are kept in the home and available for inspection. This is to ensure that there is a record of the visits and the findings, and that the people who use the service can be confident that the running of the home is being appropriately monitored by Cornerstones (UK). Care Homes for Adults (18-65 years) Page 8 of 11 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 Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 20 13 The home must have suitable 30/07/2010 safe storage for peoples medicines. So that peoples medicines are properly stored. 2 34 19 Decisions and discussions 30/06/2010 about appointment of anyone with a caution or conviction must be recorded. This is so that people are protected from anyone who is unsuitable to work with people who may be vulnerable. 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 7 Daily records should report peoples decision making or communication. This will show that their care plan is directing their care. Risk assessments which conclude that restrictions apply, for example, access to a persons wardrobe, should be Page 9 of 11 2 9 Care Homes for Adults (18-65 years) 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 more explanatory. 3 18 Peoples individual communication methods should be set out in more detail in their care plans. This will mean people have a consistent approach to their communication needs. Peoples files should be reviewed and rationalised so that only current information is available and any duplication is avoided. 4 41 Care Homes for Adults (18-65 years) Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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