Care Home: Stable Cottage

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What the care home does well The three people who are living at Stable Cottage are very settled and say they are happy living there. It feels very relaxed and friendly at the home. People living at the home have a care plan they are involved in making. Plans show staff their needs, wishes and goals and support they need to meet them. Staff support people at the home to keep in touch with and visit their families. Their relatives think the home offers a good service and one comments "I think staff always relate to the residents with care and respect. I appreciate the efforts to help them to relate to each other in a respectful way". People living at the home all have their own interests they follow at home and can take part in activities they like in the community. These include going to college, to town and other outings when staff can take them in the home`s car. Staff support people living at the home well with their personal care. They also make sure they have regular health checks and manage their medicines safely.Stable Cottage is homely, comfortable and is kept clean, tidy and safe. People living there enjoy using and have made their bedrooms nice and personal. The home has a small and stable staff team. This means people living there and staff know each other very well and they are given consistent support. Staff receive good training and support. This helps them understand and know how to meet the needs of people at the home better and to keep them safe. Necessary checks are always made on new staff to ensure they are suitable. What has improved since the last inspection? Progress has been made to introduce a more person approach to care planning at the home. This means the plans of people living there focus more on their personal goals to enable them to develop their life skills and independence. Staff now have individual supervision and so receive better support. This also means their training and development needs can be identified and met easier. The manager has now been registered by the Commission. The way the home is being run means the home has enough management input to ensure that the service continues to improves for the benefit of the people living there. What the care home could do better: It would better ensure the good health of people living at the home and involve them more in their own health care if each person has a Health Action Plan. When staffing is increased there should be more time for people living at the home to have individual support to go out in the community and to develop their daily living skills at home. CARE HOME ADULTS 18-65 Stable Cottage Upper Moraston Sellack Ross-on-wye Herefordshire HR9 6RE Lead Inspector Christina Lavelle DRAFT REPORT: Unannounced Inspection 5th March 2008 2:10-5.40pm Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 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 Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stable Cottage Address Upper Moraston Sellack Ross-on-wye Herefordshire HR9 6RE 01989 730 491 01989 730 391 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) Parkcare Homes (No2) Ltd Miss Andrea Creed Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability (LD) 3 The maximum number of service users to be accommodated is 3. 23rd & 29th January 2007 2. Date of last inspection Brief Description of the Service: Stable Cottage was first set up as a care home in 1996. The registered provider from March 2004 had been Craegmoor Healthcare Limited, which was changed in February 2007 to one of their subsidiary companies, Parkcare Homes (No 2) Limited. The registered manager is Miss Andrea Creed who has the day-to-day management responsibility for this and another of the provider’s homes, which is located next door to Stable Cottage and is called Tithe Barn. Stable Cottage is home to three adults, who have all lived there for more than ten years and are aged around thirty. People living at the home must require care primarily because of learning disabilities. They may also have a physical disability linked with their learning disability. The home’s stated purpose is to provide a service for people with mild to moderate learning disabilities. People with poor mobility could not be accommodated, as there is no lift to bedrooms. The home is rurally located in the village of Sellack about four miles from the market town of Ross on Wye. There are few local facilities and a car is provided to enable people living there to go out into the community. The property is a two-storey building that is part of a complex of converted barns. The gardens are very pleasant and easily accessible and the extensive grounds shared with Tithe Barn include a sensory garden and a woodland trail. The house has kept its original character and has many traditional features e.g. beams. All three of the bedrooms are single (none having en-suite facilities) and are on the first floor. The house has a kitchen/dining room, a sitting room and two bathrooms with bath and shower facilities for all residents use. There is also an office. Information about the home is provided in a service users’ guide that can be obtained from Stable Cottage or the service provider. The weekly fee for the service is assessed according to individuals’ needs, as agreed with their funding authorities. Additional charges include such as hairdressing, private chiropody and dental treatment, personal items, magazines and holiday costs over £200. Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This is a key inspection of Stable Cottage. This means all the Standards that can be most important to adults living in care homes are assessed. This visit was made without telling staff or anyone who lives at the home beforehand. Time was spent talking with two people who live at the home about their care and lifestyles. The way the home is run and any changes made to the service since the last inspection were also discussed with the manager and deputy manager. Surveys were left at the home for all staff and people living at the home asking their views of Stable Cottage. Surveys were also sent to relatives of everyone living at the home. Feedback received is referred to in this report. An annual quality assurance assessment (AQAA) was completed before this visit, as now required. This asks managers to say what they think their home does well and could do better, what has improved in the last year and about their plans to improve the service. It includes information about people living there, staff and other aspects of the home. Various records kept by the home were checked and the house looked around. All other information received by the Commission about the home since the last inspection was also considered. What the service does well: The three people who are living at Stable Cottage are very settled and say they are happy living there. It feels very relaxed and friendly at the home. People living at the home have a care plan they are involved in making. Plans show staff their needs, wishes and goals and support they need to meet them. Staff support people at the home to keep in touch with and visit their families. Their relatives think the home offers a good service and one comments “I think staff always relate to the residents with care and respect. I appreciate the efforts to help them to relate to each other in a respectful way”. People living at the home all have their own interests they follow at home and can take part in activities they like in the community. These include going to college, to town and other outings when staff can take them in the home’s car. Staff support people living at the home well with their personal care. They also make sure they have regular health checks and manage their medicines safely. Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 6 Stable Cottage is homely, comfortable and is kept clean, tidy and safe. People living there enjoy using and have made their bedrooms nice and personal. The home has a small and stable staff team. This means people living there and staff know each other very well and they are given consistent support. Staff receive good training and support. This helps them understand and know how to meet the needs of people at the home better and to keep them safe. Necessary checks are always made on new staff to ensure they are suitable. What has improved since the last inspection? 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 summary of this inspection report can be made available in other formats on request. Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. Thorough assessment and admission procedures are in place to help to ensure the home could suitably meet the needs and wishes of potential service users. EVIDENCE: Required information about the home is provided which include a statement of purpose, service users’ guide and Terms & Conditions of residence documents. The guide is also available in a suitable format so that people with learning disabilities are more likely to be able to understand it. No one has moved into Stable cottage for over ten years. The processes that the home would follow if a vacancy arises were therefore discussed with the managers. It was confirmed that having received a referral for a prospective service user (with relevant information from their funding authority about their care needs) they would arrange to visit to meet them at their current residence to assess their care needs and to give them information about Stable Cottage. Introductory visits would then be arranged to the home with their family and or advocate as appropriate and a trial stay at the home of at least 3 months would follow. At the end of this trial period a review would be held to discuss the suitability of the placement and make a decision about the person moving into the home. This review would appropriately involve home staff, the person themself (whenever feasible), their family, social worker and relevant others. Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. People living at the home have plans showing their needs and wishes and how staff should support them. Risk assessments are also carried out to minimise risks to their safety. Although they make some choices in their daily lives and routines when more focus on their personal goals is fully implemented they can be supported to achieve their goals as part of a more independent lifestyle. EVIDENCE: Two care records of people living at the home were checked and care planning discussed with them, the manager and deputy manager. Their files include their photographs, information about their history, family, health, contacts and background details and a care plan. Records are also kept by staff of any contacts and communication with their relatives and they make daily reports of their mood, behaviours, activities and events etc., which all provides helpful information about their lives, progress and current health and general welfare. Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 10 Progress has been made to implement an appropriately more “person centred” (PC) approach to care planning. A PC plan format has been completed with each person living at the home that focuses more on their personal goals and encouraging them to make choices, develop life skills and independence. The plans include sections on “What I do now” and “What I would like to do” and goals identified should be evaluated regularly. Other relevant areas are also covered such as personal care, mobility, health, finances and communication. People have a keyworker allocated to them from the staff team who provides them with more individual support. One of the keyworkers’ roles is also to make and review their plans with them and the manager’s aim is for them to review the plans and progress to meet their goals monthly. An annual formal review is also being arranged annually when their families, placing authorities and relevant other people are invited to attend and participate. It is also intended that keyworkers will help each person set up a life book. Plans appropriately include risk assessments relating to health, road safety etc. Risk assessments should however also focus more on promoting their life skills and independence. Whilst people living at Stable Cottage have lived together for years, and clearly are a very settled group who are used to their daily and life routines, it is good that they are being encouraged to make more individual choices and decisions about the day to day running of the home. This includes more opportunities to develop their life skills and mix within the community. Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. People living at the home are enabled to take part in activities they enjoy and to go out in the wider community. Staff are encouraging them to take more responsibilities in their daily lives and support them to maintain links with their families. They also ensure they have varied and wholesome meals they like. EVIDENCE: Plans of people living at the home include their regular weekly activities, their hobbies and interests e.g. using their computer, television, puzzles and writing and an assessment of their social interactions and skills. Activities were also discussed with them and the manager and deputy and records kept showing what they have done and where they have been etc. were looked at. People were seen to follow their interests such as using an exercise bike and drawing when they arrived home and one person says they like helping in the garden. Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 12 They all still attend various sessions at a local college. Staff are helping them to look for other options, such as voluntary work, and new social activities out in the wider community. It is also planned to introduce more life skills training in the home and other activities with the activities co-ordinator for Tithe barn and Stable cottage. This would require more individualised staff support which is currently being reviewed. They now go out more as a group on outings, for meals, to the gym and a local social club for people with learning disabilities. One relative commented in their survey “I think they do well within the limitations of the residents and what is possible, however I do wish they had more fun times, socially”. It is good therefore the manager plans to facilitate more opportunities for them to integrate and make friends outside the home. Regarding the daily routines of people living at the home they can be more flexible at the weekends when they have no prearranged activities. However it has been recognised they could be more involved in daily household tasks and not stick so rigidly to routines for tasks such as doing their laundry. Staff are trying to make both their daily and weekend routines more flexible and to give them more I to 1 time to go out to lunch, personal shopping and to choose their own style of clothes and grooming etc. and to involve them more in meal preparation and cooking. It is planned to set up house meetings so they can be more involved in making decisions about the home’s day-to-day running. Everyone who lives at the home has regular contact with their families. They all talked about going home for weekends and on holiday with their parents. Staff support them to keep in regular contact with their relatives and to make calls to them when they want. They have few friendships outside the home however, which the manager hopes they will develop when they go out more. In relation to food provision at the home, plans show their individual likes and dislikes and staff clearly know these well. There are now 4 weekly menus that are in a suitable picture format so they can be more involved in choosing their meals. Everyone has a main cooked meal together, but they can choose their breakfasts and lunches and have them more flexibly. Alternative meals are always provided on request and individual records of meals taken are kept. No one needs a special diet, although staff promote healthy eating and fresh fruit and vegetables, yoghurts etc are always available and meals are home made. This weeks menu was seen to include cauliflower cheese, baked potatoes, fish pie, pasta and so has a range of meat and vegetarian dishes. Staff are also encouraging people living at the home to be more involved in food shopping, preparation and cooking to help them to develop their daily living skills. Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. People living at the home are being well supported with their personal and health care. Their medicines are also managed safely by staff on their behalf. EVIDENCE: People living at the home are all fairly self-caring in respect of their personal hygiene, needing guidance rather than actual physical help. A daily checklist is kept so staff and some people can monitor their personal care and keyworkers have a role in ensuring they purchase their toiletries and clothes. The home has established with individuals and/or their family that any personal intimate care is provided by a person of the gender they prefer. Everyone was seen to be well presented and suitably dressed in accord with their age and lifestyles. There is information about each person’s medical history, health issues and medication including their mental health and behaviours. Keyworkers ensure they have regular health checks and medication reviews. They support them by arranging routine health care appointments e.g. dentist and chiropodist and escort them to attend. Records are kept of all visits and input from GPs and other health care professionals with outcomes. Any accidents, incidents and Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 14 physical checks relating to health and welfare e.g. weight are also recorded. The home obtains appropriate support from relevant health care specialists, e.g. Psychiatrist and epilepsy nurse and staff had completed epilepsy training. It is still planned to implement individual Health Action Plans (HAPs) and the home is progressing towards this as part of implementing more person centred planning. HAPs are considered as good practice by the Department of Health for people with learning disabilities. They can help to ensure that all aspects of their health are closely monitored and any problems identified. HAPs also show that any special health care needs have been recognised and understood and that people are being supported to stay healthy through preventative as well as specialist and routine health care input. They also involve the person themself in managing their own health care to the extent this is feasible. Regarding medication there are general & service specific policies & procedures in place for their safe management, including for homely remedies and when medicines can be taken as and when required. It is confirmed that the storage for medication in the home is suitable and secure. Records of administration were being maintained appropriately, with details of each person’s prescribed medication alongside their photographs. The staff team had all completed accredited training for the safe handling of medicines and there is a list kept of staff who are authorised to administer. An assessment had also been made of each person living at the home in respect of their ability to self-administer. Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. People living at the home feel they can express their views and raise concerns with staff and are confident they will be dealt with properly. Staff understand their responsibility to promote their welfare and safety for their protection. EVIDENCE: There is an appropriate complaints procedure, which is in a format people with learning disabilities are more likely to understand. People living at the home confirmed they know who to raise concerns with and feel confident they would be listened to and action taken. They were observed to have an open rapport with the manager and deputy, which their positive comments about them and staff also reflected. The home’s AQAA states that advocates would be sought if needed and everyone at the home also has close family involvement. Their relatives say they would know who and how to make a complaint. One saying “I don’t have concerns generally and if I do I raise them and feel that I am listened to and that the staff respond appropriately and adequately”. There had been no complaints made to the Commission, or issues raised affecting the safety and welfare of anyone living at the home, since the last inspection. The provider has comprehensive policies & procedures in place relating to adult protection, preventing abuse and for whistle blowing. Staff receive relevant training and it is part of their induction. The home has a copy of local multiagency procedures for Protection of Vulnerable Adults (POVA) and the manager knows when referrals should be made under them. This should all ensure that staff understand their responsibility to protect people living at the home and know how and where to refer any incidence or suspicion of abuse or neglect. Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. Stable Cottage offers people living there a stable, comfortable and safe home, which suitably meets their needs. Appropriate arrangements are made for the accommodation to be kept clean, tidy and in a good state of repair. EVIDENCE: The home has a rural, fairly isolated location, although this seems to suit the three people living there who say they love the garden and walking around the seven acres at Tithe Barn, which include a sensory garden and woodland trail. Whilst there is only a post office and pub within a reasonable walking distance the countryside around the home is lovely and the home has a car so they can go out to town and the community when staff have time and can drive them. Stable Cottage has a warm, homely atmosphere and the house is comfortable. The property is a converted barn that has attractive, original features such as beams and an open fireplace. There are seven acres of grounds, an activity & sensory room and an indoor swimming pool available at Tithe Barn. The house is tastefully decorated with individualised decor and furnishings in bedrooms. Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 17 Whilst the manager recognises that some redecoration, new kitchen units and furniture are needed to modernise and improve the environment the overall impression is of a good standard. It is positive however that some upgrading work is planned within the next 12 months as no improvements have been made to the accommodation since the last inspection. In particular carpeting in some areas such as the stairway and landing is looking worn and stretched. The maintenance worker from Tithe Barn has responsibility for minor repairs at Stable Cottage and carries out routine health & safety, fire and vehicle checks. Two people living at the home kindly allowed their bedrooms to be looked at. Both are well personalised and clearly valued by them as their private space. Only one bedroom has a wash hand basin so the three people living there share a bathroom with bath & shower facilities and a ground floor cloakroom. The kitchen and laundry are well equipped and as they are all physically able no special aids, adaptations or equipment are needed. All parts of the home were found to be clean, warm, tidy and fresh. There is a cleaning schedule for household tasks and staff are trying to encourage people living there to be more involved. Attention is clearly paid to good hygiene and infection control policies & procedures are in place. All staff have completed infection control and COSHH training. Disposable gloves and aprons are provided although there is no need of soiled waste arrangements at this home. Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. People living at the home are supported by a small, stable staff team who are suitably experienced, trained and supervised and so should understand and know their needs and how to keep them safe. There would be more scope to facilitate individualised support to access the community and develop their life skills at home with more staff time available. Good recruitment procedures help ensure only suitable staff work at the home to protect people living there. EVIDENCE: There is still only three permanent staff working solely at the home, although the deputy manager for both care homes has been spending much of her time there recently to develop person centred planning and review the service etc. There is also the option of staff from Tithe Barn covering shifts and being on call in an emergency. Whilst this level of staff cover is adequate because there is usually only one person on duty it does limit the flexibility for individualised support. It is good therefore that the manager recognises this and is trying to recruit another full time care worker. This will mean there will be more time and scope for staff overlap and keyworkers to support people on a 1 to 1 basis Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 19 Regarding recruitment, as there has not been any new staff employed at the home for several years staff records were not checked. However records seen during the last inspection included necessary checks and other information. The home’s AQAA and the manager also confirmed the provider will not allow anyone to start work with people using their care services without first having a CRB/POVA (police check) and two suitable written references. Applications must all also include a full job history, with any employment gaps explored. New staff are also expected to undertake the provider’s induction programme, which is comprehensive and accredited and must be completed during their probationary period before appointments are confirmed. All new staff are also required to complete the mandatory health & safety training areas as well as other relevant topics, such as medication, adult protection and epilepsy. They can then go onto achieve an NVQ qualification in social care. With such a small team clearly staff see each other regularly and seem to work together to promote the welfare of people living at the home. The manager is now ensuring however they receive regular individual supervision so their work performance and training & development needs are monitored and assessed. They each also have an annual appraisal and team meetings are held. Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including this visit to the service. People living at this home benefit from a well managed service, which offers them good support. There are systems in place to monitor and review service quality, resulting in plans for the home to keep on improving as people living there wish and/or for their benefit. Policies, procedures and practices help to promote the welfare and safety of people who are living and working there. EVIDENCE: Since the last inspection the manager Andrea Creed has been registered by the Commission in respect of Stable Cottage & Tithe Barn and she and the deputy manager share joint responsibility for the day to day running of both services. Ms Creed has thirteen years experience working with people who have learning disabilities and has achieved NVQs 4 and 5 in management & social care. She attends monthly service managers’ meetings and feels that she and the home receive appropriate external management support from the provider. Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 21 Regarding quality assurance (QA) there is a formal QA and monitoring system operated for the provider’s care services. This involves regular audits of all relevant aspects to ensure that they are meeting required standards. Some are self audited by home management and cross-checked during the monthly visits made by a manager from the provider organisation. There is also a clinical governance framework that facilitates the process of continual improvement. This measures structures and outcomes and the evidence from their audits is then used to formulate action plans. These action plans identify any shortfalls to ensure they are addressed within given timescales. Stable Cottage recently had a full audit undertaken of its service and the manager says are currently working towards completing all quality improvement points in the action plan. As part of the QA process questionnaires are sent to people using the services and relevant others involved and their feedback informs the planning process. Craegmoor have also set up a service user group called “Your Voice”. Meetings are held regularly and service user participation is invited, although people living at Stable Cottage have chosen not to attend. The AQAA is also now a required part of providers’ self-assessment. It was discussed during this key inspection visits with the manager that their AQAA needed more evidence of what the service does well and about their plans to improve it. Some standards groups also did not refer to all the relevant outcome areas. It was advised therefore that they needed to refer to the Commission guidance called KLORA (key lines of regulatory assessment). In respect of promoting health & safety staff are required to undertake all the core topics, with refreshers as and when needed. The AQAA details that PAT tests and the fire safety system and equipment are being tested or checked at specified intervals. The heating system and gas appliances were also serviced last year. There were no other safety hazards identified in the environment during this visit and overall it is evident that due attention is paid to ensuring safety in the home to promote the welfare of people living there and staff. Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X X X X 3 X Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 23 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 persons meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered provider must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the registered provider to consider carrying out. No. 1 Refer to Standard YA19 Good Practice Recommendations Health Actions plans (HAPS) should be set up for each person living at the home. HAPs would better ensure their good health and involve them more in managing their own health. More staff should be provided so that there is more scope and time to provide individualised support to people living at the home. 2 YA33 Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: 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 © 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 Stable Cottage DS0000069514.V361392.R01.S.doc Version 5.2 Page 25 - 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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