Care Home: Stepping Stones

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What the care home does well One person had moved into Stepping Stones quite recently. We saw that a range of professional assessments had been carried out, to make sure this home was able to suitably meet the person`s needs, and to give guidance to staff. The person had visited several times before making the decision to move in, and was able to choose which bungalow to move into. Care plans included comprehensive advice for staff about service users` care needs, and how they like their care to be provided. We saw that people had been consulted about many aspects of their care. Issues of consent were being discussed by residents with their Facilitator (Support Worker), for example, whether they minded whether a man or woman assisted them with their personal care. The Manager had been leading discussion groups with service users; the current topic being their medicaiton, to help them understand their own medication and its effects. Stepping Stones is made up of two bungalows each with six residents, and three onebedroomed flats. The bungalows each had their own team of staff, with a Team Leader and Senior Facilitator. This meant that service users have better consistency of staff working with them. It also meant they could make their opinions heard more clearly. Each bungalow had a regular residents` meeting. Weekly activities had been introduced, having listened to peoples` preferences. `Helper days` had been introduced, so that residents could take turns with household tasks. The bungalows and flats are easily accessible throughout, with automatically opening front doors and two-way bedroom doors. New external doors to the garden were being arranged, that would stand the wear and tear of constant use. There is a call alarm system in place, and all aids and adaptations to meet the needs of wheelchair users. There were lowered light switches, accessible power points, lowered work surfaces, sinks and cooker hobs, and a low washing line. We saw that the recruitment process was sound, with all checks made on new staff, to be sure they were suitable to work with vulnerable adults. The Registered Manager, Mrs Susan Davidson, is a qualified nurse and has the Registered Managers award. An Assistant Manager had recently been appointed. They had suitable experience that enabled them to take responsibility for people living in the flats, and working towardsindependent living. Staff who completed surveys told us that they nearly always have the support and experience they need to meet the needs of their service users. Typical quotes were, `Personally I think Stepping Stones has a professional caring approach, striving to achieve the very best, identifying the support needs of each individual tenant or staff member, encouraging personal development through good communication, skills, choices and those opportunities arising in their lives, while giving each individual a chance to learn and make their own mistakes`. `Maintaining each individual`s privacy, dignity, wishes, and identity as a human being`. What the care home could do better: More useful and reflective analysis of peoples` behaviour could be helpful, with periodic professional input. We saw several records made by staff of incidents of residents` verbal abuse. There was a lack of useful analysis. On one occasion when a resident had called for help during the night, the support provided may not have been sufficient, which may have lead to later disturbance. One service user told us of friction with a fellow resident. Staff and management should record what they might have done to prevent the service user from getting frustrated. This might make apparent a resource implication, such as increased staffing or alternative living accommodation. It may be helpful to recognise any such deficit, even if it cannot be altered at the present time. One staff member said in a survey, that management should - `Look into a way that staff on sleep-in duty are stopped from being woken up when they have to work the next day`. This suggests that residents` night time needs should be kept under review, as alternative arrangements may be needed. An adult approach should be adopted by staff at all times. One relative told us in a survey that they found some staff to be `bossy` in the way they interacted with service users, though we only saw staff being polite and helpful. A service user said that the Manager decides when they go shopping. The Manager told us she arranges the 1;1 time for service users in turn, which allows for them to have individual attention, which would include shopping trips. The team should work together to make people who live at Stepping Stones feel more in control of what they can do. The premises were very accessible. One exception was the kitchen sink in one of the flats, which had not been adapted for a wheelchair user. The damage caused to furniture and doorways by wheelchairs gave a drab feel to otherwise comfortable surroundings. While we agree that residents should be encouraged to feel free to move around their home, we suggest that attractive protective coatings might be available for parts that have been gouged out. Locks on doors of bedrooms and bathrooms should be reviewed, as some were not adequate for protecting peoples` privacy and dignity. The home could provide a lockable box or cupboard in peoples` own rooms, where they could keep their own things like money and medicines, and still be supported to use them well, with the key provided to the resident when risk assessment showed this to be safe and satisfactory. There had been an inspection of the premises by the Fire Safety Inspecting officer during the previous week. Requirements were made with respect to some of the fire doors. TheRegistered Manager should inform the CQC when the requirements have been fully met. The Registered Manager said she was pleased that soon she should be able to delegate some management and supervisory tasks to the new Assistant Manager, which would enable them to keep up to date. Random inspection report Care homes for adults (18-65 years) Name: Address: Stepping Stones 1-6 Boxhill Close Chard Barton Honicknowle Plymouth Devon PL5 3QB three star excellent service 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: Stella Lindsay Date: 2 7 0 5 2 0 1 0 Information about the care home Name of care home: Address: Stepping Stones 1-6 Boxhill Close Chard Barton Honicknowle Plymouth Devon PL5 3QB 01752788273 01752768613 stepping_stones1@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Susan Davidson Type of registration: Number of places registered: Conditions of registration: Category(ies) : Tamar Housing Society care home 15 Number of places (if applicable): Under 65 Over 65 0 physical disability Conditions of registration: 15 The maximum number of service users who can be accommodated is 15 The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Physical disability (Code PD) Date of last inspection Brief description of the care home The last key inspection at Stepping Stones was carried out on 11th July 2007. Tamar Housing Society is a housing association registered with the Housing Corporation. They own Stepping Stones, a care home providing care for up to fifteen Care Homes for Adults (18-65 years) Page 2 of 10 Brief description of the care home people, aged 18 - 65, with physical disabilities. While the home offers long stay placements, the service aims to work with service users to develop independent living skills, to enable them to move out into their own accommodation. The length of stay depends on the individuals needs as identified with the Care Manager and through care plans. The house at the end of a cul- de- sac on a housing estate in the residential area of Honicknowle, close to shops, pubs, the post office and other amenities. The home was purpose built and opened in 1994. It is comprised of two self-contained bungalows, each providing six bedrooms, and three one-person flats. All the bedrooms are single and those in the flats have en suite facilities. Each bungalow and flat has its own facilities, amenities and services with the design and layout enabling ease of access for people whose main source of mobility is wheelchairs. The home has plenty of communal space, with a kitchen and combined dining and lounge area in each bungalow. There are a variety of accessible garden areas. Inspection reports may be obtained on request at the Managers office. The fee is basically 640 pounds per week, with extra funding required if needed to meet assessed needs. Care Homes for Adults (18-65 years) Page 3 of 10 What we found: We visited Stepping Stones on a Thursday in May 2010. We met with the Registered Manager, three staff on duty, and four of the people who were living at the home. We had received responses to our surveys from nine service users and eight staff, and the Manager had sent us the Annual Quality Assurance Assessment which gives information about how the service is run, improvements that have been made and which are planned. We found that several of the people who live at Stepping Stones were out, attending various activities. Others were engaged in chores around the house, or going shopping. During the day we saw people engaged in discussions, relaxing in the lounge and garden, and entertaining guests. What the care home does well: One person had moved into Stepping Stones quite recently. We saw that a range of professional assessments had been carried out, to make sure this home was able to suitably meet the persons needs, and to give guidance to staff. The person had visited several times before making the decision to move in, and was able to choose which bungalow to move into. Care plans included comprehensive advice for staff about service users care needs, and how they like their care to be provided. We saw that people had been consulted about many aspects of their care. Issues of consent were being discussed by residents with their Facilitator (Support Worker), for example, whether they minded whether a man or woman assisted them with their personal care. The Manager had been leading discussion groups with service users; the current topic being their medicaiton, to help them understand their own medication and its effects. Stepping Stones is made up of two bungalows each with six residents, and three onebedroomed flats. The bungalows each had their own team of staff, with a Team Leader and Senior Facilitator. This meant that service users have better consistency of staff working with them. It also meant they could make their opinions heard more clearly. Each bungalow had a regular residents meeting. Weekly activities had been introduced, having listened to peoples preferences. Helper days had been introduced, so that residents could take turns with household tasks. The bungalows and flats are easily accessible throughout, with automatically opening front doors and two-way bedroom doors. New external doors to the garden were being arranged, that would stand the wear and tear of constant use. There is a call alarm system in place, and all aids and adaptations to meet the needs of wheelchair users. There were lowered light switches, accessible power points, lowered work surfaces, sinks and cooker hobs, and a low washing line. We saw that the recruitment process was sound, with all checks made on new staff, to be sure they were suitable to work with vulnerable adults. The Registered Manager, Mrs Susan Davidson, is a qualified nurse and has the Registered Managers award. An Assistant Manager had recently been appointed. They had suitable experience that enabled them to take responsibility for people living in the flats, and working towards Care Homes for Adults (18-65 years) Page 4 of 10 independent living. Staff who completed surveys told us that they nearly always have the support and experience they need to meet the needs of their service users. Typical quotes were, Personally I think Stepping Stones has a professional caring approach, striving to achieve the very best, identifying the support needs of each individual tenant or staff member, encouraging personal development through good communication, skills, choices and those opportunities arising in their lives, while giving each individual a chance to learn and make their own mistakes. Maintaining each individuals privacy, dignity, wishes, and identity as a human being. What they could do better: More useful and reflective analysis of peoples behaviour could be helpful, with periodic professional input. We saw several records made by staff of incidents of residents verbal abuse. There was a lack of useful analysis. On one occasion when a resident had called for help during the night, the support provided may not have been sufficient, which may have lead to later disturbance. One service user told us of friction with a fellow resident. Staff and management should record what they might have done to prevent the service user from getting frustrated. This might make apparent a resource implication, such as increased staffing or alternative living accommodation. It may be helpful to recognise any such deficit, even if it cannot be altered at the present time. One staff member said in a survey, that management should - Look into a way that staff on sleep-in duty are stopped from being woken up when they have to work the next day. This suggests that residents night time needs should be kept under review, as alternative arrangements may be needed. An adult approach should be adopted by staff at all times. One relative told us in a survey that they found some staff to be bossy in the way they interacted with service users, though we only saw staff being polite and helpful. A service user said that the Manager decides when they go shopping. The Manager told us she arranges the 1;1 time for service users in turn, which allows for them to have individual attention, which would include shopping trips. The team should work together to make people who live at Stepping Stones feel more in control of what they can do. The premises were very accessible. One exception was the kitchen sink in one of the flats, which had not been adapted for a wheelchair user. The damage caused to furniture and doorways by wheelchairs gave a drab feel to otherwise comfortable surroundings. While we agree that residents should be encouraged to feel free to move around their home, we suggest that attractive protective coatings might be available for parts that have been gouged out. Locks on doors of bedrooms and bathrooms should be reviewed, as some were not adequate for protecting peoples privacy and dignity. The home could provide a lockable box or cupboard in peoples own rooms, where they could keep their own things like money and medicines, and still be supported to use them well, with the key provided to the resident when risk assessment showed this to be safe and satisfactory. There had been an inspection of the premises by the Fire Safety Inspecting officer during the previous week. Requirements were made with respect to some of the fire doors. The Care Homes for Adults (18-65 years) Page 5 of 10 Registered Manager should inform the CQC when the requirements have been fully met. The Registered Manager said she was pleased that soon she should be able to delegate some management and supervisory tasks to the new Assistant Manager, which would enable them to keep up to date. 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 6 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Adults (18-65 years) Page 7 of 10 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 42 23 The service must fully comply with the Regulatory Reform (Fire Safety) Order 2005, as recorded in the report following the visit of the Fire Safety Officer on 18/05/2010, and inform the CQC when this is accomplished. This is to ensure as far as possible the safety of people living and working at Stepping Stones. 14/08/2010 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 23 Verbal aggression by any service user should be understood and dealt with appropriately, including selfreflection by staff, and consideration of any wider implications. Management should review the locks on bedroom and bathroom doors, and the provision of lockable storage in peoples private rooms. This is to promote peoples privacy, dignity and autonomy. Page 8 of 10 2 24 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 3 33 Residents need for support during the night should be kept under review, and alterations made to staff arrangements if/when necessary. Care Homes for Adults (18-65 years) Page 9 of 10 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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