Care Home: Stiperstones

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What the care home does well Prospective residents and their representatives have accurate information about the home in order that they can make an informed choice about moving to the home. The homes admission and assessment procedures ensure that prospective residents needs are appropriately identified and met and prospective residents can visit the home prior to residency. Residents are supported to maintain bonds with their family and friends. What has improved since the last inspection? Residents are more fully consulted about matters which affect their daily lives. Residents rights to exercise choice and take part in planned social and recreational activities has improved. The dining arrangements, menu options and support residents receive during mealtimes has improved to promote their best interests and their health and welfare. Residents health care needs are met and the recording of health care needs has improved. There are improved standards regarding promoting residents rights to privacy, dignity and respect. Medication procedures have been improved to ensure that medication is administered to all residents in a safe way at all times. An open culture of raising complaints or concerns about the home has been promoted. The physical design and layout of the home enables residents to live in a safe and comfortable environment. Improvements have been made regarding the control of the spread of infection in the home. The corporate policies and procedures for the recruitment of staff promote residents protection and welfare. The management and administration of the home has improved. The staff are working together to provide a service which is based on an improved quality of life for the residents living at the home. Residents views and their representatives are sought and procedures have improved to ensure residents general health and welfare continue to be promoted. What the care home could do better: The care plans and risk assessments must be further updated to ensure that residents needs and support are fully documented and met and to ensure the safety and wellbeing of residents at all times. Procedures and policies are available in the home to promote the protection of residents from harm yet not all staff have received training in the safeguarding of vulnerable adults. Some further maintenance and repairs within the home need to be undertaken. Some staff in the home have not undertaken the required mandatory training in order to ensure that residents are supported safely. Key inspection report Care homes for adults (18-65 years) Name: Address: Stiperstones Stiperstone Clappers Lane Chobham Surrey GU24 8DD     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home 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 full review a ‘key’ inspection. Lead inspector: Suzanne Magnier     Date: 0 5 1 0 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Adults (18-65 years) Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Stiperstones Stiperstone Clappers Lane Chobham Surrey GU24 8DD 01276858440 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Welmede Housing Association Ltd Name of registered manager (if applicable) Type of registration: Number of places registered: care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following category/ies 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 Date of last inspection Brief description of the care home Stiperstones is a care home for eight adults with learning disabilities and provides personal care only. The property is located in Clappers Lane, Chobham, Surrey and accommodation is provided on two floors accessed by stairs. The home has eight single bedrooms and facilities include a kitchen, lounge, dining area, office, laundry, bathrooms and toilets. The property has a private drive and a large garden, which is secure and easily accessible. Private parking is available. Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 8 1 5 0 4 2 0 0 9 Brief description of the care home Care Homes for Adults (18-65 years) Page 5 of 34 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 peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. This inspection of the care home was an unannounced Key Inspection carried out by Ms S Magnier Regulation Inspector. The homes person in charge of the day to day running of the home and the deputy manager represented the service throughout the inspection. A random inspection was carried out by Ms Suzanne Magnier Regulation Inspector on the 10th July 2009 in order to follow up the compliance, by the service, following the requirements made at the previous announced key inspection of the service on the 15th April 2009. The findings of the random inspection and this key inspection have been included within this report. Care Homes for Adults (18-65 years) Page 6 of 34 As part of this key inspection the commission invited an expert by experience and an assistant from My Life My Choice to be part of the visit in order to be with and observe residents and staff in the home about their experiences of the home. The expert by experience and assistant have produced a report and the findings have been included within this document. For the purpose of the report the individuals using the service are referred to as residents. The inspector arrived at the service at 07.30 and was in the home for eight hours. It was a thorough look at how well the was meeting the National Minimum Standards for Younger Adults and has in this report made judgements about the standard of the service. The commission received five written completed surveys from staff which have been included within the report, one completed survey from a health care professional and have taken into account surveys completed by a staff member on behalf of the residents. The inspector spent time being with and talking to residents and observing the residents and staff members in order to gain their views and opinions about the service. Documents sampled during the inspection included the homes Statement of Purpose and Service User Guide, some residents care and person centred plans, risk assessments, medication procedures, a variety of training records and several of the services policies and procedures including complaints and safeguarding. No staff recruitment files were sampled during the inspection as the commission have been advised that no new staff have been employed by Welmede since the previous inspection. No complainant has contacted the commission with information concerning a complaint made to the service since the last inspection. One safeguarding referral has been referred by Welmede to the local authority the outcome of which has not been concluded. The home had submitted an Annual Quality Assurance Assessment (AQAA) prior to the previous inspection so an AQAA was not requested for this key inspection. From the evidence seen by the inspector it is considered that the home continues to be able to provide a service that meets the needs of people who have diverse religious, racial or cultural needs. The final part of the inspection was spent giving feedback to the person in charge and the deputy manager representing the service about the findings of the visit. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The care plans and risk assessments must be further updated to ensure that residents Care Homes for Adults (18-65 years) Page 8 of 34 needs and support are fully documented and met and to ensure the safety and wellbeing of residents at all times. Procedures and policies are available in the home to promote the protection of residents from harm yet not all staff have received training in the safeguarding of vulnerable adults. Some further maintenance and repairs within the home need to be undertaken. Some staff in the home have not undertaken the required mandatory training in order to ensure that residents are supported safely. 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 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 Care Homes for Adults (18-65 years) Page 10 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their representatives have accurate information about the home in order that they can make an informed choice about moving to the home. The homes admission and assessment procedures ensure that prospective residents needs are appropriately identified and met and prospective residents can visit the home prior to residency. Evidence: The homes Statement of Purpose and Service user Guide included large print and up to date photographs of the home and the local community. Both documents detailed the current facilities and services offered by the home in order that any prospective residents or their representatives are informed of what services and facilities the home offers. Welmede have a pre admission and assessment policy and procedure which enables any prospective resident and their representative the time to meet and get to know the home and the other residents prior to moving into the home in order to ensure Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: that staff can meet the persons needs. There have been no admissions to the home since the previous inspection. Care Homes for Adults (18-65 years) Page 12 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans and risk assessments must be further updated to ensure that residents needs and support are fully documented and met and to ensure the safety and wellbeing of residents at all times. Residents are more fully consulted about matters which affect their daily lives. Evidence: Following the previous key inspection on 15th April 2009 a requirement stated that arrangements must be made to ensure that all care plans and risk assessments for each resident are reviewed and up to date. During the random inspection on 10th July 2009 the person in charge explained that as part of the updating of care plans the homes staff were continuing to gather information to assist in the updating of the care plans and person centred plans and have been gaining this information from residents significant others, where possible, and from other carers. The commission were advised that the information would be included within the residents care plan and also in their person centred plan. Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: During the random inspection it was identified that a person centred plan was in the process of being developed and would be used as a template for the development of further person centred plans for other residents. The person in charge explained that there had been a review of the staffing at the home which had resulted in some staff who had worked in the home for several years leaving the service which had had an unsettling affect on some residents. As a result the homes staff team had changed with some staff being transferred from other Welmede homes to support residents in their daily lives at Stiperstones. It has been acknowledged by the commission that the poor rating of the service from the previous key inspection has resulted in a complete review of the service with regard to the outcomes in residents lives. There was evidence to support that the home have made efforts to update the care plans and risk assessments and due to the many other changes in the home the updating of the care plans and risk assessments has taken considerably longer than anticipated. In discussion with the person in charge it remained evident that they had a good understanding of the value and importance of appropriate care plans and risk assessments and that the homes staff continue to work toward ensuring the safety and well being of all the residents in the home as far as reasonably practicable. The commission were advised that some residents risk assessments have been reviewed in conjunction with the care plans to reflect genuine hazards identified in residents daily lives. Seven written resident surveys were received from residents which had been completed by staff and included the following comments most staff treat me well but some can be rather controlling I am always clean and have plenty of good food, I would like to always have appropriate clothes to wear I would like staff to give me a cup of tea early morning when I get up before the others. It was observed during the key inspection that some staff on duty were more confident than others in their duties and it was confirmed that staff were working well as a team in order to support each other and offer a mentor ship role with their duties and also with the completion of the revised care plans. It was noted that the two care plans and one person centred plan sampled had not been fully updated yet there was evidence to support staff were receiving support and guidance in completing the care plans and reviewing the information available. It was agreed with the person in charge that some historic documentation needed to be removed from the residents files sampled as it did not reflect the residents rights to respect. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: It has been required that further arrangements must be made to ensure that the remaining care plans and risk assessments for each resident must be reviewed and updated in order to ensure that residents are provided with the appropriate care, support and supervision to ensure that their safety and well being at all times. The person in charge has formalised the the key working system which has offered residents in the home a more consistent approach to the care and support they receive. It was observed that one residents testing behaviour had decreased as Welmede management had identified the need for the resident to have some stability for the resident to be supported by staff that they were familiar with. Staff were confident to talk with the inspector about their roles and responsibilities and it was evident that they were motivated in the ongoing improvement and stability of the service for the benefit of the residents. It has been recommended that the expected roles and the responsibilities of the key workers be documented in order that any new staff to the home are aware of their key working duties. Care Homes for Adults (18-65 years) Page 15 of 34 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. Residents rights to exercise choice and take part in planned social and recreational activities has improved. The dining arrangements, menu options and support residents receive during mealtimes has improved to promote residents best interests and their health and welfare. Residents are supported to maintain bonds with their family and friends. Evidence: Following the previous key inspection on 15th April 2009 a requirement stated that arrangements must be made for a planned and consistent activities programme be introduced in the home in consultation with residents in order that they know what is happening in their daily lives and they have a choice and can be supported to make decisions. Whilst speaking with the person in charge both during the random inspection and the key inspection they have confirmed and demonstrated that the Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: homes culture has moved toward providing a service which is led by the residents rather than led by tasks undertaken by staff. It was observed that there has been a significant shift in the culture of the home and residents were seen to be making some choices and decisions in their lives. One staff member was observed to ask a resident what they wanted for breakfast and the cereals had been displayed in order that the resident could choose which one they wanted which they did. Another resident was encouraged to enter the kitchen and supported staff in getting their breakfast ready, another resident was observed to be arranging the new dining tables as they wanted them to be, another resident was observed to go to the laundry to put a towel on the washing machine. The decisions residents were making were respected by staff and encouragement was offered in a courteous and inclusive manner. It was evidenced through observation and sampling care plans, daily records and activities plans that the homes staff have made a significant effort to research and provide residents with a more fulfilling programme of interests and activities. During the day of the inspection four residents were supported by two staff to attend a local farm to spend time with the horses whilst the other residents enjoyed working with the two individuals employed by the home to offer arts and crafts sessions. There was a variety of residents art and crafts in the home and in their private accommodation which some residents showed the inspector. It was observed that the planned activities for the day were well organised and that staff on duty were able to inform residents of the planned activities in a confident manner which supported the residents to know what to expect and that the daily routine was predictable. An activities board within the home indicated that there were several community interests which were being offered to residents for their leisure time which included plans to go to the railway rally, fitness sessions, the local swimming pool and the local Get Together Club. The person in charge advised that the home are researching to improve the facilities within the home to incorporate an extended garden patio area and also have a centre built within the garden to offer alternative activities and a sensory suite. The expert by experience and their assistant from My Life My Choice who were in the home for three hours and who took part in the inspection in order to be with residents, speak with staff or other people in the home about their experience of the home reported that one resident spoken with the interpretation from a member of staff nodded to indicate that they were happy in the home. They observed that residents were engaged in various activities in the home and that during the visit, two Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: people came into the home to do arts and crafts with residents who were at home and later a lady came in to give reflexology and foot massage to those residents who enjoy it. Other residents had gone out to do some shopping and visit a horse farm. It was confirmed that outings are normally planned and the staff have the use of the homes van and do borrow another van if required for the day from another home. The expert by experience also reported that staff encourage residents to be involved in household chores like cleaning their bedrooms and laundry, by taking their washing out of their bedrooms in the bins which have been provided since the last inspection as part of the improved hygiene standards in the home. It was also confirmed that residents can have family and friends to visit if they so and some residents visit family members often. Another significant improvement observed was the promotion of residents individual lifestyle choice. The flexibility of the service has continued to improve to offer residents more choice and continued support throughout their morning routine. Staff confirmed and were observed to support residents individually, following providing personal care, and to support the resident to have their breakfast, which as previously documented, included the resident being involved in making some of the decisions about what they wanted for breakfast, have help with preparing some aspects of their breakfasts and being supported to have their breakfasts meal at their own pace. The homes staff have undertaken a workshop regarding active support which incorporates working with residents individually to support them in retaining and maintaining their skills and abilities and building on their skills and abilities. The person in charge advised that this will be a future ongoing way of working with residents in order to promote their independence, self esteem and to provide a consistency and predictability for residents in their daily lives. The expert by experience and their assistant from My Life My Choice reported that they observed that residents have a choice of what to eat and a member of staff said they have pictures of foods and show these to residents to make their choices for the menu. It was also reported that during lunch the expert by experience observed a member of staff going round with aprons and putting them on each resident in readiness for lunch which looked quite undignified and a question was raised if residents needed them. Another observation made and reported was that sandwiches were made by staff and plated in the kitchen which were then put in front of each resident. The members of staff were observed not to ask the residents if they wanted that particular sandwich or what the sandwich was. It was observed that one resident had a bite and put the rest into the bin and were not offered an alternative. A large jug of what looked like blackcurrant squash was brought by a member of staff from the kitchen was poured out for each resident and no choice was given. These observations were discussed with the person in charge and the deputy Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: manager. The deputy manager advised that she had directed that sandwiches be made for all the residents as there had been a great deal of activity in the home, which also included strangers in the home, and that some of the residents were finding the situation difficult to cope with. The sandwiches were made in order to ensure that the residents received their midday meal when they expected it in order to reduce any further frustrations and was undertaken with the residents best interests taken into account. The feedback relating to lack of choice for residents was addressed with the person in charge who assured the commission that the concerns would be addressed as part of the inspection feedback and to continue to raise staff awareness of the rights of residents to have choice. The home has a weekly menu and residents are provided with colourful pictures of meals in order that they can be helped to identify meals to make informed choices about what they would like to eat. It was confirmed that some residents have received support and advice from the local authority dietitian and the home continues to improve their provision of healthy eating options, which includes increased mobility, to promote residents health and well being by ensuring the supply of a nutritious, varied and balanced diet. Care Homes for Adults (18-65 years) Page 19 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health care needs are met and the recording of health care needs has improved. There are improved standards regarding promoting residents rights to privacy, dignity and respect. Medication procedures have been improved to ensure that medication is administered to all residents in a safe way at all times. Evidence: Following the previous key inspection a requirement stated that arrangements must be made to ensure that residents were supported with respect privacy and dignity. It was observed during the inspection that the culture of the home was more inclusive to wards residents to promote their rights to be supported in a dignified manner and their rights to privacy upheld. Some residents general demeanour highlighted an improved confidence and residents looked well groomed and their clothes were clean and smart and appropriate for the weather. Staff were observed to address residents respectfully using their preferred names and staff interactions were calm and supportive. Some residents were observed to respond to staff in a way which indicated trusting relationships. Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: As part of the review of the service residents needs have been identified with regard to their preferences of staff who support them in their daily life and this has been addressed by Welmede by transferring staff who are known to the residents which has helped some residents to accept the changes in their home and has offered them a sense of security and stability. From information received from the home under specific notifications it is evident that the homes staff have had a challenging time in assisting some residents to settle and accept some changes in the home which have been necessary for their welfare and well being and this transition has been acknowledged by the commission and other health care professionals who have been working closely with the home to improve standards and better outcomes for the residents. Two health action plans were sampled and although one was not yet fully updated there was evidence to support that each resident had had a full medical review. The documents sampled evidenced that the health care review had been attended in the home by the residents general practitioner and other health care professionals including consultations with the district nurse dentist occupational therapists to review residents furniture optician dietitian speech and language therapy for eating and drinking assessments physiotherapy referrals continence management consultations and specialist professionals to support staff in understanding communication and behaviours which may test the service and to document communication passports for residents. The commission received one completed health care professional comment card which stated historically referrals to the community learning disability team and assessments undertaken but recommendations were never implemented. A recurring frustration. With the recent changes of management its expected and hoped this will improve and some recommendations are starting to be implemented. The home seeks advice from the community learning disability team they keep residents warm dry and clean the new staff team are keen to learn and are motivated to do whats best and improve their practise. The recording of the appointments within resident health action plans has been improved and the daily records written by staff regarding the care and support provided to residents were well written. The home has an up to date medication policy and procedure in place. The medication procedures in the home have been reviewed and maintained and where errors have occurred the commission have been notified and procedures implemented to address the shortfall. Staff confirmed and it was observed that the monitored dosage system and records regarding the ordering stock taking and returns of medication and medication administration charts were well Care Homes for Adults (18-65 years) Page 21 of 34 Evidence: managed. It was confirmed that no residents are receiving controlled medicines and no resident self medicates. The person in charge confirmed that as part of the health review for all residents each person has had a review of their medication which has also included consultation with specialist health care professionals and which has been of benefit to residents in their daily lives. All staff apart from three have received medication training in order to ensure the safety and well being of residents whilst receiving their prescribed medicines. Care Homes for Adults (18-65 years) Page 22 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An open culture of raising complaints or concerns about the home has been promoted. Procedures and policies are available in the home to promote the protection of residents from harm yet not all staff have received training in the protection of vulnerable adults. Evidence: The home have an up to date complaints procedure which is also in a pictorial format to support residents or their representatives on how to make a complaint or raise a concern if they are dissatisfied regarding the service. The person in charge is promoting a culture whereby complaints or concerns would be encouraged and dealt with transparently and staff remain aware that residents would state their unhappiness or concern through a change in their general demeanour change in behaviour and by tones and staff confirmed they would address the concerns with the person in charge or the deputy manager in order to support the resident and their rights to raise concerns. The home have not received any complaints since the previous inspection and have a complaints book which detail the chronology of events for investigating complaints which would be used should a complaint be received by the home. The local authority multi agency procedures for safeguarding adults were current and Care Homes for Adults (18-65 years) Page 23 of 34 Evidence: available and one safeguarding referral has been referred by Welmede to the local authority the outcome of which has not been concluded. The inspector sampled that the home has a policy statement regarding reporting abuse which was noted to be in accordance with the local authoritys multi agency procedures in order to safeguard people in their care. Training records evidenced that the majority of staff had undertaken safeguarding vulnerable adults training and where updates to training were necessary these had been booked however it was evidenced that two night staff members had not received safeguarding training and a requirement has been made that all staff must receive safeguarding training in order to ensure they are aware of the protocols of their right to protect and safeguard residents in their care. Failure to comply with this requirement is an offence and may lead to enforcement action being taken. During the previous key inspection the use of restricting residents access to areas in their home was discussed with the person in charge who assured the commission that residents would have access to all communal areas in the home including the kitchen. It was observed during the day of the inspection that there were no restrictions in the home and residents were able to move freely around their home including in the the kitchen area with staff support if necessary to ensure the safety and well being of the resident. Care Homes for Adults (18-65 years) Page 24 of 34 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 residents to live in a safe and comfortable environment. Some further maintenance and repairs need to be undertaken. Improvements have been made regarding the control of the spread of infection in the home. Evidence: Following the previous key inspection on 15th April 2009 there has been an ongoing plan to improve the decor and furnishings in the home. During the tour of premises with the deputy manager it was observed that several areas in the home have been decorated which included residents bedrooms and hallways and fashionable ornaments and framed pictures have been purchased. The aquarium has been repositioned into the hallway which is a focal point and old furniture from hallways has been removed to offer more space for residents to move around their home. The expert by experience and their assistant from My Life My Choice reported that the home has a large lounge dining room and a large tidy garden at the rear of the home furnished with swings and a climbing frame. The expert was able to into the bedrooms of two service users and found the bedrooms were personalised with the service users ornaments and pictures. The staff spoken with said the service users enjoy being in the garden when the weather is good. One member of staff said that the home Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: management is in the process of updating the home will new flooring in the lounge and building a log cabin summer house and create more activities for the residents. In some residents bedrooms furniture had been re-arranged which has given the resident more comfort and stimulation for example moving a bed in order that the resident could see out of the window and generally tidying up the bedrooms from unwanted furniture to give residents more space in their bedrooms. It was observed that the standard of cleanliness in the home and in the residents rooms had significantly improved and staff spoken with confirmed that the cleaning of residents rooms is part of their key working responsibility which they also do with the resident. Arrangements within the laundry have been improved to control the spread of infection in the home and the purchase of plastic containers for soiled and clean linen have been implemented. It was observed that residents were encouraged to bring their washing to the laundry in the baskets and each resident has a specific day when their laundry is washed. There has been an increased awareness of the care of residents clothing which was seen to be hanging in wardrobes or neatly folded within drawers. The deputy manager advised that there is a cleaning rota in place which involves the inclusion of the residents and the whole of the staff team including night staff. Future plans within the home include the purchase of new armchairs and sofas and the replacement flooring cover in several residents bedrooms. Whilst sampling the bathroom upstairs it was noted that the bath is attached to the wall which only offers staff to get to one side and the residents to step into the bath. It has been recommended that due to the future changing needs of the residents group that the bathing facilities be reviewed by Welmede in order to ensure that residents bathing needs can continue to be met. There were some areas within the home that required further attention and it has been required that the laundry ceiling be painted due to general wear and tear, some areas of the walls in the lounge need to be redecorated, some areas of the wall in the toilet by the office need to be redecorated, the upstairs toilet flooring is stained and needs to be replaced and the pull cord light socket was noticed to be loose in the upstairs bathroom and need to be rectified. The home have provided suitable equipment including hand washing facilities throughout the home. It was observed that the disposal of general and clinical waste was well managed. An improvement was suggested that clinical waste is double bagged to further ensure and promote the control the spread of infection in the home. Care Homes for Adults (18-65 years) Page 26 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The corporate policies and procedures for the recruitment of staff promote residents protection and welfare. Some staff in the home have not undertaken the required mandatory training in order to ensure that residents are supported safely. Evidence: The home continues to support 8 residents. The expert by experience and their assistant from My Life My Choice reported that some members of staff in the home have worked for a long time with the residents and are aware of their needs by expression or body language and staff are friendly and treat the residents well as was evident during the visit and that staff do receive training and are willing to do more training in order give better support to the residents. It was observed that there were sufficient staff available on the day of the inspection and they worked in a confident way which was well organised and unrushed. Residents were seen to be supported throughout their morning routine by one staff member who offered support and encouragement at all times in a respectful manner. The person in charge advised that they would be reviewing the staffing rotas in the future which would benefit the residents and the home overall in order that staff could support residents to additional community activities and offer one to one support more Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: frequently. Welmede have a recruitment and selection policy. No staff files were sampled as Welmede advised that no new external staff have been employed. Some experienced Welmede staff have been transferred to the home to take up permanent positions which has improved the level of continuity of care for the residents. The staffing training matrix was sampled and it was evidenced that there were some gaps in staffs mandatory training. It was confirmed that the moving and handling training had been booked to be undertaken at the home yet several staff needed to have update in their training which included First Aid, Food Hygiene and three staff to undertakes medication training. The person in charge confirmed with the Welmede Head Office that the courses had been booked but had been cancelled either by Welmede or by the staff member. It has been required that all staff must undertake mandatory training within the timescales set in order to ensure that staff have the skills and abilities to provide the care and support needed by the residents living at the home. Failure to comply with this requirement is an offence and may lead to enforcement action being taken. Six written comments received from staff about the home included I feel that members of staff work well as a team and that there is a good continuity in attendance and working practise, I feel that management are unfairly delegating too much paperwork to the lower paid members of staff inducing stress through people rushing to get all the work done in the relevant time given.Stiperstones is a nice place to work and it is always a pleasure to team up with other staff and a joy to give support to the service users. Good management and team work. Management to take more responsibility for paperwork and decisions about the home furnishings etc to be done so that all members of staff can have input on these. Management should also ensure all confidentiality and data protection regulations are continually adhered to within the home. Enthusiastic place to work, good atmosphere, pleasant surroundings and everyone willing to work together for the best interests of service users. All staff work well as a team to ensure that service users needs are matched to the best of our abilities. Care Homes for Adults (18-65 years) Page 28 of 34 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 management and administration of the home has improved. The staff are working together to provide a service which is based on an improved quality of life for the residents living at the home. Residents views and their representatives are sought and procedures have improved to ensure residents general health, safety and welfare continue to be promoted. Evidence: The person in charge and deputy manager have been employed by Welmede for the last six months and have worked full time in the home over this period. With the staff team a total review of the service has been undertaken over this time and it has been acknowledged by the commission that the review has been far reaching and there have been many changes which also have included working with external agencies. This in turn has generated additional responsibilities and work yet the management and staff team have continued to monitor and improve the standard of care and support provided to the residents at Stiperstones. The further plans for improvement in the service were discussed openly during the inspection and the managers were Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: aware of the need for the service as a whole to have time to consolidate the changes that have been made over the last six months. The person in charge and the deputy manager were present during the inspection and it was confirmed that requirements made during the last inspection have been met. The person in charge has advised the commission that they will be applying to register with the commission to be granted registered manager of the service. Evidence was seen to support that the views and opinions of residents and other stakeholders continue to be sought through meetings contact with residents relatives and friends and visitors to the home. The homes area manager came to the service during the feedback session of the findings of the inspection and affirmed that Regulation 26 visits are carried out by other Welmede managers and records sampled evidenced the visits had been attended. Health and safety checks within the home have been maintained and records were sampled. The gas safety electrical certificates and a current insurance indemnity certificate and certificate of registration were sampled and all documents were up to date. The home have improved in reporting any incidences to the commission under Regulation 37 notifications of any event that affects the well being and welfare of people in home. It is acknowledged that the person in charge and the staff team have maintained a focus and made efforts to improve the service and facilities offered to residents however several requirements have been made that care plans and risk assessments must be further updated to ensure that residents needs and support are fully documented and met all staff must receive safeguarding vulnerable adults and mandatory training in order to ensure that residents are supported safely and some further maintenance and repairs need to be undertaken. It is required that the home must forward to the commission an improvement plan detailing how the home intends to improve the services provided in the home to ensure the safety and well being of residents. The requirements made during the inspection and detailed within the report have a bearing on the safety of and outcomes for the residents who live at the home and failure to comply with the regulations is an offence and may lead to enforcement action. Care Homes for Adults (18-65 years) Page 30 of 34 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, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 31 of 34 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, 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 Requirement Timescale for action 1 6 12 Further arrangements must be made to ensure that the remaining care plans and risk assessments for each resident be reviewed and updated. In order to ensure that residents are provided with the appropriate care, support and supervision to ensure that their safety and well being at all times. 26/02/2010 2 23 13 Further arrangements must be made that all staff must receive safeguarding training. In order to ensure staff are aware of the protocols of their right to protect and safeguard residents in their care. 26/02/2010 3 24 23 Arrangements must be made that all areas of the home are kept in good decorative order and 26/02/2010 Care Homes for Adults (18-65 years) Page 32 of 34 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 Requirement Timescale for action maintenance and repairs attended. In order that residents live in a well decorated and homely environment. 4 35 18 Arrangements must be made that all staff must undertake mandatory training within the timescales set. In order to ensure that staff have the skills and abilities to provide the care and support needed by the residents living at the home. 5 42 24A Arrangements must be 26/02/2010 made that the home forward to the commission an improvement plan. Detailing how the home intends to improve the services provided to ensure the safety and well being of residents. 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 26/02/2010 1 27 It has been recommended that due to the future changing needs of the residents group that the bathing facilities be reviewed by Welmede in order to ensure that residents bathing needs can continue to be met. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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