Inspection on 19/05/09 for St Judes House

This is the latest available inspection report for this service, carried out on 19th May 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Judes House 21/06/07

St Judes House 05/10/06

St Judes House 24/02/06

St Judes House 10/10/05

St Judes House 02/03/05

St Judes House 11/08/04

St Judes House 26/03/04

Similar services:

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Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Spring Lane Care Home

Avenues (The) (Neave Crescent)

Delrose House Ltd

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOME ADULTS 18-65 St Judes House 14 Canadian Avenue Catford London SE6 3AS Lead Inspector Claire Taylor Key Unannounced Inspection 19th May 2009 10:00 St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 2 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 St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Judes House Address 14 Canadian Avenue Catford London SE6 3AS 0208 6904493 0208 690 4501 stjudes@hotmail.com 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) Elizabeth Peters Care Home Limited Mrs Priscilla Kagijo Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (0), Physical disability (0), Physical disability over 65 years of age (0) St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for 10 persons aged 40 years and above with a past or present mental disorder, 2 of whom can have a physical disability service users can be over 65 years To include one named person aged 39 years, until May 2006 2. Date of last inspection 20th May 2008 Brief Description of the Service: St Judes is a large Victorian property offering care and accommodation to ten adults with past or present mental health problems, some of who may be over 65 years of age. The home is on a main road and is a short walking distance of shops and facilities of Catford town centre. This provides the home with good transport links as the town centre has two train stations and is well served by buses. The home offers single bedroom accommodation and communal space including a large rear garden. St Jude’s is one of four registered care homes owned and managed by a local provider, Elizabeth Peters Care Homes Ltd. The registered manager Priscilla Kagijo, also one of the owners, remains in day to day charge of the service. The weekly fees for a place at the home ranged from £650.00 to £690.00 and there was one vacancy at the time of this inspection. There have been no changes in the ownership, management or the service’s registration details in the last 12 months. St Judes House DS0000025643.V375442.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 stars. This means the people who use this service experience good quality outcomes. We as it appears throughout this inspection report refers to the Care Quality Commission. Prior to our visit, the home returned its Annual Quality Assurance Assessment (AQAA) when we asked for it. This is a self-assessment that must be completed once a year. It is used to tell us about the services provided, how well outcomes are being met for people using the service and any planned developments. Some details from the AQAA are included in this report. Following the homes last key inspection in May 2008, we asked the provider to complete an improvement plan which is used to tell us how the home will meet the required improvements. We received a detailed response within the correct timescale and checked that the plan had been actioned as part of this inspection. We spent a full day at the home and during our visit; we spoke to the registered manager, deputy manager, five people who live in the home, and one staff member. We case tracked three people’s records of care. Case tracking means we looked in detail at the care people receive. We also looked at various records in relation to the staff and the way the home was being run. All this information helps us to develop a picture of how the home is managed and understand what it is like to receive support and care at St Jude’s. Following this visit, we asked the manager to send in some records to further evidence that the home had met with two previous requirements. We received the required documents within the agreed timescale and have assessed the requirements as met. Three people living in the home completed ‘have your say’ comment cards with support and we also received surveys from four staff. All those who took part are thanked for their time and contribution to this inspection. What the service does well: St Jude’s has a good assessment and admission process to ensure that people are fully involved in the decision and process to move to the home. Clear information about the home and its services enable people to make their decision. Care plan records show that people are involved and that they are often consulted about their care and aspirations in life. Peoples health care needs are met; they receive their medication on time and are supported to attend hospital appointments. The home works closely with other health and social care professionals to ensure peoples health, well-being and independence is promoted. People we spoke to were all positive in their comments about the overall standard of care they receive. Examples included, “the staff are very good” and “the food is nice and has got much better.” The service provides a comfortable and structured home life for people and they are supported in their chosen lifestyle. There are regular meetings where St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 6 people are informed and involved in making decisions about the home such as the choice of meals, social events and outings such as trips. People are treated with respect and dignity that promotes their individuality and values their rights. The staff have formed good supportive relationships with people at the home. The team has worked at the home for some time and knows each person’s needs well. This means that people living in the home benefit from general stability and consistent care. The home is kept clean, safe and decorated to a good standard meaning that people live in comfortable and homely surroundings. Bedrooms are furnished to meet people’s needs and wishes and individuals can personalise their rooms as they prefer. Well managed systems are in place to promote and protect the health, safety and welfare of people living and working in the home. What has improved since the last inspection? The manager and staff have worked hard to make the required improvements following our last inspection in May 2008. They have shown a commitment to improve standards in the home and this is reflected by the significant reduction in the number of requirements and recommendations being made. Information within the home’s contract has been updated for more accuracy and relevance. This ensures that people using the service have better information about the care that is promised and likewise the home’s duty of care to them. Plans of care were more detailed and individualised to ensure that peoples needs are met. They give staff clear guidance on how to support individuals with personal care and routines in ways that they prefer. Care records reflected any changes to care or support needs and had been regularly reviewed with the full involvement of the person and their keyworker staff. People now benefit from regularly reviewed risk assessments to ensure that best actions to minimise any risks are in place and followed. The overall standard of record keeping has improved significantly for which the home is commended. A new IT system has been set up and is accessible to the staff. Staff have had training to use the computer so that they can maintain the necessary records about the care that people receive. In addition, policies, procedures and other guidance are available to them through the home’s intranet system. At our last inspection, we identified some concerns around medication practices. During this visit, we saw that systems for managing medication have improved so that people are more fully protected. Progress has been made with regards to training and development for staff. Staff have refreshed key areas of training to keep their knowledge and skills up to date and meet the needs of people using the service. Courses have included training on diabetes and safeguarding vulnerable adults. Staff supervision has improved so that staff are more supported in their work to discuss and reflect upon job performance and development. Health and safety practices have improved. Staff have received training on key topics and the home has developed a more detailed risk assessment of the building with guidance on how to minimise risks. This further ensures the safety and well being of all those living and working in the home. St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 7 Following this key inspection, we have assessed that the home has improved upon standards in the required areas and judged the home to provide good outcomes for the people who use this service. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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. St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 8 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 St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides the necessary information about the services offered so that people can decide whether the care home can meet their support and accommodation needs. Good arrangements are in place for assessing people’s needs so that staff know how to support them. Contracts now provide people with clearer information on the services available to them, how much they will pay and what the home provides for the money. EVIDENCE: For how the home has improved over the last twelve months, the AQAA stated, “We have ensured that our service users contract contains all the elements listed in standard 5. We have restructured the information in the service users’ files to ensure all the standards are covered.” The manager had reviewed the Statement of Purpose and Service User Guide in January of this year. Both were clear and reflected all the required information to ensure that people and their representatives know about the service and facilities available to them. We saw that each person is given a copy of the Guide at the point of moving in. Feedback from the three surveys St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 10 was that each person received enough information about the home before moving there. We looked at records for the newest person and for two other people. The home had undertaken their own assessment which covered the persons whole life needs as well as any known risks to their welfare. The assessment refers to social care needs, health, personal care, mobility, communication and dietary needs. Needs assessments also identified any physical and psychological needs associated with mental health and cognition. Some equality and diversity issues are also explored through assessment such as ethnicity, preferred faith and culture. Each individual had a recent Enhanced Care Programme Approach (CPA) detailing their needs and presenting risk factors as well as other reports from professionals involved in their care. The care plan approach (CPA) provided by the placing authority was up to date and the homes care plan was based upon the desired outcomes from the needs assessment. The manager carries out a needs based pre-admission assessment on all prospective residents. This helps ensure that admissions to the home only take place once the service is confident that assessed care needs can be met. At the last inspection we required the home to improve upon its contracts as some were not up to date and did not reflect accurate details about the service being provided or the costs involved. We looked at three contracts which had been reviewed and rewritten in August 2008. They were also signed by each person in agreement. This helps ensure that people using the service have better information about the care that is promised and likewise the home’s duty of care to them. The cost of services and any extras was clear and fees included a week’s holiday. St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements have meant that care plans are more detailed and staff know how to support each person’s needs. People are supported to make decisions about their lives and have a say in how the service is run. People are supported to take risks that promote their independence and safety. This is because the staff have better information on which to base decisions. EVIDENCE: Since our last inspection, the information in the care plans has been improved to provide further details on how to meet each person’s needs. We looked at three different plans of care which were based upon individual assessed needs and included any outcomes from the CPA summary. The goals and objectives for each person were more descriptive and also reflected their wishes and expectations. Plans focused on supporting people to promote their independence in areas such as personal care, daily living skills and managing St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 12 money. Plans of care provided staff with clearer direction about the most appropriate ways to give the required support and help people to achieve their goals in life. The owning company has created an intranet system and staff can now use the computer to write daily reports, care plans and other necessary records for meeting the needs of people who use the service. We looked at some reports which gave a good outline of a person’s daily experiences, activities, their health and well being and any significant issues. Each person has a named keyworker staff to support them. As good practice, we suggest that a monthly summary of events is written up for each person so that staff can check what has been happening for the individual and to further ensure they are meeting their needs and aspirations. As suggested at our last inspection, the deputy manager has worked hard to streamline the care records and files were more accessible. Historical records had been archived so that files included the most relevant and up to date information about a person’s needs and support plans. Staff complete detailed daily notes concerning peoples’ general well being and if there has been any changes to their care needs. We received four staff surveys and a 100 response that they were always given up to date information about the needs of the people they support. Through regular house meetings, relevant issues are discussed concerning all aspects of life in the home and in relation to individual needs. We sampled some records of meetings. Recent discussions centred on people’s choices for outings, meals, holidays and general house issues. Individual requests included trips to Kew gardens, Hyde Park and Eastbourne. As good practice, we suggest that the home reviews the previous meeting minutes each month to show how any actions agreed have been acted upon. Records included individual risk assessments that stated how staff are to support individuals to take risks in their day -to-day lives whilst ensuring that they can be as safe as possible. As required at the last inspection, risk assessments had been consistently reviewed so that staff had up to date guidance on any presenting risks and how best to minimise them. We also saw up to date ‘contingency and crisis plans’ on the three sampled files. These show staff how to monitor individuals to ensure that if they have a relapse in their mental health, staff would be able to recognise this and ensure they had the support needed. St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 13 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): This is what people staying in this care home experience: 12- 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to make choices about their lifestyle and are supported to be part of the local community and do leisure activities if they wish to. Visitors are welcome and people are supported to keep in touch with their families and friends. People are involved in the choices of menus and they are provided with a healthy diet. EVIDENCE: Care records included information about people’s aims and ambitions, and how staff are to support each person with their social interests and occupation. Examples seen included visiting friends in the local community, cooking, gardening and shopping trips. People were leading different lifestyles dependent on what they liked, could and/or wanted to do wherever possible. Some people are independent in leaving the home to make visits to the local St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 14 community. Other individuals are resistant to activities and prefer to stay in the home. This was reflected in their respective care plans and staff make good efforts to encourage people to join in with tasks or activities. One person ticked on their surveys that they “always” made decisions about what to do each day and two people wrote “usually”. All three responded that they could do what they wanted during the day, evening and weekend. We looked at some records of meetings held in the home. At the most recent one, people were asked about what outings they would like to go on and their preferred holidays. We saw that peoples right to privacy is respected and that they can choose when to spend time alone or with others in the house. We saw staff knock on bedroom doors before being invited in and that people have their own key to their bedrooms. In house activities include a widescreen television, DVD player and music system. One person showed where they had helped to plant flowers and vegetables in the back garden. One person kindly showed us their room. They have displayed a number of their works of art and had lots of equipment to support their painting hobby. Information about how people kept in contact with their family and friends was recorded in their care plans. Care plans and daily diaries confirmed that people who live in the home maintain links with their families and that this process is supported by staff at St Jude’s. Records told us that people are often asked about their food preferences and had recently been involved with planning new menus. We spoke to three people who all felt that the food in the home was much better. One person confirmed that they could choose a different meal if they didn’t like what was on the menu. The menu file included photos to help promote choice. Breakfast offered a range of options including a cooked breakfast. The main cooked meal of the day is usually served at lunch time. We saw that some individuals chose a salad for lunch instead of the chicken dish. People are encouraged to eat meals together in the dining room, although they are able to eat separately if they request. In the dining room, there is an area for people to make their own drinks. St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples health and welfare is closely monitored to ensure that their physical and emotional needs are met. Medication practices have improved so that people’s well being is more fully protected. EVIDENCE: Records showed that individuals are involved in the domestic routines of the home. They are encouraged to take responsibility for their own room, menu planning and cooking meals. Getting up, having meals and attending appointments or activities are all part of their plan of care. They receive guidance, prompting and encouragement from the keyworkers when appropriate. For what the home does well, one person wrote on their questionnaire, “look after us well in hygiene.” People attend health check ups to ensure their health needs are met. Care files showed people are supported to visit their G.P., Optician, dentist and specialist health support from the CPN and Consultant. These allow for any health issues or interventions to be monitored and acted upon. People are able to arrange their own health care St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 16 appointments or staff provide support where needed. Records confirmed that each person is fully supported to access relevant mental health services. This shows that the staff team monitors healthcare needs closely and works positively with other health care professionals to offer a responsive and supportive approach in assisting people to maintain good health. In response to our last inspection, the home had purchased a new metal medicine cabinet and installed it in the office. In addition, a list was displayed of those staff eligible to administer medication. We saw that all medicines were stored securely and observed safe practice when medication was administered. The home’s policy had also been updated in September 2008. The Manager reported that none of the current people living in the home manage their own medication but if required, they would be given the support they need. Medication records were accurate for the receipt, disposal and return of medication. The administration charts were all signed and accounted for. As good practice, we think that the home should undertake regular medication checks to maintain an audit trail and further ensure safe practice. Records we saw confirmed that staff had received training in the safe administration of medicines from the supplying pharmacist in October 2007. We saw a booking confirmation that all staff were due to refresh their training in June of this year. Medication had been reviewed at regular intervals and according to any changed needs. An appropriate healthcare professional reviews each person’s condition regularly to ensure that they receive the correct medication regime or treatment where necessary. St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes arrangements for dealing with concerns and complaints have improved so that people who use the service feel listened to and their views are acted upon. Improvements have ensured that the homes safeguarding procedures and practices are more effective in protecting people. EVIDENCE: The AQAA stated, “We have displayed a complaints procedure on the notice board.This information is also in the service user guide and every service users has a copy of it.” We checked the home’s complaints procedure which lacked some of the required information. At our request, the deputy manager revised the procedure and sent us a copy following our visit. This included clearer details about how the home would manage any concerns or complaints and gave timescales and information about alternative ways for raising a complaint. People using the service should now be provided with a copy of the amended policy. As mentioned at our last inspection, the home should still look at developing its complaints procedure in alternative formats. One person living in the home uses English as their second language. People who returned surveys to us responded that they knew who to complain to if they were unhappy about something. We have received no complaints about this service in the last 12 months. Records confirmed that staff are properly inducted on abuse awareness and there are policies and procedures for safeguarding adults that St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 18 give clear specific guidance to those using them. We were also sent a copy of the home’s revised safeguarding policy which included information about relevant local authority procedures. This guides staff on who to alert in the event of a safeguarding concern. Records showed that most staff had received training on safeguarding in February of this year. During our visit, the manager discussed a recent safeguarding issue within the home and appropriately informed the local authority while we were at the home. We also received a report of the incident following our visit. Staff surveys confirmed that Criminal Record Bureau checks had been carried out before starting work and that staff understood what to do if a concern was raised. Systems and processes have therefore improved to ensure that people using the service are protected from harm and poor practice. St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 28 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, homely and safe environment. Bedrooms are designed and furnished to meet peoples individual needs, personal preferences and interests. The premises are kept clean, hygienic and in a good state of repair. EVIDENCE: For how the home has improved over the last twelve months, the AQAA said, “The home has been redecorated externally. New dining room furniture has been bought. New garden furniture has been purchased. Two bedrooms have been redecorated. Service users’ tea making area has been redecorated.” In addition, new leather sofas had been bought for the lounge and the old office has been modified as a smoking room. At our request during the manager arranged for a follow up visit from the local fire brigade to check that the premises met with fire safety regulations. Shortly after our visit, we received a St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 20 copy of the LFEPA letter which confirmed that arrangements were satisfactory. People responded on their comment cards that the home was always fresh and clean. The home looked clean and well maintained, which supported the survey responses we received. Cleaning materials and other hazardous substances were securely locked in a cupboard. We saw records to show that staff carry out a monthly check around the home to identify if any repairs or improvements are needed. A repairs/ maintenance report form is used to highlight any areas within the premises that need attention. The owning company employ a handyman to carry out repairs and redecorations. A summary report is then completed each month to show what maintenance work has been done. Some of the bedrooms were viewed with people’s permission. Each one was furnished to a good standard and people had their chosen personal possessions and property. Individuals we spoke to said that they were happy with their rooms. House rules allow people to smoke in their bedrooms although a new smoking room has been created on the ground floor. The manager explained that up to five people could use this room at any one time. This needs to be reflected in the home’s fire risk assessment which must now be updated to include the use of the smoking room. Other risk assessments were in place for people who smoke in their bedrooms. St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by a stable staff team who have a range of skills and experience to meet their needs.There are good recruitment practices which safeguard people from unsuitable staff although some additional checks are needed to ensure that people are fully protected. Increased training and regular supervision for staff has resulted in a more skilled workforce to meet peoples needs. EVIDENCE: We checked some staff rotas which showed that the home is staffed efficiently and people benefit from a stable team, most of who have worked at St Jude’s for many years. There are always between three and four staff during the morning and two staff in the afternoon/ evening. At weekends staff allocation remains between two to three and depending on people’s activities and other events. Two staff live in at the home and provide night time support with one awake and one staff sleeping in. People who use the service appeared relaxed at the home and were able to approach staff for casual conversation or more St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 22 in-depth discussion and support. Three people ticked that staff always treat them well and that staff always listen and act on what they say. People we spoke to also expressed a confidence in the staff team. Staff on duty were respectful and supportive to individuals. Staff meetings are held regularly. We looked at some minutes of these meetings which showed clear discussions for keeping everyone up to date and sharing information about developments and practices in the home. At our last inspection we identified several areas for improvement concerning staff training and supervision. Positively, the home had addressed these requirements. One improvement concerning recruitment is needed however. We looked at three staff files which included the most recent employee. These contained most of the required legal checks and documentation which shows that the home takes care to recruit staff correctly. For each staff however, there were some gaps in their employment histories with no written explanation. Full recruitment checks must be carried out on all employees to ensure that people are fully protected and any gaps in employment must be explored and recorded. We further suggest that the homes job application form be revised to request any future employees full employment history and not the previous ten years. Good progress has been made with regards to staff training and supervision. Staff training records and certificates showed that staff had received training in a range of topics relevant to the service. Since our last inspection, some of the recent raining has included mental health in later life, first aid, safeguarding, equality and diversity, moving and handling and food safety. The home manager, deputy and one senior staff had also attended training on the Mental Capacity Act and Deprivation of Liberty Safeguards. This relates to new legislation which came into force in April of this year and concerns the protection of people’s rights when using care services. The deputy explained that there were plans for remaining staff to do similar training. There were training certificates to show that two of the three staff had completed the NVQ level 2 qualification in care. The deputy manager confirmed that any new staff now complete the induction workbook through Skills for Care, which is a recognised level of minimum training. New staff are also given an in house induction that covers specific objectives on working at St Jude’s and includes a fire drill. We suggest that this process is recorded to show that new employees have familiarized themselves with the service and in particular, the specific needs of the people who use it. Four staff replied to our questionnaire and responded that they were given training relevant to their role and that there were always enough staff to meet the individual needs of the people using the service. Records showed us that staff are supported in their jobs through regular supervision and an annual appraisal of their work. Frequency of supervision had much improved and staff were meeting with their line manager every month to discuss work issues, training and development needs. Both the manager and deputy had completed a course on supervisory skills in January 2009. St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from the stability of a manager who aims to run the home in their best interests. People are often consulted about quality of the services provided and have influence over the way the home is run. Record keeping has improved so that peoples rights and best interests are better safeguarded. Health and safety practices are managed well to ensure that the environment is safe for people and staff. EVIDENCE: Priscilla Kagijo continues to manage the home and is also the responsible individual for the other homes owned by Elizabeth Peters Care Ltd. As registered manager, she has yet to complete the required NVQ level 4 qualification. We were advised that this was due to a change of assessor but St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 24 she explained that she has now begun her studies. The manager has kept her training updated and recent courses have included the Mental Capacity Act and Deprivation of Liberty Safeguards as well as safeguarding vulnerable adults and supervision skills. She is supported by a deputy who has also worked well to meet our requirements and improve outcomes for people using the service. The four staff surveys gave a 100 response that they ‘regularly’ meet with their manager for support and to discuss how they are working. From our discussion with the registered manager and deputy we saw that the home continues to provide people with a stable environment, where the management and staff are as approachable and supportive. People’s views are sought through regular reviews and monitoring of their care, and monthly house meetings encourage people to make decisions and choices about the way they want to live.The home provided surveys to people who use the service, their family or representatives and other professionals who have involvement with the home in April 2008. We saw a copy of the home’s annual quality development plan. This showed that the service recognises how it needs to improve and involves the staff and the people living at the home. A responsible individual from the owning company visits the home once a month and completes an audit of the service. Reports were detailed and showed that the owners make sure the conduct of the home is closely monitored and action is taken to make improvements when needed. Previous inspection requirements (May 2008) that centered around training and risk management have been addressed meaning that the health, safety and welfare of people living and working in the home is better safeguarded. The deputy manager had undertaken a risk assessment of the premises and recorded the findings. This was written in good detail and reflected any hazards and best actions to reduce the risk of harm. ensure the safety and well being of all those living and working in the home. The completed AQAA stated that all relevant safety checks were up-to-date. Some health and safety records were sampled including fire safety and general risk assessments. We examined the fire log, which shows that tests on the alarm system are carried out each week and each person who lives in the home, and staff members, take part in regular fire drills. The home now keeps records to show what training courses staff have done, and when they are due to refresh.Most staff had completed training on moving and handling, infection control, food hygiene and first aid. There were arrangements for remaining staff to update such training. As required by law, the service keeps us informed of any reportable events and we saw clear reports for any incidents or accidents. As good practice we think that information about reporting events under Regulation 37 could be kept in a folder so that it is readily available to staff. St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 X 4 X 5 3 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 2 25 X 26 3 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 3 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 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 3 3 3 X Version 5.2 Page 26 St Judes House DS0000025643.V375442.R01.S.doc 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 person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23 (4 a) Requirement The fire risk assessment must be updated to include the new communal smoking room and its use. This is to ensure the safety of people living and working in the home in the event of a fire. All of the required information and vetting checks must be obtained prior to staff beginning work. Full employment histories with an explanation of any gaps must be explored and recorded for all existing and future employees. This makes sure that all people who work at the home are safe to do so. Timescale for action 31/08/09 2. YA34 19 (1)(b) Sch 2 (6) 31/08/09 St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA34 Good Practice Recommendations The job application form for staff is revised to include a request for a Full employment history and written explanation of any gaps. This further ensures that all people who work at the home are safe to do so. Those discussions from previous house meetings are reviewed. This is to form an audit trail of decision-making and show how these are being followed up for people who use the service. The home should undertake regular medication checks to maintain an audit trail and further ensure safe practice. Person centred plans should be developed with each person using the service. This will enhance people’s involvement and contribution to their plan of care. Repeated from last inspection. A monthly summary of events is written up for each person so that keyworker staff can check what has been happening for the individual and to further ensure they are meeting their needs and aspirations. The complaints procedure should be adapted so that it is accessible to all people using the service. i.e. Available to people in their preferred language. Repeated from last inspection The home’s own induction process is recorded to show that new employees have familiarized themselves with the service and in particular, the specific needs of the people who use it. Information about reporting events under Regulation 37 could be kept in a folder so that it is readily available to staff. 2. YA7 3. 4. YA9 YA6 5. YA6 6. YA22 7. YA35 8. YA41 St Judes House DS0000025643.V375442.R01.S.doc Version 5.2 Page 28 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: 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. 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