Inspection on 25/04/07 for 1 St Anne`s Road

This inspection was carried out on 25th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 1 Saint Anne`s Road 1 St Annes Road Exeter Devon EX1 2QD Lead Inspector Ms Rachel Fleet Key Unannounced Inspection 25th April 2007 09.30 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1 Saint Anne`s Road Address 1 St Annes Road Exeter Devon EX1 2QD 07071 780795 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) Alias Choice Limited Mrs Hazel May Gibbons Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (5) of places 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19 January 2006 Brief Description of the Service: ‘1 St Annes Road’ provides accommodation, care and support for up to five adults, male and female, who have learning disabilities. It does not provide nursing care other than that which local district nurses can provide or supervise. Since the last inspection, Mr Chris Brown (the registered provider at the time) has registered Alias Choice Limited as the new provider, and he now acts as the Responsible Individual for the company. No other changes were made to the running of the home, in relation to the new ownership arrangements. The home is close to local bus routes and shops, being in a residential area less than a mile from the centre of Exeter. It is similar externally to the other houses in the road. Accommodation is on two floors, so residents must be able to manage stairs. It includes single occupancy bedrooms, separate bath and shower facilities, and some off-road parking. Furnishings and fittings are domestic in nature, residents having little need for environmental adaptations or specialist equipment at present. Weekly fees at the time of the inspection were from £700 - £2000; extra costs to these include personal toiletries, hairdressing, some activities outside the home, and use of public transport – all at cost price. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are then determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk Inspection reports by the Commission for Social Care Inspection (CSCI) are available from the office at the home, or can be accessed through the Commission’s website at www.csci.org.uk. 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the inspection, CSCI comment cards had been filled in by four of five residents who were sent one, by three of six residents’ supporters (- family and friends) who were sent them, by two of five Care managers who were sent them, and five staff members who received one. This inspection lasted eight hours, without the home being told in advance of the intended date. The inspector met all five residents (- the majority being men below retirement age), getting the views of four of them. She also spoke with both staff on duty and the manager, who came in especially for the inspection. Some written records and documents were looked at, as well as areas inside and outside of the house that were used by residents and staff. This report has information from all these sources and from communication with the home since the last inspection. The Commission has not heard any complaints about the home since the last inspection. What the service does well: One relative, when asked this, said that staff try to meet (A’s) needs to keep him happy. Another said, It is a great relief that (B) is well cared for. Two said the home communicated well or excellently - including about any difficulties, which they try their best to resolve’. Community-based professionals said the manager was good at her job, the home kept the same staff which was helpful to residents, and the home helped people to be independent. A staff member felt the home was good at providing trips, activities and opportunities for residents to meet people outside of the home. The home tries to ensure the home will be the right choice for any new resident, before the person goes to live there, by getting to know them well and giving them information about the home. There is good information about each resident and the help they need, so they are supported well to make choices that will make their lives better. This support also helps them to have happier lives that include friends and family, as well as good experiences both at the home and in other places. The staff team have done training and most have worked at the home for a while, so they are very good at looking after and supporting the residents. Residents get the help they want or need, from staff and other care professionals, to keep healthy. This includes safe use of medicines if they are needed. Meals include residents’ favourite foods and healthy food, which some 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 6 residents help to make. Residents are encouraged to do other things for themselves whenever possible. If residents are worried about anything, staff want to hear about it so they can try to help. Staff also try to protect residents from harm, even if people want to take risks (which staff understand can be part of everyday life). The home is a comfortable and safe place to live. The home is managed well by a good manager, who listens to people who live and work there, or who visit the home. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 (Adults 18-65); 1, 2 & 3 (Older People). Quality in this outcome is good. This judgement has been made using available evidence, including a visit to this service. The home does not provide intermediate care. Good efforts are made to get to know, inform and support each individual thinking about moving in, to ensure the home is a suitable choice for each person. EVIDENCE: The Statement of Purpose and Service User Guide to the home are detailed and informative. The manager said they had been explained to individual residents, who have various communication needs. Some copies seen needed updating - regarding the age range of residents cared for by the home under its new registration, the manager’s newest qualification, CSCI’s new contact 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 9 details, etc. The manager had begun to do this before the end of the inspection. She also confirmed she would be looking into different ways of giving information about the home and for other communication, for existing and future residents’ benefit. There have been no admissions to the home since the last inspection. However, the manager described full but gradual assessments and introductions to the home over time, for any prospective residents, before agreement on admission was made. She also said the home would always speak to any previous carers. The last resident to be admitted said they had visited the home before going to live there. The manager was clear that current residents’ wellbeing would be carefully considered in relation to the needs of any prospective residents, to ensure that they not be unfairly affected by the person’s admission. Individual residents’ contracts were seen, with evidence these had been discussed with the resident. They were written in fairly plain English to make them more easily understood, promoting residents’ rights and choices. 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 (Adults 18-65); 7, 14 & 33 (Older People). Quality in this outcome is excellent. This judgement has been made using available evidence including a visit to this service. Availability of very good information about each resident’s needs, capabilities and preferences ensures they receive the support they need to make choices and to take risks that will enhance the quality of their lives. EVIDENCE: All residents asked were either aware of their care plans or said the manager talked to them about the help they needed or wanted. Three care plans seen had comprehensive information, recording that residents each had unique life experiences. They also included residents’ abilities, their preferred ways of 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 11 spending their time, and goals set within the last year to develop their independence and life skills as an individual. Residents reflected these goals in conversations with the inspector – one saying they were going to be doing some cooking soon, another talking about doing their laundry. Care plans had been reviewed six-monthly, or were updated more often when a resident’s circumstances had changed. Observation during the inspection showed care information was current, and used by staff. A resident said that staff or other residents helped them with things such as writing cards or changing duvet covers, but staff encouraged the person to do what they could unaided. During the inspection, some residents went out to their usual club. The others made it known to the staff how they wished to spend the day, staff checking their understanding of what it was the resident wanted and arranging the time, etc. so as to accommodate everyone. Care plans included when staff should encourage residents to make healthier choices (in personal care, for example), if their initial choices were placing them at some sort of long-term risk. An advocate no longer comes to the home, and the manager agreed to look into advocacy again – so that residents could have independent support at their meetings or to complete CSCI surveys. The Responsible Individual is appointee to one resident only, so most residents get independent help with their finances. Care plans included whether people handled their own personal money or needed help. One person said they were happy with arrangements – they got advice about money from staff but did their own shopping. The manager confirmed all residents have at least some involvement in shopping for themselves, one staff confirming how they assisted certain people according to their needs. Records of personal monies received and expenditures were seen for three residents, and balances shown correlated with the money held for them. Receipts were kept when possible, the manager explaining residents might keep the receipt when they had made the purchase. Records had been checked and signed at intervals by the responsible individual, Mr Brown, to confirm their accuracy. The manager agreed to clarify one resident’s records, where the total on a new page was greater than previously recorded. Risk assessments with care plans stated action that staff should take to minimise risks yet also enable the resident to benefit as much as possible from the activity. (See the next section - regarding activities, etc. - for related information). One resident confirmed they felt supported and treated fairly by staff, regarding certain choices they made that could increase their vulnerability. The home has informed the Commission and other relevant agencies appropriately, when residents have made decisions that might put them at more serious risk of harm. Strategies have been put in place following agreement or consultation with other agencies - that give some residents some opportunity to experience and try to manage a certain amount 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 12 of risk, protecting their right to independence, liberty, etc. One such strategy was seen recorded, where someone may go to stay elsewhere without letting the home know. The Missing Persons policy has been updated in the last six months. 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 15-17 (Adults 18-65); 10, 12, 13 & 15 (Older People). Quality in this outcome is excellent. This judgement has been made using available evidence including a visit to this service. 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 14 The home provides very good individualised support that enables residents to have fulfilling lives that include meaningful relationships and enriching experiences within and outside the home. Good arrangements for meals enable residents to have a varied, balanced and enjoyed diet suited to their preferences and other needs. EVIDENCE: Residents told the inspector about activities they had done recently, a variety being seen noted in residents’ care records. These included using an allotment through a local club, going to a disco, and seeing friends. One person enjoyed knitting, showing the inspector a blanket they were making. The manager explained how they had supported a resident who had wanted to go to church, and accompany a newer resident who has progressed to attending a day centre occasionally, to reassure and support them there. A survey from a community-based professional was positive about how the home had helped a particular resident to be independent in their local community. One hoped to start a literacy course in the Autumn, the certificate of achievement for the last course they undertook being on display in their room; staff said they would be encouraging the resident to do this, despite potential problems. A resident said they got on with the neighbours, who were very friendly. Staff said they have time to accompany those residents who need support to go out, whenever they wish to go. And confirmed extra staff are on duty to accompany people to evening events - such as discos or a local fair. Care records showed most residents enjoyed regular and varied trips. The manager said one was beginning to go out more often; they enjoyed listening to music in their room, but had a portable music-player that they could take if they went out. The manager confirmed that the home pays for residents to attend day centres and to have a holiday, evidence of such events being seen in care notes. Two residents spoke about recent visits to family; one had stayed locally with a relative for several days, with the home manager visiting in the daytime to offer ongoing support. Care records for one resident showed they were able to phone their girlfriend regularly. (See also the previous section, where risk management of activities is discussed for ‘Younger Adults - Standard 9’). During the inspection, residents spent time in different areas of the home – mostly in their own rooms, but also using the lounges (- one to play cards with a staff member) or kitchen facilities. Residents who were asked felt staff respected their privacy, treating bedrooms as residents’ personal space. Care records included residents’ preferred names, used by staff during the inspection. 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 15 Care plans included participation in housekeeping tasks such as cleaning, tidying the person’s bedroom, or helping make meals. Conversations with some residents and their care notes showed these were undertaken, some expressing much satisfaction from their achievements and role within the household. Residents who were asked said they like the food, and one remembered being involved in drawing up new weekly menus. The manager said these were a collection of all the residents’ personal favourites, having been a topic at a recent residents’ meeting. There are facilities for residents to make themselves hot drinks, with a resident making the inspector a drink on her arrival. Some said they helped themselves to fruit or other snacks. Fresh vegetables and salad items were also seen during the inspection. Residents were beginning their evening meal together in the dining room, as the inspector was leaving. Some had been out for lunch, whilst others had taken a packed lunch to their club. 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18-20 (Adults 18-65); 8-10 (Older People). Quality in this outcome is excellent. This judgement has been made using available evidence including a visit to this service. A very good level of person-centred support and care promotes residents’ independence and wellbeing, in a holistic way. There is good management of medication, with improved systems promoting residents’ safety and best interests. EVIDENCE: Two surveys said ‘Sometimes’ when asked if staff listened and acted on what residents said, whilst other surveys and those spoken with said ‘Always’ or 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 17 ‘Usually’. One resident said that staff gave an explanation if they couldn’t do what a resident asked of them. A survey from a community-based professional said the home was good at developing residents’ independence. Care plans included individuals’ abilities, levels of independence relating to each identified need, and the help otherwise needed; staff were seen to communicate and interact with residents as indicated. The manager felt that with a stable, relatively small staff team, it was easier to ensure constancy in the support given to each resident. Staff described a discrete approach regarding personal care - prompting residents and only giving essential assistance (for safety, etc.), thus also promoting people’s privacy and dignity. Rotas showed that occasionally there was no female staff on duty. A female resident indicated this did not concern her, and care notes showed she needed minimal practical help. The manager said there was always a female staff member on call, should a female resident wish to have a same gender carer; but she said she would keep the situation under review and should the situation change, she would rearrange staffing at the home. See also other sections for other information on how residents are supported according to their individual needs and preferences. Care records showed one resident sees a speech therapist, and that staff had sought advice from residents’ GPs. The manager said residents usually went out for medical appointments, although a consultant had made a home visit when the resident was too unwell to go out. The home has just arranged for all residents to begin to see a dentist regularly, and one resident talked about their recent appointment. Several spoke about the chiropodist, and there was evidence of routine sight checks for some also. Residents’ weights had been regularly recorded. The home now receives medication in blister packs from the pharmacist, thus avoiding the ‘secondary dispensing’ discussed in the last report, with three residents being on medication (fewer than at the last inspection), in minimal amounts. One resident said their medication had been reduced, being happy with the change. Another was satisfied with how staff managed their medicines for them, and knew what their medications were. One care plan included why it had been decided that one person couldn’t self-medicate. Records of medications received into the home and returned to the pharmacy were seen. Information about potential side effects of medication was seen with administration records. Staff described safe administration procedures, but one staff was not sure of procedures for disposal of refused or dropped medication, having never had to deal with this. The manager said she would ensure staff are fully aware of safe disposal methods. 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22-23 (Adults 18-65); 16-18 & 35 (Older People). Quality in this outcome is excellent. This judgement has been made using available evidence including a visit to this service. Good communication within the home ensures residents’ concerns are expressed, recognised and taken seriously. An excellent knowledge of residents’ individual needs and personhood ensures that protection from abuse and self-harm is given with regard to their rights and responsibilities. EVIDENCE: A survey from a professional said the home had given one resident much more confidence in going to the manager to discuss any concerns. One resident said senior staff had told them they must tell them if they have a problem or complaint so that it can be sorted out. Another felt staff would sort the problem out if they were told something was wrong. Those spoken with clearly felt enabled to contribute positively to their own lives, or life at the home, as a result of how they had been encouraged to speak up about any concerns. When asked about a resident who couldn’t communicate verbally as well as others, one staff member said that person could let them know something was 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 19 wrong; and they would then go through a process of elimination to try to find the problem, using their knowledge of that person. The complaints procedure displayed in the dining room had required information, and has been discussed with current residents (at a residents’ meeting, for example). The manager agreed to look into using other formats that may be more suited to residents’ communication needs, and update the version included in information about the home. There was nothing recorded in the ‘Complaints’ book. Staff were not aware of any ‘complaints’ as such, saying that dealing with individuals’ concerns was part of the support offered at the home. One resident said they had been told to tell the manager if ‘someone was nasty’ or shouted at them, even if it was another resident who was upset, so that staff could support them. They had also been told, “You shouldn’t keep things on your mind...it’s better to tell someone.” They felt the home would act to keep them safe, and others reflected this. The pre-inspection questionnaire confirmed staff have attended training about safeguarding vulnerable adults, and that the home has written policies to inform staff about this issue and their responsibilities. When asked about residents with limited verbal communicate, staff spoke about looking for changes in their behaviour or reactions to other people as a possible sign of abuse. They knew what they should do if they thought a resident was being mistreated, being aware of agencies outside the home that they could contact if necessary. And staff have contacted these agencies - including CSCI – since the last inspection, when they have had concerns or known a resident may be at risk of harm (through choices they have made). Records showed ongoing multidisciplinary input, with action taken to try to ensure people’s safety. This included supporting them to make and benefit from other choices, whilst being mindful of their rights. See also the section on ‘Choice of home’, for information on the home’s contracts (which protect residents’ rights), and the following section - where appropriate handling of residents’ monies is discussed. 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29 & 30 (Adults 18-65); 19, 26 & 29 (Older People). Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. Residents have a comfortable and safe home, and will benefit further from planned improvements. EVIDENCE: Residents said they liked their private accommodation, and did not indicate any problems with the shared facilities. All have single bedrooms, and nearby access to a bathroom and separate shower room (– each with a toilet). One 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 21 said they had the key to their bedroom but chose not to use it. Residents’ bedrooms were personalised with photos, ornaments, DVDs, etc. that reflected the interests recorded in care notes and discussed by residents when talking to the inspector. Rooms were furnished in line with residents’ preferences and needs, again as confirmed by individuals and recorded. Most had had a new bed since the last inspection. On three surveys, people had answered ‘Sometimes’ to a question about the cleanliness of the home (rather than ‘always’ as others had). On this unannounced inspection, the home looked clean and generally well maintained, with no issues noted during the time spent at the home. Staff said they make regular checks around the home to attend to cleanliness. A resident said the residents had helped to choose the new stair carpet. Staff said the manager had just repainted the lounge, and new dining chairs and pictures had been bought once that area had been redecorated. Records showed a plumber had just been contacted to mend the faulty kitchen tap. However, surveys from community-based professionals and some people at the home said the bathroom could do with redecoration. It was also seen to have a broken tile and some exposed woodwork, which could affect levels of cleanliness and safety. The manager discussed redecoration of the bathroom with Mr Brown during the inspection, and it was agreed that this would be done. One resident said they were having trouble getting in and out of the bath. Their care plan showed staff had recently provided an aid to enable the resident whilst still protecting the resident’s privacy and independence. The manager confirmed there would be ongoing monitoring, there being no grab rails, etc. in bathrooms. Laundry facilities are domestic in nature, with some residents being encouraged to do their own washing now; one said staff still usually help them. Machines are not in food preparation areas, thus minimising crosscontamination from washing. Staff said there was little soiled laundry but it was washed separately to other laundry, with disposable gloves and aprons available for their use – again to minimise cross-infection. 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 (Adults 18-65); 27-30 (Older People). Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. Excellent attention to staffing means that residents benefit from a skilled care team and flexible arrangements that are adjusted to meet their needs. The home’s recruitment procedures help to ensure residents are protected from unsuitable people. EVIDENCE: Residents spoken with said staff are always around if they need them. Staff said that there are at least two staff members on duty in the day, enabling 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 23 residents to go out when they want to, with more on duty in the evening as necessary, so that residents can go out later if they wish. One said there had been extra staffing when a resident was new to the home, with levels returning to usual once they had settled in. Night staffing levels have recently been changed because residents currently need little help overnight. The manager said the new arrangement is being monitored closely, and staffing would be increased or adjusted as necessary to ensure residents’ needs continue to be met. Staff spoken with showed a good understanding of residents’ needs. Both had undertaken training over the past year, including obtaining an accredited qualification in promoting independence, first aid, and safeguarding of vulnerable adults. They confirmed they have one-to-one supervision with the manager, useful monthly staff meetings and full handovers between shifts, and feel well supported. Of six permanent care staff, the manager reported that four have a recognised care qualification at Level 3, with two others studying for them. Both staff members spoken with confirmed that they have the qualification. A survey from a community-based professional said the stability of the staff team was a positive factor. The manager said agency staff have not been employed for some time (– which rotas seen reflected), with staff working extra hours if necessary to ensure continuity of care; records showed she monitors staff work hours, so that they do not work excessively. The preinspection questionnaire showed no staff have left since the last inspection. A new person has joined as ‘bank staff’, the manager saying this person was known to the home before their employment. One resident said they hadn’t been involved with the person’s recruitment, but said they had met them several times before they became a staff member. Information from the person’s staff file and the Responsible Individual showed the home had carried out required pre-employment checks. 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 25 37, 39, 40 & 42 (Adults 18-65); 31, 33, 35 & 38 (Older People). Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. Good management of the service, which is informed by good practice and the views of those who live and work there, promotes the welfare of people at the home. EVIDENCE: A survey from a community-based professional included positive comments about the managers skills and qualities shown in running the home. She has several years of experience as the home’s manager, and has a recently obtained care management qualification. Since the last inspection, she has attended training/updating on medications, supporting people with particular behaviours, and citizenship (related to people with a Learning Disability). She showed full knowledge of each resident’s care needs, using knowledge of their preferences to ensure their individualised needs were met in ways suited to the resident. Comments made by residents and staff during the inspection showed they trusted and respected her. The home’s ‘Quality Assurance Annual Development plan’ includes gathering views from a variety of sources. Residents’ meetings take place at least threemonthly, with residents talking to the inspector about one that had taken place in the previous week. One resident, when asked by the inspector if they liked their room, wanted their room a different colour - but said they felt able to raise this at the next meeting or with the manager. The home carries out a yearly residents’ survey, most recently in March 2007, with completed forms seen. Use of advocacy support for completion of surveys, etc. was discussed, and the manager confirmed she would be looking into this. Issues are also dealt with as they arise or come to the home’s attention. The home has a record of addressing CSCI’s requirements and recommendations very promptly. CSCI surveys from families and professionals were very positive with the way the home communicates with them, saying they are kept informed of important matters and know problems brought to their attention will be dealt with well. Training records showed the Responsible Individual attends training with the staff, keeping himself up-to-date with topics important to the service he is responsible for. The manager confirmed he visits the home regularly (usually unannounced), with residents confirming they also spoke with him. 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 26 Policies are currently in a standard format, but the manager felt current residents’ communication needs were such that these would have to be explained to them in any case, rather than trying to produce ‘easy read’ pictorial versions, etc. The inspector saw no major hazards during the visit. Residents confirmed staff dealt promptly with any breakages or repairs, with some clearly comfortable about reporting any problems. Staff confirmed they felt they had a safe working environment, and also that they did not need any handling equipment currently. They do not have safe handling training currently. Since one resident is beginning to have mobility problems and staff handle laundry, shopping, etc., the manager confirmed she will risk assess the situation within the whole home. A resident confirmed fire alarms were tested regularly and said fire drills took place, also describing what they should do if the alarms sounded. The record of fire safety checks was up-to date. Certificates showed all staff had had fire training, and all permanent staff had had Food Hygiene training within recent months. The pre-inspection questionnaire listed various maintenance checks that had taken place within the last year - promoting the safety of gas systems, for example. See also the section on the environment for related information. 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 27 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. Where there is no score against a standard it has not been looked at during this inspection. 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 4 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT Standard No Score 37 3 38 X 39 3 40 3 41 X 42 3 43 X 4 3 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 1 Saint Anne`s Road Score 4 3 3 X DS0000068002.V338409.R02.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NA 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 1 Saint Anne`s Road DS0000068002.V338409.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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