Inspection on 03/09/08 for 14-15 St James Road

This inspection was carried out on 3rd September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

14-15 St James Road 05/03/08

14-15 St James Road 23/05/06

14-15 St James Road 27/09/05

14-15 St James Road 25/04/05

14-15 St James Road 22/11/04

14-15 St James Road 15/07/04

14-15 St James Road 16/03/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 26/11/2008.

CARE HOME ADULTS 18-65 14-15 St James Road 14-15 St James Road Exeter Devon EX4 6PY Lead Inspector Rachel Doyle Key Unannounced Inspection 3rd September 2008 10:00 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 14-15 St James Road Address 14-15 St James Road Exeter Devon EX4 6PY 01392 670160 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) Mrs Deborah Veronica Phillips Mr Warwick Nicholas Phillips Vacant Care Home 17 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (17) of places 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The manager must obtain NVQ 4 in Care or Registration as a 1st level Nurse with the Nursing and Midwifery Council by 1st December 2006 5th March 2008 Date of last inspection Brief Description of the Service: 14-15 St. James Road is registered to provide care for up to 17 people, both men and women who have or have had a mental illness and who are between the ages of 18 and 65. The Home comprises two adjoining semi-detached houses, which have access to each other at second floor level. To the rear of one is a small garden and to the rear of the other is a patio. One house has a roof garden accessible from the first floor. Each house has its own kitchen and living rooms. The Home is situated in a residential area close to the city centre and some rooms overlook the Exeter City Football Club pitch. The Home’s Statement of Purpose says that at the Home therapeutic care is delivered…To enhance personal esteem and confidence. And ‘to help service users to achieve or regain individual life skills required to attain or return to a more fulfilling lifestyle. Currently the fees of between £375 & £500 are charged. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk . Copies of the inspection report are available from the office. 14-15 St James Road DS0000021830.V368070.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 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced visit took place over six hours by two inspectors, one day at the beginning of September 2008. The Home had been notified that a review of the home was due and had been asked to complete and return an AQAA (Annual Quality Assurance Assessment). This was completed very well and shows us how the Home has managed the quality of the service provided over the previous year. It also confirms the dates of maintenance of equipment and what policies and procedures are in place. Information from this document was used to write this report. During the inspection 4 people were case tracked. This involves looking at peoples’ individual plans of care, and speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process CSCI likes to ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to 10 people living at the home and 1 health and social care professional. At the time of writing the report, responses had been received from 7 people living at the home and verbal comments from one health and social care professional. Their comments and views have been included in this report and helped us to make a judgement about the service provided. During the inspection 4 people living at the home were spoken with individually, as well as observing staff and people living at the home throughout the day. We also spoke with 2 staff and the owner. A full tour of the building was made and a sample of records was looked at, including medications, care plans, the fire log book, policies and staff files. What the service does well: People commented on survey forms that they felt they had had good information on which to base their decision to move into the home. People we spoke with were generally happy with the care at the Home and said that they were able to pursue the life they chose. The owner appeared very caring and is very knowledgeable about the people living at the home. Everyone had a basic care plan and some showed evidence of work with care professionals. 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 6 There was a relaxed atmosphere throughout the home with people doing ‘their own thing’ and people said the food was good. People had had the chance to choose they way their rooms had been decorated and be involved in changes at the Home. Comments were received verbally from a care professional saying that they felt the Home had done some really good work with one person living at the Home and coped well with people with severe mental health problems. Contact with health professionals is thought to be appropriate and timely. What has improved since the last inspection? What they could do better: Record keeping, particularly care planning, risk assessing and healthcare professional information, should be more robust to ensure that staff have the information they need to be able to deliver appropriate, consistent care. This 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 7 will underpin the care that is given at the Home and monitor progress and successful methods. People living at the home should receive care in a person centred way from staff who are appropriately trained in mental health issues. There should be a more structured approach to the care provided to enable and promote independence, with staff being encouraged to be more pro-active in the care of people living in the home. Recordings should be useful, objective and nonjudgemental. Risk assessments should be completed for all individuals and should show details of how any behaviour that may challenge the system should be dealt with by staff and should include any triggers that staff need to be aware of. Staff should receive comprehensive training in up to date mental health care and be clear about what peoples’ needs are and how they are to be met in a consistent and effective way. Finance systems should be more robust. Cleaning systems should be looked at to ensure that staff can meet individuals’ needs and maintain the Home to a good standard of cleanliness. There were some Health and Safety issues, which could put people at risk. There were few risk assessments relating to the building and none in relation to windows above ground floor level. This means that people may be at risk of falling from windows etc. Substances hazardous to Health were not stored securely and the keys held by staff were not kept safely meaning that people could have easy access to chemicals and medication, which puts them at risk. It is noted that the owner is addressing the window restrictors and moved the COSHH items when this was brought to their attention during the inspection. 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. 14-15 St James Road DS0000021830.V368070.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 14-15 St James Road DS0000021830.V368070.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. In the future people thinking of moving into the home can be confident that the Home’s assessment and admission procedures will ensure that their needs will be met. EVIDENCE: The 7 people living at the home who returned survey forms all felt that they had had enough information prior to moving into the home to help them make their decision as to whether they wanted to live there. No one has been admitted to the home for some time and current preadmission details were sketchy. Although there were social services referral forms for the people whose care was looked at these referral forms were in an ‘essay’ form and it was difficult to see exactly what the needs of the person were, although aims and goals were clearly stated. This information remains the same as in the previous report. However, details in the AQAA show evidence of a new system for future prospective residents. This includes a full assessment by the Manager, risk assessments, facilities, Statement of Purpose and Home information and a phased introduction during visits to the Home for dinner or the day to meet 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 10 staff and people already living at the Home.The Home intends to move towards a more short stay focus with rehabilitation opportunities in one house ‘to make the Home more suited to modern needs and get away from institutionalisation. 14-15 St James Road DS0000021830.V368070.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People can be confident that they can make any decisions about their lives with assistance as needed and that their choices will be respected. Inconsistent record keeping means that people cannot be assured they will receive sufficient support to achieve their personal goals or that risks to their personal safety and independence will be consistently identified and managed. EVIDENCE: Four care plans were looked at as part of the case-tracking process. They were well laid out, although some information was very old and it was unclear as to whether information was still the case. The senior carer is currently auditing care plans and has made some progress in formatting and making them easier for staff to read. Those that had been revised still contained minimal information about how their mental health issues actually affect their day-today living. The new care plan process will include six monthly reviews. 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 12 However, they did not contain identified goals or show how identified needs should be met in relation to mental health although there were identified needs for more physical issues. For example as in the previous report, one medical history was still a list of places they had lived before. Expressing sexuality said ‘very masculine’ and did not mention any issues relating to this or how staff are managing them. Another plan said ‘needs firm boundaries’, but did not expand as to what these were. One plan did not show how a problem stated as a hobby was being addressed by staff or how staff were addressing another problem related to alcohol use. Generally issues relating to mental health problems were not clearly identified in records although some had been mentioned briefly. Social histories were very scant, especially as the people living at the home had some complex mental health needs and histories that staff would need to be clear about when communicating or managing behaviour. For example, history of drug and alcohol abuse was just ticked ‘yes’. Health issues were equally vague with statements such as ‘some health problems’ or ‘occasional diarrhoea’ with no actions or explanations. One plan had ‘verbal aggression’ ticked as ‘occasional with provocation’ but this was not expanded on as to what the triggers might be or actions staff should look out for. It should be noted that the owner was extremely well informed as to the history, characteristics and needs of the people living at the Home. He gave examples of how staff interact with the people living there. However, he is not on the rota and the records do not ensure that his knowledge is passed on consistently, although at present the owner is at the Home every day. They also said that their wife, who works as staff on the rota was very informed about the people living at the Home but again this detailed information is not recorded. For example, one plan said that someone was ‘not happy and a bit quiet’ so they had a chat with the owner. There is no record of the content that may be helpful to staff to follow this comment through. However, people did say that they are generally free to do as they pleased throughout the day and all survey responses from people living at the Home stated that they were happy living at the Home. It is noted that some people living at the Home have lived there successfully for some time in comparison to their experiences prior to St James Road. Care plans did not clearly show what peoples’ individual risks were or how to minimise them. There were various Health and Safety risks in the Home but no individual risk assessments to show that all reasonable steps are taken to ensure that people are safe. However, there were individual fire risk assessments and details of how staff were monitoring individual smoking habits, which was good. The owner was able to show that they were aware of triggers leading to behaviour that may be challenging, and the ‘ways’ of people at the home. 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 13 Their knowledge was detailed and they clearly knew the people living at the Home well having known them for a long time. However, not all staff were so knowledgeable when spoken to and records did not enable them to consistently have available information to be able to meet peoples’ needs. There was little indication on the plans of a ‘person centred’ approach to care. This is where the person is put at the centre of their care, and is seen as a ‘whole person’ with their history and future plans taken into account. There was no mention of any specific plans in relation to the mental health of people such as WRAP (Wellness Recovery Action Plan). The owner said that he hoped to enable staff to undertake training in this system in the near future looking into rehabilitation but at present staff learn ‘on the job’. Staff appear to gain information about people living at the Home mainly verbally and during staff meetings, which does not ensure consistency. Recordings on the progress of the individuals’ mental health needs were minimal. Most recordings just stated ‘fine’, ‘in a funny mood’ or ‘snappy’, ‘avoiding people’ or said what activity they had been doing. There was no explanation as to why the individual might be in a particular mood, or any evidence of any work done by staff with individuals during the time period although the owner said that he and his wife often spent a long time with people. One plan said that the person had ‘been very rude but had apologised after’ with no further explanation. Another plan said that someone had not felt like doing their room as they had a cold but later it was recorded as ‘did it this evening after some persuasion’, which does not indicate a person centred approach. The Home has started regular Residents’ Meetings, which is good and people are encouraged to air their views. This process has informed the care plans about peoples’ food preferences for example and people spoken to confirmed that they felt happy to talk to the owner and staff. The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit indicates that in order to improve the service the home intends to implement a quality assurance process and to complete in-depth risk assessments. 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the Home enjoy the relaxed atmosphere and the freedom they have along with food they like. In general staff maintain an approach of support and encouragement but improved records would ensure that this is pro-active and consistent with peoples’ needs. EVIDENCE: One staff member and people spoken to at the Home said that the people living at the Home ‘just do their own thing’. There were lots of activities at the Home although they are not related to identified goals or records of what people living at the Home like to do with their time. One person said that they did not see staff very often but that they did not need them. 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 15 However, the Home has records of what people at the Home actually do. These include trips to Exmouth, snooker and visits to town. People are very free to come and go as they please. The owner is again very knowledgeable about what people like to do and has organised golfing trips and a recent holiday for people at the Home. People spoken to were happy with what they were doing. However, it would be good practice to relate activities and interactions with staff to identified goals and abilities relating to peoples’ mental health needs and to record successful progress such as for the person who finds socialising difficult. For example, one person said that they would like to do a course. The owner was clear about this person’s needs but little was recorded about staff therapeutic input and reviews. People living at the Home are encouraged to be involved in the day to day running of the Home such as laundry, cleaning and domestic duties. Most people have their own key to the Home and others will be offered this in the future, which is good. One care referral said that the aim of the placement was to ensure support, activity and structure and to develop their interests with help. Records did not show that this was happening but rather stated ‘no interests other than music, chats and company’ and there was no indication of how this need was being met although the owner said that it was. This has not been expanded when care plans were updated. One person is stated as being a practising Roman Catholic but records do not say how this is facilitated. Another person needed a more structured lifestyle but this was not detailed. The owner said that they had given some thought to getting people at the home to be more occupied and is encouraging staff to interact with people at the Home more. At one person’s request is going to build a ‘smoking’ summer house in the garden with the help of some people at the home. People can also help with the gardening or do-it-yourself. One person goes to a garden centre every year to choose things to grow at the Home and another is supported to continue holding down a job. People go to the shops, pubs and use the bus services. Staff are trained in staff meetings on how to interact in an appropriate manner with people and all people spoken to said that staff were nice and friendly. There is a pay phone, which is always available for the use of people living at the home. The money box is not secure and this should be addressed for security purposes. Care plans did not show how links with the community were aided for people at the Home although speaking to the owner, who knows people in detail; there are regular contacts with friends and family. Plans should be clearer about peoples’ relationships with their families as these can be complicated. The owner explained how they ensure that people can choose who they see and when and showed that he focussed on peoples’ choice. This information again should be clear to staff in the records. One plan said that the person would like more people to talk to and that a lack of social contacts was 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 16 a problem. However, there were no actions documented to show how this was being addressed. People at the home are able to socialise with whomever they choose. However, there are no risk assessments in place in relation to this and problems have been caused by inappropriate friendships being formed. One incidence, although not clearly documented was dealt with well. Comments received via surveys indicated that people generally enjoyed living at the home and the freedom they had to pursue their own interests. The Home has a Residents’ Handbook, which gives information about how people living at the home should behave for the comfort of everyone, for example, House Rules. People living at the home confirmed that they have what they want for breakfast when they get up. It seems that people have a relaxed lunch when they seem to help themselves to what they want, and when with free access to the kitchen. The main evening meal is more structured and one person living in no. 15 is encouraged to come and socialise with the people living in no. 14. Other people prefer to eat their meals in their rooms. It is not clear how everyone living at the home would eat at the same time in the evening, as there is not enough room in either part of the home. This does not ever seem to happen, however, and the owner said how they had always organised a fun Christmas Day meal for whoever was in the Home. Records clearly show what peoples’ dietary preferences are, which is good practice. One staff member makes nice homemade cakes and the food being cooked by staff for dinner looked tasty and filling. The owner said they wanted to move back to a more enabling ethos at the home and this was one thing that needed to be addressed to enable people to become more independent. This information is not yet clearly recorded in the care plans although there are good records relating to one person who is not good at remembering to eat well. The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit indicates that in order to improve the service the home intends to introduce new policies and procedures and are comprehensively reviewing the Home’s management style. 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported to live their lives as they choose. Improvements could be made in record keeping to underpin this. Medication procedures and practices have improved and safe systems are in place. EVIDENCE: Records relating to the care that people living at the home receive are generally not very detailed in indicating good practice in mental health care (see Individual Needs and Choice). However, the owner was verbally able to demonstrate how individuals’ needs are met. This information is currently not available in sufficient detail in the care records for staff. However, it is noted that the owner is spending most of the time in the Home with his wife at the moment, who also works in the Home and has good information about people and they are accessible to staff. Some plans did show evidence that social and health care professionals visited the Home although there is little information recorded about the content of 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 18 these visits so that staff have up to date information available. The Care Professional spoken to said that although record keeping was poor, the Home do not hesitate to contact them if they have a mental health issue and relationships with the Home are good. There was little paper evidence of multi-disciplinary work to underpin that the personal and healthcare needs of people living in the home were met. However, when speaking to the Care Professional it seemed that although records are not very detailed in the Home, the Home does involve the multidisciplinary team in a timely way and work well with them to ensure that peoples’ healthcare needs are met. They said that health care workers visiting the Home tend to keep their own notes about people living at the Home and records made by the Home about visits are brief. For example one plan said ‘not himself today, seen by Community Psychiatric Nurse’, with no further explanation. Another plan said if blood pressure dangerously high to contact the GP but did not indicate what the person’s normal range was or who was doing the BPs, i.e. are they trained? Important healthcare information should be shared with all staff in individual records to ensure consistency and enable staff to meet peoples’ needs at all times. Comments were received verbally via another care professional saying that they felt the Home had done some really good work with one person living at the Home and coped well with people with severe mental health problems. All staff in the Home have received training in medication administration to ensure a safer medication system and further training is planned. The Senior Carer has also visited a specialist clinic to learn about certain medication, which is commendable. The Services Operations Manager from Boots also checks the system and the Home contact them for advice. Regular audits are carried out. People are assessed as to their suitability for safe self-medicating and supported to do so. These should be risk assessed again on a regular basis to ensure that this is still appropriate. People who are able can self-medicate using lockable storage in their rooms. They pick up their own medication and staff keep an eye out to ensure that they people remember to tell staff what medication they have picked up. There is a procedure for people requiring medication who will be out at administration times and staff check compliance. The Home records consents for medication to ensure that people living at the Home are involved in their medication therapy. However, we found that although medicines were stored in a locked room and in a lockable cabinet the keys to this room were not kept secure by staff during the inspection but left accessible to anyone in the Home on a shelf near the main kitchen putting people at risk (see Management). The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit indicates that in order to improve the service the home intends to carry on 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 19 with improvements to make St James Road a Home which is safe and risk free in terms of the above. 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are dealt with appropriately and individuals are not at risk of abuse as staff have not been properly trained to recognise abuse and know their duty to report poor practice. EVIDENCE: The complaints procedure remains the same as at the last visit. This means that the complaints procedure contains all the necessary details and is displayed in the main hallway and there is now a specific system for recording complaints, their investigation, outcomes and any actions to be taken. All individuals living in the Home said that they felt staff would sort out anything they may be worried about. Others indicated (via surveys) that they knew how to make a complaint. There is now a complaints record showing any actions taken and outcomes, which was seen. A suggestions box is in the hall and comments can be anonymous in sealed envelopes if people wish. There is a good POVA (Protection Of Vulnerable Adults) policy. All staff have recently received formal training in POVA issues, including folders of this information and were aware of what incidences need reporting to ensure peoples’ safety. Staff will also be tested on this knowledge via regular questionnaires. One occurrence had been well dealt with involving the appropriate multidisciplinary team. However, staff are not able to demonstrate clearly that they know how to deal with incidences of aggression appropriately 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 21 and records also do not inform them of actions that should be taken for individuals. The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit indicates that in order to improve the service the home intends to continue to improve training and management in this area. 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although not all areas of the Home currently have a good standard of décor, the Home are in the process of ensuring that individuals have a homely, hygienic and comfortable environment in which to live. EVIDENCE: The Home is in the process of totally refurbishing and decorating most areas of the two houses. The overall feel is now brighter and people living at the Home have been able to have input into choices of décor and some have helped in the refurbishment itself such as with painting. This is good as some people at the home have a severe mental illness and current thinking suggests that people’s environment impacts on their state of mind and well-being. The Home said that they have implemented a more robust cleaning rota although this is carried out by staff on the floor, as the Home does not employ a cleaner. As there seems to be only one staff member on the floor when Mrs 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 23 Phillips is dealing with other tasks this could impact on meeting peoples’ needs as the Home is large and requires a lot of cleaning. Notices state that ashtrays are emptied on Tuesdays and Thursdays, which means that some were full and would remain so until the allocated day, which is not good practice. Showers needed some attention and left room for infection possibilities. Some carpets were dirty, especially in bathrooms and around showers. Other bathroom floorings were not well sealed and were cracked and old. There was a mouldy bathmat, not very clean towels in communal bathrooms, dirty bar soap and some areas were dirty. The owners often bring their dogs into the Home which people enjoy but a system should be put in place to stop them going into the kitchen for hygiene reasons. However, overall the Home was fairly clean as staff have been doing more cleaning but improvements could be made. People living at the Home are encouraged to be involved with their own cleanliness to promote their independence. All staff have received infection control training and good practices were seen to be adhered to. Since the change in manager the Home have implemented a comprehensive maintenance programme where all rooms will be redecorated, re-carpeted and re-furnished. A new second kitchen is due to be fitted and the owner said that this would be used by people to cook their own food as part of an enabling programme. New patio doors, new furniture, decorators in place for 6 weeks are all done or in progress. The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit indicates that in order to improve the service the home intends to carry on with their extensive overhaul and improvement plan relating to the environment. 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home may not always receive the support they need, as not all staff have the recorded information and specialist skills they need to care for people who have mental health problems. People living at the Home benefit from staff who are approachable and friendly and appear to genuinely care for people. Generally recruitment procedures ensure that people are not put at risk of abuse from staff who may be unsuitable to work with vulnerable adults. EVIDENCE: There were 12 people living at the Home at the time of the inspection. The staff duty rota indicates that there are at least two staff on duty at all times. However, the owner is also in the Home most days and has a large input although they are not on the rota. 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 25 The Home has 7 carers employed and a new cook started that day. A Senior Carer is currently working their probation period with a view to applying to register as the Manager. On duty at the time of the inspection was a staff member who was mainly alone on the floor. They were not sure as to which residents were in or out and there was a very relaxed structure to the staff role. The other staff member was Mrs Phillips, who is registered as owner of the home with her husband. During the visit she was mainly engaged in administration, cooking and preparing wages for staff. She said that this was generally her role and during the inspection she was not seen working ‘on the floor’ with any people living at the Home. Records did not indicate that there was a clear focus as to how people’s needs were met and during the day people living at the home were not seen to interact very much with staff but mainly ‘did their own thing’. Generally, most of the interaction was focused around tasks such as cleaning, and not the needs of the individual. However, staff have recently had excellent First Aid training and are now working through a mandatory training programme to include POVA (Protection of Vulnerable Adults). The Home has spent a lot of time since the previous inspection ensuring that staff receive training in Health and Safety, Infection Control and all staff are encouraged to start National Vocational Training (NVQ). Due to circumstances beyond the control of the Home there is a high proportion of new staff at present and the Home now has an induction up to the levels required by ‘Skills for Care’. This means that staff are receiving training appropriate to the jobs they are expected to do although this does not specifically include mental health care. Staff spoken to had read the brief history for one person living at the Home but were not aware of their identified needs relating to their mental health although they could describe how they physically looked after them. They were also not aware of any person in the Home who had had issues with aggression in the past or how to deal with that should it arise although care plans have this subject ticked for some people. Care plans also did not contain this information should staff need it to ensure consistent care. It appears that staff would get this information verbally but that may sometimes depend on the owners being in the Home. A few staff remain since the previous manager left who have been at the Home for some time so the owner is positive that a low staff turnover and continuity for people living at the Home will be promoted. All surveys from people living at the Home showed that they thought that the staff listened to them and helped them. Staff were friendly and said that they enjoyed working at the Home. The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit indicates that in order to improve the service the home intends to remain 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 26 committed to ongoing improvement and training programmes and have regular staff meetings. 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate systems in not in place to manage the Health, Safety and Welfare of people living and working at the home although there is a more stable management structure. EVIDENCE: Although there is not a registered manager at the Home at present, the Senior Carer is about to complete her probation period with a view to applying to register as manager. The owner said that they were well qualified, quick to learn, setting higher standards and keen to make improvements. She was not on duty at the time of the inspection but the owner felt that she would be capable of managing the Home and she will be attending training on Care Home Management. Although there are issues with the recorded detail relating to mental health care needs for individuals and recording of the delivery of 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 28 care in general, it is noted that the owner is also taking a far more active role in the Home and feels that the Home is going in the right direction after a period of instability. They are showing that staff discipline and conduct is being addressed and training is being actively encouraged. A care professional felt that although records could be improved, that contact with the healthcare team was good and better relationships were being built upon. The owner is obviously caring and very well informed about the people living at the home although this information is not recorded consistently. The owner has worked at the home a lot since the previous inspection and spends time with people living at the Home with whom he has a good rapport. He takes them to play golf, plays games in the Home and spends time talking, which they seem to enjoy and also talks to staff. However, this type of time spent with people is on an ad-hoc basis and not clearly related to any individual’s identified well being goals or recorded so that staff can continue this input. Although staff are caring, they are not always as informed as they need to be to be able to meet peoples’ needs consistently or be clear about mental health needs. It appears that therapeutic care is delivered but is not always recorded using a clear system to ensure that people are safe. There is an informal system for dealing with people’s finances and when the owner does not have access to the safe keys, they give people money from their own pocket and settle up later. This does not ensure a safe and clear recording system and at the time of the inspection records were slightly out. Receipts are kept but it is not easy to follow a clear audit trail. Some aspects of the home suggested an institutionalised feel such as notes on toilet doors and bed changing lists but the owner said that they would address this. The Home have introduced a new quality assurance system and are being proactive in finding out the views of people in the Home through the suggestion box, residents’ meetings and surveys to health care professionals, which will be collated. There is also a key worker system so people can speak to allocated named staff. People living at the Home are clearly involved in any choices made at the Home such as décor and the menu. The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit, provided evidence that St James Road complies with fire legislation. The fire logbook, record of fire safety training and accident and incident records were found to be accurate and up to date and the Home have been carrying out random fire drills. Policies and procedures are not always inspected during the visit but the information provided on the AQAA helps us form a judgement as to whether the home has the correct policies to keep people living and working at the home safe. Information provided by the home, evidenced that policies and procedures are in place but are being updated. 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 29 There were limited risk assessments available relating to the building (such as the high wall and fire escape), and there were none in relation to windows above ground floor level. This means that people may be at risk of falling from windows etc. There were still various tools around the garden, a broken step and a piece of the end of a metal bedhead. In the Home various substances that could be hazardous to health were accessible such as toilet cleaning fluid and bleach and a flame cooker lighter, which must all be securely stored and/or risk assessed to ensure that individuals are safe. There were no clear risk assessments to indicate that this was safe in relation to the mental health status of people living at the Home. It is noted that the owner has booked someone to come and fix window restrictors and has spoken to staff about some risks in staff meetings but these must be clearly recorded. One person does not want one and will need a risk assessment. When this was discussed during the inspection the owner immediately removed substances hazardous to health and looked at risks outside so an immediate requirement was not made about this. People living at the Home are also put at risk by the practice of staff leaving the Home’s keys accessible on a shelf near the main kitchen as seen throughout the inspection. In addition cigarettes and lighters are accessible in the staff area as well as phone numbers written on the wall. Bathrooms do not have safety locks, which can be over-ridden to ensure peoples’ safety should an emergency occur. This should be risk assessed to protect individuals. The AQAA (Annual Quality Assurance Assessment) submitted prior to the visit indicates that in order to improve the service the home intends to continue training the senior carer to become the manager, continue with updating paperwork and then concentrate on encouraging people with their outdoor interests and community integration. It is also noted that the manager has requested training on mental health care and related issues. 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 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 2 3 X 3 X 3 2 X 1 X 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 31 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 YA42 Regulation 13 (4) (a) Requirement You must ensure that systems are in place to make sure that all parts of the Home to which people living at the Home have access are so far as reasonably practicable free from hazards to their safety. This relates to ensuring that systems are in place so that risks are identified and minimised relating particularly to COSHH items, securing keys usually held by staff, maintaining a safe building and outside space, bathroom locks and unrestricted upper floor windows. Timescale for action 17/10/08 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 32 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 YA6 Good Practice Recommendations Care plans should reflect the needs of people and show how they are to be met by staff, especially in relation to their mental health needs. Any input by health care professionals should included in the care plans to ensure that staff have up to date information and can review the care plans. Risk assessments should be completed for all individuals and should show details of how any behaviour that may challenge the system should be dealt with by staff and should include any triggers that staff need to be aware of. You should relate activities and interactions with staff to identified goals and abilities relating to peoples’ mental health needs and to record successful progress and people’s preferences. Plans should be clearer about people’s relationships with their families and friends as these can be complicated and have an impact on mental health. Risk assessments should be completed appropriately. To ensure that people’s mental health is supported properly advice from mental health professionals should be incorporated in their care plans and followed by care staff. You should ensure that self-medication risk assessments are reviewed regularly to make sure that people remain safe. You should review the cleaning systems to ensure that staff are able to clean the Home to a good standard and meet people’s needs. You should also ensure that a system is put in place to make sure that animals are unable to enter the kitchen areas. You should ensure that there are systems in place so that staff have the skills and experience necessary to meet people’s needs including knowledge of the disabilities and specific conditions of people, specialist skills such as communication and dealing with anticipated behaviour and aggression. 2. YA9 3. YA14 4. YA15 5. 6. 7. YA19 YA20 YA30 8. YA32 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 33 9. YA35 10. YA40 You should carry out a training needs assessment for the staff team (on the rota) as a whole to ensure that mental health needs can be met and to inform future training planning. You should make sure that the system for managing people’s finances is robust and can be audited. 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 14-15 St James Road DS0000021830.V368070.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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