Inspection on 04/09/06 for 193 St Andrews Road

This inspection was carried out on 4th September 2006.

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 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

193 St Andrews Road 28/04/08

193 St Andrews Road 01/02/06

193 St Andrews Road 04/10/05

193 St Andrews Road 18/03/05

193 St Andrews Road 03/12/04

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 ADULTS 18-65 St Andrews Road (193) Bridport Dorset DT6 3BW Lead Inspector Marion Hurley Key Announced Inspection 4th September 2006 10:00 DS0000020420.V305894.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 DS0000020420.V305894.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. DS0000020420.V305894.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Andrews Road (193) Address Bridport Dorset DT6 3BW 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) 01308 425824 dch.193standrews@tiscali.co.uk Dorset Residential Homes Mrs Cheryl Lisa Jarvis Care Home 8 Category(ies) of Learning disability (8) registration, with number of places DS0000020420.V305894.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st February 2006 Brief Description of the Service: 193 St Andrews Road is a care home that provides nursing care and accommodation for 8 learning disabled people who may also have associated emotional and behavioural needs. The home is operated by Dorset Residential Homes, a registered charitable trust that operates a number of care homes in Dorset. The home is located in Bridport within easy reach of the town centre. It is a large detached property that has been carefully extended and adapted to meet the needs of service users; the home does not stand out from neighbouring properties. There are 6 single bedrooms and 1 shared room for service users; on the ground floor there is a lounge, kitchen, dining room and conservatory. There are bathrooms and toilets on both the ground and 1st floor. The home is staffed by a team of registered learning disability nurses and care staff, who provide 24-hour care and support. DS0000020420.V305894.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key announced inspection that took place at the home over a period of four and half hours. Additionally, time was spent in preparation for the visit, looking at previous inspection reports and Regulation 37 and 26 reports and other relevant documents. The inspection methods used included observation of documentation, record checks, case tracking and discussions with the manager and staff. Two residents were at home most of the morning others were met briefly while they were waiting for their transport to the Day Services in Sherborne and Bridport. Comment cards were received from the relatives and professionals. The cards generally provided positive comments about the service, staff employed within the home. Current fees are £1515.00 but may vary according to the individual’s support needs. What the service does well: The home continues to provide a good quality of care to the residents that live at 193. Good relationships were seen to exist between staff and the residents. Routines within the home are flexible, giving residents an element of control over their lives and supporting them in maintaining a degree of independence and autonomy. The home provides a pleasant and comfortable environment for the residents. Individuals have been encouraged to personalise their own bedrooms. There is good support for the home by the provider organisation, with effective monitoring through the Regulation 26 visits. There is an extensive range of policies and procedures, providing staff with relevant information and about all aspects of care and the home/organisation. Staff receive the relevant training to make certain safe working practices are maintained. All records for health and safety matters are accurate, up to date and well maintained. DS0000020420.V305894.R01.S.doc Version 5.2 Page 6 The pre inspection questionnaire was comprehensively completed and provided valuable information, which was verified throughout the inspection. 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. DS0000020420.V305894.R01.S.doc Version 5.2 Page 7 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 DS0000020420.V305894.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. 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. The assessed need and preferences of residents’ are met and there are processes in place for the review of their care. EVIDENCE: The organisation, Dorset Residential Homes has an appropriate admissions policy and procedure and assessment form which would be fully utilised by the manager and staff at 193. Prospective residents would receive a thorough needs assessment undertaken by staff trained to do so ensuring that the home could meet all the care need requirements and aspirations of the person. The manager stated that they would conduct the assessment, often involving other professionals i.e. psychologist, community nurses and staff from other services e.g. day services. The opportunity to visit the home prior to admission is an integral part of the admission process, which means that service users are orientated to the environment and have met and are familiar with staff and other residents beforehand. DS0000020420.V305894.R01.S.doc Version 5.2 Page 9 The files of two residents were read and both contained a comprehensive range of information based on contact with other professionals and relatives. An on -going assessment was relevant and identified needs reviewed. The terms and conditions/contracts were checked and the address and details of the CSCI were incorrect – this needs to be changed and the copy in the residents’ files had not been signed. For most people living at 193 a representative would need to sign the contract on their behalf. There have been no new admissions since the last inspection. DS0000020420.V305894.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents make decisions about their lives, with assistance and communication support, that allows them to influence their lifestyle. Choices are offered in many areas of day-to-day life. Risk assessments in the home promote effective and consistent risk management. Where a restriction has had to be implemented the information needs to be clearly recorded to ensure all staff are clear about the reasons for the restricting the resident access to certain parts of the home. The manager explained that any restrictions are implemented following a comprehensive risk assessment based on the individual’s general welfare and health and safety. The records provide staff good information regarding those people living within the home. DS0000020420.V305894.R01.S.doc Version 5.2 Page 11 EVIDENCE: The care files of two residents were reviewed. These records contained considerable information including, personal profile, daily support plan, daily living record, choice plan and active support plan. References to how links with friends and relatives are maintained were also noted. Each resident is linked into a group worker system and staff from this group help the resident to identify and express his or her needs and aspirations. The Plans need to describe how residents’ have been consulted in the process of generating their lifestyles and should also include if the resident has expressed preferences around the gender of the staff providing support. It is understood this is recorded in each service users’ daily life plan and at the commencement of each shift service users are encouraged to choose which member of staff they would like to support them. The Manager explained that all service users are consulted in advance of their meeting regarding their Lifestyle Plan, and staff help them identify what skills they need help to learn and how that support might be delivered. Service users’ are encouraged to invite people who they want at their meeting. There are personal restrictions in place within the home and these are based on practical health and safety issues e.g. the entrance to the garden is secured by a coded lock, the kitchen at certain times is locked and whilst the manager described in detail the reasons for these restrictions which were valid it is important this information which is contained within the personal risk assessments is regularly reviewed and where practical agreed with the resident and/or their representative. The staff encourage and support residents, where possible, to manage their own money. Each individual has their own pursue which is kept securely on their behalf or in their own locked safe place in their bedroom. Staff maintain individual balance sheets for all the residents, which are submitted to the Dorset Residential Homes Head office for scrutiny. Cash was counted against one of the written balances and found to be exact. Each resident has a bank account and cash card, which staff support him or her to use appropriately and safely. Records seen relating to the administration of medicines (MAR sheets) were adequately maintained. However, for the past two months there was no record of the date and quantity of medicines received into the home. This needs to be addressed so an audit of medicines could be completed. DS0000020420.V305894.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are presented with opportunities for social inclusion and benefit from good staff support to do so. Residents engage in appropriate leisure activities inside and outside of the home, allowing individuals to pursue their own interests and hobbies. Residents are supported to maintain important relationships in their lives. Residents’ rights are respected and the daily routines of the home promote individual choices and providing residents with the ability to be as independent as needs allow. Residents are encouraged to participate in some cooking tasks, which promotes independence and choice while promoting at the same time reinforcing independent skills. Residents contribute to the menu planning. A varied and balanced diet is encouraged. DS0000020420.V305894.R01.S.doc Version 5.2 Page 13 EVIDENCE: Each resident has an individual programme of daily activities. All the residents attend formal day services either in Sherborne or Bridport. Attendance is mostly on a part time basis, which ensures residents have time at home with their key workers to enjoy one to one sessions. One resident uses their one to one time to go to the local shops. Activity charts are completed to monitor the residents’ involvement in different occupations and to help the staff identify preferred choices. Residents’ files referred to their preferred term of address under the section “salutation”. There was evidence from the Life Support Plans that residents access local amenities and facilities i.e. pubs, shops, cinema and local restaurants. The home has three adapted vehicles available for their use though where possible residents are encouraged to walk to the local shops. Residents have personal televisions, videos music centres, computers and the there is a large television and video in the communal lounge for all the resident plus a good selection of videos and DVDS. Residents have annual holidays and or trips out and one resident who has a particular interest in steam trains travelled to Yorkshire and really enjoyed the experience of steam train trips. Family and friends of residents are welcomed into the home. The home operates an open house policy and there are no restrictions on visiting. Residents can see visitors in the privacy of their own rooms or in one of the communal areas. Staff were observed knocking on bedroom, toilet and bathroom doors to ensure privacy for the residents. Some residents have a key to their own bedroom others based on personal risk assessments and at this stage would not be safe to manage their own key. Staff were observed interacting with residents and this was done with respect and in a manner that was appropriate. Residents were seen taking part in a cookery session and appeared to be enjoying this. Residents are also involved in the “big weekly shop for the house”. The nutritional needs of the residents are assessed and reviewed and regular weight checks completed. Two residents are following a weight watchers diet regime and their “points” are recorded. It is recommended that all staff write in detail what the individual resident has eaten i.e. Sunday roast is not sufficient to describe the food consumed. DS0000020420.V305894.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical and emotional needs of residents are met with evidence of multidisciplinary working taking place where appropriate. The management of medicines is adequate and further work to ensure all errors are eradicated from the administration and recording of medicines need to be addressed. EVIDENCE: Staff described providing personal care in accordance with residents’ needs and preferences and demonstrated awareness of issues around privacy and dignity. Correspondence indicated that people living in the home receive appropriate specialist healthcare services e.g. psychology services. There are procedures in place to seek the views of individuals through advocates, staff and families. DS0000020420.V305894.R01.S.doc Version 5.2 Page 15 The majority of residents at 193 are unable to self-administer though one person is given theirs day by day to manage and this is proving very successful. All medicines were stored appropriately. There is a Dorset Residential Homes’ medication policy and this covers all key areas such as storage of medication, security of keys, the administration of keys, homely remedies errors in medication and the return of unwanted medication. None of the MAR charts checked had a record of the quantity or the date the medication was received into the home and therefore there was no evidence to indicate if the quantities had been checked. The local pharmacist who supplies the home inspected the homes’ procedures in August 2006 and highlighted certain aspects of good practice for staff to follow. i.e. medication is only kept for the safe period it is deemed to do so. e.g. some creams it may only be retained for up to six weeks. DS0000020420.V305894.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are systems in place to take forward concerns and complaints. Vulnerable Adults are protected through a range of policies and procedures and well-informed staff. EVIDENCE: The pre inspection questionnaire indicated that no formal complaint had been made to the home in the last year. Incident sheets and other documentation provided descriptions of events, which had occurred since the last inspection e.g. Regulation 37 reports. There is an organisational (DRH) Adult Abuse Policy and the home had a copy of the multi-agency No Secrets Policy dated May 2004. It is recommended that all staff undertake regular refresher training in POVA . DS0000020420.V305894.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe and comfortable place within which to live. There are good standards of hygiene and cleanliness within the home. EVIDENCE: The home provides comfortable and practical accommodation that is well decorated and pleasantly furnished. There is ample space and seating in all the communal areas. Major refurbishment work is currently being completed with the accommodation being reconfigured to remove the shared bedrooms and create all three new single bedrooms with en suite facilities. An activity room is being created and a staff office on the first floor. The current office is extremely small and not a practical room. A tour of the premises found all areas to be clean and free from any obvious odour. DS0000020420.V305894.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a staff team who are appropriately trained to ensure that residents are cared for by skilled staff at all times. Recruitment procedures are robust, which ensure that staff are compelled to apply for legislative clearances that render the appropriate for the post applied for and in turn suitable to care for and support residents with a learning disability. There is a staff training and development programme, which ensures staff fulfil the aims of the home and meet the changing and sometimes challenging needs of the residents. EVIDENCE: The manager said she felt the staff team are aware of, and support the aims and values of the homes. Staff are aware of the organisations policies and procedures and understand how their work, and that of other staff promotes the main aims of the home. This is achieved through regular meetings and training opportunities. DS0000020420.V305894.R01.S.doc Version 5.2 Page 19 There was evidence in residents’ files that demonstrated that needs are met, with particular attention to age and personal interests. Staff undertake training and awareness regarding the understanding of physical and verbal aggression and self harm and the role of the multi-disciplinary team. Further training for staff include first aid, basic food hygiene, moving and handling and fire awareness. The use of agency or bank staff is kept to a minimum. Two staff files were checked and these contained all the necessary documentation as detailed in Schedule 2. All prospective candidates are requested as part of their application to visit the home and this helps ensure that candidates are aware of the work undertaken at 193. DS0000020420.V305894.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager is qualified, competent and experienced to run the home and meet the organisations stated purpose, aims and objectives. The management approach of the home creates an open, positive and inclusive atmosphere. There are various methods in place to informally measure the quality of services and standards provided to those people both living and working at 193. Staff are committed to the protection and well being of residents. DS0000020420.V305894.R01.S.doc Version 5.2 Page 21 EVIDENCE: The Registered manager is NA both qualified and competent to run the home. They have a special interest in complex behaviour management and successfully completed a masters degree in Positive Approaches to Challenging behaviour. The manager has overall responsibility for ensuring the home meets the organisation’s standards ensuring the home’s aims and objectives are achieved, the homes budget is properly managed and all policies and procedures implemented. The manager communicates a clear sense of direction and leadership to the team. Staff meetings are regularly held and the minutes fully recorded. Residents’ views are informally sought daily. However, the home needs to consider ways to formally seek the views and opinions of residents or at least record the informal views of residents. Health and safety recording was up to date and the details provided in the completed pre-inspection questionnaire verified. DS0000020420.V305894.R01.S.doc Version 5.2 Page 22 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 3 STAFFING Standard No Score 31 x 32 3 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 x DS0000020420.V305894.R01.S.doc Version 5.2 Page 23 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 YA20 Regulation 13(2) Timescale for action The registered manager and staff 31/10/06 comply with the home’s policy and procedure for the receipt, recording, storage, handling, administration and disposal of medicines. Requirement 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. 2 Refer to Standard YA17 YA22 Good Practice Recommendations Details of meals consumed should be recorded in more detail identifying the food contained in the meal. It is recommended that all staff receive refresher training in the Protection of Vulnerable Adults. Please note since this inspection a series of workshops have been arranged. DS0000020420.V305894.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 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 DS0000020420.V305894.R01.S.doc Version 5.2 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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