CARE HOME ADULTS 18-65
56 St Saviours Road St Leonards-on-sea East Sussex TN38 0AR Lead Inspector
Caroline Johnson Announced Inspection 9th November 2005 09:20a 56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 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 56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 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. 56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service 56 St Saviours Road Address St Leonards-on-sea East Sussex TN38 0AR 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) 01424 443657 Sussex Autistic Community Trust (Care Services) Limited Vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places 56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. That only service users with an autistic spectrum disorder may be admitted. The maximum number of service users to be accommodated must not exceed 3 (three). The people accommodated will be between the ages of 18 (eighteen) and 65 (sixty-five) years of age on admission. 11th May 2005 Date of last inspection Brief Description of the Service: 56 St Saviours Road is a semi-detached property situated in a residential area of St Leonards on Sea. The town centre with its shops and railway station is approximately one mile away. Resident accommodation is on two floors with a lounge and dining room on the ground floor and bedroom accommodation situated on the first floor. The home is registered to accommodate three adults with a learning disability who have an autistic spectrum disorder. The home is one of four homes in East Sussex that are run by The Sussex Autistic Community Trust (care services) Ltd. 56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection, the second inspection in the year running from April 1 2005 to March 31 2006. The inspection was carried out on 9 November and lasted from 9.20am until 3.00pm. Time was spent going through various records and documentation. A full tour of the house was undertaken. The acting manager was on duty at the time of inspection and there was an opportunity to meet with two care staff. There was also an opportunity to meet with one of the residents at the start of the inspection and to speak very briefly with another resident at the end of the inspection. What the service does well: What has improved since the last inspection? What they could do better: 56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 Page 6 The new system for checking if residents are happy with the care provided is good and could be expanded further to gain more information about a wider range of topics. There are currently vacancies for one full time and one parttime support workers. These posts must be filled. At least 50 of the staff team must be enrolled on an NVQ (National Vocational Qualification) at level two or above and the acting manager must commence studying for NVQ level four or an equivalent course. The home must, as far as it is possible to, assess the wishes of residents in relation to dying and death. The acting manager must clarify with the relatives and representative of residents how DLA (Disability Living Allowance) payments are managed. The home’s fire risk assessment must be reviewed to include an assessment to determine if there is a need to have fire doors fitted and to check if there is a need to have mains wired smoke detectors. The outcome of the quality assurance audit carried out by the home must be available for inspection. The organisation is currently reviewing their policies and procedures manual. A number of policies need to be introduced and a number of those in place need reviewing. This work will take some time however, it is recommended that the home prioritises this work in order of importance and that the whole manual be up and running within six months. 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. 56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 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 56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 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): 2,4 There is a clear and detailed admission procedure in place allowing both prospective residents and the home ample time to determine suitability of placements. EVIDENCE: The acting manager has not had to admit any new residents to the home. However, she was able to talk about the home’s procedure, which is to carry out a detailed assessment of the needs of prospective residents. This would include obtaining information form a variety of people and places. A meeting would be held to determine if it was considered an appropriate placement. If it was considered appropriate then the individual would be invited to tea and gradually visits would be increased to include overnight stays. The number and frequency of visits would be dependent on the needs of the resident. Admission to the home would be on a trial period and the needs and wishes of the individual would be continually assessed during this period. 56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 Page 9 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): 7,8,10 The format used for checking if residents are happy could be expanded upon to record the choices given to residents and show evidence of how residents make choices and decisions. The home’s policy on confidentiality needs to be available for all staff. EVIDENCE: Care plans were not examined on this occasion. The acting manager advised that the format for care planning is to be changed. The new format will enable more detailed records to be kept in relation to the monitoring of progress in achieving goals. It is hoped that the care plans will be implemented by the end of February 2006. The acting manager advised that due to the different abilities and needs of the residents, house meetings would not be appropriate. Instead they have devised a system, using picture images of happy and sad faces, to check with residents on a weekly basis if they are happy and if there is anything else that would improve the quality of their lives. The home’s policy on confidentiality could not be located on the day of inspection.
56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 Page 10 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): 11,12,14,16,17 Residents continue to lead very active and interesting lives. They have their own set routines and each plays their part in the house keeping arrangements for the home. EVIDENCE: One of the residents spoken with during the inspection advised that he works three days a week. In addition he attends college and has a variety of hobbies and interests that keep him busy in the evenings and at weekends. It was his birthday the week of the inspection and he had invited twelve of his friends to a birthday party at the weekend. He had decided to have a gourmet night and the acting manager and staff were assisting in the organisation of the party. The other two residents continue to attend a day centre run by the Trust, and they also have a number of hobbies and interests that keep them busy in their spare time. The residents have lived together for six years. They know which house keeping tasks they need to carry out and there is no need for a rota to be in place. Each has responsibility for cleaning their individual bedrooms with staff
56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 Page 11 support. Residents do their washing and ironing. One of the residents prepares and cooks his meals. He chooses to eat on his own. The other two residents eat together. They can both make decisions about the food they would like to eat. Menus seen in respect of the food served indicated that residents receive a varied and well balanced diet. All bedroom doors have locks. The manager advised that staff knock before entering and if a resident does not answer staff are advised not to enter unless it is urgent but to try again later. Two of the residents have a key to the front door. The third resident has been assessed as unable to manage a key. 56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 Page 12 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): 20,21 The introduction of a homely remedies policy would enable unprescribed medications, (for example for colds and coughs) to be administered when required, without having to go to the Doctor each time to seek permission. It is acknowledged that the process of assessing each of the resident’s wishes in relation to dying and death could be a lengthy process. The home may wish to seek specialist advice on the best approach to take. EVIDENCE: One of the residents has been prescribed medication. Record keeping was seen and was in order. The home does not have a homely remedies policy in place. There is a detailed procedure in place in respect of dying and death. The home has consulted with the relatives of the residents in relation to any particular arrangements or customs that would need to be followed in the event of death. A record is kept of the outcome. The home has not yet discussed this subject with the residents. 56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 Page 13 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): 22,23 The home needs to clarify the arrangements in place in relation to the management of residents’ DLA monies and the running of the car. They also need to make sure that relatives and their representatives are also clear about the arrangements in place. EVIDENCE: Records showed that there had been no complaints since the last inspection of the home. There is a detailed complaint procedure in place. Residents are given the opportunity to raise issues during weekly meetings with staff (see standard 7) to raise issues of concern. In addition there is a suggestion box in the hallway to encourage residents to share their views. Staff have received training on adult protection and prevention of abuse. There are detailed arrangements in place in respect of residents’ finances. Record keeping held in relation to one of the resident’s finances were examined and were in order. Two of the residents pay their disability living allowance (DLA) towards the cost of running a car. The acting manager was not clear about the ownership of the car. Clarification was also sought regarding whether residents’ family and representatives are clear about the arrangements for the running of the car. Another resident pays their DLA to the Trust weekly but the home then provides money to him as required for transport. The acting manager advised that the Trust’s Accountant visits the home periodically to monitor the management of residents’ finances. 56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 Page 14 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): 24,25,26,27,28,29,30 56 St Saviours is decorated to a very good standard. The environment is comfortable and homely and there is a warm and friendly atmosphere. However, the flooring in the kitchen is rucked and this could be dangerous if staff or residents were to trip whilst carrying hot food through to the dining room. The fire risk assessment needs to be more detailed to consider potential risks in relation to not having fire doors and in not having mains linked smoke detectors. EVIDENCE: A full tour of the building was undertaken. Communal areas consist of a large lounge area and a separate dining room. In addition there is a small conservatory, which is used as a sensory area. Within this room there is a swing chair, which is used for relaxation. There is a garden to the rear of the property. On the first floor there is a small room used by one of the residents as a music room. New furniture has been provided in the lounge. One of the residents has a particular talent for art and some of his work has been framed and is on display. Bedrooms have been personalised. All areas of the home seen during the inspection were clean. The flooring in the kitchen is rucked in places. The lock on the bathroom has been replaced since the last inspection
56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 Page 15 and a new shower has been installed. At the time of inspection residents did not require any specialist equipment. Record keeping in relation to the testing of fire equipment was detailed. Fire drills are held regularly but they are announced drills. There is a fire risk assessment in place. The format provides limited information. Currently there are no fire doors in place and smoke detectors are not mains linked. The home needs to carry out a more detailed fire risk assessment to determine if there is a need for fire doors to be fitted and for smoke detectors to be mains linked. 56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 Page 16 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): 32,33,34,35,36 The home has appointed two care staff but it is essential that the remaining positions be filled. Staff receive good training opportunities but it is now essential that staff are enrolled on a NVQ course. Clear communication is one of the home’s strong points and staff feel supported in their work. EVIDENCE: In addition to the manager there is now one full time carer and one carer who works twenty-five hours a week. There are still vacancies for one full time and one part-time member of staff. The acting manager advised that interviews would be held the week of the inspection. There are regular relief staff working in the home and they now receive the same training opportunities as permanent care staff. Recruitment records were seen in relation to one member of staff. The home’s procedures had been followed with the exception that verbal references had been obtained but there were no written references. The acting manager was confident that references had been obtained and were stored at the head office. Staff have attended a number of courses relevant to their position in the home and further training has been planned. Neither of the care staff have completed NVQ training, however both staff stated that they would like to do a course.
56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 Page 17 Staff advised and records showed that they receive supervision on a monthly basis. In addition staff stated that if they have questions they could always talk to the manager. They also stated that there is a one-hour handover between shifts and this enables good communication between shifts. 56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 Page 18 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): 37,38,39,40,42,43 The home is run well and staff are supported in their work. They find the acting manager approachable and can talk through any concerns that they might have. If the acting manager comes across something new that she is unsure of she will do research to ensure that she is able to provide an answer in future. In relation to the monitoring of hot water temperatures it was recommended that until there is a new system in place staff should on occasions monitor water temperatures at weekends prior to baths. EVIDENCE: The acting manager has applied to become the registered manager of the home and her application is currently being processed. She advised that she has enrolled on a NVQ level four course and she hopes to start the course in January 2006. Staff spoken with during the inspection described the manager as `very supportive’. She will talk through any issues of concern and if there is a situation that they have found stressful or daunting she will make sure that they know what action needs to be taken should a similar situation occur. 56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 Page 19 As part of the inspection process comment cards were sent to the home for distribution to residents and their relatives. The comment cards are an opportunity to raise issues about the quality of care provided in the home. All three residents responded. Two of the residents needed some support to complete the form. One resident stated that they make their own decisions. Another stated that they would like to live on their own. The third resident didn’t understand some of the questions but those he could answer he responded positively. Three responses were received from relatives. Responses were positive with one relative stating that they `always feel able to talk to staff and know they will do their best to sort out the problem’. They stated that this is especially so since the new manager took over the running of the home. Another relative stated that there are sufficient staff but that they come and go and they `would like more experienced staff to stay longer in care homes’. The home also monitors the quality of the care provided. The acting manger advised that a questionnaire was sent to relatives at the beginning of the year. She was not sure where the outcome of the data collected was stored and agreed to locate this information. Hot water temperatures are monitored on a weekly basis. There are mixer valves fitted on all outlets. Records showed low readings. The acting manager advised that readings are taken after residents have had their baths so generally there is not much hot water left. If they do the readings prior to the baths there is a risk that there might not be enough hot water for the baths. She advised that she would like a new water system put in and hopes that this can be accommodated in next years budget. A working parting was set up within the Trust to review the policies and procedures and to identify policies and procedures that need to be introduced. A report was produced in July detailing the outcome. A lot of work is required to produce a comprehensive list of policies and procedures. At the time of inspection there was business insurance certificate on display in the home indicating that the home is adequately insured. As recommended at the last inspection of the home there is now a work mobile phone available for staff to take with them when they out with residents so that they can seek help in the event of an emergency. Accident and incident records were examined and they were sufficiently detailed. 56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X 3 X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 2 3 X 2 Standard No 24 25 26 27 28 29 30
STAFFING Score 2 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 4 12 3 13 X 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 2 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
56 St Saviours Road Score X X 3 2 Standard No 37 38 39 40 41 42 43 Score 2 3 2 2 X 2 3 DS0000021338.V250605.R01.S.doc Version 5.0 Page 21 NO Are there any outstanding requirements from the last inspection? 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. 2. Standard YA21 YA23 Regulation Requirement Timescale for action 30/06/06 31/01/06 3. 4. YA24 YA24 5. YA32 6. 7. 8. YA33 YA37 YA39 12(3)(4)(a) The home must assess the wishes of residents in relation to dying and death. 17(2) Sch The arrangements in place for 4 para. 9 the management of residents’ DLA monies need to be clarified and the acting manager must ensure that relatives and representatives of residents are clear about how these monies are managed. 13(4) The flooring in the kitchen must be replaced. 23(4) In relation to fire safety the home’s fire risk assessment must be reviewed in relation to not having fire doors and not having mains linked smoke detectors. 18(1)(c)(i) The home must ensure that at least 50 of the staff team are enrolled on an NVQ at level two or above. 18(1)(a) The home needs to ensure that the remaining staff vacancies are filled. 9(2)(b)(i) The acting manager must commence training at NVQ level four or equivalent. 24(2) The outcome of questionnaires
DS0000021338.V250605.R01.S.doc 15/01/06 30/01/06 30/01/06 30/01/06 30/01/06 28/02/06
Page 22 56 St Saviours Road Version 5.0 9. YA40 17(2) Sch. 4 that were carried out as part of the home’s quality assurance system must be available for inspection. The home must prioritise the 30/04/06 revision of the policies and procedures manual to ensure that all policies and procedures required by the Regulations are reviewed and if not already implemented introduced as soon as possible. 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 YA7 Good Practice Recommendations The format in place for encouraging residents to say if they are happy with the care they receive should be expanded upon to seek further advice and to encourage residents to make decisions about the care they receive. The home should introduce a homely remedies policy. Hot water temperature readings should be taken prior to bathing at weekends. 2. 3. YA20 YA42 56 St Saviours Road DS0000021338.V250605.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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