Inspection on 20/04/05 for Highwater House

This inspection was carried out on 20th April 2005.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Highwater House 17/05/06

Highwater House 26/10/05

Highwater House 06/12/04

Highwater House 05/07/04

Highwater House 16/12/03

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 ST MARTINS HOUSE Westwick Street Norwich Norfolk NR2 4SZ Lead Inspector Roger Andrews Announced 20 April 2005 9:30. 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 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 Stationary 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. ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service St Martins House Address Westwick Street, Norwich, Norfolk, NR2 4SZ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01603 766627 01603 766672 St Martins Housing Trust Miss Angela Herbert Care Home 38 Category(ies) of LD Learning disability, MD Mental Disorder and registration, with number PD Physical disability. of places ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Total number of service users not to exceed 38 Date of last inspection 06 December 2005 Brief Description of the Service: St Martin’s House is a care home operated by the St Martin’s Housing Trust, a Norwich based registered charity working with people who have experienced homelessness. The care home is registered to accommodate up to a maximum of 38 people who fall within one or other or a combination of categories: people with mental disorder, learning difficulties (excluding dementia) or physical disabilities. Service users may also have problems with substance or alcohol misuse. Although the care home does not offer specific rehabilitative services, service users are encouraged to develop confidence and skills to potentially enable them to ultimately acquire greater independence.The premises were originally designed to offer hostel accommodation to homeless people and as such fail to meet National Minimum Standards for a care home. ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and lasted for just under eight hours. At the time of the inspection there were seventeen residents living at St Martins House. Four residents were chatted with and two members of staff were interviewed in addition to discussion with the manager. A tour of the premises was also undertaken and a selection of records and care plans were examined. In addition to the above a pre-inspection survey was undertaken. Nine residents responded and three relatives/visitors responded. A response was also received from the local G.P. who offers a service to the residents at St Martins House. The views expressed in these survey responses are included in the report where appropriate. What the service does well: What has improved since the last inspection? What they could do better: The premises leave much to be desired. A number of bathroom/shower/toilet facilities have reached an unacceptable state. For example, some baths are badly stained and toilets do not promote privacy. The décor throughout St Martins House is in need of attention and many bedroom sizes are far too small for an environment that is providing a long term home for many of the residents. Although the Commission understands that there has been a delay in rectifying these matters due to ongoing discussions about the future of St Martins House, ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 Page 6 the Commission has previously asked for a plan of action to be drawn up to show how these problems will be corrected. A plan was submitted following the previous inspection. However, timescales have drifted and there continues to be no firm decision made on development of this service. The failure to address requirements made in previous inspection reports cannot continue. The Commission will review progress with the requirements made in this report in two months time when it will consider what legal enforcement action to take. 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. ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 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 standard(s) 2 Residents are being supported and assessed on an ongoing basis by staff that are experienced and knowledgeable about the client group. EVIDENCE: No new admissions have occurred since the previous inspection took place. However, each resident has an admission assessment on file and a comprehensive admission form has been developed by the home. A sample form was examined. It covers a wide range of aspects such as physical and mental health care needs and includes a risk assessment process. Within the last year all of the residents have had a full review assessment by an allocated Social Worker. The comprehensive training that staff receive and the stability of the staff group, (refer to comments later on in this report), helps ensure that experienced staff are contributing to this assessment process. This was reinforced by discussion with two staff members who conveyed a very good understanding of the resident group and the issues they need support with. ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 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 standard(s) 6, 7, 8 & 9 Residents are actively involved in developing care plan goals with staff, they participate in decision making and are supported and encouraged by staff in reducing risks to themselves. EVIDENCE: Three care plans were examined. These reflected ongoing work and progress with aspects such as money management, behaviour, and use of appropriate language and harm reduction. Residents have an allocated member of staff who acts as a link worker. Residents are involved in deciding goals with their link worker on a monthly basis and sign their care plans to indicate this. Discussion with both residents and staff confirmed that they discuss together their preferred manner of working. For example, one resident stated he preferred working with his link worker on a one to one basis rather than joining in group activities. Residents have the opportunity to join in ‘residents meetings’, which are held on a regular basis. The last one took place on 10th April 2005. Examples of ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 Page 10 topics discussed included changing breakfast times and organising chess and scrabble competitions. Care plans reflect goals designed to encourage residents to reduce harmful behaviours. One resident, for example, discussed the progress he felt he had made in reducing his level of alcohol consumption. However, progress in reducing risk will depend on the degree of compliance by residents themselves. ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12, 13, 14, 15, 16 & 17 Residents have opportunities to develop life skills, be involved in fulfilling activities and access the local community. Residents are involved in positive choices about the food they eat, though the dining room environment must be improved. EVIDENCE: Care plan goals indicate a focus on daily living skills such as money management, doing laundry and achieving greater stability in lifestyle and behaviour. St Martins is very well placed for residents to make use of community facilities being within easy walk of the city centre. Residents have opportunities to be involved in activities such as bowling, going to the cinema, going for a coffee, (e.g. on a one to one basis with their link worker), and a forthcoming trip to the theatre is planned. The home has a people carrier vehicle to provide group transport where required. One resident reported that he liked reading, (he has a good collection of books in his room), and collecting prints of which he has many displayed on his bedroom walls. There is also a snooker room in the home. ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 Page 12 Residents can come and go as they please and one resident described the telephone contact and occasional visits with his family. In their survey responses relatives/visitors all stated that they were welcomed into the home at any time. All residents have single bedrooms and reported that they have keys to their rooms. One reported that he was waiting for a new key to be cut. All of the residents chatted with stated that the staff were supportive and one resident said, “the staff are very fair”. The menu is reasonably varied and residents reported that the chef will always make them something different if the choices on offer are not fancied. The menu for the week is now displayed in line with the recommendation in the previous inspection report. Residents reported that they always received ample portions of food and one said that a meal is always kept if they arrive back after usual mealtimes have finished. The dining room has an institutional feel and staff and residents have to walk through this room to access other communal areas making it a ‘corridor’ which is not appropriate when others may be eating their meals. See requirement. ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 Page 13 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 standard(s) 18, 19, 20 & 21 Residents’ receive personal support on an individual basis according to needs and preferences and their health needs are met to the extent that they decide to comply with treatment programmes. Medication is properly stored and managed. Residents are included if they wish where other residents/friends may be terminally ill and in paying their respects at funerals. EVIDENCE: All of the residents who responded to the survey reported that they felt their privacy was respected. The residents are extremely able and generally do not require “hands on” care. The support offered by staff is via developing good relationships with residents and supporting and encouraging efforts to achieve greater control over their lifestyles. Residents make their own choices about what to wear and their general appearance on a day to day basis. Residents are registered with the local surgery. The local G.P. confirmed that the staff work closely with him and that his advice is acted upon. The manager meets with the G.P. on a quarterly basis to review medications prescribed over the previous three months. Other support services, e.g. local alcohol counselling services, are actively involved in visiting and supporting residents at St Martins House. ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 Page 14 Residents sign an agreement as part of the admission process agreeing to the staff looking after medication. Medications are securely stored in a metal cabinet secured to the main office wall. Controlled medications are also appropriately stored and recorded. The records for two controlled medications were checked against the number of tablets present. In both cases the record was correct. A member of staff was observed dispensing a medication to a resident and was observed signing the administration record. The process followed was appropriate. All staff that handle medication undertake Boots training. Unfortunately there has been a recent death of a resident in the local hospital. This has coincided with the death of a former resident. Current residents have been kept informed and staff are assisting those residents who wish to attend the funerals. Bereavement Counselling is also part of the training programme. ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 Page 15 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 standard(s) 22 & 23 Residents know who to complain to and processes are in place to protect residents and to react to allegations of abuse. EVIDENCE: The staff interviewed on the day were clear about the types of abuse that may occur. They were also sensitive to the fact that residents may have been abused in the past prior to coming to St Martins House and this might need to inform the style in which support is offered. Whistle blowing and adult protection policies are in place. The manager discussed an example of a previous allegation and the action that had been taken. This example reflected an appropriate response to inappropriate behaviour. Adult protection training is scheduled for June 2005 on the training programme. Changes have been made to the complaints procedure in line with a requirement made in the previous inspection report. ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 Page 16 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 standard(s) 24, 25, 26, 27, 28, & 30 The environment is poor and does not contribute towards a domestic atmosphere for residents who live at St Martins on a long term basis. The state of some facilities such as bathrooms are unacceptable. Small bedroom sizes detract from the residents’ abilities to create a reasonably furnished personalised private space and such small rooms are unacceptable. Toilet facilities do not promote privacy and dignity. EVIDENCE: Many bedrooms are under the current National Minimum Standards size of 12 sq m. and also significantly under the old standard of 10 sq m. Although there are examples of residents trying to personalise their rooms the small size hampers the range of basic furniture and storage space that bedrooms can accommodate. See requirement. Several baths are stained and showers areas, although cleaned regularly, are obviously in need of refurbishment. Toilet facilities are of a cubicle type and are not appropriate to an environment that people live in as their home. See requirement. ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 Page 17 The décor throughout St Martins House is poor and some furnishings such as armchairs in communal areas are old fashioned and detract from a domestic feel. The majority of floor space is covered by institutional looking linoleum, though the two lounges are carpeted. See requirement. ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 & 36 Staffing is satisfactory and allows one to one work with residents both inside and out of the home. The staff team are experienced and receive relevant training and supervision on a regular basis. The stability of the staff group is excellent. EVIDENCE: The staff rota for the week shows that three staff are on duty from early morning till late evening. In addition to these staff, additional staff may be scheduled in to assist residents, (e.g. on a one to one basis and with outside activities). The manager is in addition to the above staffing levels. There are separate domestic and catering staff provided. There has been minimal turnover in the staff group. Only one member of staff has left since the last inspection took place. Most staff have worked at St Martins House for several years. Several staff are educated to degree level and have relevant qualifications such as psychology, teacher training and counselling skills. The ongoing training includes NVQ, city and guilds and a wide variety of courses. Examples include an introduction to mental health, vulnerable adult protection, advanced ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 Page 19 medication, substance misuse, report writing and working with problem drinkers. These examples are by no means exhaustive. An induction training programme is in place. Written references and Criminal Records Bureau checks are undertaken on new staff. However, not all documentation required by schedule 2 of the Care Homes Regulations 2001 are kept on the premises for inspection at all times. See requirement. Staff receive regular supervision and an annual appraisal. These processes are documented. ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39 & 42 The home is run by a qualified manager who promotes good communication within the home. Health and safety matters are monitored and records are kept up to date. EVIDENCE: The manager is fully qualified and holds the Registered Manager’s Award. From observations and feedback from staff and residents the manager is approachable and residents feel free to approach staff to discuss various matters. Records relating to health and safety matters were examined. Fire records were up to day and the fire alarm and fire equipment is serviced in line with good practice guidance. Certificates are in place for the electrical wiring and gas. Accidents records are kept and are up to date. A weekly health and safety checklist is completed and submitted to head office. ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 Page 21 Monthly regulation 26 visits are carried out. Residents meetings are held regularly and an annual survey carried out. The organisation has achieved the Investors in People award. ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 1 1 1 2 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 2 Standard No 31 32 33 34 35 36 Score x 3 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 ST MARTINS HOUSE Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 x x 3 x I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 Page 23 yes 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. Standard 24 Regulation 23 Requirement The registered person must inform the Commission of their plan to deal with the shortfalls in the premises as identified in this and the previous inspection report. The registered person must keep the records on staff required by Schedule 2 of the Care Homes Regulations 2001 available for inspection at all times Timescale for action To be reviewed on 30th June 2005 Immediate and ongoing 2. 34 17 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 None Good Practice Recommendations ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 3rd Floor Cavell House St Crispins Road Norwich NR3 1YF 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 ST MARTINS HOUSE I55 S27464 St Martins Hs V215354 200405 Stage 4.doc Version 1.30 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. 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