CARE HOME ADULTS 18-65
James Court 6 St Pauls Square Burton on Trent Staffordshire DE14 2EF Lead Inspector
Jane Capron Announced 6 September 9.30am
th 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. James Court E51-E09 s4963 James Court v241359 060905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service James Court Address 6 St Pauls Square Burton on Trent Staffordshire DE14 2EF 01283 740411 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) Mrs Perpetua Jasmine Sathianathan Mrs Perpetua Jasmine Sathianathan Care Home 12 1 12 Category(ies) of LD (E) registration, with number LD of places James Court E51-E09 s4963 James Court v241359 060905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 1st March 2005 Brief Description of the Service: James Court is a residential home located in the centre of Burton, Staffordshire. The home provides a service for twelve adults of both gender groups who have a learning disability. The large Victorian detached property provides six single occupancy bedrooms and three shared rooms. The home had a lounge, dining room and a quiet room/music room located on the ground floor. The home had a large domestic kitchen, where service users are encouraged and supported to prepare and cook their own meals. Bathrooms and toilets were located throughout the home and were in close proximity to bedrooms and communal areas. The home is not registered for physical disability and would not be suitable for individuals who have a mobility problem; grab rails are provided through parts of the home. Due to the location of the home it is accessible via public transport and all local amenities are within a short walking distance. Limited parking space is provided within the grounds.
James Court E51-E09 s4963 James Court v241359 060905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over one day and lasted approximately five and a half hours. The inspection included discussions with five residents, the staff on duty and the owner/ care manager. A sample of resident documentation was examined as well as documentation relating to health and safety. The premises, including the residents’ private accommodation, were inspected. The home completed a pre inspection questionnaire and a re inspection survey of residents, relatives and professionals took place. There was a high level of response with all respondents being positive about the service provided. The home had had no complaints since the last inspection and no additional visits have taken place. What the service does well:
The home was providing a good service to the residents. The residents liked living at the home and were consulted and had choice over the their lives and over aspects of running the home. The residents benefited from a full and varied lifestyle. They had the opportunity to develop independent living and social skills including a range of household tasks such as meal preparation, cleaning and tidying their bedrooms, doing their washing and ironing. All the residents were undertaking worthwhile activities with most attending college or day services and undertaking activities in the home. Residents took part in a number of leisure activities including going for walks, swimming, bowling and going out for trips and to the pub. All the residents spoken to liked the meals and said the staff asked them what they liked and that there was always a choice of food available. The residents liked the staff, feeling that they were kind to them. They said the staff helped them to do things and listened to what they wanted. Staff were well motivated and were aware of the residents’ individual needs and how these needs were to be met. The home had the necessary quality of staff and the numbers of staff on duty to meet the needs of the residents and to do specific individual work with them. James Court E51-E09 s4963 James Court v241359 060905 Stage 4.doc Version 1.40 Page 6 The home met the personal care and health needs of the residents and involved specialist health staff when needed. The home was well managed and led by the owner/ manager who had lengthy experience in working with people with a learning disability. She had an open and inclusive style of management that listened to the views of staff and residents. What has improved since the last inspection? What they could do better:
Although the home was providing a good standard of care to the residents there were some issues that were required to be addressed to ensure that the home met all the necessary standards. The home were required to ensure that all staff undertook training in food hygiene training which would improve the infection control measures in the home. Whilst the home kept accurate records of the residents’ finances and there were no discrepancies, the home must refrain from allowing staff to retain residents’ money for lengthy periods when buying items for residents. If
James Court E51-E09 s4963 James Court v241359 060905 Stage 4.doc Version 1.40 Page 7 money is not spent immediately it should be returned to the residents’ account and withdrawn again when necessary. Whilst the home had undertaken a range of decorating it was required that the downstairs toilet be decorated. Although there was a good level of resident involvement it would be beneficial for resident information to be in a variety of formats such as on audio tape and pictorially. 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.
James Court E51-E09 s4963 James Court v241359 060905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection James Court E51-E09 s4963 James Court v241359 060905 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3 The assessments completed prior to admission ensured there was the necessary information to ensure that the home had the necessary staffing levels and staff skills to meet the needs of the residents. The quality of staff and the working relationships with other professionals provided residents with the support they needed to have their needs met. EVIDENCE: Although there had been no recent admissions the residents’ documentation showed that residents had an assessment prior to admission. This document covered the areas of health and personal care, social and family contact. Staff had the necessary knowledge, training and experience to be able to meet the needs of residents with a learning disability and involved the necessary external health professionals to provide advice and support as needed. The home was aware of the needs they were able to meet with the current staff and the home’s staffing levels and sought reassessments when there were issues that were outside their scope or required additional staffing. The residents reported in the pre inspection survey that they felt well cared for and safe at the home.
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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 The home’s care plans identified the residents’ needs and how these would be met ensuring that staff had the necessary knowledge to meet the needs of the residents. The home’s risk planning processes identified the nature of risks and the actions taken ensuring that risks to residents were addressed and that there were no unnecessary restrictions. Choice and participation were encouraged in the home leading to the residents having control over their lives and being involved in aspects of running the home. EVIDENCE: The home developed individual care plans for the residents. These covered the health and personal care needs of the residents as well as occupational and household tasks, leisure, spiritual and needs relating to budgeting. The home also developed a plan relating to any specific communication needs of residents. Evidence confirmed that plans had been reviewed.
James Court E51-E09 s4963 James Court v241359 060905 Stage 4.doc Version 1.40 Page 11 Discussions with a number of the residents confirmed that they felt involved in their care and that staff respected their wishes. They stated that they were able to make choices over their lives. They choice whether to go to college and were involved in choosing the courses. They decided how to spend their time in the home deciding whether to spend time in their bedrooms or in the communal rooms. They felt involved in choosing activities and were consulted over the meals. They chose when to go to bed and when to get up depending on their agreed schedule. Residents stated that they went out to the shops and decided how to spend their money and were involved in buying their own clothes. Residents participated in aspects of running the home including doing the weekly shopping and undertaking a number of household tasks. Individual risks were identified and plans in place to reduce the level of risk. Risks related to accessing the community, bathing and accessing the community. These had been reviewed and kept up to date. James Court E51-E09 s4963 James Court v241359 060905 Stage 4.doc Version 1.40 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 standard(s) 11,12,13,14,15, 17 The residents were involved in a range of educational, social and leisure activities both in the home and in the community providing them with a full and varied lifestyle. Opportunities to engage in independent living tasks and social skills development were provided, enabling residents to maintain and develop their skills. The home’s meals provided residents with a varied menu and that considered residents’ preferences. EVIDENCE: The home provided residents with the opportunity for personal development. They engaged in a range of independent living tasks dependant on individual ability. Some residents were involved in food preparation, baking, washing up, and laying and clearing the table. Those residents that were able did their own
James Court E51-E09 s4963 James Court v241359 060905 Stage 4.doc Version 1.40 Page 13 laundry and ironing with staff supervision. All residents were involved in cleaning their own bedroom although the level of staff supervision and involvement varied according to the individual resident’s abilities. The home had developed individual plans to aid effective communication for those that needed it. Residents that wished, attended church every Sunday and were involved in church events. All except two of the residents either attended college or the local authority day services. Some attended for five days with others attending for fewer days. One service user was a member of the Red Cross and attended the local football games in that role to provide any necessary support. When residents were in the home the staff supported them to undertake a range of activities including indoor games, music, going for walks and watching TV. Other activities included beauty evenings, going to the pub, going to a local club, bowling, swimming, going to the cinema and trips out. The home organised a holiday and this year they had been to Wales. The residents paid for the holiday. Residents accessed the community on a daily basis using the local leisure, health and shopping resources. Relatives felt welcomed when visiting the home and felt they were infirmed of important matters relating to their relatives. They were satisfied with the care provided. A resident spoken related that he had friends both in and out of the home. The home had a varied menu that provided residents with three meals a day as well as snacks between meals and with supper. Fruit was provided. Residents without exception stated they liked the meals and that they were consulted over food they wanted and that there was always a choice. Some residents assisted with meal preparation, laying and clearing the table and with washing up. The home monitored the food intake for residents if needed and the weight of all residents was monitored on a monthly basis. James Court E51-E09 s4963 James Court v241359 060905 Stage 4.doc Version 1.40 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 standard(s) 18,19 The personal care and health care needs were met with evidence of positive interagency working. EVIDENCE: The health and personal care needs were identified in the care plans. Most residents needed support and encouragement to maintain their own personal care and staff were aware of the specific individual needs of the residents. Residents were involved in buying and choosing clothes. Observation showed residents to be appropriately dressed for their age and that their hair and nail care was attended to. Discussions confirmed that residents received specialist health care when needed. This included community nurses, and psychological and psychiatric specialists. Residents confirmed that they had a key worker and explained the role they had in ensuring that their needs were met. The residents were registered with a GP and the health care needs were being met. Residents confirmed that if they felt ill they went to the doctor that they went to the dentist, optician and had chiropody treatment. A GP that responded to the pre inspection questionnaire felt that home worked in partnership with their practice and that any advice given was acted upon and confirmed that they saw residents in private. Whilst medication was not fully inspected on this occasion the home had completed the requirements and recommendations made at the last inspection.
James Court E51-E09 s4963 James Court v241359 060905 Stage 4.doc Version 1.40 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 The home had a satisfactory complaints procedure with evidence that the residents felt that their views were heard and acted upon. The adult protection procedures in place increased the protection provided to residents however the home needs to ensure that the procedures relating to the management of residents’ monies ensure that money is always returned promptly to their account if not spent. EVIDENCE: The home had a complaints procedure. The home had received no complaints since the last inspection. Residents spoken to were clear over how they would raise a concern they had and felt confident that the staff would deal with it. The home also involved advocates to support residents when necessary. Whilst those residents spoken to were aware of how to complain it would be of benefit to residents if the complaints procedure was in a more accessible format. The home had an adult protection procedure and had a copy of the interagency procedure. Staff spoken to stated they were aware of the procedures and had received training as part of their NVQ training. The home was the appointee for a number of the residents. Sampling showed that the home maintained suitable records of the expenditure by residents and these records were supported by receipts. It was noted however that one staff member had been given a resident’s money a month ago to buy some clothes and neither the items nor the money had yet been returned.
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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 premises were suitable for the residents and were generally satisfactorily decorated and maintained although one toilet required decorating. The home’ provided residents with adequately furnished and decorated communal areas where they could meet with others and private accommodation which they could make their own and where their privacy was respected. The home’s cleaning and hygiene procedures reduced the opportunity for the spread of infections and provided the residents with a clean environment. EVIDENCE: The premises was a large Victorian house and was located a short walk from the shops in Burton. The home was indistinguishable from the properties nearby. The home was generally satisfactorily maintained, decorated and furnished although the downstairs toilet needed to be decorated. Decoration and furnishings were domestic in style. The home had CCTV covering the side
James Court E51-E09 s4963 James Court v241359 060905 Stage 4.doc Version 1.40 Page 17 and front of the property as a security measure. Externally the home had a car park at the front and had a garden laid to grass with seating facilities. The home had six single bedrooms and three double rooms. One double room was downstairs. All rooms had a washbasin. Bedrooms had suitable decoration and furniture and since the last inspection a number of bedrooms had been provided with new chest of drawers although the residents had also wanted to keep their old one. The bedroom, identified at the last inspection as needing attention had been decorated. Bedrooms were all lockable and the service user that had been assessed as able maintained their own key. Bedrooms had been personalised with residents’ belongings, pictures and ornaments. Residents were involved in choosing the colours when their bedrooms were decorated. A discussion with a resident confirmed that they liked sharing a room. The home had suitable communal rooms. There was a large lounge that could seat all the residents, the music room that served as quiet room, a dining room and a domestic style kitchen. The home had adequate bathing and showering facilities with bathrooms both upstairs and downstairs. The home had toilets in the bathrooms as well as additional separate toilets. Liquid soap was provided. These facilities were lockable. The home had a laundry that provided the necessary washing and drying facilities to effectively laundry the residents’ clothing. The home was clean and tidy throughout and part of the deputy’s role was to ensure that the necessary cleaning tasks were undertaken to an acceptable standard. James Court E51-E09 s4963 James Court v241359 060905 Stage 4.doc Version 1.40 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) 31,33,34, The quality of the home’s staff and the level of staffing provided the necessary support to meet the needs of the residents. The recruitment and selection procedures in place at the home supported and protected the residents. EVIDENCE: Discussions with staff showed that they were aware of the needs of the residents and how the needs were to be met. Staff had developed relationships with the residents and they were observed communicating freely with residents and residents felt at ease approaching the staff. There was a friendly and relaxed atmosphere. Staff had been provided with contracts and were provided with information over the terms and conditions of their employment. The home’s recruitment and selection procedures ensured that pre employment checks were completed. The home had introduced a comprehensive application form and was checking the identity of staff. The home had a good record of staff retention with some staff having worked for the home for over five years.
James Court E51-E09 s4963 James Court v241359 060905 Stage 4.doc Version 1.40 Page 19 The homes staffing levels were at a suitable level. When all the residents were in the home there was three care staff on duty. That level may be reduced if there were a smaller number of residents in the home. The owner/ Care Managers’ hours were not included in the care staff hours. Over night there was one waking care staff member and another staff member who slept at the home. This level of staffing allowed for individual work to take place with residents and staff to take residents out of the home for leisure activities and to attend appointments. The care staff undertook catering and domestic tasks within the home and spent time supporting and assisting residents in undertaking household tasks. James Court E51-E09 s4963 James Court v241359 060905 Stage 4.doc Version 1.40 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 residents benefited from a well managed home with the owner/ manager being supportive to staff and residents and consulting with them over changes and developments and providing the necessary management practices. The homes’ quality assurance scheme provided the information to look at ways that the home could be developed to provide a better service to the residents. Although some staff required training in food hygiene the home’s Health and Safety procedures served to protect the health and welfare of the residents. EVIDENCE: The owner/registered manager had a qualification in nursing with people with a learning disability and had significant experience of working in the field. She demonstrated that she had the necessary knowledge and skill. She had achieved NVQ level 4 in management and the award for managers of care
James Court E51-E09 s4963 James Court v241359 060905 Stage 4.doc Version 1.40 Page 21 homes. She had an open door policy to staff and residents. Staff stated she was approachable and supportive and that they were kept informed about changes and developments. She had developed close relationships with residents and they clearly felt at ease in her presence. Residents said how they liked her and that she would sort out any problems they had. The home had a number of Quality Assurance procedures in place that included surveying relatives, residents and health specialists. In addition the staff completed a questionnaire in respect of how they felt the home was managed. These processes provided audit information as a basis to look at areas of the home that could be developed. The home had a health and safety procedures in place. Procedures were in place to ensure that staff received the necessary training although two staff needed to undertake training in food hygiene. The home reported that it had valid gas safety and electrical installation certificates. The home was undertaking the necessary fire training and fire testing of the fire alarm and emergency lighting. Fire training was provided including by an external fire specialist yearly. The home checked the temperatures of water and had procedures in place for the control of the legionella bacteria. The home had restrictors fitted on the upstairs windows. The owner was the manager of the home and undertook the budgeting and financial planning within the home. The home had the necessary insurance cover in place. James Court E51-E09 s4963 James Court v241359 060905 Stage 4.doc Version 1.40 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 3 x x Standard No 22 23
ENVIRONMENT Score 3 2 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 2 3 3 3 3 3 x Standard No 11 12 13 14 15 16 17 3 4 3 4 3 x 3 Standard No 31 32 33 34 35 36 Score 3 x 3 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
James Court Score 3 4 x x Standard No 37 38 39 40 41 42 43 Score 4 4 3 x x 2 3 E51-E09 s4963 James Court v241359 060905 Stage 4.doc Version 1.40 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 23 Regulation 13(6) Requirement To ensure that financial practices make sure that residents money is returned to residentss accounts promptly . That the downstrairs toilet is decorated That all staff receive training in food hygiene Timescale for action Forthwith 2. 3. 24 42 23(2)(d) 18(1)(i) 15/10/05 1/12/05 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 1 & 22 Good Practice Recommendations That information be provided in a format more accessible to residents. James Court E51-E09 s4963 James Court v241359 060905 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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