Inspection on 09/05/07 for Kestrel House, St Anne`s Opportunity Centre,

This inspection was carried out on 9th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Kestrel House, St Anne`s... 13/12/05

Kestrel House, St Anne`s... 31/05/05

Kestrel House, St Anne`s... 22/12/04

Kestrel House, St Anne`s... 29/04/04

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

CARE HOME ADULTS 18-65 Kestrel House, St Anne`s Opportunity Centre, 84 Hambridge Road Newbury Berkshire RG14 5TA Lead Inspector Robert Dawes Unannounced Inspection 9th May 2007 11:30 DS0000011175.V335824.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 DS0000011175.V335824.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. DS0000011175.V335824.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kestrel House, St Anne`s Opportunity Centre, Address 84 Hambridge Road Newbury Berkshire RG14 5TA 01635 40862 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) St Anne`s Opportunity Centre Limited Mrs Jacqueline Louise Thompson Care Home 5 Category(ies) of Learning disability (5) registration, with number of places DS0000011175.V335824.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th December 2005 Brief Description of the Service: Kestrel House is a small residential home located close to the local town and all amenities. The home is registered for three clients aged 18 - 65 years who have learning disabilities. The home offers structured care to enable clients to develop more independent life skills at their own pace and within their own abilities. The home is well equipped throughout and has a large secluded garden which is well utilised. Fees charged range from £997.13-£998.07 per week. DS0000011175.V335824.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced site visit, which took place during the day on the 9th May 2007. The pre-inspection questionnaire, four clients’ questionnaires, three relatives questionnaires and one comment card from a visiting professional were returned to the inspector before the site visit. These, together with the site visit, were the main sources of information for the key inspection. During the site visit the inspector spoke with two clients; interviewed the manager and two members of staff; toured the premises; looked at records; case tracked; and observed the interaction between clients and staff. Twenty-two standards were assessed during the site visit of which eleven were met and eleven were exceeded. One recommendation was made. What the service does well: What has improved since the last inspection? What they could do better: Ensure LDAF is incorporated into the induction and foundation training programme; staff are offered training to give them a better understanding of mental health problems that people with a learning disability can suffer from; and all staff receive training in ‘breakaway techniques’. DS0000011175.V335824.R01.S.doc Version 5.2 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000011175.V335824.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 DS0000011175.V335824.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. JUDGEMENT – we looked at outcomes for the following standard(s): Number 2. People who use the service experience good quality outcomes in this area. Prospective clients’ individual aspirations and needs are assessed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Records showed that full assessments were undertaken on the two clients admitted to the home since the last inspection. The home has appropriate admission policies and procedures in place. DS0000011175.V335824.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Numbers 6, 7 and 9. People who use the service experience excellent quality outcomes in this area. The home’s principal philosophy is that the clients should be in control of their lives and decide how the home is run and what happens in their lives as much as possible. This is reflected in the individual plans, which reflects their diverse needs and are reviewed at regular intervals; how clients make decisions about their lives; and the level of support they receive to take risks as part of an independent lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All the clients have detailed and comprehensive person centred care plans that reflect their preferences and what they want to achieve. They are reviewed annually with the clients, relatives and key professionals. Changes are made whenever the need arises. DS0000011175.V335824.R01.S.doc Version 5.2 Page 10 The weekly house meeting records and individual files demonstrate how clients are involved in making decisions about their daily lives, i.e. choice of meals, activities, household tasks, colour of their rooms, holidays and clothes. In reply to the question in the relatives survey ‘does the care service support people to live the life they choose?’ all three replied ‘yes’. In reply to the question in the client survey ‘do you make decisions about what you do each day?’ one replied ‘always’, one replied ‘usually’ and one replied ‘sometimes’. A client said he makes up his own mind about what to do. The manager’s philosophy is that it is the clients’ home and they decide how it is run and what happens. Staff said clients have a say in what happens, can change their programme and voice their opinions at any time. Clients are encouraged and supported to take risks and be as independent as possible. Four of the five clients are left on their own in the home for short periods of time; one client travels on his own to neighbouring towns and cities; another client travels to his home town on his own; all undertake personal care tasks such as ironing and bathing on their own; they cook their own meals with support from staff; and several use public transport on their own to attend college. All clients have risk assessments to cover potentially risky activities. DS0000011175.V335824.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Numbers 12, 13, 15, 16 and 17. People who use the service experience excellent quality outcomes in this area. People who use the service are able to maintain paid employment and take part in a wide range of appropriate activities which reflect their diverse needs; they participate in the local community and are enabled to keep in touch with their families and friends; their rights are respected and responsibilities recognised in their daily lives; and are offered a healthy diet and enjoy their meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Clients said they are supported to: maintain paid employment, i.e. delivering a local paper once a week and work experience at a local church and in the home; attend courses at the local college, such as pottery, drama, music, art therapy and computer skills; and take part in activities such as swimming, badminton, table tennis and gardening. DS0000011175.V335824.R01.S.doc Version 5.2 Page 12 Clients are supported to go to the cinema, theatre, car boot sales and sporting events; have meals out, go shopping for food and personal items, use the library; belong to local groups such as slimming clubs; and attend church. They all said ‘they have lots of things to do’. All can vote at elections. Each client has a detailed individual plan in respect of work, education and leisure to ensure their diverse needs are addressed and a “strength and needs profile” which has been developed with each client to identify areas of development. Clients can ask to change their programmes when they wish. Clients are encouraged and enabled to keep in regular contact with relatives and friends in the community and from other homes. The home has a sexuality (intimate personal relationship) policy. In response to the questions in the relatives’ survey, ‘does the home help you keep in touch with your relative?’ and ‘are you kept up to date with important issues affecting your relative?’ all replied ‘yes’. One relative commented, ‘we are in regular contact, he comes home frequently, we go to football matches with him and take him abroad’. Clients were observed to have unrestricted movement around the home, except other people’s bedrooms. Clients can choose to be alone. Records and observation showed staff consult with clients as much as possible about the daily routines to encourage them to feel respected and responsible. A very positive and respectful interaction between staff and clients was observed. Clients said they assist with many of the housekeeping tasks, are supported to shop for and cook their own meals and have their own front door keys. In response to the question in the clients’ questionnaire, ‘can you do what you want to do during the day, evening and week ends?’ four replied ‘yes’ and one replied ‘no’ to during the day. Clients choose their own menus. Clients shop for their own food and generally cook their own meals, with support. Meal times are very flexible to accommodate the activities of the clients. Menus showed clients have well balanced and nutritious meals and their dietary needs are catered for. DS0000011175.V335824.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Numbers 18, 19 and 20. People who use the service experience excellent quality outcomes in this area. People who use the service receive personal support in the way they prefer and require; and their physical and emotional health needs are well met. Clients administer and control their own medication where appropriate and are protected by the home’s medication procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The clients are physically independent and require little assistance with personal care. Staff provide guidance and emotional support when required. In response to the questions in the clients’ questionnaire, ‘do the staff treat you well?’ two clients said ‘always’ and two replied’ usually’. In response to the question ‘do the staff listen and act on what you say?’ three clients replied ‘always’ and one ‘usually’. Comments made by relatives in their surveys were; ‘St Anne’s staff have always been very sensitive to our son’s needs’; ‘ we have always been very DS0000011175.V335824.R01.S.doc Version 5.2 Page 14 impressed with the care our son receives’; and ‘ Kestrel staff are always caring, sensitive and professional. We have complete confidence in them’. Clients said ‘they can go to bed and get up when they like’; and ‘they like the home’. The GP said in his survey that he is able to see the clients in private. The clients looked clean and presentable. Staff were observed to respond and care for the clients in a sensitive and professional manner. Care plans detail how any preferences in respect of the delivery of any care and support needs. A “healthcare profile” is in place on each individual file. Records showed clients’ physical and emotional health is monitored. Clients are provided with emotional support and guidance to manage their every day lives, i.e. one client becomes very anxious when talking about problems so the manager has encouraged her to write a diary, which helps her voice problems and concerns. Behavioural guidelines and coping strategies were evident on the individual files, i.e. to help a client attend football matches. Clients are encouraged to voice their feelings and helped to manage their anxieties through activities in the house i.e. social interaction groups, art therapy, and music relaxation. All the clients have regular medication reviews and sight and dental checks. Two clients are currently receiving support from a psychiatrist for emotional and anxiety problems. Clients are encouraged to have regular exercise. The GP said in his questionnaire that staff demonstrate a clear understanding of the care needs of the clients. None of the clients self administer their prescribed medication. Two clients administer their own non-prescribed medication. They have a lockable cabinet in their rooms and administration records. No controlled drugs are on the premises. The GP said in the survey that he considered the clients’ medication was appropriately managed in the home. The medication administration records were in order. All the staff have received medication training. Appropriate medication policies and procedures are in place. DS0000011175.V335824.R01.S.doc Version 5.2 Page 15 A pharmacist visits the home once a year to inspect the storage, administration, recording and disposal of the medication. DS0000011175.V335824.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. JUDGEMENT – we looked at outcomes for the following standard(s): Numbers 22 and 23. People who use the service experience good quality outcomes in this area. People who use the service feel their views are listened to and acted on; and are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaints to the home or the Commission have been made since the last inspection. The home has clear complaints procedures in place. In response to the question in the relatives’ survey ‘do you know how to make a complaint?’ all three relatives replied ‘yes’. In response to the questions in the clients’ questionnaire, ‘do you know who to speak to if you are not happy?’ and ‘do you know how to make a complaint?’ all four clients replied, ‘yes’. Clients said they would go to the manager if anything was wrong. A client showed me her client guide which contained the complaints procedures in a user friendly format. Staff said the clients are all very good at airing their views and will inform the manager or a senior member of staff of any upsets. No allegations of abuse have been made to the Commission since the last inspection. DS0000011175.V335824.R01.S.doc Version 5.2 Page 17 A vulnerable adults procedure, a racial harassment policy and a bullying policy are in place. The organisation operates a non-physical intervention policy. None of the clients have been physically challenging but on occasions can become very agitated and distressed. Some of the staff have received ‘breakaway technique training’ and the inspector recommended all staff receive this training. Safeguarding younger people training has been arranged for the staff who have not received the appropriate training. The home has appropriate policy and procedures for handling clients’ personal money. All the clients manage their own personal money with the assistance of staff. They keep their money in secure tins in their rooms. Records are kept and regularly audited. Staff are prohibited from receiving money or gifts from clients or relatives. DS0000011175.V335824.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Numbers 24 and 30. People who use the service experience good quality outcomes in this area. The home is comfortable, safe and well maintained. The home is clean and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is comfortable, well furnished, well maintained and has a pleasant garden. Since the last inspection the upstairs bathroom has been refurbished and now includes a shower and a toilet; the communal area has been decorated; a summerhouse has been erected in the garden; and the use of several rooms has been changed. On the day of the inspection the home was clean and hygienic. In response to the question in the clients’ survey, ‘is the home clean and fresh?’ all four clients who replied said ‘always’. DS0000011175.V335824.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Numbers 32, 34 and 35. People who use the service experience good quality outcomes in this area. An effective, competent and qualified staff team who receive adequate training support the people who use the service fairly, without discrimination and in a caring manner. The home operates a thorough recruitment procedure. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff interviewed demonstrated a good understanding of the conditions and needs of the service users. 33 of care staff have achieved a NVQ 2 or above in care. A visiting GP said in his questionnaire that he was satisfied with the overall care provided to the clients. In response to the questions in the relatives survey ‘do you feel the care home meets the needs of your relative?’; ‘does the home give the support and care to your relative that you expect?’; ‘do the care staff have the right skills and experience to look after people properly?’; and ‘does the care service meet the different needs of people?’, all three replied ‘yes’. DS0000011175.V335824.R01.S.doc Version 5.2 Page 20 The organisation complies with the recruitment procedures. All new staff undertake an induction training programme and receive training in the key areas of their work. Refresher training of key areas of work takes place. The inspector recommended LDAF is incorporated into the induction and foundation training programme and staff are offered training to give them a better understanding of mental health problems that people with a learning disability can suffer from. DS0000011175.V335824.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Numbers 37, 39 and 42. People who use the service experience excellent quality outcomes in this area. People who use the service benefit from a well run home; their views underpin all self-monitoring, review and development by the home; and their health, safety and welfare are promoted and protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is qualified, competent and experienced to run the home. She has been a manager in the organisation since 1995 and manager of Kestrels since October 2005. The manager undertakes periodic training to maintain and update her knowledge and skills. Staff described the manager as very supportive, approachable, clear in how she wants the clients cared for and operates a client centred approach to how the home is run. DS0000011175.V335824.R01.S.doc Version 5.2 Page 22 The organisation ensures an effective quality assurance and monitoring system operates in the home through regular staff and clients’ meetings taking place; a representative of the organisation visiting the home every month to inspect the quality of care being delivered; the clients, relatives and care managers completing an annual satisfaction questionnaire; and the manager ensuring clients’ views and opinions are listened to and acted upon, i.e. ‘it is the clients’ home and they decide how it is run and what happens’. The annual development plan is discussed at a house meeting. Records showed all health and safety checks and inspections are up to date and completed as required. Necessary health and safety policies and procedures are in place. All the clients’ files contained appropriate risk assessments and had been reviewed regularly. All the staff have received the necessary health and safety training including first aid. DS0000011175.V335824.R01.S.doc Version 5.2 Page 23 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 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 X 4 X 4 X X 3 X DS0000011175.V335824.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 YA35 Good Practice Recommendations LDAF is incorporated into the induction and foundation training programme; staff are offered training to give them a better understanding of mental health problems that people with a learning disability can suffer from; and all staff receive training in ‘breakaway techniques’. 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