Inspection on 14/06/05 for St Michael's

This inspection was carried out on 14th June 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 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

St Michael's 13/10/09

St Michael's 31/07/09

St Michael's 19/06/09

St Michael's 20/04/09

St Michael's 31/10/07

St Michael's 15/12/06

St Michael's 14/02/06

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

CARE HOME ADULTS 18-65 Lauraston Residential Home 129 - 131 Wingfield Road Stoke Plymouth PL3 4ER Lead Inspector Brendan Hannon Announced 14 June 2005 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. Lauraston Residential Home D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Lauraston Residential Home Address 129 - 131 Wingfield Road, Stoke Plymouth Devon, PL3 4ER 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) 01752 - 564944 al.Patel@healthcare- trust.com Stoke Healthcare Ltd. Lorraine Cunningham Care home 37 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (37) of places Lauraston Residential Home D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The Home is registered for 37 service users. 8 staff who provide care must be on duty from 8am to 2pm; 7 care staff from 2pm to 8pm and at least 2 waking night staff from 8pm to 8am. Date of last inspection N/A Brief Description of the Service: The home was purchased by Stoke Healthcare Ltd on the 24/03/05 and a wholely new service for adults with mental health needs has been established. The service is located in a large detached building, approximately 150 years old, on a residential road close to Stoke village in central Plymouth. A full range of amenities and facilities are within walking distance of the building. The service will be able to accomodate up to thirty seven residents over two floors when building works have been completed. The building is being redeveloped and only one half is open to residency at the present time. ll the necessary facilities are available to residents in the occupied half of the building. There is a large non smoking lounge/dining room next to the front entrance of the building on the ground floor. Opposite this room is a smoking lounge. To the side of the building is a large area of enclosed garden surrounded by mature trees. Only single room accomodation is provided in the home. Due to age of the building many of the rooms have high ceilings which help the rooms and the home in general to feel spacious. The service offered by the home is for people with long standing mental health issues of various types. Some residents have mobility difficulties but mostly the residents are fully mobile. There is no shaft lift in the building. The residents group has a mixed range of abilities from highly independant to more significantly disabled. The home allows smoking in desginated areas either in the specified smoking room or outside the home. Lauraston Residential Home D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced. Preparation for the inspection included analysis of the pre inspection questionnaire, and communication with Stoke Healthcare Ltd before and after registration of the service. An inspection plan was developed from this information. The inspector was in the home for 6.5 hours from 9.45am till 4.30pm. The inspector spoke to all of the residents and looked closely at the care of two of the residents. The whole of the building was inspected. Two care staff, the registered manager and the managing company director Mr A. Patel were spoken to at length. Care records, medication records, staff/employment records and health and safety records were inspected. Some policy and procedure was also inspected. What the service does well: What has improved since the last inspection? What they could do better: Risk assessment within care planning and within the building must be further developed. Risk assessments for the individual residents must be more extensive to thoroughly document the risk and the measures put in place by the home to reduce the risk to an acceptable level and to ensure that risks are managed consistently by the care staff. In particular any physical intervention Lauraston Residential Home D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 Page 6 must be carefully risk assessed to ensure that the residents safety is always maintained. Specific risk assessments for hot water taps and radiators must also be completed in addition to the existing general building risk assessment. It was recommended that the existing care plan be added to, to make both the information on assessed needs and the directions to staff to meet the assessed needs more detailed. Finally some changes to procedure in medication administration were recommended, as was some further health and safety recording of freezer temperatures. The service needed to obtain a mains wiring certificate for the occupied part of the building. 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. Lauraston Residential Home D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 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 Lauraston Residential Home D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 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) 1,2,3,4 The service provides good quality information to new residents, their relatives and the professionals responsible for managing care. These practices allow potential residents to make an informed choice, based on good information, about the service. EVIDENCE: The statement of purpose for the home and the service users guide are of good quality. The service users guide is available to both existing and future residents. The information in this document helps potential new residents to understand the service provided by the home. Residents care planning files were sampled. The registered manager said that the service would carry out its own assessment of a prospective resident’s needs before offering admission to the home. The homes decision that the service is, or is not, appropriate for the person will be based on this assessed information. This policy was supported by assessments on residents’ files. The management of the service have the experience and qualification to carry out comprehensive mental health assessments. The Statement of Purpose states that the service does not accept emergency admissions. A resident recently admitted to the home had come for daytime visits to experience the service in advance of accepting an offer of admission. They had settled successfully at the service. Lauraston Residential Home D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 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) 6,9,10 The delivery of resident’s care is good but is affected by generalised care planning and resident risk assessment. Improvements in these areas will further support progress in the delivery of consistent, high quality support to the residents. EVIDENCE: Resident’s care plans were sampled. There was an adequate care plan format and risk assessment format available to use. All the residents’ files had a care plan and risk assessments in place and these were being appropriately reviewed. Though aspects of care planning could be improved, in general the care plans were adequate. The information held in the care plan document should be comprehensive to cover all the issues affecting the resident and the information should be more detailed. There was little detail in the care plan on the leisure and/ or valued activities participated in by the resident. The manager wants to introduce a plan of regular and irregular activities when placements have become more established. When a detailed and comprehensive care plan has been developed for each resident the quality of the care support for the residents will be further improved and this should further improve their quality of life. Lauraston Residential Home D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 Page 10 Some residents have behaviours that challenge the service. It was advised that in these circumstances there should be clear behaviour management plans within the individuals care plan to ensure that staff always intervene in a consistent planned manner. Similarly if there may potentially be physical intervention by staff, then these interventions should be planned in advance and staff should always comply with the directions given. A consistent approach will keep residents safe, may help residents to adapt their behaviours and will enable residents to enjoy a better quality of life. There were individual risk assessments in resident’s care plans. They did not identify all the risks and agreed restrictions affecting the resident and they did not address the resident’s identified risks in enough detail. Individual residents risk assessments must be comprehensive and detailed to identify all the risks and agreed restrictions affecting the resident and the measures in place to reduce these risks to an acceptable level. Lauraston Residential Home D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 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) 12,16,17 Residents have enough appropriate activity to ensure a good quality of life while living at the home. EVIDENCE: An individual daily log is maintained for each resident. This record provides excellent evidence of the quality of life being enjoyed by the residents. The residents’ placements at the home are at an early stage and therefore leisure and valued life activity is similarly at an early stage of development. Residents are however enjoying a high degree of individual support which allows residents to have considerable flexibility and choice in their daily lives. For example residents are choosing their meals, purchasing food individually to meet their own personal tastes and helping in food preparation. Some of the daily living activities participated in by residents include shopping, cooking and laundry. Some of the leisure activities participated in include music, films, swimming, gardening, computing and manicures. The registered manager stressed the individuality of the activities that are being designed to meet the preferences and needs of the individual residents. Lauraston Residential Home D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 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 standard(s) 18,19,20 The administration of medication in the home is well managed ensuring that residents prescribed medication is effectively delivered. The residents physical and mental health needs are being supported by the home. EVIDENCE: The registered manager described some of the personal care issues that the staff were sensitively supporting residents to manage. The residents care plans and information given by the registered manager showed the considerable health support being received by the residents. The input of Community Psychiatric Nurses, Psychiatric consultants, dieticians, district nursing and GPs was noted. This professional input and the homes support for health service intervention helps to keep the residents mentally and physically well. The medication administration system was seen. The home administers the majority of medication through a blister pack monitored dosage system. Recording for medication administered was good. The medication policy and procedures were also of good quality. A recommendation was made to amend this procedure to include reporting of medication errors and the decision making process used to decide to administer PRN medication. The staff who administer medication have had internally delivered training form the new management but external accredited level traing should be delivered to these satff in the future. Good administration of medication by the service ensures that residents receive the medication they require to maintain their health. Lauraston Residential Home D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 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 standard(s) 22,23 Complaints are properly managed by the home, which protects the welfare of the residents. EVIDENCE: There is an adequate complaints procedure and this is clearly displayed in the home and is contained within the Service Users Guide. All the staff team have received internal Adult Protection training and the required Adult Protection policies are in place. There have been three complaints made to the CSCI since the home changed hands. However two of these referred to the difficult process of transferring the former older residents who used the former service to other care homes. The substantiated area of complaint in both these cases was regarding communication problems. The third complaint remains under investigation. Lauraston Residential Home D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 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 standard(s) 24,25,26,27,28,30 The residents have a good quality of life within the home because the environment in the building is maintained at an adequate level of quality. EVIDENCE: The half of the building presently available for resident occupancy is appropriate to meet the residents needs. However the presently occupied half of the building is only an interim facility as, when the other half of the building is complete, this half will in turn be redeveloped. Residents are made aware before moving into the home that they will need to transfer within the building during the redevelopment process. The communal areas presently in use have a good standard of décor. The smoking lounge is a pleasant room for residents to use. Resident’s bedrooms had been personalised and decorated to different degrees but all were of an acceptable standard. All the bedrooms had a good quality of furniture. Residents commented on how happy they were with the furnishings and facilities in their rooms. Toilets and bathrooms were adequately decorated. The occupied part of the building was clean and hygienic and the existing laundry facility had appropriate equipment and met infection control requirements. Lauraston Residential Home D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 Page 15 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) 31,32,33,34,35,36 Residents’ needs are satisfactorily met because the management, training and employment of staff in the home is adequately handled. EVIDENCE: The pre inspection questionnaire and staff records showed that training for NVQ is at an early stage of development at the home. 36 of the care staff will be qualified if all the care staff who are presently engaged on NVQ2 courses complete their courses. There is an extensive training plan for this year covering both basic training such as moving and handling and mental health awareness and other useful additional courses such as Adult Protection. There is a staffing level condition in place on the certificate of registration. However this only applies to when the home is occupied at its maximum level. At present a much lower level of staffing is necessary. This level is set through an assessment of the residents needs and by the requirements of the individual resident’s contracts. The registered manager stated that the staffing level in place is adequate to meet the needs of the residents. The staff were seen throughout the inspection to be relaxed and helpful when supporting the residents. The staff team is made up of the existing staff team from the former service and some newly recruited members of staff. Stoke Healthcare have sent the staff similar services to gain experience and have given direct training in mental health awareness. This training has supported the staff with less Lauraston Residential Home D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 Page 16 experience with residents with mental health needs to deliver an appropriate service. An appropriate structured induction is available to use and is underway with all members of the staff team. A thorough training plan and training record was available both for the team and for individual members of staff. Staff training will help the competency of staff to be able to meet the residents care needs. The staff personnel files, and the pre inspection questionnaire, supported by the evidence given by the registered manager showed that all of the staff had received Criminal Records Bureau (CRB) clearances. The residents can be sure that all the staff working with them are both properly checked against CRB and Protection Of Vulnerable Adult (POVA) register records and therefore that they are safe to be left in the care of all the staff. Residents are involved in the recruitment process and their opinion of a potential new staff member is taken into account in this process. An appropriate system of staff appraisal and supervision is specified in policy and procedure. This system of staff supervision is underway. This will help the management to monitor the quality and consistency of staff practice towards meeting the needs of the residents. Lauraston Residential Home D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 Page 17 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) 37,38,39,40,41,42 An adequately managed service is meeting the needs of the residents. EVIDENCE: The registered manager, Lorraine Cunningham, is experienced in managing care for this client group and she has been in her present post since the establishment of the new service at the end of March 2005. She intends to continue to develop the service. Developments will include complying with the requirements given, and noting the recommendations made, in this report. The manager and staff were seen to be working well together. Good working relationships amongst the staff will promote better quality support for the residents. A quality assurance system designed with a focus on residents’ interests is in place but due to the short period that the service has been in existence it has not yet been put into operation. The planned system will be practical to use and is likely to produce meaningful results. A full policy and procedure manual is in place covering much more than the list of issues identified in schedule B1 of the pre inspection questionnaire. The Lauraston Residential Home D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 Page 18 registered manager was advised to expand on the policy on the use of physical restraint to include individual planning of any physical intervention and the appropriate training of staff to carry out such interventions safely. The changes that should be made to the medication administration policy and procedure are noted under standard 20. Records were generally well maintained. Health and Safety is generally adequately managed in the home though, as noted under standard 9, a number of new risk assessments must be written for the individual residents. Though there is a general building risk assessment individual risk assessments for hot water outlets and radiators, that have not been physically adapted to reduce risk, should be written for each specific tap and radiator to identify their safety. The record of fire protection checks and fire training is thorough. The record of accidents is well maintained. For example a minor accident had been cross referenced from the accident record to the daily log entry and then to a body map bruise chart. Safety checks are being carried out or have been planned. The service is presently reliant on some of the former services safety checks such as domestic electrical equipment. Not all of the fridges and freezers had consistent temperature records. These records of temperatures should be maintained for all of these appliances. Though electrical safety testing had been carried out during the last year for all the domestic items in the home a certificate verifying the safety of the mains wiring was not available. A mains wiring certificate should be obtained for the part of the building in use. A safe environment benefits both the residents and the staff. Lauraston Residential Home D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 Page 19 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 3 3 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 2 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 x 3 Standard No 11 12 13 14 15 16 17 x 3 x x x 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Lauraston Residential Home Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 1 x D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 Page 20 N/A 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 9 Regulation 13 Requirement Each resident must have a comprehensive and detailed individual risk assessment. This must include all the restrictions of choice, or personal freedom, agreed to be in the residents best interests to maintain their safety. An individual risk assessment must be in place for each hotwater outlet and radiator that has not been physically adapted to limit hot water, or surface, temperature. Timescale for action 01/09/05 2. 42 13 01/09/05 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 6 Good Practice Recommendations All the residents should have a careplan in place which is comprehensive and detailed. Each residents needs should be comprehensively identified and how staff are to meet these needs. Any physical intervention or the management of behaviours which challenge the service should be detailed within the care plan. The medication policy should be amended to include the D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 Page 21 2. 20 Lauraston Residential Home 3. 42 decision making process on when to administer PRN medication, and when to report medication incidents under regulation 37. A general incident record should be established. All staff administering medication should recieve accredited level medication administration training. Fridge and freezer temperatures should be maintained for all such appliances. A mains wiring certificate should be obtained for the part of the building in use. Lauraston Residential Home D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Lauraston Residential Home D52-D04 S62825 Lauraston V223236 140605 Stage 4.doc Version 1.40 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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