Inspection on 30/09/08 for Santa Maria

This inspection was carried out on 30th September 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Santa Maria 20/03/07

Santa Maria 14/02/06

Santa Maria 23/06/05

Santa Maria 01/02/05

Santa Maria 10/08/04

Santa Maria 26/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Santa Maria 268 London Road Wokingham Berkshire RG40 1RD     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Amanda Longman     Date: 3 0 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Santa Maria 268 London Road Wokingham Berkshire RG40 1RD 01189791546 01189791546 santa.maria@atlas.plus.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Atlas Project Team Ltd The registered provider is responsible for running the service Name of registered manager (if applicable): Name of registered manager (if applicable) Mr Grahame Lawrence Dillon Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category of service only:Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Learning disability - LD Date of last inspection Brief description of the care home Atlas Project Team Ltd is the registered provider for Santa Maria, which is a care home providing personal care and accommodation for 3 adults aged 18-65 who have a learning disability with associated behavioural problems. The home is situated on the outskirts of Wokingham on a main road and has unmarked vehicles used for the short drive to all the recreational and shopping amenities within Reading and Wokingham. Santa Maria is a three-bedroom detached bungalow with communal space comprising Care Homes for Adults (18-65 years) Page 4 of 25 3 Over 65 0 care home 3 Brief description of the care home lounge, separate dining room and a kitchen. There is a large garden at the back of the house with the front garden used as space for car parking. Care Homes for Adults (18-65 years) Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced key inspection. It was a thorough look at how well the service is doing. We (the commission) received detailed information from the service in the form of an Annual Quality Assurance Assessment (AQAA). This gave details of current care provided, improvements made since the previous inspection and plans for the future. It also provided information about staff numbers, training and qualifications and about the policies and procedures of the service. A site visit was undertaken by Amanda Longman, regulatory inspector, on 29 September 2008. During the site visit we spoke with the area manager, the manager and members of the care staff. We toured the home spoke with the people who live there and observed care practices. We also examined a sample of care records, staff records and policies. Care Homes for Adults (18-65 years) Page 6 of 25 The last inspection of this service was completed on 20 March 2007. The current fees for the service are 1,788.69 pounds per week. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has appropriate information in place and the capacity to appropriately assess prospective service users. Evidence: The home has a statement of purpose and service user guide in place. Key information is presented in an easy read format. However the staff informed us that the current service users still require assistance to understand information. For example the complaints procedure is presented in an easy read format but the people living at the home would still not understand the formal procedure. There have been no new admissions since the previous inspection. There are procedures in place to fully assess someones needs prior to offerring them a place, should a vacancy arise. Care Homes for Adults (18-65 years) Page 10 of 25 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are appropriately supported to make choices about their needs and lives. The manager needs to ensure that records are always kept up to date and there is scope to improve risk management. Evidence: All the people who live at Santa Maria have a service user plan. These plans are monitored by staff every three to four months, or more frequently if required, and formally reviewed every 12 months, most recently in February 2008. Care managers or interested relatives are invited to the annual review. Care workers maintain daily diaries for all service users and the information in these feed in to the service user plan reviews. We reviewed one service user plan in detail on the day of the site visit and saw confirmation that it had been reviewed in February 2008. It contained relevant personal information, personal likes and dislikes and their preferred method of communication. It listed up to date medication needs, physical and healthcare needs Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: and behaviour management guidelines. Details were provided about the persons preferred morning and daily routines which was signed by care workers as evidence that they had read them. A series of risk assessments were in place for activities thought to present an obvious risk of harm and risk reduction methods were in place. We discussed with the provider the possibility of expanding risk assessments and management plans to cover a broader range of everyday activities. We did notice that not all records were kept accurately up to date. For example an agreed plan of action for one person had not been carried out. The provider explained that this plan has not been followed for safety reasons but this was not documented anywhere. We discussed with the provider the importance of ensuring all records were accurately up to date and they agreed to ensure this is done. Care Homes for Adults (18-65 years) Page 12 of 25 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are generally supported to enjoy a lifestyle which promotes positive outcomes. Evidence: A number of activities are planned in advance and we saw the plans for October which included swimming, trampolining and massage sessions. Staff informed us that everyone goes out most days. This may include going for a walk, going shopping or going to the pub, for example. The home has a car which is used to go out and one person in particular enjoys going on trains and buses and is supported to do this. Evening activities are limited because there is usually only one member of staff on after 8.00pm. This does not limit freedom within the home as everyone is able to get themselves ready for bed when they wish and only require prompting by way of assistance. Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: During our site visit people were free to do as they wish. A member of staff took one person out. Staff chatted easily with the people who live at the home. No one living at Santa Maria currently attends college or work. Employment was found for one person but was not successful. Everyone living at the home is encouraged to participate in the daily running of the home. People are supported to do their own laundry and housework. We saw evidence of this during our site visit. Staff informed us that none of the people at Santa Maria are religious so no arrangements for religious services are in place. The home has a policy on sexuality and relationships which supports individual choice. People are encouraged to help with cooking and baking. They have open access to the kitchen and we saw that they make themselves a cup or tea as and when they wish. Menus are planned with the people who live at Santa Maria on a Sunday. Staff spoken with know their likes and dislikes well. On the day of our site visit lunch was chicken curry which seemed to be enjoyed. Staff ate with the service users. A food safety management policy is in place, which was reviewed in 2006. Care Homes for Adults (18-65 years) Page 14 of 25 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users personal and healthcare needs are individually and appropriately supported. Evidence: Information received prior to the site visit indicated that personal support preferences are documented, personal communication plans are in place and new behavoural guidelines have been devised. We examined one service users records in detail on the day of the site visit and found that physical and healthcare needs are well documented. Daily routines are documented and signed by all the care staff to show they have read them and behavoural guidelines are in place.. However the morning routine was due to be reviewed in April and there was no evidence that this had been done. We spoke with two members of staff who were familiar with each individuals preferred routines and the guidelines for manageing behaviour. However a documented incident resulted in a service user not being able to go out in the car for 24 hours. The manager explained that as the staff know the service user very well such a decision was made to avoid a further potentially dangerous occurrence. Whislt there is no suggestion that this was by way of a punishment we could find no evidence Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: of a protocol for making this decision. Such decsions, which may infringe on an individuals liberty must be covered by a clear protocol. Santa Maria has a medication policy which ensures two people administer medication, people are trained in-house and only allowed to administer medication when they have been assessed as competent to do so. However, contrary to the National Minimum Standards, no actual medication training course is in place. Medication was securely stored and records were up to date. We observed that the procedure of two people administering medication was followed and staff spoken with confirmed this is always the case. Care Homes for Adults (18-65 years) Page 16 of 25 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service takes appropriate steps to ensure service users complaints are heard and dealt with and service users are safeguarded from abuse. Evidence: The home has in place a complaints procedure and this has been produced in an easy read format. The telephone number for the Commission for Social Care Inspection in the easy read procedure was wrong. However, staff spoken with confirmed that the people who live at Santa Maria would not be able to use such a formal complaints procedure. Addressing concerns or anxieties is therefore dependent on the staff in the home knowing the individuals really well and their preferences, likes and dislikes being well documented and well known. Staff confirmed they do know the individuals well and are able to understand when someone is not happy about something. Our observations on the day of the site visit confirmed that staff do appear to know the individuals at the home well and that service users and staff communicate effectively with each other regarding everyday needs, for example whether they are too hot, too cold happy or not happy. The commission has not received any information regarding any complaints since the previous inspection. The home has in place a procedure for safeguarding vulnerable adults and staff confimed they received training and regular updates is this area. However the procedure needs to be reviewed as it states that the homes manager would undertake Care Homes for Adults (18-65 years) Page 17 of 25 Evidence: an investigation of any allegation, whereas this should be referred immediately to the local social services department the first instant. This was discussed with the area manager on the day of the site visit and will be addressed. Care Homes for Adults (18-65 years) Page 18 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a comfortable, safe and clean environment for the people who live there. Evidence: The home is decorated and presented in a homely way. We toured the home on the day of the site visit and were invited in to the bedroom of one of the people who live there. She told us she was happy with her room and it appeared to be well decorated and contained all her possessions. The home has a homely lounge which we saw the people who live there were happy to spend time in. The kitchen was open to all the people all the time. They freely went in there, made their own teas or coffees whenever they wished, supported by the staff, appropriately. Also a cleaning schedule is in place. Maidenhead and District Housing Association are the landlords for the home. Evidence was seen that they do undertake all the necessary electrical, gas and other safety checks within the home. Care Homes for Adults (18-65 years) Page 19 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Santa maria are well supported by appropriately recruited and trained staff. Evidence: The home has an NVQ training programm in place and six out of seven staff are qualified to NVQ level 2 or above. Information received from the home prior to the inspection stated that an induction and training programm was in place and during the site visit we saw evidence of the induction and training programm, which includes health and safety, first aid, fire safety, food hygeine, and training in the safeguarding of vulnerable adults. The exception is medication training which is referred to in section four above. Specialist training is also offerred for working with people with learning disabilities and staff spoken with confirmed they had access to appropriate training courses. An appropritae recruitment procedure is in place to safeguard the pople who live at the home. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well managed and provides positive outcomes for service users. Evidence: Santa Maria is operated by Atlas Project Team. A new manager commenced at the home in May 2008 but has not yet applied to be registered with the Commission. They are experienced and hold an NVQ level four and the registered managers award. On the day of the site visit the regional manager was present who explained that it was Atlas policy not to apply for registration for a new manager until they had successfully completed their six month probationary period. We advised that this is not good practice and recommended that the new manager applied to be registered. At the time of writing this report an application to register the new manager has still not been received. The home was also displaying an out of date registration certificate which had the previous managers name on it. We discussed this with the regional manager on the day of the visit. He believed that Atlas had notified the Commission of the departure of the previous manager and that Atlas had chased up the new certificate by telephone. He will write to us and send a copy of the previously sent letter to chase up Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: the new certificate. Santa Maria has a quality assurance process in place whereby a member of the head office visits the home monthly to conduct an audit which includes finances, fire prevention, medication records, accidents, staff and service user records, training and premises. An action plan for the manager then highlights any issues to be resolved. Service users do not take part in a formal quality assurance process but service user meetings and one to one discussions take place to ensure they are involved in the running of their home. Staff know them very well and understand their wishes. An annual development plan is produced. Santa Maria has in place appropriate health and safety and infection control policies and we saw evidence that staff receive training in these areas. 100 of staff have received training in food safety. Electric and other equipment is regularly checked in line with manufacturers recommendations. Water and fridge temperatures are monitored. A fire risk assessment is in place and the alarms were seen to be tested regularly. The home underwent a satisfactory environmental health inspection in August 2007. Care Homes for Adults (18-65 years) Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 The service user plans must be kept up to date. To ensure accurate information is available. 22/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 20 37 It is recommended that staff have access to an appropriate medication training course. It is recommended that the manager applies to register with the Commission as a matter of urgency. Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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