Inspection on 01/08/06 for St Andrews House, Exmouth

This inspection was carried out on 1st August 2006.

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 Andrews House, Exmouth 19/11/08

St Andrews House, Exmouth 25/01/06

St Andrews House, Exmouth 26/07/05

St Andrews House, Exmouth 10/01/05

St Andrews House, Exmouth 22/09/04

St Andrews House, Exmouth 25/03/04

Similar services:

Clouds House

Trevaylor Manor

Closereach

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

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

CARE HOME ADULTS 18-65 St Andrews House, Exmouth St Andrews Road Exmouth Devon EX8 1AS Lead Inspector Sue Dewis Key Unannounced Inspection 01 August 2006 10:00 St Andrews House, Exmouth DS0000022035.V307830.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 St Andrews House, Exmouth DS0000022035.V307830.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. St Andrews House, Exmouth DS0000022035.V307830.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Andrews House, Exmouth Address St Andrews Road Exmouth Devon EX8 1AS 01395 223737 01395 223536 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) Christian Alliance Housing Association Mrs Ruth Brinsden Care Home 6 Category(ies) of Past or present alcohol dependence (6), Past or registration, with number present drug dependence (6), Mental disorder, of places excluding learning disability or dementia (6) St Andrews House, Exmouth DS0000022035.V307830.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th January 2006 Brief Description of the Service: St. Andrews is one of more than 20 projects managed by Christian Alliance Housing throughout the United Kingdom and is registered to care for up to six adults who may be suffering from past or present mental illness, drug or alcohol dependency and find themselves in a position where they can no longer live alone. The property is a converted former church in a central residential area of Exmouth. The residential home is situated on the ground floor of the building. All rooms are for single occupancy. There is a communal smoking room, lounge, kitchen and dining room. There is also a small laundry for residents use. There are car-parking facilities on site. Also managed on the same site, but physically separated, are two sheltered housing units - one on the first floor of the main building and one in an adjacent bungalow. CSCI reports are available on request from the office. The fees for accommodation at the home are £390.14 per week and do not include, hairdressing, transport, outings and activities. St Andrews House, Exmouth DS0000022035.V307830.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day in early August 2006. The home had been notified that an inspection would take place within three months and had returned a pre-inspection questionnaire, information from which was used to write this report. During the inspection 3 residents were case tracked. This involves the inspector looking at the residents’ individual plans of care, and speaking with the resident and staff who care for them. This enables the Commission to better understand the experience of residents living at the home. Comment cards were sent out to 4 residents, 12 staff, 4 GPs and seven health and social care professionals. At the time of writing the report replies had been received from 4 residents, 4 staff, 2 GPs and 4 health and social care professionals. Three residents and three staff were spoken with as well as the manager of the home. A variety of records were sampled including residents’ care plans, staff files and the fire log book. What the service does well: The home continues to provide a safe environment for residents in which they can gain independent living skills. Residents are encouraged and enabled to take part in a wide range of activities within the home and the local community. There is a good care planning system in place that gives staff the information that they need in order to care for the residents without limiting their independence. Records are well maintained and staff recruitment and training ensure that residents are protected from abuse. One resident told the inspector that they thought the staff worked at the home ‘entirely for us’, and comment cards received from all connected with the home indicated that they were entirely satisfied with the care that is received. St Andrews House, Exmouth DS0000022035.V307830.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Andrews House, Exmouth DS0000022035.V307830.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 St Andrews House, Exmouth DS0000022035.V307830.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are assured that their care needs can be met. EVIDENCE: The files of three residents were inspected. All contained detailed preadmission assessments that included budgeting skills, training and employment, physical limitations , future aspirations and culture and faith. Following on from this initial assessment, residents visit the home and the process of assessment is continued. All three residents were spoken with and all told the inspector that they had known about the home and had visited prior to their long-term admission. St Andrews House, Exmouth DS0000022035.V307830.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear and consistent, resident involved system in place, which provides staff with the information they need, in order to satisfactorily meet the needs of the residents and minimise environmental and situational risks. EVIDENCE: Three residents’ care plans were inspected. All three contained evidence of regular review and resident involvement. Care plans are drawn up based on the pre-admission assessments and contain a support plan which sets out how identified support needs will be met. Identified needs included managing money, personal hygiene and laundry, and the plans give clear step by step instructions to staff on how the support is to be given to the resident. The individual care plans include behavioural management guidelines for residents who are likely to become aggressive or St Andrews House, Exmouth DS0000022035.V307830.R01.S.doc Version 5.2 Page 10 self-harm. These have been compiled with consultation and advice from other professionals, such as psychologists and nurse specialists. Support sessions are held as required and the plan is reviewed when necessary. There were good daily records maintained including activity and contact sheets. Residents were aware of their care plans and told the inspector that they are fully involved in setting their goals. Residents are encouraged to be as independent as possible and some previous residents have moved on to move independent living. Detailed risk assessments are completed and look at areas such as self-harm, emotional wellbeing and alcohol use. A risk management plan is then completed for any risks that have been identified as either medium or high and shows what impact the risk would have and any control measures put into place. St Andrews House, Exmouth DS0000022035.V307830.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a variety of activities and occupations. Links with the community and family are good, enriching residents’ social life. Meals are nutritious and balanced and offer a healthy and varied diet for residents. EVIDENCE: St Andrews House, Exmouth DS0000022035.V307830.R01.S.doc Version 5.2 Page 12 Residents told the inspector that they are encouraged and supported to take part in activities. Currently residents attend Quiet Mind Centre, Exmouth Adult Community College, Age Concern and Bell Industries. A computer is available at the home for residents use. The manager and service users confirmed that they have good relations with the local community. A notice board in the entrance hall displays local events, and residents are encouraged to develop activities away from the unit. Residents told the inspector that they using local facilities and local transport and often go shopping in the town. Residents are encouraged to maintain contact with friends and family, and visitors are always made welcome, except where restrictions have been agreed and recorded in their care plan. Two service users spoke about visiting their families. One resident told the inspector they were looking forward to the holiday they would be taking in Okehampton with the home. All residents have keys to their rooms, and doors are kept locked, affording them privacy and “ownership”. Residents said that staff respected their privacy at all times and did not enter their rooms without permission. Regular residents’ meetings are held during which menus are discussed, amongst other things. Residents are encouraged to shop, plan and prepare their own breakfast and lunch. Residents eat together for the evening meal and each resident takes it in turn to prepare and cook the meal. St Andrews House, Exmouth DS0000022035.V307830.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have a good understanding of the residents’ personal support needs, and residents benefit from the positive relationships they have with staff. The health needs of residents are well met with evidence of good multidisciplinary working taking place on a regular basis. Though the systems for the administration of medications are generally good, training could be improved. EVIDENCE: The manager, staff and three residents confirmed that there is complete flexibility in relation to daily routines at the home. The home does not provide any physical personal care to residents. One resident who needs help with physical tasks, receives this from a Domiciliary Care Agency. Records show that resident’s health is closely monitored. Healthcare visits take place at the GP surgery and this was confirmed during discussions with a St Andrews House, Exmouth DS0000022035.V307830.R01.S.doc Version 5.2 Page 14 resident and staff. The home has close links with Community Psychiatric Nurses and GP’s. Medication was stored appropriately and securely. Good records are maintained of all medications received, administered and leaving the home. Some medication is written on to the medication administration records. When this happens two people sign now to agree that the prescription has been checked and that the written directions are correct to maintain residents safety. The pharmacy carries out 6-monthly checks and regular training for staff. Though the home provides in-house training for staff in relation to the safe handling and administration of medicines they do not receive accredited training. Some residents currently look after their own medication. The decision as to whether a resident looks after their own medication is based on individual needs and abilities to undertake the task. Residents are always involved in this decision-making process as well as their care manager and link worker. St Andrews House, Exmouth DS0000022035.V307830.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system with evidence that complainant’s views are listened to and acted upon. Staff training and financial recording practices ensure residents are protected from abuse. EVIDENCE: There is a clear and simple complaints procedure for the home. Residents told the inspector that they would speak to a member of staff or the manager if they were unhappy about anything. The home keeps excellent detailed records of complaints and concerns raised by residents. The records include details of the issue, the investigation process and a detailed record of the outcomes. The complaints policy had good information on each stage of the complaints procedure. Residents are given a handbook on admission, and the complaints procedure is included in this. Small amounts of money are held on behalf of one resident and this is managed appropriately. All three staff spoken with had received training in POVA (Protection Of Vulnerable Adults) issues and were able to describe to the inspector what action they would take if they suspected abuse was occurring. All three staff St Andrews House, Exmouth DS0000022035.V307830.R01.S.doc Version 5.2 Page 16 said that they would have no qualms whatsoever on reporting any bad practice that witnessed. St Andrews House, Exmouth DS0000022035.V307830.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 24, 28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good standard of décor throughout, and therefore presents as an entirely homely and comfortable environment for residents. All areas were clean and odour-free. EVIDENCE: St Andrews House, Exmouth DS0000022035.V307830.R01.S.doc Version 5.2 Page 18 St. Andrews is well located, close to shops, beach, and local facilities. There are three separate units in the building, the home is situated on the ground floor, a more independent unit on the first floor, and a sheltered housing unit attached to the building. Residents accommodated in the registered unit downstairs can visit the unit upstairs for leisure activities such as pool or art if they wish. However, the occupants of the upstairs unit may only visit the ground floor if they are invited. All areas were bright, clean and well and tastefully decorated. The decor, furnishings and fittings are contemporary in design and create a warm, friendly and homely atmosphere. The home has a good budget for cyclical maintenance and decoration. A record is kept confirming that all routine maintenance has been carried out as required. Level access is provided throughout the ground floor and there is a passenger lift to the first floor. St. Andrews does not employ domestic staff; all residents, assisted by staff as necessary are responsible for keeping the home clean. All areas of the home were free from offensive odours at the time of the visit. There is a small laundry, which has impermeable floor covering and washable walls. It is fitted with a domestic washing machine and tumble drier. The home does not require a sluice. There is a detailed infection control policy for the home. St Andrews House, Exmouth DS0000022035.V307830.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are appropriate to meet the needs of the residents. Training arrangements for staff are good and the provision of some specialist training ensures staff are kept up to date with best practice in the area of mental health. The procedures for the recruitment of staff are robust and offer protection to residents. EVIDENCE: The home has a stable team and uses minimum agency and bank workers. Residents confirmed that there are always enough staff on duty to meet their needs. The staff team covers the entire St Andrews project and the staff hours available to the care unit are flexible depending on the needs of the residents. Regular staff meetings are held at St Andrews. St Andrews House, Exmouth DS0000022035.V307830.R01.S.doc Version 5.2 Page 20 Staff confirmed that there is a good induction programme provided by Christian Alliance. The manager told the inspector that she has been told the induction programme meets the Sector Skills Council specifications. Three staff files were inspected, including the most recently appointed. All three files contained evidence of proof of identity, CRB (Criminal Records Bureau) checks and two written references. The home has a dedicated training budget that provides staff with at least 5 paid days training per year. Staff spoken with confirmed that there are excellent training opportunities. This was also evident in staff files. The inspector was told that staff training needs are assessed as a whole, through regular staff and management meetings, and individually, through supervision. St Andrews House, Exmouth DS0000022035.V307830.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and this results in practices that promote and safeguard the health, safety and welfare of the residents. There is a good quality assurance system in place that ensures that the standard of care is monitored. EVIDENCE: The registered manager has many years of experience working as a manager in the care setting and has achieved NVQ level 4 in management and care as well as the Registered Managers Award. She attends all training sessions available to staff. Staff and residents told the inspector that they felt she was approachable and would listen to them if they had any concerns or suggestions. St Andrews House, Exmouth DS0000022035.V307830.R01.S.doc Version 5.2 Page 22 The home has quality assurance systems in place that are based on a systematic cycle of planning, reviewing and setting targets. Residents occasionally attend staff meetings and have some input into the selection of staff. The pre-inspection questionnaire provided evidence that St Andrews complies with health and safety legislation in relation to maintenance of equipment, storage of hazardous substances, health and safety checks and risk assessments. The fire logbook, record of fire safety training and accident and incident records were found to be accurate and up to date. Restrictors are fitted to windows above ground floor level and risk assessments in relation to radiator guards are completed for individual residents. St Andrews House, Exmouth DS0000022035.V307830.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 3 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 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X St Andrews House, Exmouth DS0000022035.V307830.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 YA20 Good Practice Recommendations You are recommended to ensure staff receive accredited training in relation to the administration of medicines St Andrews House, Exmouth DS0000022035.V307830.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Andrews House, Exmouth DS0000022035.V307830.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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