Inspection on 19/11/08 for St Andrews House, Exmouth

This inspection was carried out on 19th November 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Andrews House, Exmouth 01/08/06

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 30/01/2009.

CARE HOME ADULTS 18-65 St Andrews House, Exmouth St Andrews Road Exmouth Devon EX8 1AS Lead Inspector Vivien Stephens Unannounced Inspection 19 November 2008 10:00 th St Andrews House, Exmouth DS0000022035.V366605.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.V366605.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.V366605.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 278076 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.V366605.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st August 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. St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Several weeks before this inspection took place we asked the agency to complete an Annual Quality Assurance Assessment. The completed document gave us very good information about the way the home is run and the services they provide. We also asked the home to distribute survey forms on our behalf. We received four completed forms from people who use the service. Their responses have helped us to form the judgements we have reached in this report. This inspection took place over one day beginning at approximately 10.15am and finishing at approximately 5.30pm. The manager was not present at the time of this inspection and instead we talked to five project workers who were on duty that day. We also spoke to one of Christian Alliance Housing Association’s senior managers on the telephone. On the day of this inspection there were five people accommodated. One person was in hospital and we talked to the other four people during our visit. We also looked at the communal areas, kitchen, laundry, toilets and bathrooms, and two bedrooms. We looked at some of the records the home is required to maintain including assessment and care plan files, staff recruitment, training and employment records, medicine administration records, policies and procedures and health and safety records. What the service does well: The people who completed a survey form before this inspection told us they were happy with the service provided. One person said “St Andrews has an amazing team of staff – dedicated – supportive – caring – empowering. We are incredibly lucky. This is a true sanctuary – I’ve never been somewhere like it. It’s safe - warm – no-judgemental – non-threatening – they respect each individual’s rights and feelings and encourage you in every way…Thanks so much for Ruth and all the staff at St Andrews.” We found that the home takes great care to get to know people and to assess their needs before agreeing that the person can move in. Anyone who is interested in moving in is invited to visit as often as they want before deciding to move in. They can stay just for a night, or for a few nights, gradually building up the length of stay until they feel confident that the home will meet their needs. During this time the home gathers information and carries out an St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 6 assessment to make certain that the home is suitable. Short respite breaks can also be booked in advance. The home has helped people stay healthy, or improve their health by reminding and encouraging them to attend appointments for health check ups and appointments. A healthy and balanced diet is encouraged by offering carefully planned menus for evening meals and a good selection of foods for people to prepare their own breakfast, lunch and drinks and snacks throughout the day. Safe systems have been put in place to help people retain control of their own medicines wherever possible. If it has been agreed that the home should hold and administer the medicines on behalf of a person there are secure storage facilities and good recording systems in place. There is a satisfactory complaints system in place and people have been given copies of it. We saw clear evidence to show that complaints have been listened to and acted upon satisfactorily. The property has been well maintained and decorated throughout. The furnishings were of a good quality and all areas appeared comfortable, clean and safe. There is a peaceful and welcoming atmosphere. The staff team have received a good level of training on relevant topics including health and safety and nationally recognised relevant qualifications. There were sufficient staff on duty on the day of this inspection to provide support to people when requested. At the time of this inspection the registered manager had been absent for several months. A senior member of staff was acting as temporary manager, but she was not working on the day of this inspection. During the manager’s absence the staff team had coped well and we found they were positive and knowledgeable, and were able to answer most of our questions competently. We found that the home was well organised and daily routines ran smoothly What has improved since the last inspection? What they could do better: We found that the home provided a safe refuge for people during difficult times in their lives. However, we found it difficult to identify from the care plans what additional support the home offered to people that demonstrated that they provided more than supportive accommodation. We found that, while the care plans contained some information about each person, the use of standardised forms did not help the staff team to draw up a care plan that was meaningful St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 7 and helpful to both the individual and to the staff team. We talked to the staff (and the acting manager after the inspection) about ways the care plans could be expanded so that they explain how the staff should support people with the key problems they experienced in their daily lives. The care plans should provide a clear picture of the person, their personality, their background, and the support they expected to home to provide in order to help them work towards complete independence. While the home provides some structured activities each week, on most days we found that people living in the home had been left to organise their own daily lives and interests. The home is close to the local shops and seafront and people could easily go out to local clubs, groups, or local facilities if they wanted to, but this was often self-directed and depended on the motivation of the individual. While some group activities have been provided from time to time we felt the home could do more to help individuals find opportunities for personal development and to help them find interesting things for to do throughout the week. The home should review their policy on the safe administration of medicines to ensure it covers all stages of medicine ordering, receipt into the home, storage, administration, and disposal. The policy should be in line with current national good practice guidance. The records we saw did not provide evidence to show that the home had followed safe recruitment procedures before new staff began work. This potentially placed vulnerable people living in the home at risk of harm or abuse. The home must make sure they receive satisfactory confirmation that the person is of good character and entirely suitable for the job before the person is offered employment. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Quality in this outcome area is excellent. The home takes great care to get to know people and understand their needs, and to give people plenty of opportunity to visit and get to know the home before any decision to move in is made. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home gave us a wide range of information in their Annual Quality Assurance Assessment about the careful admission procedures they follow before a new person moves in. They told us – “Prospective service users are usually referred by their care manager. We send out an initial application form and request that this is returned with a current CPA care plan and risk assessment. Once we have these items we can then arrange an interview. We inform the service user that they may bring an advocate along with them. This is usually a family member, carer or care manager. The assessment that takes place follows the assessment of needs form. This gives the service user the chance to express their needs and what support they require. From this a support plan will be devised based on the support needs identified within the assessment.” St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 10 We also heard that people have been offered plenty of opportunities to visit and get to know they home before moving in. Some people have stayed for one day, then for two days, gradually building up to a longer term stay. The home also provides regular respite care for periods of approximately one week. We looked at four of the care plan files to find out what information the home had gathered before people had moved in. We found that the home had received a wide range of important and relevant information from the person, and from health and social care professionals, on all aspects of the person’s needs. Each person had been offered a copy of their assessment. We saw copies of letters that have been sent to people after their assessment to let them know if they could offer to accommodate them. The letter explained some of the most important conditions of their stay. They had also been given a contract of residence. St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is good. People usually receive excellent support from a skilled staff team and they are consulted and encouraged to make decisions about all aspect of their daily lives. However the care plans could give greater detail and explanation of the strategies and support methods that have been agreed to help people work towards complete independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the care plan files of the four people living/staying at St Andrews on the day of this inspection. Two people were there on a longer term basis and two people were there for respite care. We found that the home offered a safe and peaceful refuge where people could regain their health and self–confidence. The people who completed a survey form or talked to us during this inspection praised the skills of the staff team St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 12 for the wonderful support they have received. However, we found it difficult to see exactly how the staff achieved this from the level of information in the care plan files. We found that the home used the same care plan documents that were used for the supported accommodation units. The documents identified some basic needs and gave a brief outline of the support needed. However, the plans did not give a clear or detailed outline of each person’s typical daily routines or the support they wanted from the staff during their day. While the level of information in the plans may have been sufficient for someone who required a lower level of support, they did not give enough detail or explanation of the support needed by someone with a higher or more complex level of needs. In one file we found a short list of the person’s daily care needs and how the staff should offer support with those needs. This list was helpful and gave some information about the person’s preferred daily routines. Although perhaps this could have been expanded further. The other three files did not contain a similar list. We talked to each of the four people living at St Andrews to find out if the care plans were accurate, and if they had been agreed with each person. We found the four people had very different backgrounds, histories, needs, and interests. The plans did not give a clear description of each person’s personality, and we found it difficult to recognise each person from their care plans. We could see that people had been offered a copy of their care plans and assessment documents but most people had refused. This was documented in the files. The people we talked to said they had not seen a copy of their care plans. The plans did not give detailed explanations of any strategies the staff should follow to help each person with specific problems. We talked to the staff about the difficulties they faced when offering support to people who may be feeling upset, anxious or angry. The staff confirmed that at times it was difficult to deal with people in a consistent manner, and sometimes this caused them problems. The staff said they work closely with the community psychiatric nurses who visit regularly. We did not find any detailed advice or guidance from the community psychiatric nurses or other specialists on specific strategies to help people. We found that the staff team worked very closely together and there were excellent support systems and communication methods. Good practice and strategies for working with individuals were passed to each member of staff verbally through handover systems and also through detailed daily reports. Staff read the daily reports and the communication book each time they began a shift so that they were aware of any changes in current support needs. They did not rely on the care plans. People told us that they were able to lead their lives as they wanted and that the staff team were non-judgemental, supportive, and allowed them to make St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 13 choices in all aspects of their lives, although they gave advice and guidance when they felt it was appropriate. The home has recognised the importance of giving people choices and involving them in daily routines. There has been weekly residents’ meetings where people have been consulted on the day-to-day routines within the home, including menus. Residents were involved in the choice of colours and materials when the communal lounge and kitchen were refurbished. Each care plan file contained a risk assessment form. In some of the files the forms were blank. It was unclear if this was because no risks had been identified, or if the person completing the assessments had forgotten to fill out the forms. St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16, 17 Quality in this outcome area is adequate. The close proximity to local shops and facilities enables people to go out and about every day if they wish. People are generally left to organise their own daily lives and interests. Some group activities are provided from time to time but the home could do more to help individuals find opportunities for personal development and provide interesting things for people to do. People are encouraged to eat a healthy and balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is situated close to the centre of Exmouth and most people enjoy going out every day. The home is close to the shops, seafront and local transport facilities. The home told us in their AQAA that they provide information about local services, facilities and activities in the local community. St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 15 This is displayed on the board in the hallway. They also told us that people are given information on local transport services and helped to access concessionary deals if entitled. We heard that volunteers from the community assist with in-house activities, such as the coming carol service held annually at St Andrews. People have been encouraged to attend centres such as Meeting Street, the Open Door project and Age Concern. Group activities are generally organised for everyone living at St Andrew’s, including those people who are living in the supported accommodation. We found that people generally were left to organise their own daily lives and routines, although the staff were on hand to offer suggestions or guidance if requested. Each person has a key worker and they usually spend time together at least one day a week in a specific activity such as going out to a café or to a pub. One keyworker said she was going to a football match in the near future with the person she is linked to. The home holds weekly Residents’ Meetings where activities are discussed and planned. We also heard that they do not have a regular plan of activities but will often have ad hoc activities such as board games, gardening or arts and crafts. One person has been given specific responsibility for organising activities. The home had an activities file where activities have been recorded. We saw that group activities such as minibus trips that have been offered on average once a month and heard that these had been very successful. In addition the staff will often sit down with people during the afternoon or evening and play board games or sit and chat. The care plans we looked at did not clearly identify individual interests or explain how the staff will help people to develop new skills. None of the people living in the home had jobs, although one person talked about his hopes for employment in the future. We talked to the staff about how they could support people to work towards finding education, employment, or learn new skills. One member of staff has a qualification in nutrition and she explained how she has been helping people to improve their diet. She said that evening meals have been carefully planned to make sure they are varied and balanced. Menus for evening meals have been discussed every week in the Residents’ Meetings and the menus have been adjusted following suggestions from residents. Each person has been encouraged to help plan, prepare and cook at least one evening meal each week. People are expected to make their own breakfast and midday meals, and also their own drinks throughout the day. There were good stocks of foods in the kitchen giving people plenty of choice. St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 16 Two people we talked to said they felt the home provided very good food and they felt their health had improved as a result of having a better diet since moving in. St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. The home has maintained good relationships with external specialists and health professionals and they ensure that people receive the help, support and treatment they need. People are helped to retain control of their own medicines wherever possible. Safe systems are in place for those people who cannot manage their own medicines. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection none of the people living at St Andrews needed physical personal care. The staff we talked to said that if help is needed with physical tasks this will be provided by a domiciliary care agency. However, the staff will offer support and guidance on personal care if this has been agreed with the person through the assessment and care planning process. The staff explained how they remind people to take a bath or shower or to change their clothes. St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 18 All of the people living/staying in the home have been linked to local health services such as GP’s and dentists. The home does not provide counselling for people, and instead people usually receive this from external professionals and specialist organisations. People usually receive regular support from their local Community Psychiatric Nurses (often referred to as CPN’s). The CPN’s visit St Andrews on a regular basis and are well known to the staff group. We looked at the care plans to see if the home had recorded any advice or guidance they had received from the CPNs but we could not see any specific guidance. The home told us that if a person developed severe mental health problems they would contact the local mental health services crisis team. They also told us they would work with the individual to develop a crisis management plan. We talked to the staff team about the difficulties they faced where people had complex problems, and asked how they made sure they all worked in a consistent way. We heard that the staff work closely together and talk about the day-to-day difficulties they faced. However, we could not see detailed explanations in the care plans about strategies the staff should follow when they are guiding, supporting or advising people, or advice on when to refer to external specialists. (See also section 2 Individual Needs and Choices). The home expects people to arrange for their medicines to be packed in monthly monitored dosage blister packs supplied by one of the major pharmacies before they move in. This reduces the risk of having several different systems for medicine administration. Since the last inspection all staff have undertaken a training course on the safe administration of medicines. This is a distance learning course with a test at the end that has been marked by a trainer to check the person has understood the training they have received. We were also told that all staff are expected to complete a more intensive training course following nationally agreed standards as soon as a course can be arranged. We heard that new staff usually observe an experienced member of staff giving out medicines at least 3 times. After this they are observed by an experienced member of staff while giving out medicines at least 3 times before they are allowed to give out medicines on their own. The home had a policy on the safe administration of medicines. The policy contained some good instructions covering many aspects of medicine storage and administration. However, there were some areas not covered including receipt of medicines into the home, ordering new stocks, and checking the balances held at the end of each month. We talked to the staff about the places they can get further information from, including the CSCI website, and how this should be used to update their policies in line with national good practice guidance. St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 19 At the time of this inspection only one person had help from the staff team to administer their medicines. These medicines were held in lockable storage their rooms. The administration records were also kept in the person’s room and we did not see these. The other 3 people had complete responsibility for their own medicines. This represented good practice as we could see that the home recognised the importance of enabling people to retain independence and responsibility for their own medicines. The home has secure storage for medication if any person who moves in who is unable to hold their own medicines. At the time of this inspection the home held some medicines on behalf of people who were living in the supported living accommodation. We looked at these records and found they were generally well maintained. St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. The home has a satisfactory complaints system with evidence that complainant’s views are listened to and acted upon. While the home has some good measures in place to protect vulnerable people, poor recruitment procedures may place people at risk of harm or abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We found that the home had a clear and simple complaints procedure. People told us they felt confident they could speak to a member of staff or they could speak to their CPN or social worker if they had any concerns about anything relating to the home. We saw detailed records of the complaints and concerns raised by people living in the home since the last inspection. The records included details of the issue, the investigation process and a record of the outcomes. We were satisfied that the home had listened and taken all issues raised seriously. The complaints policy had good information on each stage of the complaints procedure. People have been given a handbook on admission, and the complaints procedure is included in this. At the time of this inspection no money was held on behalf people living in the home, with the exception of some cash held safely while one person was in St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 21 hospital. Safe and secure procedures had been followed in this instance. Each room had a lock on the bedroom door and also lockable storage in the room so that people could keep their money and belongings safe. We saw records that showed that staff have received training on POVA (Protection Of Vulnerable Adults). The recruitment files we looked at showed that the home has failed to check that prospective new staff are not on the Protection of Vulnerable Adults list (the checks are known as POVA 1st checks) before staff had been confirmed in post or started work. We heard that when staff were offered employment the home sent off a request for a criminal records bureau (CRB) check and that the staff usually started work before this check was completed. Although new staff initially worked alongside an experienced member of staff, vulnerable people may still be at risk of harm or abuse due to the home’s failure to receive confirmation that the person is entirely suitable for the work. We talked to a senior manager for the Christian Alliance Housing Association about the home’s recruitment practice. She said they had been unaware of the current nationally recognised standards on receipt of CRB and POVA 1st checks before new staff began work. We advised that the organisation must keep up-to-date with current guidance, including guidance provided by the Commission and the Criminal Records Bureau. St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area good. The home has been well maintained and has a good standard of decoration and furnishings throughout, and gives people a homely and comfortable place to live. All areas were clean and odour-free. This judgement has been made using available evidence including a visit to this service. EVIDENCE: St Andrews is a converted church within easy walking distance to the centre of Exmouth and the beach. The residential part of the home is on the ground floor and on the first floor there are bedsitting rooms for people who live more independently. There is also a bungalow next door providing supportive accommodation. People staying in the residential unit 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. During St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 23 our visit we saw two bedrooms, bathroom, shower room and toilet, the office, lounge, kitchen and dining room and the laundry room. We found all areas were in good decorative order, comfortable, homely and well maintained. The home employs cleaning staff to keep the communal areas clean. People living in the home were responsible for keeping their own rooms clean (with support and guidance from the staff if needed). People were also responsible for doing their own laundry. There was a domestic washing machine and tumble drier, and also washing lines outside if people wanted to dry things naturally. We found all areas were clean, tidy and free from any odours. St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is good. People are supported by a well-trained and competent staff team, although recruitment methods have not followed nationally recognised standards. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of this inspection there were 5 support workers and one cleaning staff working across the three units. The staff team were relaxed and cheerful and there was evidence of good teamwork and good communication systems. We looked at the recruitment files of four staff who had been recruited since our last inspection. We found that in three of the files there was just one reference and in one file there were no references. (We expect employers to obtain at least two satisfactory written references before applicants are offered a job). We saw that the home had obtained criminal record bureau (CRB) checks on each member of staff but these had not been received until after they had started work. (We expect employers to wait until they receive a St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 25 satisfactory CRB before new staff begin to work directly with vulnerable people). At the time of this inspection the manager had been absent from the home for several months and so we spoke on the telephone to her line manager to discuss the recruitment procedures in the home and to check that the records we saw at St Andrews were complete and what we saw was correct and no other documents had been filed elsewhere. She said that they had a clear policy that stated they must always obtain at least two satisfactory references before new staff were recruited in post and agreed to check the recruitment records to find out the correct position. She also said that the CRB’s usually took several weeks to be processed and they were unable to wait for these and so they usually started new staff while waiting for these. New staff always shadowed an experienced member of staff for several weeks. (See also Complaints and Protection). The staff we spoke to confirmed that all new staff have received thorough induction at the start of their employment. We also saw training records that showed that staff had received regular training and updates on all mandatory health and safety topics. The staff team have a wide range of experience and qualifications including a trained psychiatric nurse, staff trained to BA level in Social Sciences, English and Sociology. Several staff have studied, or are currently studying the Open University Certificate in Health and Social Care. One member of staff has been studying for the certificate in Abnormal Psychology. Over 50 of the staff team have nationally recognised qualifications to at least NVQ level 2 or equivalent. The records we saw showed that staff team have received regular supervision. Two people we talked to during this inspection told us they were very happy with the level of support they received from the staff team. One person who completed a questionnaire told us “St Andrews has an amazing team of staff – dedicated – supportive – caring – empowering. We are incredibly lucky. This is a true sanctuary – I’ve never been somewhere like it. It’s safe - warm – nojudgemental – non-threatening – they respect each individual’s rights and feelings and encourage you in every way…Thanks so much for Ruth and all the staff at St Andrews.” St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. The home is generally well organised and runs smoothly, although the registered manager has been absent for several months leaving the remaining staff team to cover most of the management tasks between them. People’s views have been actively sought to check that the home continues to provide a good quality of services. The home has taken a range of measures to minimise the risk harm to people’s health and safety. This judgement has been made using available evidence including a visit to this service. St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 27 EVIDENCE: The registered manager of the home has been absent since July 2008. On the day of this inspection there was no senior person in charge of the home. Despite this we found that the home was calm and the staff team were positive and appeared to be coping well. The staff team were able to answer most of our questions confidently and we found that they worked well together to make sure that daily routines continued to run smoothly. The staff team had worked together to complete our Annual Quality Assurance Assessment (AQAA) while the manager was absent. They gave us lots of information about they way the home operates and demonstrated they had a good understanding of many of the management routines within the home. The home has consulted with people living or staying in the home in a variety of ways to seek their views on the way the home is run. The home told us in their AQAA “There is continuous self monitoring, using an objective, consistently obtained and reviewed and verifiable method and using service users, in linkwork meetings, residents meetings, exit questionnaires, residents consultations and CSCI forms. CAHA undertakes an internal linkwork audit each year, reviewing linkwork practice, and interviewing residents and staff. The registered manager and staff can demonstrate year on year development for each service user, linked to implementations of their individual support plan Feedback is actively sought from service users, through informal contact, linkwork meetings, residents meetings, exit questionnaire, residents consultation and CSCI forms. The views of family, friends and advocates and of stakeholders in the community are sought on how the home is achieving goals for service users through informal verbal contact, and CSCI questionnaires. All CAHA policies, procedures and practices are regularly reviewed in the light of changing legislation and good practice advice form the Department of Health, local health/authorities and specialist/professional organisations. A recent example of this is the new smoking legislation which means residents cannot smoke within the home and a new outdoor smoking area has been established.” We saw recording systems and received evidence through the AQAA that the home has taken good measures to protect the health and safety of everyone living and working in the home. This included good training for all staff, a range of policies and procedures, regular servicing and maintenance of equipment, and good risk assessment procedures. We checked the fire log book and found that regular checks and maintenance has been carried out on St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 28 all fire safety equipment and regular fire drills and training have been provided. St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 29 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 3 2 x LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 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.V366605.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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 YA6 Regulation 15 Requirement Timescale for action 01/01/09 2 YA23 19 Sch 2 Each care plan must clearly explain how staff are expected guide and support the person with their daily social, emotional and physical needs. The plans must give enough detail to ensure all staff work in a consistent manner and fully understand the support and assistance each person needs and wants with their daily lives. You must receive at least two 01/01/09 satisfactory references and a satisfactory Criminal Records Bureau (CRB) check before any new staff are confirmed in post. These measures are necessary in order to protect vulnerable people from harm or abuse. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 31 1 2 YA9 YA11 3 YA20 The home should assess and document any potential risks each person may face, and any strategies that have been agreed to minimise or eliminate those risks. The home should review the level of support they give people to help them lead an interesting and stimulating lifestyle. The home should identify each person’s goals and help them work towards further education, obtaining a job, or developing new skills or interests. The home should also consider ways of increasing the level of regular organised activities they provide on an individual or group basis. The home should review their policy on the receipt, storage and administration of medicines to ensure it covers all aspects of medications in line with national good practice guidance. St Andrews House, Exmouth DS0000022035.V366605.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: 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 © 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.V366605.R01.S.doc Version 5.2 Page 33 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!