CARE HOME ADULTS 18-65
St Andrews 24 St. Andrews Road Paignton Devon TQ4 6HA Lead Inspector
James Rose Unannounced Inspection 1st March 2007 09:00 St Andrews DS0000018429.V330842.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 DS0000018429.V330842.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 DS0000018429.V330842.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Andrews Address 24 St. Andrews Road Paignton Devon TQ4 6HA 01803 559545 01803 391582 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) Mr John Davies Mrs Paulette Davies Vacant Care Home 21 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (21), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (21) St Andrews DS0000018429.V330842.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A Manager to be registered by 15th June 2004 Date of last inspection Brief Description of the Service: St Andrews is a care home for up to 21 younger or older adults with mental health needs. The building is situated in a residential area of Paignton, within walking distance of the sea front, shops and amenities. There is level access through a small front garden, with one step inside the lobby area to access the house. There is also a concreted area and lawn to the back of the home. The home has a lower ground, ground, first and second floor with stairs throughout. This may cause difficulties for residents with mobility problems, as there are no bathing/shower facilities on the ground floor. An external fire escape connects all floors. On the lower ground floor there is a laundry, storeroom, bedroom, shower/bathroom, and lounge/staff sleep-in room. On the ground floor there are bedrooms, a kitchen, toilet, office, dining room and lounge. The first floor has a shower room, bathroom, and bedrooms, and on the second floor there are bedrooms and a toilet. Two of the bedrooms are shared by two residents. One bedroom currently being used by a resident is under 10sqm, when this resident leaves the home the use of this room must be reviewed. The costs per week for residential care at St Andrews are: Lowest £257.00 and the highest £1064.00. St Andrews DS0000018429.V330842.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken over three visits, 12.5 hours in all, during March 2007. Evidence was also obtained from three healthcare professionals, from psychiatric services and doctors that provide a service to the home. Samples of the care records were examined and a complete tour of the building was undertaken and observations were also made during the inspection process of the way care was delivered to residents. Three residents were consulted individually in private and other were seen in a group. Three of the care team were also interviewed and the proposed registered manager assisted the inspectors throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better:
It was disappointing to note at this inspection that the effort to manage the home made by the proprietor had not been sustained. Time was taken at the
St Andrews DS0000018429.V330842.R01.S.doc Version 5.2 Page 6 last inspection to draw the proprietor’s attention to the need for comprehensive risk assessments and it was understood that these matters would be attended to, this has not been achieved and consequently appropriate solutions have not been found and residents remain at risk. The requirement raised in earlier reports concerning the need for comprehensive risk assessments for residents has been repeated in this report. Residents and members of the care team complained of interference by one of the proprietors to the normal planned running of the home and the repeated use of obscene language. Clearly this is unacceptable. The care planning processes undertaken by the home are being developed further by the proposed registered manager, this process has been undertaken with little support and fundamental issues have been missed. Detailed health needs have been included, however, personal and social care needs must also be developed to enable the home to provide a comprehensive service to residents that meets the legislation. The activities programme undertaken by the home on an individual basis must be part of the care planning undertaken and appropriately recorded. A specialist member of staff was recruited to provide activities for residents but was only at the home for a very short time and the post had not been readvertised at the time of this inspection. The home currently has no cleaners and the cook had resigned. The care team is undertaking all these tasks at present. The home had employed a member of staff to provide care in the home without having a personnel file available and none of the required checks had been undertaken. A requirement has been raised in this report to ensure appropriate care is undertaken when staff are employed and residents are in safe hands. When the care planning has been completed a review should be undertaken to ensure the staff hours available could provide an appropriate service to the residents. St Andrews DS0000018429.V330842.R01.S.doc Version 5.2 Page 7 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 DS0000018429.V330842.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 DS0000018429.V330842.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): 2. Quality in this outcome area is adequate. Assessments are in place for the residents currently in the home. This process will need to be developed further when the home assesses new residents to ensure all needs are covered. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No new residents have been admitted into the home since the time of the last inspection. The way assessments were undertaken was discussed with Mr Davis at the last inspection and it was agreed that the approach would be developed further to cover all needs. This has not yet been achieved. St Andrews DS0000018429.V330842.R01.S.doc Version 5.2 Page 10 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 and 9. Quality in this outcome area is poor. Residents advised that their needs were in their care plans that they signed for and were reviewed. Assistance and support is provided where needed to residents to help than make decisions. The risk assessments approach in place in the home continues to be inadequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the time of the last inspection a proposed registered manager has been employed in the home and she has introduced a new care planning process. Samples of these documents were examined and some clear deficits were seen. Health needs were covered in a comprehensive way but personal and social needs require development for the care plan to be able to inform an appropriate service to the individual resident. Little development work has been undertaken by Mr Davis on the necessary risk assessment which was an understanding reached at the last inspection and recorded in the last report.
St Andrews DS0000018429.V330842.R01.S.doc Version 5.2 Page 11 It is now understood that the new care plans and risk assessments are going to be undertaken by the proposed new registered manager and the Community Psychiatric Nurse that provides a service to the home. It was also agreed that residents in the home would be reassessed by the psychiatric services to ensure that they are appropriately placed in a social setting. St Andrews DS0000018429.V330842.R01.S.doc Version 5.2 Page 12 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): 12, 13, 15, 16 and 17. Quality in this outcome area is poor. The opportunities for personal development and appropriate activities are limited. Residents who are able use the facilities of the local community and are able to take part in personal and family relationships. The rights of residents are respected, however, this is an area that should be developed further by the home. The meals provided were to the liking of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The new care planning documents that are being developed by the proposed registered manager and the community psychiatric nurse are going to include activities and opportunities for personal development for residents on an individual basis. Residents are able to use the facilities provided in the local community and can come and go as they wish. The home has an unrestricted visiting policy and procedure in place and residents confirmed that they could have visits anytime during the day.
St Andrews DS0000018429.V330842.R01.S.doc Version 5.2 Page 13 It was clear from observations made during the inspection process of the way care was delivered by the care team that residents were respected and support was provided in a sensitive way. One resident said, “They staff will always help me” another remarked “I can always get help if things go wrong”. One resident complained that the proprietor used obscene language in the home to staff. Since the last inspection the cook for the home has resigned her post and has not been replaced. Currently this task is being undertaken by care staff. A daily menu system is in place and residents can see what foods are available from a notice on the dining room wall. At the time of the inspection the home was well stocked with food products and fresh produce was delivered on a regular basis. The residents consulted advised that they liked the food at the home. St Andrews DS0000018429.V330842.R01.S.doc Version 5.2 Page 14 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 and 20. Quality in this outcome area is adequate. Residents receive personal support in a way that they preferred. Physical and emotional needs are met. Residents who are able can self medicate subject to a risk assessed approach to ensure they have the capacity. The administration of medication undertaken by the home ensures residents are appropriately protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was clear from observations made during the inspection that care was delivered to residents in they way that they preferred and residents confirmed this when asked. For an informed judgement to be reached concerning the emotional support of residents the care planning approach needs to be completed with the emotional support expressed in detail. Therefore the judgement that has been expressed above is provisional only. Residents who wish to self medicate are able to do so subject to a risk assessed approach undertaken to ensure they have the capacity.
St Andrews DS0000018429.V330842.R01.S.doc Version 5.2 Page 15 The administration of medication records maintained by the home were examined at this inspection. They were found to clear and up to date, medication was booked in when received, recorded appropriately when issued and a record was maintained of the return to the pharmacist of any unused medication. It was understood at the time of the inspection that the proposed new manager monitored these processes on a daily basis. Medication that required low temperature storage was kept in the kitchen in a fridge that was unlocked, at the time of the inspection. This was discussed with the proposed registered manager and the fridge was recited in a locked office, thus providing the necessary security. All other medication was stored appropriately. St Andrews DS0000018429.V330842.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate. Residents advised that they felt their views were listened to and acted on by the staff team. The home has an adult protection policy and procedure and carers are trained in its use. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents that were consulted in private and as a group during the inspection advised that they felt the staff team listened them to and that their concerns were taken seriously and acted on and resolved for them. The home has an adult protection policy in place and carers were trained in its use. Three carers were interviewed during the inspection and all were aware of the different types of abuse and what action should be undertaken if abuse was discovered in the home. St Andrews DS0000018429.V330842.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is adequate. St Andrews provides a comfortable safe environment for the residents who live there. The home was clean with reasonable standards of hygiene apparent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home was undertaken as part of the inspection process and all rooms were seen. Several bedrooms had been redecorated since the time of the last inspection and residents had been given new bedding; in general the home provided an appropriate environment for the residents. It is acknowledged that the tiling work that was outstanding at the last inspection had been completed. At this inspection a large quantity of paint had been spilt over carpet in the home, it was understood, that this was about to be replaced. The residents that were consulted advised that they liked their rooms and liked the facilities provided in the home.
St Andrews DS0000018429.V330842.R01.S.doc Version 5.2 Page 18 St Andrews DS0000018429.V330842.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is poor. The care staff team in the home is competent and is effective in supporting the residents. The home’s recruitment policy is appropriate but the practices undertaken do not protect residents. Staff are appropriately trained but operated with incomplete care plans. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three members of the care team were interviewed individually and in private as part of the inspection process. They were all appropriately qualified and clearly knew their role in the home. They spoke of the interference to the normal running of the home by one of the proprietors and the bad language that had been used. They also explained that there was now no domestic staff employed and that these tasks were covered by them and the cooking since the cook resigned. The activities person had also been at the home for a very short time and had also not been replaced. There are clear deficits from the staff team that used to be employed by St Andrews and all these tasks are now covered by the limited care team. On completion of the new care plans a review should be undertaken to ensure that there are sufficient hours provided to ensure that residents needs are appropriately met.
St Andrews DS0000018429.V330842.R01.S.doc Version 5.2 Page 20 It is a matter of concern that the Commission was informed that one of the proprietors cut care staff hours recently and then reinstated them. This does not provide a stable environment for the residents who have already had lots of changes and suffer their own mental health issues. It was found at this inspection that the home had employed a carer to complete shifts in the home with no checks having been undertaken, a clear breach of the legislation. The requirement for the home to undertake these checks was well known to the proprietors, as it has been an issue in the past. A requirement has been raised to ensure that the home does not employ a carer in the home until they have satisfied the legislation to ensure residents are safe. The training programme that was in place at the time of the last inspection is currently being modified and updated by the proposed registered manager. St Andrews DS0000018429.V330842.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is poor. At the time of the inspection the residents do not benefit from the ethos, leadership and management approach of the home. The review and development of the home is currently in flux. In general the health and safety and welfare of residents is not currently sufficiently promoted by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The proposed registered manager has embarked on a new comprehensive care planning approach for each individual resident. The new plans contain detailed health needs but need the addition of personal and social needs. The proprietor has provided little support. The development of the plans was discussed during the inspection and it has been agreed that the care planning approach will be undertaken by the proposed manager and the community psychiatric nurse who knows the residents well and this will ensure that all needs are met. St Andrews DS0000018429.V330842.R01.S.doc Version 5.2 Page 22 Residents had confidence in the new proposed manager and felt that their interests would be taken into account in the future development of the home. The health and safety recording undertaken by the home was examined at the inspection. The fire precautions undertaken were clear and up to date. Currently the management are considering how to proceed with the issue of smoking in the home. Appropriate recording was available of the testing of electrical appliances and the electrical installation in the home. The understanding given by Mr Davis at the last inspection that the risk assessments for residents would be completed has not been achieved. These must be completed without delay. The effort that was being made to manage the home appropriately by the proprietor has not been sustained. The proposed manager has made some progress but a substantial task remains. Against this background there is interference by the other proprietor with no discernable gain achieved for the residents or the home. St Andrews DS0000018429.V330842.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 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 1 13 2 14 X 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 1 X 3 X X 1 X St Andrews DS0000018429.V330842.R01.S.doc Version 5.2 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13 (4) Requirement Residents must have comprehensive risk assessments, signed and agreed by them and reviewed regularly (Previous timescale 26/09/05 20/01/06 - 04/07/06 - 31/08/06 14/11/06 not met) Timescale for action 30/04/07 2. YA6 15(1) 3. YA34 19(1) The registered provider must produce comprehensive care plans that contain all the needs of residents in the areas of health, personal and social. The registered provider must ensure that all the issues covered in Schedule 2 are undertaken for each staff member. 30/04/07 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. St Andrews DS0000018429.V330842.R01.S.doc Version 5.2 Page 25 No. 1 Refer to Standard YA33 Good Practice Recommendations It is recommended that an urgent review should be undertaken to ensure there are sufficient care hours available to meet all the residents’ needs in the home. St Andrews DS0000018429.V330842.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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
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