CARE HOME ADULTS 18-65
St Andrews 24 St. Andrews Road Paignton Devon TQ4 6HA Lead Inspector
James Rose Unannounced Inspection 10th October 2006 09:20a St Andrews DS0000018429.V310329.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.V310329.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.V310329.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.V310329.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 16th May 2006 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. St Andrews DS0000018429.V310329.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place during October 2006; one visit was made to the home and evidence was also obtained from three healthcare professionals, from psychiatric services, one of the doctors that provides a service to the home and the district nursing service. Samples of the care records were examined and a complete tour of the building was undertaken, observations were also made during the inspection process of the way care was delivered to residents. Four residents were asked for their views of the service they received and three carers were also interviewed. The inspectors were assisted throughout by Mr J Davies the proprietor. What the service does well: What has improved since the last inspection?
Since the time of the last inspection a substantial effort has been made by the home to meet the national minimum standards and to provide an appropriate service to the residents. Requirements were raised at the last key inspection and the additional visit, these have received serious attention and good progress has been achieved. The requirement calling for all residents to have a contract and for that contract to be signed by them to demonstrate agreement has been satisfied. Assessments have been given attention and although there continues to be some work to be completed, the requirement has been met.
St Andrews DS0000018429.V310329.R01.S.doc Version 5.2 Page 6 Care plans are now in place for each person receiving a service at St Andrews, these are reviewed appropriately and have been agreed with the residents concerned. The home is providing more social care with regular trips out undertaken with residents. It is acknowledged by Mr Davies that this element of the service is not complete and it is going to be developed further when a new manager is in post, which is understood to be within the next few weeks. The administration of medication in the home was much improved with, in general, appropriate records maintained. The requirement calling for complete staff records to be maintained has been satisfied and regular supervision of carers is undertaken and recorded. A complete appropriate system of quality assurance is being activated in the home by Mr Davis at the time of this inspection. The Commission has received a complete set of accounts since the last inspection and these demonstrate that the financial position of the home is sound. The outstanding work to be undertaken in the laundry has been completed. The home has given serious consideration to the recommendations made in the last report and they have been adopted. What they could do better:
The administration of medication in the home is much improved as previously stated. However, the code system has been used inappropriately and clear instructions concerning a prescription must be available. These matters have been discussed with Mr Davies who understands why the requirement has been repeated here. St Andrews DS0000018429.V310329.R01.S.doc Version 5.2 Page 7 The limited risk assessments that are available in the home are not comprehensive or appropriate. Risk assessments should state what the hazards are and demonstrate an analysis of the issues with options and then a judgement should be made. The requirement concerning the need for comprehensive risk assessments has been repeated again. The Commission acknowledges that a serious effort has been made by the home to meet the requirements of the last report. Some of the current missing details regarding the service have been discussed with Mr Davis, the proprietor, who has advised that he agrees with the points raised and will ensure that the development work is undertaken. He is about to appoint a new manager for the home, within the next few weeks who is experienced and will be in a position to improve the service offered further. 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 DS0000018429.V310329.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.V310329.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 The performance in this group is adequate. Detailed assessments are available for all residents in the home. A contract is available for each person receiving a service in the home that has been signed by them. EVIDENCE: A contract is available for each person that details the service to be provided by St Andrews. Four of these were examined in detail and these had all been signed to demonstrate the residents’ agreement. Assessments were now in place for all residents. Four of these were examined in detail and they clearly showed that needs had been addressed in the areas of health, personal and social. These were discussed in detail with Mr Davies and he has agreed that some further development would be undertaken to improve the quality and detail of the needs expressed. This position is much improved from the last inspection. St Andrews DS0000018429.V310329.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 The performance in this group is poor. Residents advised that their needs were in their care plans that were reviewed and signed by them. Assistance is provided where needed to residents to help them make decisions. The risk assessments processes in the home continue to be inadequate. EVIDENCE: The care planning processes undertaken by the home are much improved since the time of the last inspection. Residents health, personal and social needs are addressed. The quality of the of the care planning was discussed in detail with Mr Davis who has undertaken to improve the overall recorded quality which will better reflect the service actually provided to individuals. Four care plans were examined and discussions took place with the individuals concerned who felt that their needs were expressed in the care plan and were then met by the home. Recording was also available to demonstrate that regular reviews of all care plans were undertaken and any changes addressed. It was clear from observations made during the inspection and from discussions with service users that support and assistance is provided by the
St Andrews DS0000018429.V310329.R01.S.doc Version 5.2 Page 11 care team to the residents in the home to make their own decisions about matters that affected them. Some risk assessments were seen during the inspection process, these tended to lack detail and did not cover the range of hazards faced in a comprehensive way. This has been discussed in detail with Mr Davies who has agreed to make this a priority and to engage healthcare professionals where necessary. The requirement made regarding the need for risk assessments has been repeated in this report. St Andrews DS0000018429.V310329.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, and 17 The performance in this group is adequate. The opportunities for personal development have improved in the home and residents are able to take part in activities as they choose. Residents use the facilities of the local community and are able to take part in appropriate personal and family relationships. The rights of residents are respected, although some development in this area is needed. A healthy diet is provided that is to the liking of the residents. EVIDENCE: Information from the local college has been provided to the residents about the courses that are offered locally. However, several of the residents at the home are mature persons that prefer to spend their time at leisure of their choice. The development of peoples’ interest and activities is seen as an area that requires further development and when this was discussed with Mr Davies he advised that this would be given priority by the new when manager, when they took up their post. Currently the home has an unrestricted policy of visiting during the day. If a visit needs to be undertaken outside of the daytime this can be arranged with the consent of the management. Residents advised that they felt the
St Andrews DS0000018429.V310329.R01.S.doc Version 5.2 Page 13 arrangements for visiting were appropriate and they could come and go from the home as they pleased. It was clear from observations made during the inspection the residents were respected by the staff team and were helped in a sensitive way when required. The residents consulted during the inspection advised that they considered they had a good relationship with the staff team and they said the staff were helpful and assisted them in the way that they preferred. A menu system was used in the home and the day’s meals were displayed on a chalkboard on the wall of the dining room. The home was well stocked with food products and fresh produce was delivered regularly. The residents stated that they liked the meals provided at the home. St Andrews DS0000018429.V310329.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The performance in the groups is adequate. An agreed care plan provides a foundation for the care to be given to residents to ensure their needs are met. The administration of medication in the home is much improved with some few points only left outstanding. EVIDENCE: The residents consulted during the inspection advised that they received personal support and assistance in a way that they preferred and this was confirmed by observations made of the way care was delivered. Care is now provided according to an agreed care plan, which has been signed by the person concerned. There remains room for the planning process to be expanded to make them more comprehensive. This will be a task to be undertaken by the new manager of the home when appointed in the near future. The recordings of the administration of medication were examined and were found to be much improved from the time of the last inspection. The code system used on the medication administration sheets was used inappropriately and some of the prescriptions did not give clear instructions. For example, one of these was; as directed. Clearly this is not appropriate. Although the requirement for the administration of medication has been repeated in this
St Andrews DS0000018429.V310329.R01.S.doc Version 5.2 Page 15 report it should be acknowledged that a great improvement in the way this task is completed has been achieved. St Andrews DS0000018429.V310329.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The performance in this group is adequate. Residents felt that their views were listened to and acted on. A clear abuse policy and procedure is available in the home, which is followed by the care team. EVIDENCE: The residents that were consulted individually and in private during the inspection advised that they felt their concerns were now listened to and acted on by staff and added that the service provided by the home had improved a great deal. Complaints received by the home have been dealt with appropriately. Since the last inspection an agreed care plan has been put in place for each resident in the home and this clearly states how care should be delivered. The home has introduced a comprehensive training programme for the care staff, including adult protection training. Currently the home is being run fulltime by Mr Davies, a new manager is being recruited and will be taking up the post in the near future. The home has an adult protection policy and procedure and the staff interviewed in private were clear concerning its use. St Andrews DS0000018429.V310329.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 and 30 The performance in this group is adequate. St Andrews is comfortable and safe, a suitable environment is provided for residents. The home was clean with reasonable standards of hygiene apparent. EVIDENCE: A complete tour of the home was undertaken as part of the inspection process and all rooms were visited. In general the home was appropriately decorated and the replacement of some of the carpets was apparent. Bathrooms and toilets were seen; some outstanding work around the tiles in one of the bathrooms was observed and discussed with Mr Davies who said he would ensure the necessary work was undertaken without delay. Residents consulted advised that they liked their rooms and were satisfied with the environment provided at the home. St Andrews DS0000018429.V310329.R01.S.doc Version 5.2 Page 18 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 The performance in this group is adequate. The home has a competent care team with an active comprehensive training programme in place. The recruitment practices currently used ensures that residents are appropriately protected. EVIDENCE: St Andrews has a committed care team who are keen to provide a good quality service to the residents. The home has invested in a comprehensive training programme for the staff with basic and NVQ courses being made available. Additional courses are also being offered on mental health and challenging behaviour. All the residents consulted during the inspection advised that they had a good relationship with their carers and one advised “I always have someone to talk to and they are never too busy to listen” another said “It’s better here since I saw you last”. Three carers were interviewed individually in private during the inspection, they all were committed to providing a good service and were conversant with the policies and procedures of the home. St Andrews DS0000018429.V310329.R01.S.doc Version 5.2 Page 19 Staff files were inspected and were found to have all the necessary checks in place. St Andrews DS0000018429.V310329.R01.S.doc Version 5.2 Page 20 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 The performance in this group is adequate. Residents’ benefit from a much improved management approach in the home and were confident that their views were listened to and acted on. The health and safety and welfare of residents are seen as a priority, currently the deficit in this area concerns appropriate risk assessment. EVIDENCE: The recording and care records available in the home were much improved at this inspection and had benefited from Mr Davis being in the home on a fulltime basis and the involvement of a consultant. Care planning was much improved and it has been agreed with Mr Davies that further development will be undertaken to improve the detail to ensure all needs are reassessed and then covered in a revised care plan to meet those needs. Risk assessment continues to be a concern and Mr Davis has advised that this will be his priority. St Andrews DS0000018429.V310329.R01.S.doc Version 5.2 Page 21 An appropriate response has been seen at this inspection to the last two reports and substantial progress has been made. A new experienced manager is about to be employed by the home, which should enable the service to be developed further, particularly the social element of the care provided. Appropriate comprehensive risk assessments are going to be addressed by Mr Davis and may need the involvement of healthcare professionals; until this progress is completed it is not possible to conclude that residents are safe. The issues outstanding on the administration of medication concern the code system and a clear prescription and are matters that should be quickly resolved. Health and safety issues in general are now appropriately managed in the home. St Andrews DS0000018429.V310329.R01.S.doc Version 5.2 Page 22 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 3 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 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 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 2 X St Andrews DS0000018429.V310329.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 1. YA9 13 (4) 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 not met) 14/11/06 2 YA20 13 (2) The registered providers must 17/10/06 ensure that all staff adheres to the policy and procedure for the correct administration of medication. (Previous timescale of 23/05/06 – 30/07/06 not met) St Andrews DS0000018429.V310329.R01.S.doc Version 5.2 Page 24 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 DS0000018429.V310329.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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