Inspection on 13/01/09 for St Andrews, Paignton

This inspection was carried out on 13th January 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St Andrews, Paignton 24/12/09

St Andrews, Paignton 29/06/09

St Andrews, Paignton 28/01/08

St Andrews, Paignton 08/08/07

St Andrews, Paignton 01/03/07

St Andrews, Paignton 10/10/06

St Andrews, Paignton 16/05/06

St Andrews, Paignton 13/12/05

St Andrews, Paignton 20/06/05

St Andrews, Paignton 13/10/04

St Andrews, Paignton 19/05/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: St Andrews, Paignton 24 St. Andrews Road Paignton Devon TQ4 6HA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Clare Medlock     Date: 1 3 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: St Andrews, Paignton 24 St. Andrews Road Paignton Devon TQ4 6HA 01803559545 01803391582 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Paulette Davis,Mr John Davis care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is 21. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: Mental disorder, excluding learning disability and dementia- Code MD Date of last inspection Brief description of the care home 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 , taff sleep-in room. On the ground floor there are bedrooms, a kitchen, toilet, office, dining room Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 21 Brief description of the care home 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 doubles. The costs per week for residential care at St Andrews vary between roughly three hundred and fifty pounds and five hundred pounds. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Prior to this inspection we received a well completed Annual Quality Assurance Assessment from the Registered Provider. The AQAA is a self-assessment record that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. This key inspection also consisted of an unannounced visit to the home on Tuesday 13th January 2009. Care Homes for Adults (18-65 years) Page 6 of 31 During this time we spoke to the Providers, deputy, and senior carer who is responsible for many administration tasks. We spoke with 3 people who live in the home. We spoke at length to 1 relative, and 2 other staff members. We case tracked three people who use the service. Case tracking means we looked in detail at the care three people receive. We spoke to staff about their care, looked at records that related to them and made observations if they were unable to speak to us or able to provide feedback. We looked at three staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the safeguarding systems work and what this means for people who use the service. We asked about the fees charged at St Andrews and were told the lowest fee is three hundred and sixty four pounds and the highest fee is roughly five hundred pounds. The Provider informed us the fees depended on such things as individual need and which room was occupied. During the inspection we watched interactions between staff and people living at the home. All this information helps us to develop a picture of how the home is managed and what it is like to live at St Andrews. What the care home does well: What has improved since the last inspection? Since the last inspection the staff have improved records, record keeping and many systems at the home. Care Plans are clearer to read and show what care is needed to meet the persons needs. Plans are based on the needs of each person rather than task based. The management of medications has improved which means risks are minimised and storage more secure. New storage cupboards have been provided. A new pharmacy agreement has been arranged which makes ordering and returning medications more efficient. Staff training in medication has also improved which means staff have more knowledge of how to safely manage and handle medications. The staff group is more settled since the last inspection and the staff work together as a team which has raised morale and improved the atmosphere in the home. Staff training has also improved with the introduction of the mental capacity act training and Care Homes for Adults (18-65 years) Page 8 of 31 more encouragement to do NVQ courses. The environment has also greatly improved. All areas of the home have been decorated with new furniture and carpets being provided where needed. The home now keep chickens which provides entertainment and purpose for people at the home as well as providing fresh eggs. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their relatives have the information they need to decide whether St Andrews is the right home for them to move into. The admission procedure shows that staff make sure they can meet the persons needs. Evidence: A statement of purpose and Service User guide are availaible in the foyer of the home. The document is clear to read and sets out what the service provides and contains all information people would need to decide whether St Andrews could meet their needs. People living at the home told us that thet had an opportunity to visit the home before they made a decision. Staff told us the length of visit was entirely the choice of the persons needs. One person said they had been consultated about what they needed to receive. One relative said St Andrews had been a gift from heaven and were pleasantly surprised with the homely, comfortable surroundings. Another person said it was the second time he had come to the home and he would chose again to be further away from his permanent home because he knew he would get a good service. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: People at the home said the Provider had come to see them before they moved to the home and asked questions about their needs. Staff confirmed that this was normal practice and an opportunity to discuss the persons needs with the person, their family and health care professionals. The staf at the home complete pre admission assessments which are then used as a basis of the care plan. Staff told us that because of the nature of the service provided emergency admissions are not usually accepted. Staff also told us this was because the home need to prepare for any specialist care, equipment or stafing the person may need. Each person has an A4 folder where care records are kept. The pre admission assessment and health care professional assessments are stored here and used as a basis for the care plan. Once the trial period is complete people deciding to stay at the home are issued with a contract, alongside the contracts issued by social services. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The well constructed care plans allow staff to plan how they enable people to make decisions and take appropriate risks in their lives Evidence: Each person has an A4 folder where care records are kept. These are securely stored in a locked office. Some electronic records are also stored and accessed by use of password. The pre admission assessment and health care professional assessments are stored here and used as a basis for the care plan. Care Plans were clearly written and showed how care should be provided. Plans also contained personal details, contact numbers of health care professionals and next of kin and assessments for ability, daily living tasks and preferences. It was clear to see what needs each person had, what triggers caused behavioral problems and details of how staff could support the person. One of the assessment of abilities had not been reviewed in the last month. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: Each month staff at the home writes a monthly review of any mental or physical health changes/ Staff told us this could be used as part of the review of provided if the person was admitted to hospital. People told us they had been involved in what was written in their care plan and were always involved with multi agency reviews. One person said he was aware of how to contact his care coordinator, community psychiatric nurse and GP and knew staff would support him with this if needed. People told us they were able to make decisions about their lives. Staff explained that in some cases restrictions on decision making was limited after an assessment of the persons needs and risk. An example of this was restricting people to cigarettes or tobacco because of risks to health or safety. Any restrictions are written in the plan of care and communicated to all staff and the person concerned. Staff told us they use identification tags for some people when they leave the home. These contain personal information and contact details for use in emergencies. Missing persons policies are clearly displayed within the office and pages within the care plan can be used to fax to police. The staff at the home alert the CSCI about events where people go missing and when they return. People who live at the home told us they can chose whether to participate with the day to day running of the home. One person said he chooses to help wash up, but likes the staff to do laundry. Staff said some people at the home are encouraged or prompted to do some tasks as part of their short and long term goals. People living at the home also said there had been resident meetings held where things like food and trips were talked about. The AQAA told us that the service use meetings as a way to hear what people living there have to say. The AQAA stated that following this meeting more pasta based meals had been introduced. Records showed that the last resident meeting was held in November 2008. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The flexible and supportive staff group support people to make decisions about their lives, routines and development opportunities. The food provided at the home is very good. Evidence: People living at the home told us that they are provided with opportunities to access a wide variety of activities and trips. People told us they had a member of staff they linked with (Key worker) who provided one to one care. Records showed that this one to one care was an opportunity where the staff member would spend dedicated time with the person. Staff explained that some people have been supported to gain employment or attend Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: further education, however due to the complex needs and illnesses in some cases this is not appropriate. Records are maintained explaining this need. An example seen was a letter from the job centre explaining that at present the person was excempt from applying for jobs. Another file contained a certificate for achievement issued by a local college. People told us they were able to maintain links with family and friends as they wanted. One relative said I am always calling staff and whatever time I call, staff are always fresh polite, eager and helpful. Staff told us some people do not have links with their families whilst others still have contact. Each person has an activities assessment performed on admission, which is used to obtain likes and dislikes of people in the home. Following this staff at the home ensure opportunities are avaialibale for people to be supported in their choice of activity. Staff gave examples of activities provided. These included art lessons, computer classes, BBQs, nail painting, cinema trips, shopping, days out, trips in the car and DVD sessions. On the afternoon of the inspection people were painting. A monthly newsletter is availaible for people to read what is happening in the home. This is displayed along with adverts for forthcoming events and trips out. One person told us there is stuff going on at the home and its up to us if we join in This person told us it was his first Christmas away from home and it was good fun. People said they could join in as much or as little as they wanted to. Staff said sometimes their role was motivating people to attend events and trips. The surveys we recieved reflected these findings. One person wrote I have an interesting social life, I meet friends in paignton every day, I can sort out my own decisions and am able to come and go as I please Examples were seen of how staff support people to form, develop and maintain general and intimate personal relationships in and out of the home. Staff expalined that should relationships progress, appropriate healthcare support would be facilitated. We saw knocking on doors before being invited to enter. Each person is given a key which can be overridden by a master key in the event of an emergency. People said staff were respectful towards them but occassionally had to nag to get them to do things. Staff explained that some people needed alot of encouragement to perform every day tasks or reminders to adhere to rules of the house. An example of this was the non smiking policy which people in the home ignore despite frequent reminders. People told us food at the home was very good. One person said he had the life of Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: riley at the home and was treated like a king. One person said he appreciated that when he was out when meals were served, staff would leave the food which could be eaten later at a time or in a place more suitable to the person. Staff said there was a designated cook at the home who was responsible for the preparation of food at the home. The Provider told us he and the chef did the food shopping together. Fridges and freezers were well stocked. Storage was organised and hygenic. Systems were in place for the safe running of the kitchen. On the day of inspection a home made pie, mash and veg was served. People told us it was really good, lovely and nice. Those people at risk of weight loss or gain are monitored closely. Nutritional assessmnets and records are maintained for this purpose. Those who are under weight were encouraged to eat snacks throughout the inspection. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and health care support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive a good level of support in respect of health and personal care. The management of medication systems are good. Evidence: People told us the staff are kind and helpful. Comments from relatives showed that health care is not just physical but focused on mental health issues. One relative wrote I am most impressed with the courtesy, warmth and helpfulness of staff at any time of day of night. This atmosphere has certainly helped him feel at home and comfortable. Another relative told us Their care not only helps his health and mental health but also mine, knowing he is well cared for. One survey said that the person thought care arangements were staisfactory and that carers always listen. Care Plans are well written and clearly show what specific physical and mental health needs each person has. Specific care charts are implemented when observation is required. WE saw examples of seizure charts, nutritional health monitoring charts, hourly check charts for high risk people and personal hygeine charts. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: Staff said at present they do not perform personal hygeine tasks but that thie role is to monitor and prompt people to self care. Staff told us that this varied from person to person and that staff knew who needed more prompting than others. Records of health care professional visits are recorded in the care records. Examples seen included visits from district nurses, visits to the dentist and optician, chiropodist and dentist. Staff contact the GP or mental health team appropriately and accompany people for out patient appointments where necessary. Contact details for each persons health professioanl contact is stored in the care plan. Each person also has a key worker who provides a 1:1 contact for the person. Medication management has improved in the home. Staff have opted to change the services of the pharmacist and have had new medication cupboards fitted in the office to house the blister packs of medication. The controlled drug cupboard was waiting to be secured within a locked cupboard. There were self medication policies, homely remedy policies and service agreements with the pharmacist. Certificates were on display for stafftraining in the management of medications. The storage, ordering, records and returns of medication were well managed at the home. The majority of people in the home are not elderly, although some have associated physical illness. The staff have recent experience of dealing with terminal care and death and were able to support the person, other people and staff at the home. Each person has a record of preferences with regard to illness, death and contact details. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are well managed at the home. The policies, staff knowledge and training in place help protect people from abuse. Evidence: People told us they knew who to speak t if they were unhappy or needed something. One person told us this depended on what was needed. If it was money I go to one person or if it is help with medication I go to another. Surveys told us that All staff are helpful, some are more sympathetic than others but this depends on my concept of right treatment. The home has a clear complaints procedure. This encourages the complainant to speak to the manager in the first instance but to go to the CSCI if they are not happy. The complaints file showed that the Provider received five formal complaints in 2008. Four of these were from residentsstaff about other residents.One was unrelated to the running of the home, the staff or the Providers, but was recorded as a complaint for monitoring. The Commission for Social Care Inspection recived two annonymous complaints since the last inspection. These related to staffing numbers, qualifications of staff and recruitment practices. One complaint was referred to the Provider which was dealt with Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: appropriately. One complaint was investigated by the CSCI by a random inspection. This inspection found no regulations had been breached in regard of qualifications or recruitment practices but one regulation was breached in regarding to the numbers of staff on duty for an hour on a specified day of the week. The Provider informed us that this shortfall was addressed immediately. People told us that staff were kind and aproachable. Relatives told us thet could speak with staff at any time of the day. One relative said Whatever time I call, staff are always polite, fresh, eager and helpful. Staff told us they ahd received training in safeguarding and POVA (Protection of vulnerable adults). Staff were aware of where to find the alerters guide for information on how to make an alert, although the staff had not obtained the updated version of this. Staff spoken to were aware of the adult protection policy and procedure and knew the different types of abuse possible and what action should be undertaken if this was discovered. The Provider and senior carer said they would discuss any alert with CSCI. All staff have a POVA first check (Pre employment check) to ensure they are suitable to work with vulnerable people. A CRB is also performed, although the Provider said there has been a delay in receiveing these back. Staff told us they had attending training on dealing with challenging behaviours and the mental capacity act. Care Homes for Adults (18-65 years) Page 21 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home live in a well maintained homely environment. Evidence: St Andrews is a large Victorian detached house situated in a residential area of Paignton. The house is within walking distance of the sea front, shops and local amenities. There is level access through a small front garden, with one step inside the lobby area to access the house. There is a concreted area and lawn to the back of the home which people told us is used during dry weather for BBQs. The home has a lower ground, ground, first and second floor with stairs throughout. This may cause difficulties for residents with mobility problems, but this is assessed before a person comes to the home. None of the rooms have en suite facilities, but all have access to a toilet within close proximity. One room is used as a double/shared by two people who chose or agree to share. An external fire escape connects all floors. On the lower ground floor there is a laundry, storeroom, two bedrooms and shower/bathroom. There is a designated staff staff sleep room with alarm facility. 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. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: All areas of the home have been decorated. The Provider told us some people wanted to be involved in choosing paint and curtain colours whilst others did not. Furniture within communal areas was of good quality and domestic in style. Each person had their own room which were equipped with personal items of their choice. Some rooms had tea making facilities, fridges and sandwich makers subject to risk assessments, whilst others were more stark according to the wishes or risk assessment of the person. The AQAA listed all the improvements to the fabric of the home. These include redecorations, replacement of furniture and carpets. People were able to access all areas of the home and were able to come and go as they chose. There were no offensive odours present on the day of the inspection. People told us they are encouraged to keep their own room tidy and clean. We were told of specific examples where staff had to intervene to reduce the spread of infection or examples of where extra support and encouragement was needed to support self care. One person told us that sometimes the toilets were left in a dirty state but staff always sorted this out if they were made aware. Laundry facilities were available and separate from kitchen areas. Floors and were easily cleanable and washing machines were suitable for their purpose. Staff told us they do not deal with laundry that has been soiled with bodily fluids. Care Homes for Adults (18-65 years) Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported and cared for by competent, qualified staff who have the necessary pre employment checks performed. Evidence: At the time of inspection, there were four staff on duty. The Provider was overseeing day to day issues. There was a cook preparing lunch and two members of care staff. All staff were aware of their roles and people living at the home knew who to go to for specific needs. Staff told us the new staff team work very well together and that morale was good. Off duty records showed that agency useage is minimal and that staff tend to cover shifts themselves. On the day of inspection, one of the Providers had just done a night shift. Staff files contained job descriptions which clearly listed specific tasks, althouugh some staff have more than one role in the home. The cook also works as a carer and the handtyman also covers care shifts. Care staff were aware of when to call health care professionals or refer to outside agencies. Staff told us they were encouraged and supported to do NVQ training and were asked Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: to let the Providers know what training they wanted. The senior carer has taken on a large managemnt role and has been responsible for many care record improvments and system changes. The senior carer told us she had been encouraged to do NVQ 3 in care. All staff have an induction and work alongside existing staff. Staff told us they are able to share new ideas and suggestions with the staff team and Poviders and this is done either informally or through staff meetings. Staff told us they receive staff supervision and appraisals. Staff files were organised and showed what checks staff had received prior to employment. All files contained proof of identity, application form, medical declaration and suitable references. Staff had been given terms and conditions and attended induction, given a handbook and attended staff training. The application forms were adeqaute but a discussion took place about the effectivness of some of the information requested. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. St Andrews is run in an efficient and effective way. Evidence: The Providers told us they were present most days to oversee the day to day running of the home. We were told about the different roles of each member of staff and how each role worked for the benefit of the home. The Provider told us he is responsible for the general maintenance management in the home and has a maintenence man who is responsible for the work and up keep of the home. The senior carer is responsible for the system changes and care record reviews of each of the people in the home. A deputy manager is presently responsible for kitchen duties and some care shifts and care staff work together to support people in the home and the cleaning programme in the home. The Provider also manages personal monies of people in the home. Records were seen to show this system is robust. One person said it is great as I can have access as and when I chose. Staff did explain that restrictions are placed on some people for their own protection. These Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: examples were seen in care plans. One common restriction was the acess to cigarettes and cigarette lighters. Staff told us they are clear about who is responsible for each role although sometimes staff take on different roles to help the smooth running of the home. Staff also told us that morale was good at the home at present and the improvments have helped with this morale. The Poviders told us the staff group were stable at present and were working well. Staff told us quality assurance occurs as a continual process. Staff also told us questionnaires had been sent to people in the home, staff and other stakeholders. A feedback report was published to show trends. The AQAA told us this process has initially resulted in more pasta based meals on the menu. Policies and Procedures were present in the home. Some policies contain out of date contact details for the CSCI. The Provier gave assuarnaces that these would be updated. Generally the standard of record keeping has improved in the home and reflect the level of care that is provided. All records were securely stored. Training records were stored within staff files and showed that staff had received training in respct of POVA, Food Hygeine, Fire safety, medication and 1st Aid. No records were seen for moving and handling training. Staff explained that because of the abilities of people in the home, they do not move or lift people in the home so were not concerned about this lack of training. IT was suggested to the Provider that this could be implemented as a sign of good practice especially for staff that would need to move heavy loads or boxes. The Provider told us he obtains outside contarctors for the management of some systems and equipment in the home. Up to date records were seen in respect of electrical equipment, fire systems, Gas systems, and occupational assessment of premesis. Accident records were seen and were well managed. The Provider explained that the major health and saferty issue they are faced with is people not adhering to the non smoking ban in the home. The Provider told us that some people have been restricted access to cigarettes but that all people have a fire detector in their room which are triggered in the event of a fire. The Provider showed us the business plan of the forthcoming year. This, together with the AQAA show that the Providers are aware of what changes are needed and what needs to be achieved. Care Homes for Adults (18-65 years) Page 27 of 31 Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 4 5 6 6 20 23 34 40 42 The Provider should review assessment of abilities regularly The Provider should ensure the new controlled drug cupboard is secured The Provider should obtain the updated alerters guide The Provider should consider updating the application form to obtain more detailed information. The Provider should ensure any policies contain the correct contact details of the CSCI The Provider should consider providing moving and handling training to staff at the home Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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