Inspection on 20/06/05 for St Andrews, Paignton

This inspection was carried out on 20th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Andrews, Paignton 24/12/09

St Andrews, Paignton 29/06/09

St Andrews, Paignton 13/01/09

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 13/10/04

St Andrews, Paignton 19/05/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 St Andrews 24 St. Andrews Road Paignton Devon TQ4 6HA Lead Inspector Sam Sly Unannounced 20 and 22nd June 2005 th 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 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 Stationary 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 D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service St Andrews Address 24 St. Andrews Road, Paignton, Devon, TQ4 6HA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01803 559545 01803 391582 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 D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. A Manager to be registered by 15th June 2004 Date of last inspection 03/05/05 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, store room, 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. St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection was unannounced and took 6.5 hours over a weekday in June, and was carried out by Sam Sly (Inspector) and Nicky Nendick (Regulation Manager). Evidence was gained through talking to all but two residents; all care staff and the cook on duty, the acting manager and a visiting District Nurse. Records and other paperwork were also examined and a tour of the premises was carried out. The Owners were not present on the Inspection day, but were present on the second day where compliance with statutory notices was assessed. Since the last Unannounced Inspection on 13th October 2004, there has been a CSCI Pharmacy Inspector visit on 09/06/05, due to concerns about the medication practices, a follow-up visit on 17th January 2005 to review progress on meeting outstanding requirements, and there has been six statutory notices issued; a follow up visit to review progress on 3rd June 2005 gave the owners more time to comply with the notices. There have also been two complaints received by CSCI; one was upheld and the other is still being investigated. There have been two meeting with CSCI and the owners due to concerns about the number of outstanding requirements and the latest complaint. Reports on all the CSCI visits to the home can be obtained on request from the local CSCI office (Ashburton). What the service does well: What has improved since the last inspection? There is now sufficient information for potential residents to make a choice about living at St Andrews. There is a clear complaints procedure, and residents concerns dealt with by the acting manager are handled appropriately. The majority of staff have now received training on Adult Protection and working with people with mental health needs which they described as ‘excellent’. There was a maintenance St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 6 and renewal programme in place, and the home was cleaner, more hygienic and more comfortable for residents. The acting manager was carrying out the appropriate employment checks so that staff employed were competent and fit to work with vulnerable people, also the acting manager was now notifying the Commission of any event in the home that adversely affected residents, or any misconduct of staff within the home. New staff were receiving induction training, and many staff had started NVQ training so residents were benefiting from more competent staff. Residents and staff were now being asked their views on St Andrews and this information is to be included in the home’s Quality Assurance system. What they could do better: The way St Andrews is run remains of major concern to the Commission, which is reflected in the high number of visits, and meetings with the Owners that have taken place. There remains a number of outstanding requirements and additional new requirements, and it was most concerning that the Owners were not supporting, assisting and providing resources to enable the acting manager to run St Andrews effectively, safely and for the good of the residents living there. The Owners had also not put forward an application, to the Commission, for registration of the acting manager. The Owners and acting manager need to work together to ensure that the St Andrews is managed effectively. The quality of assessment, risk assessment and care planning for residents have deteriorated, and due to the complex needs of residents this lack of clear guidance to staff puts residents at risk of harm. Residents still do not all have contracts and neither do staff. This means people living at St Andrews do not know their terms and conditions of residence, and those working there are not clear of their rights, responsibilities and roles. Residents cannot benefit from this unclear situation. Residents are not benefiting from a consistently well-prepared wholesome, nutritious diet that includes food required for health problems. Residents had been put at immediate risk by fire doors being wedged open and medication administered by staff not being recorded properly. Although there is a clear complaints procedure, it was of great concern to find that residents could not make complaints without the fear of retribution. St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 7 Some staff and the Owners had still not attended adult protection training, and one member of staff had been employed by the Owner without appropriate competency and fitness checks potentially putting residents at risk. There were still outstanding requirements from Torbay Environmental Health Department, and it was not clear that the maintenance and renewal programme in place was being followed or who was responsible for ensuring maintenance was done, which meant residents could not be sure that the environment would remain adequately maintained, furnished, and decorated. 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 D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 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 standard(s) 1, 2 and 5 Full and clear information was available to prospective residents so they could make an informed choice about living at St Andrews, however once there, residents were not fully aware of their terms and conditions. Resident’s needs and aspirations were not fully assessed, potentially putting them and others at risk of harm, and restricting their independence. EVIDENCE: There was a Statement of Purpose, and each resident was given a Service User Guide. The most recently admitted resident was spoken to, and said that information about St Andrews had been given and he had agreed to move there. The acting manager said residents had not all been given up-to-date contracts as the information required was not available in the home for her to do so, this meant residents were not all aware of their terms and conditions. This was an outstanding requirement from the last Commission visit in January 2005. Two assessments were examined. There was a Care Programme Approach assessment, risk assessment and plan for one of the most recently admitted resident’s assessment, but detailed information on their needs, potential risks and aspirations were not recorded in the assessment carried out at the home. This meant staff would not be aware of how to work with the resident to protect them and develop their independence. It was recorded that the other St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 10 assessment and plan examined had been reviewed; however through discussion with the resident, it was found that their needs had changed and this was not recorded. Some daily reports about resident activity were not recorded in compliance with Data Protection legislation. Regulatory notices had been issued to the Owners in January 2004 with regards to breaches in regulations regarding assessments, risk assessments and care plans which, at the time, had been complied with raising the quality to a satisfactory level. It was therefore of concern to the Commission that the Owners had not ensured these documents remained of a satisfactory quality. There had been significant changes to the staff and management team since the last Unannounced Inspection in October 2004, and the acting manager said that not all the original care planning documents were available to them in the home. St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9 Without clearly recorded guidance, in the form of risk assessments and plans, residents cannot be confident that staff are supporting them to achieve their goals, aspirations and a more independent lifestyle. EVIDENCE: Two risk assessments and care plans were examined. The acting manager verbally demonstrated a good understanding of risks posed to residents, and their needs, and there was evidence that staff were supporting residents to meet goals like living more independently in the community, however the risk assessment and plan for one of the most recently admitted residents was not clear and detailed so staff had no clear guidance on restrictions in accordance with the Care Programme Approach, or how to protect them, whilst supporting them to achieve an independent lifestyle. The second risk assessment and plan examined was detailed, and had been recorded as reviewed, although there was no evidence that this had been done with the resident, and it was not reflective of their current goals and aspirations. Without goals and aspirations staff will not be guided to help residents become more independent. St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 12 Regulatory notices had been issued to the Owners in January 2004 with regards to breaches in regulations regarding assessments, risk assessments and care plans which, at the time, had been complied with, raising the quality to a satisfactory level. It was therefore of concern to the Commission that the Owners had not ensured these documents remained of a satisfactory quality. There had been significant changes to the staff and management team staff since the last Unannounced Inspection in October 2004, and the acting manager said that not all the original care planning documents were available to them in the home. There was a key worker system in the home, and residents knew who their key worker was, and felt supported by them. This meant staff could develop closer relationships with some residents. St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 13 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 standard(s) 14 and 17 Residents are not offered a consistently healthy diet inclusive of special dietary needs. Residents were engaging in appropriate leisure activities, however some of these activities were not funded by the Owners but staff, which was unacceptable. EVIDENCE: St Andrews has a cook, however the cook said he was sometimes asked directly by one of the Owners to leave the home at short notice to do care work, which he said he enjoyed, but which took him away from his cooking job, leaving other care staff to continue preparing and serving the meal. Although the cook notified the acting manager when he was leaving the building, she felt she could not question the Owners request, and she was left to fill the cook’s place with a member of the care staff leading to reductions in the team working with residents. There was a menu plan displayed for residents in the dining room, which showed a varied balanced diet, however the meal on the day of Inspection was egg and chips, and was not the meal stated for that day on the menu, and on discussion with staff and residents it was clear the menu was not followed. St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 14 Most residents said the meals were fine but one said they ate a lot of ‘chicken or eggs’ in the home. Residents said they were only told on the day what the meal was to be. Residents said they had also eaten egg and chips a few days previously. On discussion with the acting manager it became apparent that some residents had special dietary needs due to health problems. These special needs required additional foods which were not ordered on a regular basis by the person ordering the food, and the acting manager had bought additional food for these residents out of her own money and not been recompensed by the Owners. The acting manager had arranged some indoor activities for residents, but found they did not always want to join in. Some residents arranged their own leisure activities, or care staff were taking them out individually, or in small groups using their own cars and often their own money to pay for expenses. Staff said the Owners had not yet recompensed these expenses. Staff described taking residents recently to a Trawler race, up to a local beauty spot and to Exeter to visit landmarks from their past. Resident said they enjoyed these trips out. The home employed a resident’s chauffeur and one resident described being taken to the Owners house, where he sat in the car outside the house and was given wine and a cheese and salmon sandwich. St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 15 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 standard(s) 18, 19 and 20 Resident’s received personal and healthcare support in ways they required and requested from the majority of care staff. Mistakes in the administration of medication meant residents were at risk of harm. EVIDENCE: All staff on duty on the day of Inspection were spoken to and most had a very good understanding of the residents personal and healthcare needs seeing themselves as ‘supporter’s’ encouraging independence, although one staff member did not hold this view describing residents as ‘likely to flare up at anytime’, and the staff role as doing tasks for residents. Ten staff had recently attended a course on working with people with mental health needs, which was described as ‘excellent’. Some residents looked after their own personal care needs; others needed quite a lot of assistance. The acting manager was able to demonstrate instances where appropriate professional assistance was gained for residents whose physical or mental health was deteriorating. A visiting District Nurse said she did not have any concerns about how the staff met resident’s health care needs. Residents were looking healthier and smarter than on previous Inspections and the majority had clean, appropriate clothes on. One resident admitted that although he was reluctant to bathe, the acting manager was in negotiation St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 16 with him to reach this goal. The acting manager and some staff spoken to demonstrated that they were aware of residents rights to refuse personal care and healthcare but that they worked hard to prompt residents to take pride in their appearance and well-being. The lack of a bathroom on the ground floor caused some problems to residents who found the stairs a problem. One resident said they had been out to buy new clothes and a new stereo with the acting manager, of which they were very proud. Locks to some bedrooms were broken, and some were worried about protecting their possessions. An immediate requirement notice was given to the acting manager as it was found on several occasions’ staff administering medication had not recorded this. All staff were booked to attend medication training in July 2005. The Commission’s Pharmacy Inspector had visited the home in June 2005 and advised the previous acting manager on issues relating to the storage of the medication. St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 17 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 standard(s) 22 and 23 Residents can be confident that their views will be listened to and acted on by the acting manager, but cannot be confident that they will not be victimised for making complaints by one of the Owners and particular members of staff. The majority of staff protect residents from abuse, neglect and self-harm, however recent incidents being investigated by the Commission and through adult protection procedures mean residents cannot be confident that they are fully protected from harm. EVIDENCE: There was a clear complaints procedure, which was being used by residents. Issues were investigated and acted on and recorded appropriately by the acting manager. However, some issues required action by the Owners and there was no evidence that this had been done. It was with great concern on the day of Inspection, to find that one staff member admitted to confronting a resident about an anonymous complaint that had been made against the staff member, and calling the resident ‘a liar’ in what they described as ‘the heat of the moment’. The resident said they were ‘very upset’ and ‘did not know what they had done wrong’. The resident also said they were upset about one of the Owners who had accused them of ‘making trouble’ The resident did not know what this was all about either. The Commission was so concerned about these incidents that an adult protection meeting was being instigated. Two complaints had been received by the Commission with regard to St Andrews since the last Inspection. One was upheld and the Owners had been required to improve practice. The other was under investigation, but information had come to light, and been confirmed at this Inspection that the St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 18 way one of the Owners was dealing with the complaint was potentially putting residents at risk of harm and an adult protection meeting was being held. The majority of care staff had attended adult protection training and there were appropriate policies and procedures in the home. This action complied with a statutory notice that was issued in February 2005. When asked a question about what to do if they came across an incident of abuse, most staff were clear of the correct action to take, one staff member, however, was confused about what constituted abuse and said they had not learned anything from the recently adult protection training as it was really just ‘common sense’ that was needed. Neither of the Owners had attended any adult protection training, despite this being required in a statutory notice issued in February 2005, as they were jointly in charge of the home due to there being no registered manager. St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 19 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 standard(s) 24, 29 and 30 The environment at St Andrews has improved, but the system in place to ensure it remains homely, comfortable and safe for residents is inadequate and improvements may not be sustained. Some fire safety practices in the home put residents at risk. EVIDENCE: A statutory notice had been issued to the Owners in February 2005 with regard to the fitness of the premises. Great improvements had been made and St Andrews was generally clean, hygienic and adequately furnished and decorated. Care staff was carrying out systematic cleaning, although the kitchen cleaning rota had stopped whilst the kitchen was refurbished and not started again. The Environmental health department had not re-visited to assess whether requirements made by them in November 2004 had been complied with. The layout of the home with bathroom/showers on the lower ground and first floors made it difficult for some residents, not confident using stairs, to use these facilities, and no additional aides or adaptations in bathroom/showers or other parts of the home had been installed for residents with mobility St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 20 problems, although an Occupational Therapist had assessed the home with regard to the general resident group. The acting manager had dismissed the maintenance person in March 2005 following a disciplinary hearing, which he had not attended. After this, staff had undertaken maintenance tasks with residents, however one of the Owners had recently re-employed the dismissed person without discussion with the acting manager, and the acting manager felt in an untenable situation and unable to manage the maintenance person. Although there was a maintenance and renewal book kept by the acting manager, it was unclear to the Commission what programme the maintenance person was working to, and who was responsible for ensuring all identified maintenance was done. An immediate requirement notice was issued as the kitchen door was found wedged open, and wedges were seen in several bedrooms although not in use. Wedged open fire doors put residents and staff at risk. St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 21 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35 and 36 Residents are not benefiting from a workforce that are all clearly guided, cohesive, effective and competent, due to lack of support to the acting manager by the Owners. EVIDENCE: Some staff spoken to, including the acting manager had not been given job descriptions or contracts by the Owners so did not feel secure in their positions and were not fully clear of their responsibilities. Some of the staff spoken to demonstrated sound values and skills describing their work in a resident focused manner however one staff member described residents in terms of their challenging behaviour, and was not sensitive to their individual needs. The acting manager had ensured that staff were reading and implementing the home’s policies and procedures. The acting manager had attempted to supervise all the staff, but had encountered resistance from some staff when she had highlighted areas of practice that needed development. When the acting manager had tried to address these issues she had found one of the Owners was supporting the staff members resistance. St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 22 Twelve staff were doing NVQ qualifications, many of which had started the work at a previous care home. Ten staff had recently attended a course on working with people with mental health needs, described by those staff as ‘excellent’. The acting manager was using supervision to highlight training needs but there was no training budget available to book courses, the Owners had to be asked for permission and funding. Regular staff meetings were being held and the rates of staff leaving the home had improved since the acting manager had started working at St Andrews. Before this the Commission had been concerned by the high turnover rate of care and key management staff. Recruitment procedures had greatly improved after a statutory notice was issued in February 2005. The staff file of the latest staff member to be recruited by the acting manager were examined and appropriate procedures were found to be have been followed. However, one of the Owners had reemployed a maintenance person dismissed by the acting manager, and the appropriate recruitment procedures had not been followed, and there was no risk assessment to support the decision-making about re-employment with regard to the vulnerability of residents at St Andrews. The rotas were examined. Rotas did not record the capacity of staff, which made it difficult to assess the tasks staff were performing on shift. Staffing levels recorded on rotas were appropriate to the needs of residents, but these levels were not always true as care staffing levels fell when one of the Owners took the cook out of the home at short notice leaving care staff to cover kitchen duties. St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 23 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39 and 42. St Andrews is not a well run home and residents are not benefiting from the ethos, leadership and management approach of the home, instead they cannot be confident their views underpin the running of the home and are potentially at risk. The acting manager was not being supported, or given the resources by the Owners to run the home effectively, safely and for the benefit of the residents. EVIDENCE: St Andrews had a condition of registration that a registered manager is appointed dating back to June 2004. Since this time there has always been an acting manager in post, and the Commission had received an application to register the previous acting manager, however she had left before the process was complete. The Commission has not received an application for the current acting manager to be registered. St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 24 There was also a split staff group with some longer serving staff taking direction only from the Owners, putting the acting manager in an untenable position. There was evidence through residents meetings, key worker meetings and feedback from staff and residents that the acting manager was trying to create an open positive and inclusive atmosphere. However without the support and encouragement of the Owners these efforts were being thwarted. The acting manager has sent out resident and staff questionnaires, which were with one of the Owners to be included in the home’s Quality Assurance system which the Commission is assessing on August 1st 2005 following a statutory notice being issued in February 2005 due to concerns about the continuing lack of quality monitoring in the home. Some staff spoken to felt supported by the acting manager, and not by the Owners, others felt supported by the Owners and not the acting manager. The acting manager was described as ‘approachable’, and residents were complimentary about her and the staff. One resident said she had a ‘pioneering task’ at St Andrews. The acting manager was ensuring that staff attended a range of health and safety training including food hygiene, manual handling and first aid. The fire and accident books was kept appropriately but an immediate requirement notice was issued as the kitchen fire door was wedged open, and wedges were found in some bedrooms, although not in use. St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 25 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 2 x x 2 Standard No 22 23 ENVIRONMENT Score 1 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x 2 3 Standard No 11 12 13 14 15 16 17 x x x 2 x x 1 Standard No 31 32 33 34 35 36 Score 2 2 2 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 St Andrews Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 1 x x x 2 x D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 26 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. 2. Standard 2 5 Regulation 14 5 (c) Requirement Residents must have comprehensive assessments. Residents must have suitable contracts, signed and agreed by them (Previous requirement timescale 19/02/05 not met) Residents must have comprehensive care plans, signed and agreed by them. Care plans must be reveiwed and ammended if necessary. Residents must have comprehensive risk assessments, signed and agreed by them and reviewed regularly.. The menu and food budget at St Andrews must cater for residents special dietary needs. Residents must have a consistently properly prepared, varied, wholesome and nutrious diet. Medication administered by staff must be recorded appropriately. Residents must be able to make complaints about St Andrews without fear of retribution. The Owners must make themselves aware of complaints about St Andrews. The Owners and the remaining staff who have not attended Timescale for action 26/09/05 26/09/05 3. 6 15 26/09/05 4. 9 13 (4) 26/09/05 5. 17 16 (2) (i) 26/08/05 6. 7. 20 22 13 (2) 22 and 12 (4) (a) 20/06/05 26/08/05 8. 23 13 (6) 26/09/05 Page 27 St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 9. 24 23 (5) 10. 24 23 (4) 11. 24 23 (2) 12. 29 23 (n) 13. 32 19 14. 34 19 15. 34 Schedule 4 18 (1) 16. 37 adult protection training must do so (Previous statutory notice not met - timescale 22/06/05) There must be compliance with the Torbay Environmental Health Department requirements dated 25th November 2004 (Previous statutory notice not met timescale 22/06/05) Fire doors must be kept shut or fitted with self-closing devices of a design agreed by the local Fire service. St Andrews maintenance programme must be adhered to, and the maintenance person directly supervised. There must be suitable facilities and equipment for those residents who are old, infirm or have mobility needs (Previous requirement not met - timescale 19/02/05) Only staff who are competent and fit must work at St Andrews. The acting manager must be supported by the Owners to take disciplinary proceedings against staff found to be incompetent and unfit. All staff employed in the home must have the appropriate fitness checks carried out before employment (Previous statutory notice not met - timescale 22/06/05) The rota must show the capacity of staff working in the home. (Previous requirement not met timescale 19/02/05) The Owners must give the acting manager the support, assistance and resources she requires to manage the home. The Commission must receive an application for a registered manager at St Andrews. 26/08/05 21/07/05 26/08/05 27/09/05 27/09/05 26/08/05 26/08/05 26/08/05 St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 6 14 Good Practice Recommendations Ensure sensitive information about residents is recorded in compliance with Data Protection legislation. The Owners should recompense staff for money they have spent on residents leisure activities, food and other expenses. There should be sufficient funds within St Andrews for staff to use when taking residents out for leisure activities. All residents bedroom doors should have locks that work. Residents should have information on opportunities for further education, distance learning, vocational, numeric and literacy training and education, employment and personal development should be reviewed as part of their next planning meeting. A staff training and development plan should be developed from staff supervision and appraisals. There should be a traiinig budget in the home. There should be a business and financial plan open for Inspection in the home. All staff should be given contracts and job descriptions. 3. 4. 16 12 5. 6. 7. 35 42 31 St Andrews D54-D07 S18429 St Andrews V214875 200605 Stage 4.doc Version 1.30 Page 29 Commission for Social Care Inspection 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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