Inspection on 09/02/06 for St Anne`s

This inspection was carried out on 9th February 2006.

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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Anne`s 29/06/07

St Anne`s 05/02/07

St Anne`s 02/08/05

St Anne`s 25/11/04

St Anne`s 23/07/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

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33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 St Anne`s 4 St Anne`s Road Eastbourne East Sussex BN21 2DJ Lead Inspector Nigel Thompson Unannounced Inspection 9th February 2006 09:30 St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 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 Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 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 Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Anne`s Address 4 St Anne`s Road Eastbourne East Sussex BN21 2DJ 01323 728349 01323 720992 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) The Complete Care Group Mrs Christine Ann Klassen Care Home 6 Category(ies) of Learning disability (6) registration, with number of places St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The number of people accommodated must not exceed six (6). Only adults with Autism and/or Asperger`s Syndrome to be admitted. Date of last inspection 2nd August 2005 Brief Description of the Service: St Annes is overseen by its parent company, The Complete Care Group, and is registered to provide care for six adults with Autistic Spectrum Disorders (ASD). St Annes is a large detached Victorian house within walking distance of Eastbourne town centre and railway station. Service users individual and collective social care needs are assessed and met. Community participation is promoted and service users are enabled and supported to access local amenities, including the cinema, college, theatre, swimming pool and restaurants. Activities within the home include aromatherapy, computer skills, board games, karaoke and cooking. The dedicated staff team provide structured, yet flexible opportunity programmes to enable service users to develop social, emotional and independent living skills. There is spacious living accommodation with six bedrooms that have shower en-suite facilities. Adequate communal areas are provided to meet the individual and collective needs of the service users, including a sensory room and a light and spacious lounge at the front of the house. There is a dining room and kitchen to the rear of the home and a conservatory that leads into a large rear garden. St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five hours in February 2006. It found that all of the National Minimum Standards that were assessed had been met or partially met and the overall quality of care provided was good. Service users and relatives spoken with during the inspection expressed satisfaction with the home, the staff and the service provided. On the day of the inspection there were four service users living at the home. The inspection involved a tour of the premises, examination of the home’s records and discussion with the Registered Manager and the Responsible Individual. All four service users and two members of staff were also spoken with. The focus of the inspection was on the quality of life for people who live at the home. In order that a balanced and thorough view of the home is obtained, this report should be read in conjunction with previous inspection reports. What the service does well: A committed management structure and dedicated support staff continue to work hard developing and maintaining the evidently stimulating, open and inclusive atmosphere within the home. Service users are actively involved in many decision making processes within the home and are regularly consulted regarding all aspects of their day to day living. Comprehensive service user care plans ensure that an individual’s ongoing care and support needs are met in a structured and consistent manner. Communication and consultation with service users’ family members is effective and ongoing. Relatives have the opportunity to partake in individual assessment, care planning and reviewing processes. Staff receive effective induction and foundation training, regular supervision and are valued and supported by the management team. St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: 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 Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 Page 7 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 Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 Page 8 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, 3 & 4 The admission procedure is comprehensive and thorough, ensuring that service users are admitted only on the basis of a full needs assessment undertaken by people competent to do so. EVIDENCE: Although there have been no new admissions to St Anne’s since the previous inspection, one service user has moved out and there are currently two vacancies at the home. A thorough and comprehensive ‘Admission Assessment’ booklet is in place, which is completed by the Manager or Deputy Manager in respect of each prospective service user. Information contained in the assessment includes self care, daily living skills, communication, social and recreational interests, self awareness and self advocacy. Prospective service users are invited to visit the home, to look around and meet with staff and existing residents. They also have the opportunity to stay overnight before moving in. The Manager stressed the importance of compatibility with existing service users and confirmed that people initially move into St Anne’s for a six week St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 Page 9 trial period of continual assessment and monitoring of their individual care and support needs. A review of the placement is held after this time to establish their suitability and compatibility and decide whether or not their needs can be met within the home. Subsequent placement reviews are held on a six monthly basis and routinely involve the service user, a relative or representative where appropriate, the Care Manager and staff, including the individual’s key-worker, from St Anne’s. Review reports that were examined were found to be full and comprehensive with updated details of the service user’s physical and emotional wellbeing, their social interaction and levels of communication and community participation. The reports also included a detailed overview of the agreed goals and objectives. St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 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, 8 & 9 Comprehensive service users’ care plans are in place and enable staff to meet service users’ individual support needs in a structured and consistent manner. Service users are enabled and supported to take acceptable risks and encouraged to make decisions about their day-to-day living. The systems for service user consultation and participation are good, with a variety of opportunities provided for individuals to be directly involved in many decision making processes and aspects of life within the home. EVIDENCE: As previously documented, despite the recent unplanned and unsettling departure of several support workers, the dedicated staff team continues to work hard to meet the assessed, individual and collective needs of service users within the home. To address this unexpected staff shortage, a number of support workers have recently been recruited. All new employees are provided with a comprehensive job description and staff spoken to, including recently appointed workers had a sound understanding of their individual role and responsibilities. St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 Page 11 The Manager confirmed that all individual care plans are reviewed and updated on an ‘ongoing’ basis, with guidance for staff being reviewed and updated as required. Key-workers are directly involved in this process and it was noted that guidance for staff, relating to ‘Absconding’, had been implemented in January 2006. However, in individual care plans that were examined, there was little evidence of recent reviews having been carried out in respect of guidelines for staff and service users’ personal risk assessments. Following discussion with the Manager, it is recommended that risk assessments and guidance notes for staff be signed and dated to indicate when they are reviewed and by whom. Guidance sheets for staff contain a section to be signed by individual members of staff, to confirm that they have read and understood the guidelines. This would represent good practice, however, it is evident by the many gaps that staff are not routinely signing the form, as they are expected to. As previously documented, a comprehensive ‘Weekly Evaluation’ sheet is completed by key-workers in consultation with individual service users. The regular discussions and structured recording format provide an effective system of monitoring changes in emotional and personal support needs and demonstrate good practice. The Manager confirmed that service users continue to be consulted regarding many aspects of their day-to-day living, including menu planning, recreational and leisure activities and holidays. St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 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): 11, 12, 13, 14, 15, 16 & 17 Independence and individuality is promoted within the home and service users are enabled and supported to be part of the local community. Service users benefit from levels of support that reflect both their rights and responsibilities. EVIDENCE: It was evident from direct observation and through discussions with members of staff that the comprehensive ‘Opportunity Plans’, in place for each service user, continue to provide a structured programme of daily activities, reflecting individual interests and preferences. Opportunity plans that were examined included activities as diverse as: ‘music’; ‘sensory room’; ‘videos’; ‘karaoke’; ‘walk in the park’ and ‘free time’. Community participation is encouraged and service users are supported, as appropriate, to access a wide range of local facilities, including swimming, bowling, theatres and restaurants. St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 Page 13 Three service users currently attend the local college, where courses in which they have chosen to partake include cookery and pottery. On the day of the inspection, one service user was preparing to go out in the car with his key-worker for a day out in Hastings. The Manager confirmed that service users’ family links continue to be supported, where appropriate, with regular contact with relatives being maintained in the majority of cases. A four-week rolling menu is in place, providing service users with a balanced, varied and nutritious diet, which reflects individual choice and preference. An alternative to the main meal is always available. The menu has been made accessible to all service users by the effective use of symbols and pictures. The Manager confirmed that staff and service users routinely sit together for the evening meal. Service users’ weight and dietary needs are monitored regularly and menus and any dietary needs and changes are discussed during regular staff and residents’ meetings. St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 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): 20 There is a potential risk for service users from the current system of labelling PRN medication. EVIDENCE: St Anne’s uses a monitoring dosage system for the administration of prescribed medicines and in house staff training is provided in the control and safe handling of medicines. The home’s medication policy and procedures are monitored and regularly reviewed by the Manager and were found up to date and generally well maintained. However an inconsistency was noted in respect of certain PRN medication. Due to the current system of using old stock bottles to store certain tablets, the information on the label did not correspond to details on the administration record. Following discussion with the Manager and to ensure the health and safety of service users, this issue is required to be addressed as a matter of priority. Controlled drugs are stored and administered appropriately. St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 Page 15 The Manager confirmed that the situation regarding service users selfmedicating remains unchanged. Following risk assessments, no service user currently has responsibility for controlling or administering their own medication. St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 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): These standards were not inspected on this occasion. All key standards were assessed during the previous inspection carried out on 2 August 2005. EVIDENCE: St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 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, 26 & 30 Environmental standards within St Anne’s are generally satisfactory and provide service users with an accessible, clean and reasonably well-maintained place to live. However, the comfort of service users (and staff) in some communal areas is being compromised by an unsatisfactory heating system and the current lack of curtains. EVIDENCE: As with many of the environmental standards, the situation at St Anne’s regarding shared space remains largely unchanged. Adequate communal areas are provided to meet the individual and collective needs of the service users, including a spacious lounge, sensory room, dining room and kitchen. To the rear of the home a conservatory leads onto a large, well maintained garden. It was evident during the inspection, however, both from direct observation and through discussions with service users and staff that comfort levels in the large communal areas were not as high as they could be. St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 Page 18 An inadequate heating system meant that radiators were not heating rooms sufficiently and with wooden floors, high ceilings and no curtains up at the large windows, there was a distinctly bleak feel to some areas of the home. Several of the rooms have been redecorated since the previous inspection, including the dining room, lounge and sensory room. The Manager explained that the curtains had been taken down in preparation for this work and are due to be either replaced or renewed. There are plans to upgrade the kitchen and bathroom and the Manager is hopeful that this work will start in the near future. Service users’ accommodation comprises of six single bedrooms with en-suite shower facilities. As previously documented, rooms vary significantly regarding furniture, furnishings and personal effects. The Manager again confirmed that this difference very much reflected individual needs, personality and choice. Levels of cleanliness and hygiene remain satisfactory throughout. Infection control procedures are in place and closely adhered to. A programme of routine maintenance, renewal and redecoration is in place. St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected on this occasion. All key standards were assessed during the previous inspection carried out on 2 August 2005. EVIDENCE: St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 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): 38, 39 & 40 Service users and staff benefit from the experienced Manager’s calm, open and approachable style of leadership and clear and positive sense of direction. Service users’ best interests are safeguarded by the home’s quality monitoring systems. EVIDENCE: The dedicated and experienced Registered Manager and Deputy Manager have clearly worked hard to develop a safe, supportive and stimulating environment within the home. The Manager confirmed that they are both currently studying for the Registered Manager’s Award and are hoping to complete later this year. Staff and service users, spoken with during the inspection, confirmed how approachable and supportive the Manager and the Deputy Manager are: St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 Page 21 ‘One of them is always around to talk to – you never have to take a problem home!’ As recommended, since the previous inspection the organisation of the homes policy files has been significantly improved, to incorporate an index system, therefore making individual policies more readily accessible. Since the last inspection, as required, the Responsible Individual (RI) for The Complete Care Group Ltd now undertakes unannounced visits to the home on a monthly basis, in compliance with Regulation 26 of the Care Home Regulations 2001 and as part of their quality assurance procedures. Although there was evidence that a satisfactory report had been completed, following this visit, it had not been forwarded to the CSCI. This was discussed and is to be addressed by the RI, in respect of future monitoring visits. St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 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 3 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X X 3 2 3 X X X St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15(2) Requirement Timescale for action 30/04/06 2. YA20 13 (2) 2. YA39 26(2)(3) (4) & (5) It is required that the service users individual care plan, including staff guidance and risk assessments, be regularly reviewed, to reflect any changing needs or circumstances. It is required that, to ensure the 31/03/06 health and welfare of service users, arrangements be made for the recording and safe administration of medicines, including PRN medication. It is required that following the 30/04/06 Responsible Individual’s monthly monitoring visit to the home, a copy of the report is submitted to the Commission. St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 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. 1. Refer to Standard YA6 Good Practice Recommendations It is recommended that risk assessments and guidance notes for staff, contained in service users’ individual care plans, be signed and dated to indicate when they are reviewed and by whom. It is recommended that guidance sheets be signed by individual members of staff, to confirm that they have read and understood the guidelines. It is recommended that the premises, including communal areas are made more comfortable and homely and provide sufficient and suitable heating for service users and staff. 2. 3. YA6 YA24 St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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. Extracts may not be used or reproduced without the express permission of CSCI St Anne`s DS0000021436.V267113.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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