Inspection on 28/03/08 for St Anthony`s

This inspection was carried out on 28th March 2008.

CSCI found this care home to be providing an Excellent 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 Anthony`s 03/10/06

St Anthony`s 06/12/05

St Anthony`s 23/06/05

St Anthony`s 09/09/04

St Anthony`s 13/04/04

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

CARE HOMES FOR OLDER PEOPLE St Anthony`s 7a Roseberry Road Langley Vale Epsom Surrey KT18 6AF Lead Inspector Andrea Leverett Unannounced Inspection 28th March 2008 3:pm X10015.doc Version 1.40 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 Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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 Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Anthony`s Address 7a Roseberry Road Langley Vale Epsom Surrey KT18 6AF 01372 278542 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) Mrs Marie Rajendra Mrs Marie Rajendra Care Home 5 Category(ies) of Learning disability (5) registration, with number of places St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The age/age range of the persons to be accommodated will be: 25-65 YEARS Date of last inspection Brief Description of the Service: St. Anthony’s is registered with the CSCI (Commission for Social Care Inspection) to provide accommodation and care to five service users with a learning disability. The premises is located in a residential area close to public amenities and accommodation comprises of an office, a lounge, dining area, laundry area, conservatory, kitchen, toilets, bathrooms and five single bedrooms. Accommodation is on two floors accessed by stairs and private parking is available. The home has a garden to the rear of the property which is private, secure and accessible to service users. The fees charged by the home range from £807 - £2,000 per week. St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This unannounced inspection of St Anthony’s Care Home took place on the 28th of March 2008. During which, samples of care assessments, care plans, and staff records were inspected. All of the key inspection standards for Younger adults services were assessed. The manager, two staff members, two relatives, two friends and three people who live at the home have been spoken with and their comments have been included in this report. The inspector would like to extend thanks to the people who live at St Anthony’s and the manager and staff for their assistance and warm hospitality during the inspection. What the service does well: The inspector met and observed the care and support provided to the most recently admitted person and inspected their care assessments and person centred plans. The person was able to visit the Home three times and the manager visited them in their previous Home five times before the person moved in on a trial basis. In addition the manager liaised with care managers, health professionals and attended multidisciplinary meetings to agree appropriate levels of care before agreeing to offer a place. It was also clear that peoples diverse needs, wishes and aspirations were given a high priority in the Home and peoples self confidence and feelings of self worth were evident. Information taken from the homes activity records and daily support plans showed that good staffing levels enabled consistent therapeutic activities and approaches to be undertaken. Records showed that staff work hard to establish peoples wishes and needs and people are encouraged to raise concerns in advocacy meetings. Many activities are on a 1:1 basis, or in groups of two or three people, depending on needs and are provided throughout the week, including evenings and weekends. St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 6 Examples were also seen of staff taking people to friend’s houses and picking them up if they could not travel late at night and supporting people to take their friends on holiday with them. It was also noted that good therapeutic ways of working with people was ensuring that (as and when required medications) used to manage behaviour and anxiety, was being kept to a minimum. What has improved since the last inspection? What they could do better: Although the manager confirmed that she does periodically observe staff administering medication a recommendation remains outstanding that a recorded system should be put in place to evidence ongoing competency of staff. There was evidence of Criminal Record Bureau checks being undertaken prior to commencing employment. However the home does not have a system in place for re checking Criminal Records periodically and a recommendation has been made that the organisation review this practice and ensure a system is in place to evidence ongoing fitness of staff employed. St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use this service receive excellent quality outcomes in this area. People who use this service can be confident that their needs and aspirations will be fully assessed before they move in to St Anthony’s and the Home will meet their needs to a very high standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three assessment and care planning documents were inspected as part of the case tracking process. Assessments are very detailed and include risk, general care, and support and health assessments. Person centred plans seen reflect peoples needs and aspirations as detailed in their assessments and records showed that both these documents are St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 10 regularly reviewed. It was clear that people are assessed and their support is planned to promote independence and choice over their lives. The inspector met and observed the care and support provided to the most recently admitted person and inspected their care assessments and person centred plans. The person was able to visit the Home three times and the manager visited them in their previous Home five times before the person moved in on a trial basis. In addition the manager liaised with care managers, health professionals and attended multidisciplinary meetings to agree appropriate levels of care before agreeing to offer a place. Records showed that a detailed community care assessment was obtained before they moved in. The homes own assessment also included likes and dislikes, social and emotional needs and detailed clear risk assessments. The person’s individual plan gave clear hour-by-hour and day-by-day guidance to ensure that their basic care and therapeutic needs would be met. Records seen showed that the Home worked closely with health professionals to ensure a smooth transition to the Home. As a result of this well planned transition and carefully planned therapeutic input, records evidenced a significant reduction in (as and when required medications) to manage behaviours. St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People who use the service experience excellent quality outcomes in this area. People are given a good standard of support to maintain their personal care in the way they prefer and require. People can be confident that their physical and emotional health needs will also be met to a high standard. People are protected by the homes policies and procedures for dealing with medicines. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Records of assessments and care plans seen and observation and discussion with people who use the service and staff showed that people receive personal care and support in the way they prefer and require. Records included guidelines for supporting people with aspects of personal care and daily St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 12 records and observation on the day of the site visit evidenced that preferred choices in daily living are respected. Staff were observed taking the time to talk to people and providing sensitive individual support as needed. Records seen and discussion with people showed that access to routine and specialist health services was facilitated. Good record keeping was maintained in order to monitor people’s health. An inspection of the Homes medication storage and administration systems showed that medication was being stored administered and recorded appropriately. Medications are kept in a locked cabinet in the homes office and staff records showed that they received appropriate training to administer medication. An independent pharmacist also audits the homes medication systems once a year. It was also noted that good therapeutic ways of working with people was ensuring that (as and when required medications) used to manage behaviour and anxiety, was being kept to a minimum. People’s files contain information regarding medication protocols and stated how medication will be administered. An independent Chemist audits medication regularly and records showed that staff training is in place. Although the manager confirmed that she does periodically observe staff administering medication a recommendation remains outstanding that a recorded system should be put in place to evidence ongoing competency of staff. St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People who use the service experience excellent quality outcomes in this area. People who use the service take part in a range of activities including community activities and their rights are respected and responsibilities recognised in their daily lives. Time is taken to encourage and support people to maintain personal and family relationships. People are encouraged and supported to maintain a healthy diet and their needs and wishes are sort and respected in this regard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 14 Records seen and discussions with people who use the service and staff evidenced that people undertake a range of activities in the community both independently and with support from staff. Two people had a job and others attended day centres several days a week. People were also supported to go horse riding, bowling, swimming, trampolining and local shops and cinemas. Many activities are on a 1:1 basis, or in groups of two or three people, depending on needs and are provided throughout the week, including evenings and weekends. In addition people are supported to go on holidays each year and the Home has its own vehicle to support people to access the community. It was evident from discussions with people that they maintained relationships with family and friends and that family and friends are welcome in the Home. Examples were also seen of staff taking people to friend’s houses and picking them up if they could not travel late at night and supporting people to take their friends on holiday with them. On the day of the visit to the Home one person was celebrating their birthday. The person had invited their family and close friends to join them in the celebrations and a three-course meal was served for everybody including staff. The person had chosen the menu them selves and invited the inspector to stay for the meal. The meal was cooked and served to a very high standard and everybody was observed enjoying their food and being supported by staff in a very respectful and sensitive manner. An inspection of the homes kitchen and food storage area evidenced that a range of healthy food was available including fresh fruit and vegetables. People are involved in planning menus, food shopping, and preparing meals with support as needed. St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. People know that their concerns will be listened to and acted upon and they will be protected from abuse, neglect and self-harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: St Anthony’s has a complaints procedure, which meets all the requirements of this standard and is laid out in a clear and accessible format for people to understand. Observation on the day of the site visit and discussion with people who use the service demonstrated that concerns and complaints would be taken seriously and acted upon. Records showed that staff work hard to establish peoples wishes and needs and people are encouraged to raise concerns in advocacy meetings. The Home has appropriate adult protection procedures and policies and staff spoken to and records seen also confirmed that Adult Protection training is undertaken. St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 16 People are supported to manage their own money and money and records of money belonging to two people was inspected. Records showed that receipts are kept and money sheets are signed and checked regularly. St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience good quality outcomes in this area. People live in a clean, comfortable and safe environment, which is maintained appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a good standard of décor with nice furniture and fittings. Observations confirmed the home is comfortable, clean and free from offensive odours. Further evidence indicated the home is in keeping with the local community and the people were observed having unrestricted access to the Home. The St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 18 inspector noted the gardens are well maintained, private, secure and accessible. The Home also keeps birds and fishes, which are looked after and appreciated by people who live at the Home. The home has a policy on infection control and a laundry area with a washing machine and dryer. Observations confirmed staff practiced infection control measures and washed their hands regularly to prevent the spread of infection in the home. Every body that lives at St Anthony’s has their own room and a sample of these was seen at the site visit. Bedrooms are spacious and nicely furnished and people are encouraged to personalize them as they wish. St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. People who live at St Anthony’s are supported by a sufficient number of staff that are competent and qualified and are supervised appropriately. On the whole people can be confident that they will be protected by the homes recruitment practices but more could be done to ensure ongoing monitoring of staff fitness. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three staff files were inspected and evidence from these and discussions with staff showed that on the whole appropriate recruitment practices are now in place. Files included application forms two written references and evidence of Criminal Record Bureau checks being undertaken prior to commencing employment. However the home does not have a system in place for re checking Criminal Records periodically and a recommendation has been made that the organisation review this practice and ensure a system is in place to evidence ongoing fitness of staff employed in the Home. Records also showed that the Home provides appropriate induction procedures and training for staff. St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 20 In addition to an in house induction staff undertake induction foundation training provided by the organisation. Records and discussions with staff also evidenced that a range of training is provided including NVQ 2 Food Hygiene, Dementia with people with learning disabilities, POVA, Moving and Handling, Person Centred Planning, emergency first aid and infection control. In addition the Home has good relations with the learning disability and psychology health teams who work closely with staff to support people with complex needs. Feedback from people who use the service and observation on the day of the site visit evidenced that sufficient staff are provided to meet needs. People who use the service spoke highly of the staff team and felt supported by them. Information taken from the homes activity records and daily support plans showed that good staffing levels enabled consistent therapeutic activities and approaches to be undertaken. St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People who use the service experience excellent quality outcomes in this area. A staff team that is led by a competent and experienced manager, who ensures that the home is run well, enhances the support of people who live at St Anthony’s. People can be confident that their views underpin all self-monitoring, review and development by the Home and their health, safety and welfare are promoted and protected. This judgement has been made using available evidence including a visit to this service. St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 22 EVIDENCE: The home has a registered manager who has a professional nursing qualification in learning disability and an approved management qualification to ensure people benefit from a well run home. Observation on the day, records viewed and discussion with people who use the service and staff evidenced that the manager delivered a highly effective person centred service. The manager works hard to promote peoples independence and ensure their involvement in the running of the home. It was also clear that peoples diverse needs, wishes and aspirations were given a high priority in the Home and peoples self confidence and feelings of self worth were evident. Examples were seen of the manager working sensitively and respectfully to meet people’s complex emotional needs and supporting people’s individuality and rights. The home had an annual quality audit carried out by the manager and used questionnaires to obtain feedback about the home. Further evidence indicated the home had annual reviews to monitor the quality of care and a review of records indicated the home had regular meetings with staff and service users to participate in the review of the Home. The home had a policy on health and safety and staff have training in food hygiene, fire safety, first aid, infection control, manual handling and other appropriate and relevant training. Typical comments from staff and people who use the service included: “I think the manager has had a marvellous influence on our son, you can’t fault her. She encourages him to have relationships with friends as well as us.” “ I like it here, I go out by myself and visit my girl friend at the weekend.” St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X 4 X x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 3 X X 3 St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action 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 YA20 Good Practice Recommendations The registered person shall ensure staff have an annual assessment to determine competency in the administration of medications to promote health. The home does not have a system in place for re checking Criminal Records periodically and a recommendation has been made that the organisation review this practice and ensure a system is in place to evidence ongoing fitness of staff employed in the Home. 2 YA29 St Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Anthony`s DS0000013795.V359456.R01.S.doc Version 5.2 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!