Inspection on 22/02/06 for St Chads House

This inspection was carried out on 22nd February 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Chads House 28/02/07

St Chads House 08/03/05

St Chads House 08/09/04

St Chads House 17/12/03

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 St Chads House Withies Lane Midsomer Norton Bath Bath & N E Somerset BA3 2JE Lead Inspector David Smith Unannounced Inspection 22nd February 2006 09:30 St Chads House DS0000008189.V283654.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 Chads House DS0000008189.V283654.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 Chads House DS0000008189.V283654.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service St Chads House Address Withies Lane Midsomer Norton Bath Bath & N E Somerset BA3 2JE 01761 413173 01761 419204 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 ORCHARD VALE TRUST Mr Paul John Maggs Care Home 4 Category(ies) of Learning disability (4) registration, with number of places St Chads House DS0000008189.V283654.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 4 persons aged 18 - 64 years of age requiring personal care only 9th September 2005 Date of last inspection Brief Description of the Service: St.Chads house is owned and operated by Orchard Vale Trust, a Registered Charity. The home was opened in 1995 to provide care and support to four adults who have a Learning Disability and Challenging Behaviour. It is located in the town of Midsomer Norton and has easy access to local shops and facilities. Bath is approximately nine miles away. St.Chads is a spacious detached house set in its own grounds. There are four single rooms, each with en-suite facilities, two communal lounges, kitchen and dining area and a large conservatory. This has been converted into a sensory room, equipped with soft fixtures and fittings, lights and a music system. There is a close relationship with Ferndale, in Shepton Mallet, another Orchard Vale Trust home. Staff are employed to work at both homes. St Chads House DS0000008189.V283654.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over one day. The home uses the term ‘resident’ to describe the people who live in the home. This term has therefore been used throughout this report. The evidence for this report was gathered from consultation with the home manager, his line manager, inspection of care plans and associated records, case tracking, a tour of the home and observation of interaction between the staff and residents during the morning routines. What the service does well: What has improved since the last inspection? The home has reviewed its staff application form to ensure relationships with referees are explained. This helps to maintain and improve the robust recruitment practices. St Chads House DS0000008189.V283654.R01.S.doc Version 5.1 Page 6 The home awaits the results of a survey to confirm the adequacy of the current fire alarm system. This is to ensure the welfare and safety of residents is promoted. The reactive strategy inspected was sufficiently detailed and provided clarity in detailing the rationale, support and interventions in relation to this resident. 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 Chads House DS0000008189.V283654.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 Chads House DS0000008189.V283654.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): 1 Prospective residents are provided with the information they require to enable them to choose where to live. EVIDENCE: The home has a brochure, which is used as both the statement of purpose and service users guide. This provides details of the service and support the home is able to provide. This would be supplemented by a comprehensive assessment process, which is operated by the home. There have been no new admissions to the home for several years. St Chads House DS0000008189.V283654.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Comprehensive care plans are in place that identify resident’s assessed needs and personal goals. Any changes in support needs are identified and acted upon. The style and terminology used are to be reviewed by the home. Behavioural approaches are detailed. These ensure support for each resident is agreed upon and clearly defined. The Risk Assessment process supports each resident to take risks. These are reviewed and updated regularly. EVIDENCE: The inspector case tracked records for one resident. This ensured all records for this person were examined in detail to determine the quality and clarity of the care planning and review processes. This care plan was both sophisticated and detailed. It contained clear guidance on the areas of support the resident requires and how this should be provided. St Chads House DS0000008189.V283654.R01.S.doc Version 5.1 Page 10 The daily recording mechanisms complement this process by ensuring there is a constant process of evaluation and review of the support being provided and the outcomes for the resident focused upon. The annual multi-agency review records were evident. The review documentation was presented under two headings, “Review- Evaluation of Behaviour” and “Quality of Life and General Skills”. The reviewing documentation was detailed and clinical in its formatting and terminology. The outcomes were used to update the care plan and risk assessments in place. The home operates a fluid process of review in addition to the multiagency and daily recording processes. These records are contained either as part of clinical supervisions or case conferences. These records were not available on the day of inspection and will be focused upon as part of the next inspection process. The resident is supported to make decisions and provided with a number of options. This is in accordance with the Active Support approach utilised by the home. The manager also explained that choices or views may also be expressed through behaviours, which can be perceived as challenging the service being provided. These however are seen as a method of effective communication and as such are viewed as supportive to the decision making process for this resident. The behavioural approaches contain a clear rationale, long-term goals, and ecological manipulations, positive programming for general skills and for functionally equivalent skills, direct treatment, reactive strategies and restrictions. The home’s methodology appears to be drawn from a select variety of sources such as Studio 3 and Somerset County Council current best practice. Both methodology and relevant training and support of staff in this area will be focused upon in greater depth during the next inspection process. Physical interventions used by the home have been recorded and shared with all appropriate parties e.g., family members, representatives, and Consultant Psychiatrists and Psychologists involved with the individual resident. Whilst the records are comprehensive, many are clinical in their construction and terminology. There are current discussions regarding amendments to the format and terminology the home uses and its suitability in relation to the home’s person centred approaches. The inspector is interested in the outcomes of these discussions and the possible changes in format and language. Care and support was being provided within a risk assessment framework. Healthy risk taking is being encouraged and supported, as evidenced within the St Chads House DS0000008189.V283654.R01.S.doc Version 5.1 Page 11 wide range of opportunities and activities all four residents have been able to enjoy. St Chads House DS0000008189.V283654.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 and 15. Residents are supported in their personal development. The residents currently accommodated clearly demonstrate the home’s success in this area. Residents are encouraged and supported to take part in appropriate leisure activities, including the use of many community-based resources. Involvement of resident’s families is encouraged and seen as central to the philosophy of the home. EVIDENCE: St Chads House DS0000008189.V283654.R01.S.doc Version 5.1 Page 13 Residents are supported to reach their full potential in relation to their personal development. A great deal of importance is placed on residents being able to participate in all aspects of home life and support to enjoy a range of leisure activities, outings to places of interest, and social functions. Each resident may be offered options within this framework, which supports their engagement. Records examined showed that residents are accessing many facilities in the community. On the day of inspection all residents were supported to play 10pin bowling. The residents who live in the home have all demonstrated significant progress in their personal development. It is evident that the outcomes for each resident are the main focus of the care planning processes and support of the staff team. By focusing on these, the home is demonstrating its commitment to maintaining a person centred approach. Families have been fully involved in the home’s assessment and care planning process and staff members ensure that families are kept informed if there are any changes in a resident’s health or care needs. All four residents have contact with members of their families and there are no restrictions on visiting times and relatives are free to visit whenever they wish. Clear records are maintained relating to any contact with families. Any concerns raised or views expressed by families appeared to be dealt with professionally and empathetically. Observation of interaction witnessed between staff and residents during the morning period provided evidence that residents are treated with respect and dignity. Staff demonstrated an awareness of the needs and preferences of the individual residents and had a good knowledge of the recording mechanisms in place. St Chads House DS0000008189.V283654.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): 18 and 19. The care plans clearly explain the support each resident requires in relation to their personal and health care. Experienced staff have a good knowledge of each resident and how to provide appropriate levels of support. EVIDENCE: All residents are registered with a local GP Practice. A GP from this practice completed an extremely complimentary comment card as part of the last inspection process. Each resident is also registered with a Dentist and other relevant professionals as required. Records show that one resident is currently supported by a Clinical Psychologist provided through the Somerset Community Learning Disability Team, based at Fiveways in Yeovil. In addition to external resources, there appears to be a high level of clinical expertise within the organisation to ensure that the care planning meets the needs of each resident. St Chads House DS0000008189.V283654.R01.S.doc Version 5.1 Page 15 The record keeping for residents is excellent and can be easily tracked. This process ensures that resident’s health care is monitored and the support provided is subject to review. The inspector observed staff interacting with residents within the home during the morning routines. One senior member of staff who assisted initially with the inspection process displayed an extremely good knowledge of the support being provided to each resident and the importance of good record keeping within the home. The continuity the home has managed to maintain within the core staff team also assists in providing consistency and quality of support in this area. St Chads House DS0000008189.V283654.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): 22 and 23. The home’s policies and procedures, care-planning system, monitoring systems and communication systems, combine to promote the safety and well being of the residents in this home. EVIDENCE: There is a formal complaints policy and whistle blowing procedure available in the home’s operational manual. This procedure sets out the various stages and levels that a complaint or concern may be dealt with and provides information with regards to when a complainant can expect a response by. The formal policy and procedure makes reference to other interacting policies and procedures, and refers to a complainant right to complain to CSCI. The home has an in house complaints and comments book. No complaints have been recorded. This file does contain several complimentary letters from residents’ families regarding the service provided or their particular relative’s development or happiness since living in the home. The home maintains accurate records relating to interventions used as part of the behavioural support for each resident. All accidents are recorded and the records stored appropriately. St Chads House DS0000008189.V283654.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, 25, 27, 28 and 30. The accommodation provides a safe and comfortable home for the residents, which is maintained to a high standard. Some remedial work identified during the last inspection requires completion. Each resident is encouraged and supported to personalise their own room and contribute to the redecoration of communal areas. The home was clean and tidy on the day of inspection. EVIDENCE: St Chads is a detached property set in its own grounds just a short walk from the town centre of Midsomer Norton. The inspector was provided with a tour of all internal and external areas of the home. The communal areas are all situated on the ground floor. These include a large and small lounge area, a kitchen/dining area, and a conservatory, which has been adapted to provide a sensory room. There is level access to the front St Chads House DS0000008189.V283654.R01.S.doc Version 5.1 Page 18 and rear of the home. Access to the first floor within the home is by stairs only. The main lounge area was recently redecorated and now also contains new leather furniture and a wall mounted plasma screen television. All residents are supported in choosing menus, preparing and cooking meals, snacks and drinks. The kitchen area is reasonably large and has high quality fixtures and fittings. There are four single rooms all with en-suite facilities on the first floor. Each resident’s bedroom has been personalised with photographs, pictures and been decorated to reflect their own personal tastes and wishes. All bedrooms are fitted with a lock so residents can lock their bedroom doors should they wish to do so. Residents are encouraged to be responsible for cleaning and tidying their own rooms, although staff support is available if needed. This forms part of each resident’s daily record. Upgrading of other areas in the home was evident. The staircase and stairwell have been prepared for repainting. The hall, stairs and landing carpets have been chosen, ordered and will be laid once the repainting is completed. New laminate flooring is planned to be laid in the area outside the downstairs toilet and shower room. The residents are actively involved in the maintenance of their home. They are encouraged and supported to help choose furniture, fixtures, fittings and colour schemes and to help with both preparation and redecoration. The home has a large secluded garden, which residents are actively involved in maintaining. Part of the hedging/trees have recently been cut back to improve the view for residents. The exterior of the house is in good order but a repair is still needed to an area of exposed brickwork on a side wall to avoid damp ingress. The timber supports require replacement and this work will be carried out shortly. St Chads House DS0000008189.V283654.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): 33 The high retention rate of staff helps to ensure the cohesion and effectiveness of the staff team. EVIDENCE: St Chads House DS0000008189.V283654.R01.S.doc Version 5.1 Page 20 Staff are employed to work at both St Chads and Ferndale. Many of these staff have been employed by the Trust for a number of years and therefore know each of the residents very well. The home has been successful in retaining staff. This ensures the core team remains consistent. This has led to a committed and skilled team being developed. The positive outcomes for each resident reflect the commitment and cohesion of the staff team. The inspector was shown the template for the revised staff application form for the trust. This now describes the relationship with each referee. Through discussion with the manager, it was agreed that this document should be amended further to ensure that all prospective staff provide a complete employment history rather than just the last five years. The personnel records for each staff member are currently stored at Ferndale. These were therefore not available for inspection as part of this process and will be focused upon during the next inspection. St Chads House DS0000008189.V283654.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 42 and 43. The home is well run and has effective procedures in place to provide residents with the support they require to lead fulfilling lives. The ethos of the service is defined and clearly communicated. The health, safety and welfare of residents is promoted. Organisational legal accountability, monitoring and support of the service must be improved through regular visits and reports. EVIDENCE: The inspector discussed the ethos, history and development of the service at length with both the registered manager, Mr.Maggs and his line manager, Mr.Phillips. The management approach appears open and positive, with a clear sense of direction and leadership. St Chads House DS0000008189.V283654.R01.S.doc Version 5.1 Page 22 Both are long standing members of the Trust’s staff team and have considerable knowledge of the service and each resident. Mr. Phillips plays an active role in supporting Mr. Maggs with the running of the home and the support of the residents. Mr Phillips has considerable experience within the learning disabilities field with a particular clinical expertise in the management of challenging behaviour. The fire log was examined. The showed that all staff are provided with regular fire drills. The fire alarm system is checked on a weekly basis together with other fire fighting equipment and lighting. The alarm system has recently been independently inspected and a report on its adequacy is awaited. The inspector could find no evidence to suggest the alarm system is inadequate in ensuring the safety of residents and staff. Risk Assessments are in place. These are both generic and person centred. These are clearly written and subject to regular review. There continues to be a lapse in the organisation’s Chief Executive carrying out monthly visits as required by Regulation 26. This issue was raised during the last inspection process. The Inspector was assured that visits to the home had occurred but not in relation to an audit of the service since September 2005. The records examined confirmed the last recorded audits were on the 31/08/05 and 09/09/05. These visits must be conducted in accordance with the regulations and a copy of each report forwarded to the Commission. St Chads House DS0000008189.V283654.R01.S.doc Version 5.1 Page 23 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 3 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 4 26 X 27 4 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 4 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 4 X LIFESTYLES Standard No Score 11 3 12 3 13 4 14 4 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 X X 3 3 X X X 3 2 St Chads House DS0000008189.V283654.R01.S.doc Version 5.1 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. 1. Standard YA39 and 42. Regulation 26 Requirement a) Ensure monthly-unannounced auditing visits are conducted. 22/02/06 b) Ensure a copy of the report is supplied to the Commission. 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. 2. Refer to Standard YA6 YA34 Good Practice Recommendations The home to review its record keeping terminology to promote a person centred approach. Review the application form for new staff to obtain a full employment history for each applicant. St Chads House DS0000008189.V283654.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Chads House DS0000008189.V283654.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. 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!