CARE HOME ADULTS 18-65
St Christopher`s House 6 Mays Lane Barnet Hertfordshire EN5 2EE Lead Inspector
Wendy Heal Key Unannounced Inspection 18th September 2006 09:00 St Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 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 Christopher`s House DS0000063893.V301125.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 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 Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Christopher`s House Address 6 Mays Lane Barnet Hertfordshire EN5 2EE 020 8364 8085 020 8364 8085 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) Platinum Health Resources Ltd Mr Ephantus Maina Njogu Care Home 6 Category(ies) of Learning disability (0), Mental disorder, registration, with number excluding learning disability or dementia (0) of places St Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 12th December 2005 Brief Description of the Service: St Christopher’s House is a care home registered to provide personal care for a maximum of six adults who may have either a mental disorder or learning disabilities. The home was opened in June 2005. It is owned by Platinum Health Resources Limited, a private company based in London. This is the only home owned by the company. The aim of the home is to provide individualised care for all it’s service users by working in partnership with service users and other relevant agencies and to encourage service users to lead as independent a life as possible and attain their full potential. The home is an end of terrace two-storey house with a loft conversion. There are a total of six single bedrooms, a large lounge on the ground floor and a smaller one on the first floor. On the ground floor there is one bedroom, a kitchen/diner, a lounge, a bathroom with a toilet, a small toilet and an office. The first floor has a bathroom and three bedrooms. The attic is converted into a further two bedrooms. There is a small parking area at the front of the house and a garden at the back. The home is set in a residential area and overlooks a primary school. It is within walking distance of Barnet General Hospital, local shops, restaurants, underground station and community facilities located along the High Street in High Barnet. The home’s inspection report and statement of purpose are available in the staff office for prospective service users to view. The fees range from £850.00 - £950.00 per week. St Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 18th of September 2006 and took approximately 7 hours to complete. The inspector had independent discussions with service users and staff. An inspection of the premises took place. A wide range of records kept at the home were examined including service user care plans, assessments and staff files. The trainee manager who provided all of the information that was requested assisted the inspector throughout the inspection. What the service does well: What has improved since the last inspection?
The manager has updated the statement of purpose, which now includes the criteria for admission, which ensures service users, and staff have up-to date information in relation to the home. The manager has updated the terms and conditions of tenancy to contain the obligations of service users, which ensures staff, know what to expect and vice versa. Service users have been provided with a programme of weekly social activities, which are appropriate and assist service users to be stimulated. There is now two staff on duty and they do not work continuously without a break and do not work a day shift after a night shift, which ensures that service users needs are met and health and safety requirements are being met. Window restrictors have been provided to all
St Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 Page 6 rooms which minimises the risk to service users by limiting the access of the window span. 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 Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 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 Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 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): 1,2,4,5, Quality in this outcome area is adequate. The judgement has been made from evidence gathered both during and before the visit to this service. Service users are given the information they need to make an informed choice about whether the service is suitable for them and their needs. The service is good at assessing individual service users aspirations and needs. Service users have an individual contract of terms and conditions, which means they know what the expectations are for them and visa versa. EVIDENCE: The service has a service user guide last updated on the 4/11/06 and an upto-date statement of purpose last updated 4/12/06. The areas covered in the service user guide include accommodation, the terms of residency, confidentiality, social contacts, service user rights and complaints. This document ensures that service users are provided with adequate information in relation to the service, which enables service users to make informed decisions in relation to whether the service can meet their individual needs. The assessment process was adequate and incorporated visits to the service and overnight stays which means that service users can feel confident that the staff understand and are able to meet service users needs. Staff have information about the individuals past history and current needs to ensure holistic support is provided. St Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 Page 9 The service users files inspected contained copies of contracts between the home and the service users, which had been signed by all parties, which ensures that service users know what is expected of them and visa versa. St Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 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): 6,8,9,10 Quality in this outcome area is adequate. The judgement has been made by evidence gathered during and before the visit to this service. Service users have individual care plans in place, which reflect their changing needs and goals. Service users are supported to take appropriate risks. However one identified service users risk assessment needs to be updated to ensure the service user is safeguarded by clear up-to date information being provided to staff. Service users confidences are kept and information about them is stored appropriately which ensures their confidentiality is respected. Service users are consulted with regard to the running of the home and participate in all activities within the home. EVIDENCE: Service users’ case notes were inspected and they were clear to read which ensures that this information is easily assessable. Service users had satisfactory care plans, which were based on their changing and current needs and were regularly reviewed, which ensures service users needs can be consistently met. The care plans contain goals which provide service users with a means to develop and provide staff with the necessary information regarding
St Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 Page 11 how staff need to support service users to achieve these goals those service users that were able to had signed and agreed their care plans. Appropriate risk assessments were in place for all service users whose documentation was seen except one. One identified service user must have their risk assessment updated so that it clearly reflects their current needs. A requirement has been made in relation to this. Service users confidential information is stored appropriately and staff have a good awareness of the issues of confidentiality, which protects the service users. Service users have monthly minuted meetings to discuss issues /practice within the home such as service users and staff carrying out a spring clean of the home and expressing their views in relation to the food they would like. This shows that service users are provided with an opportunity to express their views. The inspector also saw evidence that these minutes had been signed by the manager as having been read and the relevant issues had been acted upon which reinforces the fact that the information expressed by the service users are taken seriously. Service users spoken with discussed their participation in the daily running of the home such as being provided with money from the petty cash system and drawing up a list of items required to cook a meal for each other. St Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 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 15,16,17 Quality in this outcome area is good. The judgement has been made from evidence gathered before and during the visit to this service. Service users are encouraged and supported to take part in appropriate activities within and outside the home to promote personal development. Contact with family is promoted which assists the emotional well being of service users. Service users rights are recognised and respected which, makes them feel valued. Service users are supported to cook healthy balanced meals, which safeguards their health. EVIDENCE: The daily life and routines of service users were flexible and service users attend day centres as they wish and some have part time jobs within a sheltered environment, which empowers them. Service users are encouraged to interact with others and to improve their social skills such as art, computing gardening. The home now has a weekly programme of leisure and social activities, which ensures that service users are provided with social and mental stimulation.
St Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 Page 13 Service users have freedom passes to enable them to use public transport, which aids service users independence. Service users confirmed they could visit friends and family when they wish, which benefits service users wellbeing. Service users privacy is respected, service users have keys to their rooms and permission is sought by staff before entering service users bedrooms, which ensure their rights, are respected. On the day of the inspection the kitchen was clean and tidy, which benefits the health and safety of service users and staff. The menu of food available was wholesome and nutritious which ensures that service users dietary needs are being met to benefit their health and wellbeing. The fridge and fridge freezer were inspected and all food was identified as being within its use by date and properly labelled, which ensures that service users health is safeguarded. Service users benefit from a mixed staff team who bring a range of different ideas to the home in terms of food preparation. This benefits service users as they have access to different types of food than they may otherwise experience. St Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 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): 18,19,20,21 Quality in this outcome is adequate. The judgement has been made from evidence gathered both during and before the visit to this service. Service users receive personal support in a way they prefer, which ensures their wishes are respected. Service users receive adequate health care support to ensure their health and emotional needs are met. However self-administration assessment forms must be completed for service users who administer their own medication to ensure that professionals are satisfied with these arrangements. The ageing, illness and death of service users are not recorded which means their wishes may not be respected. EVIDENCE: Service users all have access to primary and specialist health care appointments which safeguards service users health and wellbeing. Service user care plans identified the way in which service users prefer their needs to be met which promotes their self-esteem. Records of medical appointments indicated that service users have access to General Practioners, dentists, psychiatrists, CPN’s and social workers that ensures their health care needs are being monitored and enables their needs to be met. St Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 Page 15 The medication was inspected and found to be stored appropriately in a locked medical cabinet, which ensures that medication is stored in a professional way. The medication records had been signed appropriately to indicate that medication had been administered which ensures that service users health is protected. A self-administration assessment form had not been agreed with the doctor concerned for a service user who administered his own medication. This is required to ensure that professionals concerned are satisfied with the arrangements. A requirement has been made in relation to this. The inspector did see an administration assessment form for another service user that had been obtained since the last inspection but this must be obtained in all cases. Service users wishes are not recorded on their files in the event of their death, which does not ensure their rights are respected. A requirement has been made in relation to this. St Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 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): 22,23, Quality in this outcome area is adequate. The judgement has been made from evidence gathered both during and before the visit to this service. Arrangements are in place to ensure that service users were listened to and protected from abuse and neglect. EVIDENCE: The complaints book was examined and no complaints had been recorded. The acting manager confirmed that no complaints had been received since the home opened. The home had an adult protection policy and procedure and the local authority guidelines were available in the home, which ensures staff have adequate information made available for them to follow procedures correctly when this is required and protect service users from abuse. The staff interviewed were knowledgeable regarding the procedure to be followed when responding to allegations of abuse which further safeguards service users. St Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 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): 24,25,29,30, Quality in this outcome area is adequate. The judgement has been made from evidence gathered both during and before the visit to the service. The home is comfortable and clean. However the carpet needs to be replaced to ensure the home is a safe place to live as the carpet is torn and service users may trip as a result of this. Blinds need to be provided in service users bedrooms to ensure their privacy is respected. A risk assessment is required which provides clear instructions to staff to minimise potential risks from cross infection. Service users currently require no specialist equipment to maximise their independence. EVIDENCE: The home is comfortable which benefits service users. All rooms met the required minimum standards, which ensures service users are provided with adequate space. The premises were bright and airy, clean and free from offensive odours on the day of the inspection, which provides a pleasant environment for service users to live in. St Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 Page 18 Window restrictors have been fitted to all windows, which protects service users from injury. The stair carpet must be replaced to safeguard the health and safety of service users. The kitchen cupboard must be replaced to ensure that the standard of the current living environment is maintained for service users. Blinds in the bathrooms must be provided to ensure service users privacy is respected. Requirements have been made in relation to all of the above. Service users rooms were spacious and personalised and service users confirmed they are responsible for ensuring their rooms are kept clean with staff support, which increases their independence and empowers them. The washing machine was located in the kitchen and a risk assessment could not be provided in relation to the instructions to be given to staff to minimise potential risks from cross infection. A requirement has been made in relation to this. Service users currently require no specialist equipment to maximise their independence. St Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 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): 31,32,33,34,35,36 Quality in this outcome area is adequate. The judgement has been made from evidence gathered during and before the visit to the service. The staff team supports Service users although some further training is required to ensure service users needs are fully met. Service users are protected by the homes recruitment procedures. Staff are well supported and this is documented in the staff supervision records, which assists staff in relation to their personal development and assists staff to work in a consistent professional manner. EVIDENCE: The trainee manager and two staff on duty were interviewed and were knowledgeable regarding their role and the care they provided to service users which ensures service users needs are met. The service users are protected by the homes recruitment policies and procedures all relevant documentation was in place which included CRB disclosures, references, staff contracts and evidence of identity, which protects service users from potential abuse. The training records examined, indicated that staff had been provided with some of the required essential training including adult protection, medication training food hygiene, first aid and lone working which ensures staff have the
St Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 Page 20 skills to meet service users needs. Staff must receive training with regard to challenging behaviour, which has not been undertaken by staff, which will further develop staff skills and ensure service users are adequately supported. A requirement has been made in relation to this. Staff supervision records were detailed which assists the development of staff, which assists staff to improve practices within the home and ensures that the needs of service users can be met in a consistent manner. The staff rota was examined and there were two staff on duty at all times which ensures that the individual needs of service users can be met. Staff are not working continuously without a break and they are not working a day shift after a night shift, which ensures that health, and safety requirements are being met. St Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 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): 37,38,39,42, Quality in this outcome area is adequate. The judgement has been made from evidence gathered both during and before the visit to this service. Service users benefit from living in a well run home and open management style. The health safety and welfare of service users and staff are protected. Service users cannot be confident that their views underpin all self-monitoring in the home, as a quality assurance audit has not been completed. EVIDENCE: On the day of the inspection an acting manager was managing the home. The management approach is open and organised. The feedback received from the staff team in relation to the support they receive from the manager was positive. The inspector observed the interaction between staff and service users and whilst the team are professional in their approach the home retains a warm friendly atmosphere. All relevant health and safety checks had been carried out to protect the health safety and welfare of service users and staff. During an inspection of the
St Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 Page 22 building all fire doors were closed. All fire exits were clear and free from obstruction. The fire alarm system had been tested, the fire point system and emergency lighting had been checked, a fire drill was due to be undertaken on the day of the inspection. The gas and electric certificates were seen and were up-to-date which ensures the health safety and wellbeing of service users had been protected. The company employees liability insurance was seen and found to be in order this further protects staff. The manager must ensure a quality assurance questionnaire is completed and the feedback is compiled into a report, which will monitor the quality of care provided in the home for service users. St Christopher`s House DS0000063893.V301125.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 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 3 3 X 4 3 5 3 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 2 25 3 26 X 27 X 28 x 29 3 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X 3 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 2 3 3 2 X X 3 x St Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 Page 24 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. Standard YA9 Regulation 13 (4) Requirement The registered person must ensure that a comprehensive and up to date risk assessment together with strategies for minimising risks for the identified service user is documented in the service users’ case records. The registered person must ensure that a self-administration assessment form is completed and signed (by the doctor concerned) for service users who administer their own medication. The registered person must ensure that service users wishes in the event of their death are documented on their individual file. The registered person must ensure that the hall carpet is replaced. The registered person must ensure that the kitchen cupboard is replaced. The registered person must ensure that blinds are obtained for the bathroom windows. The registered person must arrange for a risk assessment to be carried out (and documented)
DS0000063893.V301125.R01.S.doc Timescale for action 12/11/06 2. YA20 13 (1) (2) 20/10/06 3. YA21 12 (3) 11/11/06 4. 5. 6. 7. YA24 YA24 YA24 YA30 23 (2) (b) 23 (2) (b) 23 (2) (b) 13 (4) 20/10/06 20/10/06 12/12/06 10/11/06 St Christopher`s House Version 5.2 Page 25 8. 9. YA35 YA39 18 (1) (C ) (I) 24 regarding the location of the washing machine in the kitchen. This risk assessment must include a strategy for minimising cross infection. The registered person must ensure that staff receive training in challenging behaviour. The registered person must ensure that a quality assurance audit is completed and compiled into a report. 20/11/06 02/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Christopher`s House DS0000063893.V301125.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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