CARE HOME ADULTS 18-65
St Claire`s Home 38 - 40 Church Crescent St Albans Hertfordshire AL3 5JE Lead Inspector
Louise Bushell Unannounced Inspection 25th January 2006 10:30 St Claire`s Home DS0000019540.V280819.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 Claire`s Home DS0000019540.V280819.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 Claire`s Home DS0000019540.V280819.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service St Claire`s Home Address 38 - 40 Church Crescent St Albans Hertfordshire AL3 5JE 01727 762386 01727 761561 stclaires@nildram.co.uk 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) Hightown Praetorian & Churches Housing Association Jeanette MacMaster Donnelly Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (10) St Claire`s Home DS0000019540.V280819.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. This home may accommodate 10 people with mental disorder who require personal care. 20th July 2005 Date of last inspection Brief Description of the Service: St Claires in a large, two storey, period property, based in the residential area of the city centre of St Albans. The home provides personal care and support to ten mixed service users with enduring and complex mental health needs. St Claires has a car park to the rear of the property with a small patio garden available. It is ideally located for the town centre and all local amenities. St Claire`s Home DS0000019540.V280819.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection focused on seeking the views of the service users and inspecting the remaining core standards. Time was spent in the main lounge / dining area of the home with a number of service users and the staff on duty. Where information has remained the same from the last report it will be carried forward. The reader is encouraged to read the report in conjunction with the previous report to gain a full insight to the home’s progress in meeting the National Minimum Standards What the service does well:
The atmosphere throughout the inspection was calm and friendly, promoting a good relationship between staff and service users. Staff spoken with during the inspection were very complimentary of the management style within the home and the ethos of working open, honestly and with a transparent approach appears to be effective. All service users are supported within the Care Programme Approach framework and frequent reviews occur to ensure changing needs are continuously assessed and reviewed. Staff promote that the care plans of each individual are owned by the individual, those service users spoken to during the inspection were aware of their individual care plans, one spoke of the support she receives from outside services. Service users meetings occur which are recorded and details service users choices and suggestions, which have been acted upon. There is a clear positive relationship between both service users and staff that is based on mutual respect. Staff reported that they are provided with regular supervision where training needs are identified All staff have received a series of mandatory training course in order for them to meet the complex needs of the service users. Training includes Protection of Vulnerable Adults, food hygiene, risk assessment, first aid and mental health. St Claire’s is located in an ideal location amongst other residential properties. It presents itself a regular family home, which encourages integration into the local community and a sense of warmth and relaxation within the home. The home is unique in providing specialist person centred care to ten service users. Staff actively promote the skills and abilities of all ten service users in order to provide appropriate support and advice in enabling and empowering them to take positive decisions and choices within their lives. The running of the home is managed in such a way that creates an open atmosphere with the views of the service users and the staff being listen to and acted upon. All service users are able to attend a whole life review every year to review aims and objectives of their lives. All service users are further supported through the Care Programme Approach system, which provides professional specialist services for people with enduring mental health issues. Feedback
St Claire`s Home DS0000019540.V280819.R01.S.doc Version 5.1 Page 6 from a service user determined that this process was successful and supportive. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. St Claire`s Home DS0000019540.V280819.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 Claire`s Home DS0000019540.V280819.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): Not inspected on this occasion, please refer to the previous report. EVIDENCE: Not inspected on this occasion, please refer to the previous report St Claire`s Home DS0000019540.V280819.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): 9 Service users are supported in maintaining and taking risks as part of an independent lifestyle, developing daily living skills. EVIDENCE: Service users are appropriately supported and guided in taking risks as part of an independent life style. Discussion with service users determined that they are supported in shopping, seeing and visiting family and visiting places of interest. One service user talked at length about the support received from her key worker and other staff regarding trips out, holidays, visiting family and places of interest. Service users are encouraged to engage with and become part of the running of the home. Their views are recorded and listened to. Service users have generic and independent risk assessments on their file and these are reviewed annually or sooner if required. Risk assessment is seen as an enabling process for the service users as apposed to a dis enablement. The ethos of good practice ensures that risks are minimised as determined through the completion of a risk assessment but still supported with safety measures implemented as required. There is a need for the completion of individual smoking risk assessments to be completed. St Claire`s Home DS0000019540.V280819.R01.S.doc Version 5.1 Page 10 Service users are encouraged to complete tasks to maintain and further develop independent living skills. A number of service users discussed the completion of tasks and that they enjoy completing them as it supports everyone. St Claire`s Home DS0000019540.V280819.R01.S.doc Version 5.1 Page 11 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): 15 Service users are supported and encouraged to gain and maintain appropriate relationships, ensuring that independence is encouraged. EVIDENCE: Discussion with a number of service users determined that they are appropriately supported and encouraged to maintain, gain and develop relationships with relatives and friends inside and outside of the home. One service user spoke about her visits from family and also how she is supported to visit them in their own home. There is ample private seating space available for visitors with a choice available for the visitors to go to the service users own room or to remain in the main areas. On the day inspection a number of service users were going out to access an independent day care resource and a number were being supported to visit the local shops. Where required, risk assessments are in place to support all service users in their relationships. St Claire`s Home DS0000019540.V280819.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 & 21 Service users are supported in the administration of medication, ensuring that all prescribed medicines are given as instructed. Service users wish’s are supported and documented ensuring that all circumstances are dealt with respectfully and appropriately. EVIDENCE: Medication systems are supported through the Monitored Dosage System. Inspections of the medication systems occur every three months by the pharmacy. Records were examined and where recommendations had been noted actions had occurred. Staff receive induction training prior to administering any medication. Training is also received from the pharmacy and an external course is provided. Currently there is a need for staff to receive refresher training in the safe administration of medicines. An audit system has recently been implemented to monitor the administration to ensure all prescribed medicines are provided have actions following the policy have been completed. This involves the medication being checked three times a day. Where an error or a discrepancy has been highlighted a note is made. However there is a need for the system to ensure that where an error or discrepancy has occurred that action are taken to resolve the issue. Gaps must not be present on the MAR sheet. All medicines are stored appropriately with
St Claire`s Home DS0000019540.V280819.R01.S.doc Version 5.1 Page 13 records maintained of the temperature of the medicines cupboard. All medicines are marked as opened on doing so with date and initial signature of the staff member. There is a need for the staff to complete a sample signature sheet for auditing purposes. All controlled drugs are stored promptly and recorded as required, however a bound number paged book must be purchased for the accurate recoding of all controlled administrations, receipt and discharge. The company supports the ethos of person centred approach, and person centred plans are in place, which are goal focused and aim at the individual needs, wishes and desires of the service users. Service users spoken with all showed an understanding of their individual care plans and where able to discuss the involvement of their key workers. Part of the person centred plan is to ensure that the wishes of the service user are determined as far as possible with regards to ageing, illness and death. This is evident for all service users in their individual care plans. One service user stated that “all staff working were very caring and kind and would always support help out at all times”. St Claire`s Home DS0000019540.V280819.R01.S.doc Version 5.1 Page 14 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): Not inspected on this occasion, please refer to the previous report. EVIDENCE: Not inspected on this occasion, please refer to the previous report. St Claire`s Home DS0000019540.V280819.R01.S.doc Version 5.1 Page 15 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 & 29 Service users reside in a suitably clean and hygienic environment. Redecoration improvements are being made, to continue through the homely appearance. Specialist equipment is available and meets needs, however seating must be reviewed to ensure that changing needs are met. EVIDENCE: The home was extremely well cleaned, presenting as a fresh environment for the service users to live within. There are numerous living spaces available for the service users to use in every day living. The home has recently redecorated the main lounge and replaced the lighting to ensure it was domestic in style. Other areas of the home are being periodically updated and redecorated. There is a need to ensure redecoration and replacement occurs within the home, the lounge carpet is currently being costed for replacement. Following the last inspection a number of improvements have been made, this includes some redecoration to a number of the communal areas and new carpets in one service users bedroom. Plans are in place for the replacement of the lounge carpets in the new financial year. The main hallway and front lounge carpets are being replaced. St Claire`s Home DS0000019540.V280819.R01.S.doc Version 5.1 Page 16 The office area has recently been refurnished ensuring that the staff working space is suitable and adequate to promote a positive working atmosphere. There is a need for the staff to complete a detailed renewal and redecoration plan ensure that all areas are maintaining a satisfactory standard of living, this to include all equipment required. Currently the changing needs of a number of service users are being monitored, ensuring that the home is able to continue to meet specific and individual needs. Seating in the front and back lounge areas are looking very worn and tired and currently are not fully meeting all needs of the aging service user group due to them being low to the floor. Some alternative seating is provided, however not enough to seat all service users. St Claire`s Home DS0000019540.V280819.R01.S.doc Version 5.1 Page 17 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): 35 Service users are supported by staff who are appropriately supervised and trained staff, ensuring that needs are being met sat al times. EVIDENCE: Feedback from staff determined that there is a detailed induction process in place. The company offers a phased induction process that aims to ensure that all staff are suitably and adequately trained to work within a 12 week period. The induction programme provides mandatory training in first aid, food hygiene, manual handling, working with diversity, care of medicines, adult protection, fire, PCP and mental health awareness. Following discussion with some staff on duty it was determined that they felt the induction process was adequate. The manager stated that currently the company is making improvements to the training and induction provision. Records are maintained of the staff induction. The manager highlighted that there is currently a need for the staff to receive medicines administration refresher training. St Claire`s Home DS0000019540.V280819.R01.S.doc Version 5.1 Page 18 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): 39 Service users views and opinions are actively sought, however these must be further developed to ensure that a continual review occurs and clear actions taken to improve service users involvement. EVIDENCE: Positive systems are currently in place to ensure that the views and the opinions of the service users are actively sought. The complaints procedure is on display and the service users discussed the process that they would take to make a complaint. All service users discussed that they felt listened to. There are monthly service user meetings with minutes taken. Service users stated that they find these useful as they are able to make suggestions and make complaints as required. A number of service users also stated that they felt listened to by the staff on duty and their individual key workers. Currently PCP is being promoted and therefore service users are actively consulted with through this process. Other internal systems that support the seeking of views and opinions of the service users are through the CPA meetings and whole life
St Claire`s Home DS0000019540.V280819.R01.S.doc Version 5.1 Page 19 reviews. Following a detailed discussion with the manager, it was determined that there is a need for the development of a detailed quality assurance system, which would include the seeking of the views of the service users through a questionnaire system, which could be anonymous. Discussions also explored this being extended to friends, family, representatives and other relevant professionals. A risk assessment must be held on site regarding smoking within the home and be specific to service users who smoke. This has been carried forward from the last report. St Claire`s Home DS0000019540.V280819.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 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 X 23 X ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 2 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 3 X X 2 X X 2 x St Claire`s Home DS0000019540.V280819.R01.S.doc Version 5.1 Page 21 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 YA20 Regulation 13 (2) Requirement The registered manager must ensure that; • Gaps are not present on MAR sheets. • Auditing systems must show effective and clear follow up’s. • Controlled drugs book is purchased. A planned maintenance and renewal plan must be in place. All furniture must meet the needs of the service users. New appropriate seating must be provided. All staff must receive medication refresher training. Effective quality assurance systems must be in place that actively seeks the views of the service users. Individual smoking risk assessments must be completed. This requirement has been carried forward from the last report; failure to comply may result in enforcement action being taken. Timescale for action 01/05/06 2 3 YA24 YA29 23 (2) (b & d) 23 (2) (n) 01/04/06 01/05/06 4 5 YA35 YA39 18 (1) (c) 24 31/05/06 01/05/06 6 YA42 23 (4) 15/03/06 St Claire`s Home DS0000019540.V280819.R01.S.doc Version 5.1 Page 22 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 It is recommended that a sample signature sheet be implemented for auditing of medicines. St Claire`s Home DS0000019540.V280819.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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