Inspection on 04/08/05 for St David`s APL

This inspection was carried out on 4th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St David`s APL 25/06/08

St David`s APL 27/06/06

St David`s APL 26/01/06

St David`s APL 18/01/05

St David`s APL 27/07/04

St David`s APL 08/03/04

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 David`s APL 11 Barton Villas Dawlish Devon EX7 9QJ Lead Inspector Sam Sly Unannounced 4 August 2005 th 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 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 Stationary 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 David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service St David`s APL Address 11 Barton Villas, Dawlish, Devon, EX7 9QJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01626 770189 hardeeds2@aol.com David Hardee Vacant Care Home 9 Category(ies) of Learning disability (6), Mental disorder, registration, with number excluding learning disability or dementia (1), of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (2) St David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The lower ground floor to be specifically for three named residents whos care needs fall within the Commissions mental disorder category only. Date of last inspection 18th January 2005 Brief Description of the Service: St Davids cares for 3 specific residents with mental health problems two of whom are aged over 65, and up to six residents with learning disabilities aged 18 - 65. The HOme is a large semi-detached house in a residential area of Dawlish within walking distance of the the hospital, shops, amenities, bus and train services. On the ground floor is a self-contained flat for three older residents with mental health needs. These residents were living at the home when it was previously registered solely for people with mental health needs. The first and second floor is registered for up to 6 residents with learning disabilities. The first floor has an open plan kitchen and dining room, a lounge, and office. All the bedrooms are on the second floor. Five are en-suite and the sixth has sole use of a separate toilet and bathroom. The laundry facilities are in a separate building just outside the ground floor flat. There is a caravan in the back garden which is lived in by a person with a learning disability who is being supported by the staff at St. Davids. St David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspection was unannounced and took place on a weekday from 9.45am to 4pm. Mr Hardee the Owner/registered manager was present for a few hours, as was the deputy manager. Evidence was collected through a tour of the premises, and examination of care records, staff files and health and safety records. Four of the residents were spoken to as was the Owner, and staff on duty. What the service does well: What has improved since the last inspection? What they could do better: The Owner must revise the Home’s contracts to ensure information is given to residents on their rights and responsibilities. Also, any restrictions on a resident’s choice or freedom must be agreed with the resident, their representative and any relevant professional and recorded in their care plan. St David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 Page 6 All staff must have appropriate medication and adult protection training, and a review of the training needs of the whole staff group should be carried out to ensure all staff receive all the training they require to meet the needs of residents. The refurbishment and renewal plan must be reviewed and revised to include the issues identified at the Inspection to ensure the environment is safe and remains comfortable and homely. 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 David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection St David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 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 standard(s) 2 & 5 Residents can be confident that their needs and aspirations will be assessed, however they are not given suitable information on their contractual rights and responsibilities. EVIDENCE: Four resident’s assessments were examined. There had been no new residents admitted since the last Inspection, and all current resident’s assessments had been reviewed and updated to reflect current needs. Each resident had a contract within his or her Service User Guide which had been signed. However, the contract did not set out comprehensive terms and conditions that make clear a resident’s rights and responsibilities. There were also lists of ‘rules’ that residents had been asked to agree and sign. Discussion took place on the day of Inspection about the inappropriateness of this, and of finding better ways of working with residents. The Owner said that a Learning Disability behavioural specialist was starting to work with residents soon. St David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 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 standard(s) 6, 7 & 9 Residents changing needs and goals are reflected in their care plans, which aim to increase independence, however without professional guidance certain practices could infringe on resident’s human rights. EVIDENCE: Four residents care plans and risk assessments were examined and found to reflect most of the needs and goals of residents. However, records and discussion revealed that some restrictions and sanctions were placed on resident’s freedom and choices, which had not, in some instances, been recorded in care plans. Further discussion and agreement was required with the resident, their representative and a professional to ensure resident’s rights were not being infringed and that actions taken were in line with best practice. There was evidence that residents made decisions about what activities they did, and there were regular resident’s meetings where they were given the opportunity to make choices about everyday matters like meals. Residents were supported to take control of their finances as much as possible with support where necessary. The Owner looked after some resident’s finances, and in these cases appropriate records were kept. There was discussion about St David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 Page 10 working towards some residents taking more control of their finances as long term goals. St David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14 & 15 Residents lead active, stimulating, interesting lives within the home and the community. EVIDENCE: Each resident had appropriate leisure, work or employment opportunities. On the day of inspection one resident had gone to stay with relatives, two were learning office skills, and another resident was working at a stables. The older residents were all at home, however one of them went out to the shops and all of them went on trips and had activities to do in the home. There were a range of leisure activities, including an annual holiday; this year they were going to Butlins in September. The staff are continually developing new opportunities for residents, with one of them about to possibly start work at a Garden Centre, and another was already working in a garage. Other leisure activities included going to adventure parks, outward bound courses, using the trampoline at the leisure centre, going to the cinema and the zoo, bowling and visiting the local beach and walks. Residents also attend evening classes and go to pubs and clubs. St David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 Page 12 The staff team are young and this reflects the age range of the majority of the residents. St Davids is very near to Dawlish town centre and all the shops and amenities. The Home also has a 7-seater vehicle that they use to take residents out in. Involvement with family and friends is encouraged and residents have opportunities to visit family, or invite them into their own home. St David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 Page 13 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 standard(s) 18,, 19 & 20 Residents receive personal and health care support in ways they prefer and require however, weaknesses in the medication administration process may leave residents at risk. EVIDENCE: All residents had locks to their bedroom doors and access to their own bathroom; however, the bathroom and toilet door locks were broken. The younger residents mainly needed prompting to do their own personal care, however the older residents required more assistance, and staff had received manual handling training. Residents confirmed that they were able to get up and go to bed when they wished, and got involved in doing laundry and cleaning their bedrooms. The Owner had begun to involve professional’s appropriately for specialist guidance and advice. And there was evidence that care manager’s and relatives had been involved in reviewing some resident’s plans. Each resident had a comprehensive health file, which documented in detail health care needs, appointments and medical advice. Some residents had complex health needs, and the documentation reflected the level of support required. Staff had received appropriate training to enable them to meet resident’s health care needs. St David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 Page 14 All residents had their medication administered, however there was a framework to promote self-medication. There were secure facilities for medication and records showed it was being administered safely. However, not all staff administering medication had received an appropriate level of training and controlled drugs were not being recorded in an appropriate format. St David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 Page 15 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 standard(s) 22 & 23 Residents can be confident that their views will be listened to and acted on, however, staff require more knowledge on how to protect residents for abuse. EVIDENCE: There was a clear complaints procedure and residents concerns were discussed with key workers and in resident’s meetings. Neither the Commission nor the Owner had received any complaints since the last Inspection. There were policies and procedures in place to protect residents, however the adult protection policy did not refer to when the police must be involved, the Local Authority Alerter’s Guidance could not be found on the day of Inspection, and staff had not received appropriate training. The Owner did show evidence that training had been booked on adult protection for all staff. St David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 Page 16 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 standard(s) 24, 27 & 30 Although homely and comfortable, there is some refurbishment, redecoration and renewal required to reach a good environmental standard for residents. EVIDENCE: Although homely and comfortable, some parts of the home required redecoration, refurbishment and renewal. There was an annual development plan for the house and grounds, which listed some of these issues identified at the Inspection, and there was also a maintenance list, and the Owner had recently employed an external company to carry out regular environmental risk assessments. The Owner explained that the main hallway, dining room and lounge were being redecorated in September when the residents were on holiday. Other environmental issues identified on the day of Inspection were: the 1st floor toilet and bathroom locks were broken, and not appropriate locks, the laundry was flooded and the floor required re-painting to become impermeable; also the sink in the laundry was dirty. A bedroom fire door was held open with a chair, the lounge windows required restricted openings, and there was a strong odour in one of the downstairs bedrooms. The Owner agreed to send the Commission a maintenance plan listing how these issues and any others St David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 Page 17 identified would be dealt with. The environmental health department had visited and left no requirements, and the required fire checks were being carried out regularly. Aids and adaptations for the older residents were being looked into actively by the Owner and staff. St David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 &36 Residents benefit from services provided by a fit, competent, well supported staff team. EVIDENCE: Staff were found to be enthusiastic, committed, accessible and enjoying their work. Resident’s said they liked the staff. Staff said they felt supported by the Owner and were pleased with the amount of training they were given, which helped them do their jobs. Some staff had learned to sign so as to be able to communicate with one resident, and others had done total communication and Makaton training and worked alongside a Speech Therapist to help communicate with other residents. It was clear that training was encouraged and valued by the Owner. An individual record was being kept for all staff of training they had received, and it was recommended that now a training needs assessment and plan for the whole staff group is developed, so that the owner is aware of who has done what, and outstanding training needs. Staff had received a range of training including Epilepsy, food hygiene, first aid, health and safety, manual handling, medication awareness, equal opportunities, Induction, and care planning. St David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 Page 19 The Owner said he was in the process of ensuring the Home’s induction and foundation training is appropriate and in line with the Learning Disability Award Framework. Many staff had or were about to start NVQ 3 or 4. Staff were now receiving regular supervision by the deputy manager or Owner and it was recommended that appraisals took place at least annually. Staff files were examined and found to include the appropriate fitness checks including Criminal Record Bureau checks. Staffing levels were appropriate for the needs of residents with three staff on at all times, it was recommended however that the staff support hours given to the person living in the caravan is seen as separate from the resident’s support hours and this is detailed on the rota, with who is working where at any time. St David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 Resident’s health and welfare are protected through safe working practices. EVIDENCE: Staff have done a range of health and safety training, however the Owner needs to ensure that all staff have received all the required training through carrying out a training needs assessment. The environment is about to be risk assessed by an external company and this will then be reviewed on a regular basis. Contracts were in place to service the boilers and central heating, and the home had been re-wired recently. There were policies and procedures in place to ensure staff adhered to safe working practices. The windows in the lounge required restricted opening. St David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x 2 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 x x Standard No 31 32 33 34 35 36 Score x 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 St David`s APL Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 Page 22 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 5 Regulation 5 (1) (b) Requirement Contracts must contain the residents rights and responsibilities within their terms and conditions. Restrictions on a residents choice or freedom must be agreed with the resident, their representive, or any relevant professional and recorded in their care plan (Previous timescale 30/03/05 - not met) All staff must have appropriate medication training. There must be an appropriately bound controlled drug recording book. All staff must have adult protection training, and there must be appropriate adult protection policies and procedures in the home. There must be a comprehensive refurbishment and renewal plan which includes all the issues identified at the Inspection, and any other issues identified by the risk assessment being carried out by the Owner. In this instance a copy must be sent to CSCI. Timescale for action 12th October 2005 12th October 2005 2. 6 15 3. 20 13 (2) 12th October 2005 12th October 2005 12th November 2005 4. 23 13 (6) 5. 24, 27, 30 & 42 23 (2) 6. St David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 Page 23 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 16, 24 & 27 32 & 42 Good Practice Recommendations The locks on the bathroom and toilet doors should be mended, and should be able to be opened in emergencies by staff. A training needs assessment should be carried out for the whole staff team, and in this instance a copy sent to CSCI. At least 50 of care staff should have NVQ 2 by 31st December 2005. The Owner should ensure the Homes Induction and Foundation training is appropriate and LDAF accredited. Staff hours whilst working with the person living in the caravan should be separate from the hours working in the home, and recorded as such on the rota. Staff should all have an annual appraisal. 3. 4. 5. 6. 35 34 36 St David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 David`s APL D54-D07 S55164 St Davids V235183 040805 Stage 4.doc Version 1.40 Page 25 - 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!