CARE HOME ADULTS 18-65
St Erme Trispen Truro Cornwall TR4 9BW Lead Inspector
Lynda Kirtland Key Unannounced Inspection 14 &15 August 2007 9:15 St Erme DS0000009149.V340456.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 Erme DS0000009149.V340456.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 Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service St Erme Address Trispen Truro Cornwall TR4 9BW 01872 263355 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) Mail@dcact.org Spectrum vacant Care Home 20 Category(ies) of Learning disability (20) registration, with number of places St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. St Erme House - up to 10 adults with a Learning Disability (LD) The Lodge - up to 9 adults with a Learning Disability (LD) St Michaels - up to 3 adults with a Learning Disability (LD) Total number of service users not to exceed a maximum of 20 Date of last inspection 7 March 2007 Brief Description of the Service: St. Erme House is a care home providing accommodation and personal care for up to 20 adults with a learning disability. The home is run by Spectrum, an organisation that specialises in providing specialist care for people with autism. The home comprises of three separate, self-contained units: St. Erme House has undergone a major refurbishment and now provides accommodation for up to five adults in the main house. Service users have separate bedrooms, some of which are en suite and their own lounge. They share a communal lounge; dining area/kitchenette and can access the main kitchen with staff support. Service users were involved in the décor and furnishing of the property which is to a high standard. There are secure gardens attached to the house. There is a self contained flat attached to the house for one Service user. The Lodge currently accommodates three Service users. Service users have their own bedrooms, and share bathroom, lounge, dining, and kitchen facilities there is access to a secure garden area. The Lodge is currently undergoing major refurbishment and Spectrum are planning for this home to become a specialist assessment unit in the future. St. Michaels can accommodate up to three Service users. Two Service users have their own bedroom and share lounge, dining, kitchen and bathroom facilities. One Service user has their own ‘flat’ with all amenities included. On site there is a separate administrative block with a visiting lounge for service users to meet with relatives and visitors in private. The properties have been adapted to meet a range of needs and there is some disabled access. The property is set in its own, extensive grounds, slightly off the road. It is situated in the village of Trispen, which is close to the city of Truro. Current fees range from £818.00 per week to £3018. There are variable additional charges to service users for personal items such as hairdressing, newspapers, confectionary, private chiropody and off-site entertainment.
St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A key unannounced inspection took place on the 14 and 15August 2007 and lasted for approximately fourteen hours. The purpose of the inspection was to ensure that service users’ needs are properly met, in accordance with good care practices and the laws regulating care homes. The focus is on ensuring that service users’ placements in the home result in good outcomes for them. Information received from and about the home since the previous inspection has also been taken into consideration in making judgements about the quality of outcomes for the service users living there. The inspection included meeting with some service users currently living at St Erme. Members of staff were interviewed and there were opportunities to directly observe aspects of service users’ daily lives in the home and staff interaction with them. Other activities included an inspection of the premises, examination of care, safety and employment records and discussion with members of Spectrum management team and the prospective registered managers. The principle method of inspection was “case tracking”. This involves meeting with a select number of service users; staff caring for them and examination of records relating to their care. This provides a useful impression of how the home is working for service users overall. A service user from each unit was case tracked in detail at this inspection. What the service does well:
In respect of all three units it is evident that Service users are admitted to the home on the basis of an assessment, so that they can be confident it will be suitable for them and meet their needs. Service users have detailed written care plans, which set out their personal, health and social needs in full and are regularly reviewed. These are shared with their relatives and social workers and they are invited to state their views so that they are kept informed about the progress of the service users in the home. Their care plans consider their skills in making decisions with a view to enabling them to develop their abilities in this respect. Person Centred planning (PCP) is being introduced for all service users, which identifies individual aspirations to reach certain goals i.e. to become more independent in self-care skills. Service users are helped to maintain valued relationships with their families and friends outside of the home, where possible. Their rights and responsibilities are set out clearly for them, in translated formats so that they know what to expect from the home and what is expected of them as residents. They are provided with an appropriate range of healthy meals and
St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 6 staff assists them to make choices so that they stay well and enjoy the food provided to them. There are satisfactory systems in place to ensure that service users or their representatives know about their rights to make complaints if they are dissatisfied with the care and services provided to them at the home. There is a robust recruitment process so that care staff are selected fairly and on the basis that they are fit and suitable to work with vulnerable adults in a care setting allowing service users and their representatives to have confidence in the people caring for them. All staff undergo induction training before they start to work in the home and have good ongoing access to training so that service users can have faith in their skills. There are systems in place to formally consult with service users and their relatives about the quality of the care and services provided, including questionnaires, reviews and opportunities for them to make their views known less formally. Spectrum need to send these findings and any action plan to the commission when completed.. Spectrum have designed a Restrictive practice Audit which identifies practices and environmental adaptations that have restricting or controlling consequences for Service users. From this Spectrum aim to address the issues raised so that Service users benefit from more freedom within the home. In addition staff are undergoing updated training in the area of managing challenging behaviours. There is evidence that service users are provided with a range of varied and appropriate activities especially within the community. The inspector was welcomed to the home in a friendly manner by staff and service users. All were aware of the reason of the inspection. What has improved since the last inspection?
St Erme House: a major refurbishment has occurred in this home which now offers care and accommodation to 6 Service users, one of which lives in the self contained flat. It was evident from speaking with service users and a tour of the premises by them and staff that residents have been fully involved in the décor and furnishings of the home. All the rooms were decorated and furnished to a high standard. It was also evident that transitional work had occurred which allowed service users and their relatives to be fully involved and consulted about the planned move to their new home. From recently completed questionnaires residents commented that they were ‘happy’ to be ‘in the quiet house’ and had no areas of concern about the new home. Staffing in this unit were complimentary about the management structure, training, and commented that they were ‘happy’ and ‘satisfied’ working at St St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 7 Erme House. The atmosphere at the home reflected this as staff and residents were relaxed. The Lodge: two of the RSA areas have been removed. Spectrum management team stated that the third area will be moved within the next ‘few weeks; after the current lounge has been divided into two rooms. Planning permission has been approved for this to occur. The management team have reviewed The Lodge aims/philosophy and are wanting to make this unit a specialist assessment centre. Job descriptions for staff have been reviewed and a new training pack in behavioural management is in the process of being set up. Some care staff were positive about the changes. St Michaels: the manager stated that the staff team have been working at this unit for sometime now and therefore consistent care is being provided to its Service users. Staff also echoed this and felt that staff morale had increased and commented they enjoyed working at the unit. The manager is currently reviewing all Service users resident at St Michaels to assess whether it continues to meet their individual needs. The atmosphere at the home was relaxed. All units are ensuring that service users are protected from abuse, particularly from incidents between each other. Incidents are now being reported to the external agencies, including the Commission, responsible for co-ordinating strategies to protect service users from abuse. What they could do better:
Updated and personalised Statement of Purposes and Service users guides should be provided for each unit detailing what services and facilities each unit provides. This should also be presented in a meaningful way to Service users. Care plans should be provided to service users in more meaningful ways, with clear and specific goals, so that they can participate more directly in making decisions about their lives. The home’s current environment at The Lodge in particular, places a number of restrictions on service users, so that they lack free access to their bedrooms, for example. Spectrum has plans to modernise and improve the service so that these restrictions will be decreased in the future, but they need to be implemented. Service users’ risk assessments must reflect the actual restrictions placed on them and there should be improved consultation with them about the levels of restriction placed on them, where ever practicable. Restrictions should be minimal and only in individual service users’ best interests. Spectrum has undertaken an internal review of its restrictive practices, but it would be useful to consult with an external agency that specialises in service users’ rights so that they and their representatives can have confidence that restrictions imposed on service users are necessary and legal.
St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 8 In the Lodge two RSA areas have been removed since the last inspection. One will be removed when the lounge is divided making it two separate rooms. St Michaels also have an outside RSA area that is not used, and is taking up back garden space. The manager agreed that due to its unattractive design, service users and staff do not use this area. This area must be reviewed. From observations during the inspection, and discussions with staff from The Lodge, service users would benefit from more regular access to structured activities in the home. In all three units, service users need improved protection from risks due to medication errors. This includes ensuring staff are adequately trained, records are accurate and written procedures to guide staff on how to administer medicines safely are readily accessible to them. In addition sufficient equipment and access to the Royal Pharmaceutical guidance should be obtained. It remains a grave concern to the Commission that medication errors are continuing and this will be discussed with Spectrums management team. All unit managers need to attend the multi-agency adult protection training to gain familiarity with the way in which organisations should work together to protect vulnerable adults from abuse. This needs to be cascaded to staff. From discussions with staff since and during this inspection, Spectrum need to review how it manages and encourages staff to use its whistle blowing procedure. This will ensure that appropriate concerns about service users welfare are taken seriously and have no repercussions on staff. Plans to modernise and improve the home’s environment need to be implemented so that all the service users benefit from comfortable and homely surroundings in which they can develop their skills and independence in the future. In the meantime, further improvements should be made to the existing environment in The Lodge and St Michaels. During the building works risk assessments must be undertaken to ensure that Service users, visitors and staff are not placed at unnecessary risk. It was observed during this inspection, whilst a kitchen was being refurbished, that this was not considered and Service users and staff were placed at great risk. In addition a risk assessment must be undertaken when there is lone working in St Erme House, and possibility of St Michaels over the night time period. This will ensure that Service users and staff are aware of the appropriate support processes in place should there be an emergency. A greater proportion of the care staff in all units should achieve formal qualifications so that service users and their representatives can be assured of their competence to work effectively with them. Staff should receive a minimum of 6 supervision sessions a year. An overview of staff training would St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 9 be beneficial to each unit so that managers are aware of what their unit training needs are. The homes managers are not registered with the Commission, their applications must be submitted. The commission will discuss with Spectrum management team regarding what actions they will be taking in this area. Doors must not be wedged open to minimise the risk of fire. Due to the concerns highlighted in this and the previous report the Commission requests that regulation 26 reports are sent to the commission. The inspector would like to thank Service users, staff and the management teams for their assistance during this inspection process. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 10 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 Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 4, 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information provided to service users needs to be updated and more individualised so that Service users are aware of what facilities and services they will be provided in their particular unit. Service users’ needs are assessed, but the process of this should be made more meaningful to them so that they can be more directly involved in making decisions about their lives. A planned transitional programme for Service users to ensure that they are consulted before moving to a new home is undertaken. Service users contracts identify what financial coasts are involved in the placement. EVIDENCE: The three units all provide a different service to Service users. Therefore the managers of each unit agreed that the Statement of Purpose and Service Users Guide needs to be reviewed, updated and made more personalised so that they accurately reflect the services they provide. Following the major refurbishment of St Erme House it was evident that prospective residents to the home were consulted through their transitional programme about their wishes for their new home. Photographic and written documentation demonstrated the time and thought that went into this process, which has assisted in the smooth transition for the Service users to this home. St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 12 These residents all knew each other before the move, and the majority of staff moved with them, which made the transition to St Erme House smoother. Service users at The lodge and St Michaels have lived there for some time. There have been no new admissions. Service users currently placed in the home are undergoing re-assessments of their needs with regard to Spectrum’s plans to extensively modernise and improve the service. Contracts in relation to the placement clearly identify residents’ rights and what services they will be provide with. It also identifies if there are costs that the resident needs to pay and identifies their benefit entitlements. St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users have detailed written care plans, which address their personal, health and social care needs, including needs relating to their age, religion, culture and ethnicity, abilities, gender and sexual orientation but these should be provided to them in more meaningful and accessible formats so that they have greater opportunities to participate in the care planning process. Care planning process has improved and is directive to staff ensuring that consistent care is being provided. Service users need to be provided with improved opportunities to make decisions about things that are important to them to improve the quality of their lives. Service users’ individual risk assessments reflect any necessary restrictions to protect them and/or other people, which should be minimal and only in their best interests. EVIDENCE: Spectrum has improved the care planning process. Each service user has a detailed care plan, which addresses all their needs and informs, guides and directs staff on what interventions are needed to provide care. In addition a ‘micro’ care plan has been introduced for staff to access as a ‘quick guide’ of specific care needs and how this is to be provided in a consistent manner. This is again detailed and directive informing staff for example on what phrases to
St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 14 use to assist a person in their self care tasks. Person Centred Planning is being introduced for all service users so that individuals ‘milestones’ and ‘aspirations’ can be identified more easily and planned work to meet the aspiration can then be identified i.e. to develop personal self-care skills such as grooming. This is in the early stages of being implemented. It is recommended that the care plan documentation is reviewed so they can be in accessible or meaningful formats for service users During the inspection service users were observed to make some choices, for example about what to eat at breakfast. Spectrum has undertaken an internal review of all its restrictive practises towards service users to ensure that any restrictions placed on them are necessary and in their best interests. Spectrum has reviewed all service users residing at St Erme and considering what controls are ‘least restrictive’. This lead to the introduction of PCP for all service users and training for all staff. The homes action plan states that this will be implemented and evidenced for all Service users by 01/01/08. Service users have detailed written risk assessments, but they are not provided to service users themselves in accessible formats and not all restrictions, for example environmental restrictions, were addressed in those inspected. Two RSA’s out door areas at the lodge have been remove, with the third one being removed in the next few weeks after the lounge area has been divided into two rooms. St Michaels also have a outdoor RSA are which is unsightly and is not used. This takes up the back garden area and needs to be reviewed so that service users can use this out door space and not eat their meals over looking a unsightly area. St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. St Erme has increased the level and range of external activities that service users participate in the local community. In house activities could be improved further. Service users are assisted to maintain valued relationships so that they enjoy a good quality of life. They are provided with information about their rights and responsibilities so that they are aware of what is provided and what is expected of them as residents. They are provided with healthy meals so that they stay well and enjoy their meals. Appropriate risk assessments whilst building works are in process must occur to ensure the safety of all those living, working or visiting the home. EVIDENCE: It was evidenced from discussion with service users, staff and documentation that Service users in the House and St Michaels attend a variety of activities both in-house and externally. For example trampoline, horse riding, gardening, swimming and walks. Staff support service users to access these resources in the local community, which was confirmed through daily care records and
St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 16 observation during the inspection. With the implementation of Person Centred Planning the individual’s activities are identified, and where possible responded. It was noted that Service users in the Lodge were accessing a variety of external activities, and more so recently due to internal building works in the Lodge. However staff commented, and it was observed that the level of activities in the home had reduced. This needs to be reviewed. Service users’ care plans and risk assessments consider their needs with regard to their developing and maintaining relationships with their families and friends. Service users were observed in St Erme House enjoying healthy meals and making choices about food during the inspection. Advise from dieticians regarding menus is sought on a individual bases when needed. Service users have access to a kitchenette area in St erme House where they can make drinks and snacks with staff support. Service users living at St Michaels have access to the kitchenette all times. It was noted that service users are involved in the choices of menus, shopping and assist with preparation of meals. On arrival it was observed that a service user and some staff were gathered in an outdoor building where they were preparing breakfast. The kitchen in the Lodge was closed due to refurbishment. There had been no health and safety risk assessment of this area and it was inappropriate that food was being prepared in this facility. Staff stated that they were only preparing breakfasts and drinks in this area and for main meal and tea there were having take aways’. Staff stated managers informed them that they were not able to use the kitchens in the other two areas. Managers stated that it was a interim arrangement and the kitchen would be completed by Friday (two days later) and felt the situation would then be resolved. However they did acknowledge that a Service user should not have been preparing breakfast in this area and that no health and safety risk assessments had been undertaken. The commission confirmed with the Director of Spectrum the following week that the Lodge kitchen was now operational; she agreed that staff should have used the other kitchen facilities on site. As there will be further building works occurring on site it is imperative that appropriate risk assessments are undertaken to ensure that the health and welfare of Service users and staff is paramount at all times, therefore a requirement to this effect has been made. Managers in all three units stated that the majority of staff have attended food hygiene course or are booked to attend this. St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users are supported with regard to their personal care. Service users have access to appropriate health care services. Improvements are needed with regard to medication to ensure that it is administered correctly to protect Service users from potential harm due to medication errors. EVIDENCE: Staff are provided with clear written guidelines on how to support service users to maintain their personal appearance and hygiene, Service users presentation was individualised. In all three units it was evident from inspecting healthcare records that service users have access to a range of NHS provision, for example: community learning disability team, psychologist, psychiatric team, dentist, optician to name a few. The units have all been given ‘Health Action Plan for people with a Learning Disability’ folder from the Cornwall partnership trust. The unit managers will be completing these. Medication procedures were inspected in all 3 units. The storage facilities for medication were appropriate. Medication is dispensed using the Monitored
St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 18 Dose System. No Controlled drugs are administered in any of the units. All units had copies of Patient Information Leaflets to refer to if needed. Improvements in the medication process are needed as follows: In the House and St Michaels it was noted that the blister packs when cross referenced to MAR sheets were accurate. However in the Lodge there was a example of tablets remaining in the blister pack and yet signed for as administered. Medication must not be signed for until it has been administered. In all three units the Commission was unable to audit the PRN medication, as the tablets held within the medication cabinet did not tally with the MAR sheets. In the majority of cases there was too much medication in the cabinet. A tablet count of all medication that is present in the home needs to be undertaken and cross-referenced with the MAR sheets. In addition when transcribing this needs to be witnessed by two members of staff. It is required that improvements in this area are made. It was noted that St Erme House did not have a medication disposal book this should be obtained. The other two units had ad disposal book that was signed for appropriately. The Lodge had not enough pots to administer medication and these should be gained. It is recommended that a copy of the Royal Pharmaceutical Guidelines. The house had a up to date BNF reference book (2007). Managers stated the medication policy was kept in the unit offices. Managers stated that medication training for staff has either occurred or staff are booked onto complete the course - next course 6 September. Due to the concerns around medication errors in Spectrum homes the Commission will discuss with Spectrum management team the quality of the medication training for staff and its accreditation. St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There are satisfactory arrangements in place to enable service users and their relatives to make their views known and to ensure that they are taken seriously and acted upon. Improvements have been made to ensure that service users are adequately protected from abuse. Staff need to feel able to express appropriate concerns to the management team in respect of Service users welfare and for the whistle blowing procedure to be followed. EVIDENCE: Residents are provided with written and in some cases pictorial copies of the home’s formal complaints procedure and have formal and informal opportunities to raise any concerns with staff before they become serious complaints. St Michaels have received no complaints since the last inspection. The St Erme house manager has investigated a concern raised by a professional and has resolved this issue. The Commission has been contacted anonymously with concerns regarding service users care and management arrangements at The Lodge, which were investigated during this inspection, the findings of which are included in this report. The Lodge have also investigated into a concern raised by a relative that has been resolved. The home has written procedures to guide staff on what to do if they suspect a resident is at risk of abuse. There are records to show that staff are recruited on the basis that they are suitable to work with vulnerable adults in a care setting and appropriate checks are made. Residents are not isolated in the home, but take part in a range of activities in the local community and have relationships with people from outside of the home that they can communicate
St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 20 serious concerns to. Spectrum has a whistle blowing policy. Staff in St Erme House and St Michaels felt able to raise any issues of concerns with their line managers. However some staff in the Lodge felt unable to approach the management team, and in part this is to do with the number of managers the Lodge have experienced recently, plus concerns that there may be repercussions for staff if they express their concerns. The manger needs to consider how staff views can be expressed in relation to Service users welfare and how they will then be investigated in a fair and transparent manner. It is recommended that the acting managers in all three units attend the Multi Disciplinary Adult Protection course. The home does have a copy of the Cornwall Multi agency adult protection procedure. Staff are attending in house adult protection training. Following the previous inspection, staff now have a daily records file for each service user which comprises of ‘micro’ care plans, daily logs, and health notes. This allows staff to have more up to date information in the one place rather than having to look at a number of files. This allows staff to be more aware when incidents in respect of Service users have occurred and what action was taken. Service users monies were not inspected on this occasion. However managers stated that Service users have individual bank accounts and this is audited on a monthly bases at Spectrums headquarters. St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Following the refurbishment St Erme House provides a high standard of accommodation. Service users were consulted on its décor and furnishings. The home’s environment in The Lodge in particular, is overly institutional so that service users do not benefit from a comfortable or homely place to live in. St Michaels décor and some furnishings need to be replaced to provide a more homely atmosphere. Spectrum is in process of extensively modernising and improving the service for them in this respect. There are satisfactory systems in place to maintain hygiene in the home. EVIDENCE: St Erme House has undergone a major refurbishment. Service users were involved in choosing the décor and furnishings of their rooms. Service users showed the inspector their rooms which were personalised and expressed how pleased they are with them. Each service user has a separate bedroom plus own lounge area, and share the communal lounges, dining area and kitchen. They have keys to their own rooms and designated bathroom facilities. The home has improved tremendously and is now offering a high standard of comfort throughout the home. There is a secluded garden for Service users
St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 22 use. The manager was aware that there were a few ‘small’ jobs remaining to be completed and theses were being addressed i.e. to install paper towels in the staff toilet and undertake a risk assessment regarding window restrictors. The Lodge kitchen and dining area was being refurbished during the inspection. Two members of the management team explained that Spectrums aim is that the Lodge will become a specialist behavioural assessment unit and will accommodate five Service users in the future. It is planned that the lounge area is to be separated and made into two rooms and refurbished. Bedrooms will be made en suite and also decorated. Currently the condition of the home is barren and needs redecoration. The commission is pleased that Spectrum are addressing this. Two of the outdoor RSA areas have been removed. The line manager of the service stated that it is planned that the third RSA area will be removed once the lounge area has been made into two rooms. All RSA areas will then be indoors. As this remains in progress the requirement remains identified. There is a secure garden for Service users use. St Michaels offers accommodation to three Service users, one of which has their own self contained unit. The self-contained unit is personalised and decorated to a good standard. The Service user is currently considering redecorating some of the rooms. Two Service users share the rest of the accommodation. Each Service user has their own bedroom and share the bathroom, lounge, dining and kitchen facilities. The living areas are showing signs of ‘wear and tear’ and it is required that redecoration and some new furnishings would benefit the home to make the home more comfortable and welcoming. The back garden was used as a RSA area and looks unwelcoming. It is recommended that the back garden is reviewed as the manager acknowledged that due to the appearance of the garden it is not used. In respect of cleanliness, all three units were cleaned to a satisfactory standard. New staff undertakes infection control and basic food hygiene training as part of their induction and existing staff have good access to ongoing training in this respect. Laundry doors are marked to be kept closed where they lead off from food preparation areas and there are suitable laundry facilities to manage heavily soiled laundry and to prevent infection spreading through the home. St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35, 36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Sufficient staff are on duty during waking hours. Lone night working must be reviewed to ensure that Service users and staff are not placed in any risk. A greater proportion of the staff team should achieve formal qualifications so that service users can have confidence in their competence. Staff are recruited fairly, safely and effectively on the basis that they are suitable to work with vulnerable adults in a care setting. They have good access to ongoing training, so that service users can be confident that they have the training they need to be able to work safely in the home. Formal supervision of staff needs to be improved. EVIDENCE: St Erme House: rotas showed that there is four staff members on shift during the day/ evening, the manager stated that minimum staffing ratios are 3 members of staff. One staff member sleeps in. This has not been risk assessed and must be done to ensure that Service users and staff are not placed at any unnecessary risks. The manager stated that the use of bank staff is minimal. The manager stated this is a new staff team and staff team commented that they liked working at the unit .
St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 24 The Lodge: rotas showed that there is four staff members on shift during the day/ evening, the deputy manager stated that minimum staffing ratios are 4 members of staff. At the time of inspection there was four staff on duty plus two new staff members shadowing the work. There are two waking night staff members on duty. There are staffing vacancies in this unit. There has been the need to employ staff from bank due to staff sickness and vacancies; this has led to some inconsistencies in the care of Service users in this unit. St Michaels: rotas showed that there is two staff members on shift during the day/ evening, the manager stated that minimum staffing ratios are two members of staff. Currently there is one waking night post but this is being reviewed with the prospect of it changing to a sleeping in role. If this occurs this needs to be risk assessed. The manager stated that the use of bank staff is minimal and if it is needed they use workers that are known to the Service users to promote consistency. The manager stated this is a stable staff team. The staff team commented that they liked working at the unit . All managers of the units stated that fewer than half of the care staff has formal qualifications at the minimum recommended level although most are working towards achieving them. Records of staff training confirmed this. Staff also commented that access to courses in the main is positive, however the Makaton course had been stopped and they wanted this to be resumed. It is recommended that all three units have a staff training overview as managers were struggling to gain the information as to how many staff have either completed or are booked to attend mandatory courses. Staff members said that they were treated fairly when they were recruited as care workers and have received a positive induction. Staff recruitment records show that recruitment is fair and effective in that job applicants are tested against pre-set criteria, having submitted an application form and safe in that checks are made that they are suitable to work with vulnerable adults in a care setting. Staff members commented they received formal induction training on taking up their post. The Commission observed a competent, motivated and skilled staff group who managed situations as a team and supported each other well. Some staff felt that they needed more support from the management team following incidents both at local and headquarter level. Each unit hold staff team meetings and minutes of the most recent meetings were seen. The frequency of staff supervision needs to improve in all three units. St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. St Erme has no registered manager with the Commission for some time. St Erme is operating illegally as a care home. Applications are said to be in process. There are satisfactory systems in place to monitor the quality of the services provided so that it can be improved for the benefit of the service users. The health and safety procedures in the home are satisfactory. EVIDENCE: St Erme has no registered manager. St Erme has had a number of manager changes since 2003. The Commission will meet with Spectrums director to discuss what action they will be taking to address this as no applications for this post have been received. St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 26 In the interim Spectrum have appointed managers in each unit two of whom are attending the Registered Managers Award, NVQ 4 courses, and one manager is completing his NVQ 2 and 3. The managers overseeing St Erme House and St Michaels have been registered managers in other units and knowledgeable in Spectrums policies, procedures and philosophy. The manager of the Lodge is recently recruited to the company although he did work for Spectrum some years previously but in a different role. Staff spoke positively regarding the management of St Erme House and St Michaels and felt that they were able to approach them if they had any concerns or worries. It is acknowledged that there has been a lot of changes in the Lodge, change of staff role and expectations plus with the recent recruitment of the current prospective manager, the staff team are unsettled. This could account for the high levels of sickness in the home and emphasises the need for a strong leader to be appointed at the Lodge to direct, inform, guide and support staff in their work. At St Michaels service users and their relatives are consulted formally about the quality of the services provided by the home on a regular basis and records in the home were available as evidence of this. As St Erme House has just opened views have been sought but their findings not placed together yet. In respect of the Lodge no formal quality assurance system has been undertaken. It is required that this is more formalised. The units have a monthly monitoring process, known as regulation 26 and the Commission requests that these reports continue to be sent to the Commission. All three units have a variety of risk assessments in respect of working practices that are in the process of being reviewed. Managers could not recall when the Environmental health Agency inspected and therefore it is recommended that this be arranged. Fire risk assessments are completed and staff training in this area is undertaken on a regular bases. It was observed that doors were wedged open in St Michaels, this should not occur due to potential fire risks. It is also recommended that managers audit the homes communication book to ensure that it adheres to the data protection Act and does not hold personal information on Service users in the one place. St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 27 St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 28 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 2 2 3 3 X 4 4 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 2 X 2 x LIFESTYLES Standard No Score 11 x 12 2 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 x 1 X 3 X X 2 x St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 29 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 YA1 Regulation 4,5 Requirement A up to date Statement of purpose and Service users guide must be produced which accurately reflects the services that St Erme House, the Lodge and St Michaels provide. All service users must be provided with access to activities in the home in accordance with their needs and as set out in their individual care plans. (This requirement has been re notified. Previous compliance set for 01/06/07) (the Lodge) Risk assessments must be undertaken whilst building works are in progress to ensure that those living, working or visiting the home are not placed in un necessary risk. (The lodge) The registered provider must make arrangements for the safe management of service users’ medicines, including the maintenance of up-to-date and
DS0000009149.V340456.R01.S.doc Timescale for action 01/11/07 2 YA12 12(1) 01/11/07 3 YA9 YA24 23`(2)(a) (b) (c) 01/09/07 4 YA20 13(2) 01/11/07 St Erme Version 5.2 Page 30 accurate records. This requirement has been renotified. The previous date set for compliance was 01/04/06/ 01/06/07. It is of concern to the Commission that compliance has not been achieved. (ST Erme House, lodge and St Michaels) 5 YA7 12(2) 23 Service users must not be subjected to undue restrictions on their movement and freedom, with particular reference to the home’s environment and access to their bedrooms. This has been re notified The whistle blowing policy and procedure must be promoted so that staff feel able to express concerns and feel confident that the policy and procedure would be followed. (lodge) Service users must be provided with a comfortable and homely environment, which meets their needs and encourages privacy, dignity, choice and freedom of movement. This has been re notified ( lodge and St Michaels) The remaining RSA areas must be reviewed urgently and risk assessed to ensure that they do not pose a health and safety risk to Service users and staff. The lodge, St Michaels. Lone working must be risk assessed to ensure that Service users and staff welfare is paramount. 01/11/07 6 YA23 21,13 (6) 01/09/07 7 YA24 12(1) 12(2) 12 (4) 16(2) 23 01/01/08 8 YA7 13(4)(7) 01/10/07 9 YA33 18(1) 01/09/07 St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 31 10. YA37 8,9 The registered manager 15/09/07 application must be submitted. It is of concern that this requirement has been re notified, last time scale set for 01/05/07 (ST Erme campus) The summary of the quality assurance findings, when completed must be forwarded to the commission with a action plan. (ST Erme House, lodge and St Michaels) Doors must not be wedged open to minimise the risk of fire. 01/01/08 11 YA39 24 12 YA42 23 (4)(a) 01/09/07 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 3 4 5 6 Refer to Standard YA20 YA20 YA20 YA20 YA20 YA20 Good Practice Recommendations Medication should be signed for once it has been administered. (the Lodge) A record of medication disposed of should be maintained. (the House) Transcribing of medication should be witnessed by two members of staff ((ST Erme House, lodge and St Michaels) A copy of the Royal pharmaceutical guidelines should be obtained (ST Erme House, lodge and St Michaels) There should be enough medication pots available for the dispensing of medication (lodge) All staff handling service users’ medicines should undergo training in the safe handling of medicines in addition to the in-house training currently provided. (ST Erme House, lodge and St Michaels) The registered manager should attend multi-agency training on the protection of vulnerable adults. (ST Erme House, lodge and St Michaels) At least 50 of the staff team should be qualified to NVQ level 2 or above.
DS0000009149.V340456.R01.S.doc Version 5.2 Page 32 7 8
St Erme YA23 YA32 (ST Erme House, lodge and St Michaels) 9 10 11 12 YA35 YA35 YA36 YA6 Makaton/ communication courses should be reinstated to assist staff when communicating with Service users A overview of staff training in each unit should be produced so that managers are awre of what courses staff have completed or need to complete Staff should be provided with a minimum of six formal supervision sessions a year. (ST Erme House, lodge and St Michaels) Service users’ care plans should be provided to them in meaningful formats, which are directly accessible to them, with clear and specific goals. (ST Erme House, lodge and St Michaels) Service users’ risk assessments should be provided to them in meaningful formats, which are directly accessible to them, as far as is practicable. (ST Erme House, lodge and St Michaels) A environmental health inspection should be arranged in all 3 units. The Commission requests that regulation 26 reports in respect of this service are sent to the Commission. 13 YA7 14 15 YA42 YA37 St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Erme DS0000009149.V340456.R01.S.doc Version 5.2 Page 34 - 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!
