Inspection on 17/04/07 for St Germans House

This inspection was carried out on 17th April 2007.

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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Germans House 10/01/06

St Germans House 25/08/05

St Germans House 14/03/05

St Germans House 19/08/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 St Germans House 14 Lynn Road St Germans Kings Lynn Norfolk PE34 3EU Lead Inspector Mrs Lella Andrews Key Unannounced 17th April 2007 09:50 St Germans House DS0000027381.V336491.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 Germans House DS0000027381.V336491.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 Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Germans House Address 14 Lynn Road St Germans Kings Lynn Norfolk PE34 3EU 01553 617491 01553 617194 stgermans@schealthcare.co.uk the.willows@ashbourne.co.uk Exceler Healthcare Services Limited 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) Mrs Penny Clare Care Home 9 Category(ies) of Learning disability (9) registration, with number of places St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to nine (9) Service Users who have a learning disability may be accommodated. 10th January 2006 Date of last inspection Brief Description of the Service: St. Germans is a care home providing residential care for nine people who have a learning disability. It is owned by Exceler Healthcare Services Limited. The home is located in the village of St. Germans approximately five miles from Kings Lynn. The home is close to the village shop, post office , church and village pub. The home, previously a pub, was converted into a residential home and opened in 1984.The home comprises of the ground floor accommodation of two reception rooms, dining room, kitchen and office. There is one single bedroom on the ground floor. The first floor has three shared rooms and two further single rooms. St. Germans shares its garden area with Abbotsford another small home for people with learning difficulties, owned by the same Proprietors. Staff and service users from both homes mix freely. St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report brings together information gathered since the last key inspection of the service. It includes information from an unannounced visit to the service which was carried out between 9.50am and 4.15pm on Tuesday 17th April 2007. The Manager was not present during this visit. A second visit was then arranged for the 18th April to provide feedback to the manager and senior care worker. Comment cards were received from seven of the clients, who had been assisted to complete them. These contained positive responses with additional comments such as: “I love it here” “Its cosy” Comment cards were received from three relatives which all contained positive responses as well. Additional comments were made, such as: “The staff always make me very welcome” “provide…with a real home” “ full of admiration and gratitude for the care that…has always received from the staff there” During the visit the Inspector spoke to two of the clients, was shown around the communal areas of the Home, spoke to three members of staff on an individual basis and was shown around the communal areas of the Home. The fees for the Home are negotiated on an individual basis depending on the needs of the clients. Currently the fees range from £341.00 to £598.00 per week. There are currently eight clients living at the Home, two of whom are now over the age of 65 years. What the service does well: The staff know the clients well and are enthusiastic about supporting the clients. The staff work hard to meet the needs of the clients. Relatives feel that the Home meets the needs of the clients and provides a good standard of care. Staff receive good induction and ongoing training to enable them to carry out their roles effectively. St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 6 The Home is well managed. 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. The summary of this inspection report can be made available in other formats on request. St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are appropriate procedures in place for the assessment of prospective clients. EVIDENCE: No-one has moved to the service for the last few years but the service has appropriate procedures in place for assessments to be carried out. St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The individual needs of the clients are assessed and form the basis for the written care plan which provides staff with information about how to meet these needs. Risks are assessed with written guidance for staff about how to manage risks EVIDENCE: Two of the care plans were seen and these contain a lot of information about the needs of the clients. Assessments are undertaken with care plans and risk assessments based on these. There is evidence of regular reviews being carried out. St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 10 Some of the clients have become more frail in the last year and therefore their needs have changed. The staff who spoke to the Inspector were consistent in their approach to these changing needs. However, it is recommended that the care plans are more detailed to ensure that the clients needs and choices are met now that they are not so able to communicate these themselves. The current format of the care plans is quite repetitive in some instances and the Inspector was shown the new format which has started to be implemented. This contains detailed information in a format which should be easier for staff to refer to and find relevant information. The staff were seen to offer choices to clients in a range of day to day situations. Some of the clients do not use speech and the staff receive training to enable them to understand the importance of other forms of communication. Regular clients meetings are held and one of the clients explained that these are for discussion about meals, holidays, activities and anything else that a client may wish to discuss. St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The staffing levels at the Home make it difficult for clients to receive support to go out unless activities are planned in advance. Clients and relatives feel that they receive good support to maintain their relationships. Clients are offered a choice of meals and receive additional support at mealtimes if they need it. St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 12 EVIDENCE: Some of the clients attend formal day services during the week and external transport is provided for them to attend these. The other clients do not attend formal day services either due to increasing age and frailty or through personal choice. Some evening activities, such as Gateway Club, are planned with staffing and transport arranged to ensure that the clients are able to attend if they wish to do so. Only one of the clients is able to go out alone, and this is only to the local shop. The usual staffing levels are for there to be two staff on duty from early morning until the evening. Staff are responsible for all aspects of care for the clients as well as for the domestic and catering chores. This does not allow much time for staff to spend individual time with the clients. The staffing situation is made more difficult on the days that the Manager is on duty as part of the care team as it can be difficult to separate management duties from care tasks and if she is needed to address management issues then this takes her away from the direct support to the clients. One of the clients needs two staff to support them on a regular basis and at least one other client needs two staff for some of their support. This also makes it difficult for a member of staff to leave the Home. One of the clients said that they are not always able to go out shopping when they would like as there is not enough staff and that sometimes the staff do her shopping for her in their own time. Although the staff are enthusiastic about supporting the clients away from the Home and do try to ensure that this happens as much as is possible the staffing levels restrict this. It is required that this situation is addressed. The comment cards from the clients all state that they have lots to do. Two of the relatives comment cards state that the clients “always” receive the support that they would expect them to and that they are supported to live the life of their choosing. One of the relatives responded “usually” to these questions on the comment card. One of the clients told the Inspector about the arrangements in place to enable her to maintain contact with her family. The comment cards from relatives all state that the staff keep in touch with them and that they are kept up to date with information about their relative. Additional comments were made such as: “staff are always welcoming and kind” St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 13 One of the clients told the Inspector that menus are discussed at regular client meetings and that the staff know what individual preferences are. Menus are on display in the dining room. Clients are involved in shopping and one of the clients said that they sometimes help with baking and preparing meals. One of the clients is able to go into the kitchen to make themselves a cup of tea. Although staff do offer clients drinks on a regular basis they do not have easy access to snacks and drinks as they have to ask staff for additional ones and some clients would not be able to do this. The Manager said that this is due to the needs of one of the clients. Two of the clients need support at mealtimes, one of whom requires intensive support at this time. The staff are aware of the clients needs in this area and the care plans include guidance. St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The personal and healthcare needs of the clients are met. Medication is managed effectively, providing protection for the clients. EVIDENCE: One of the relatives comment cards particularly commented on the fact that the staff provide good support to the clients, even when they are in hospital. Comment cards include the following comments: “care excellently for physical needs” “full of admiration and gratitude for the care that…has always received from the staff there” The care plans include information about the personal and healthcare needs of the clients, including information about their medication. The records show that the clients have regular dentist, optician and chiropody appointments. St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 15 There is also evidence of the involvement of health care professionals, such as the Speech and Language Therapist being involved in the clients lives and care planning process. The Manager and staff are working hard to continue to support the clients who are becoming more frail as they recognise that the clients have lived at the Home for many years, feel comfortable there and know the staff team. However, the design of the building is causing some difficulties for those clients whose mobility is becoming more reduced. The Manager is aware of the need to continually monitor whether the Home can continue to meet the needs of individual clients. Staff receive training with regard to the safe administration of medication. There are usually two staff involved in the administration of medication. None of the clients are currently responsible for their own medication. It was seen that a dispensing label on one of the medications was not as clear as it could be but it is understood that the staff have raised this with the dispensing pharmacy and are waiting for them to resolve the situation. St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The clients and relatives feel that their views are listened to and acted on Staff receive training with regard to the protection of the clients from abuse EVIDENCE: The clients comment cards all state that they feel safe at the Home and that they know who to make complaints to. It would be difficult for the majority of the clients to make a complaint on their own behalf. The Manager and staff are aware of this and there are other systems in place to try and obtain the views of the clients, such as clients meetings and regular care plan reviews. Two of the relatives comment cards state that they are aware of the complaints procedure and one states that they are not aware of this despite the Manager saying that she has sent all relatives a copy of the complaints procedure. Staff receive training within their induction about Safeguarding Adults and those that spoke to the Inspector have a good understanding of what constitutes abuse and how they would deal with any concerns that they have. St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 17 A sample of the records relating to the clients financial affairs were seen and these corresponded to the cash held for that individual. Traditionally the clients have been responsible for small amounts of their own money and receipts are not obtained for this. However, some of the clients are no longer able to manage this themselves and so it is required that receipts are kept for this expenditure. St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 18 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 and 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. As the needs of the clients are increasing the environment is no longer meeting the needs of some of the clients so well. EVIDENCE: The Home has an ongoing programme of redecoration and refurbishment with the majority of the Home about to be redecorated. The Home employs a maintenance member of staff on a part time basis. The Regulation 26 monthly reports highlight maintenance issues and it was seen that the majority of these have been addressed. The clients have been encouraged to personalise their rooms and to make their own choices about the colour schemes. Screens are available in shared rooms. St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 19 The Home has a narrow staircase which is very difficult for some of the clients to manage. There is only one bedroom on the ground floor. One of the clients spends a lot of time in their bedroom if their mobility is particularly poor and they cannot manage the stairs safely. As previously mentioned in this report it is recommended that the risk assessment provides clearer guidance to staff about how to manage the risks of using the stairs. Currently every door in the Home is a heavy fire door with a closure attached which makes them particularly hard to open and causes them to bang loudly when closing. Observations show that some of the clients struggle to open the doors as do staff when they are assisting a client with mobility. The noise level is very high from the banging doors. One of the clients told the Inspector that she does not like the noise of the doors. Also, the doors are not able to be part way open and so clients either have to have the doors open or completely closed. It is required that this situation is addressed. St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 20 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 and 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff receive appropriate training and support to enable them to carry out their roles effectively. The staffing levels are not sufficient to enable the clients to go out on a regular basis EVIDENCE: A selection of staff files were seen and these show that effective recruitment procedures are followed, including obtaining the checks which provide protection to the clients. Staff said that they received good induction which enabled them to understand their roles and that of others within the team as well as getting to know the clients. The Manager said that the induction has recently been changed to comply with the Skills for Care common induction standards. St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 21 Staff said that they receive good ongoing training which is interesting and relevant. Training records show that staff are up to date with mandatory training and that future training is booked for the forthcoming months in a range of subjects. This includes the Manager and other senior staff undertaking Training the Trainer courses for some subjects such as Moving and Handling. This will enable them to provide the training more quickly and in a more realistic setting. As previously mentioned in this report, the staffing levels are not high enough to enable the clients to go out on a flexible basis although they do go out for planned activities. St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 22 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 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The Home is well managed with the needs and wishes of the clients taken into account. The health and safety needs of the clients and staff are met. EVIDENCE: The Manager has completed the Registered Managers Award and is currently working towards NVQ Level 4. She has managed the Home for several years and know the clients very well. Staff and clients spoke highly of the manager and her management style, saying that she knows the clients and staff well. St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 23 The Home seeks the views of the clients in a variety of ways, for example, regular clients meetings, care plan reviews and in a more informal way through time spent with clients on a daily basis. Monthly visits as per Regulation 26 are carried out by the organisation with reports of these provided to the Commission. The Manager said that the organisation sends questionnaires to the clients, relatives and other stakeholders but that these are not seen at the Home. The Home now need to bring together all of the strands of quality assurance into an annual report. A requirement is made about this. A selection of health and safety records were seen. These show that regular maintenance and servicing of equipment is carried out. Staff receive health and safety training, including fire safety, manual handling and first aid. St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 24 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 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 2 X X 3 X St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 25 no 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 2 3 Standard YA12 YA23 YA24 Regulation 18 (1) 17 (4) 23 (2) Requirement There must be enough staff to enable the clients to access appropriate activities Receipts must be kept for all expenditure made on behalf of the clients The situation regarding the fire doors must be addressed so that they are easier to open and so that they do not bang shut so noisily A regular quality assurance report must be produced Timescale for action 31/07/07 30/04/07 31/05/07 4 YA39 24 31/10/07 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 Refer to Standard YA6 Good Practice Recommendations It is recommended that the care plans and risk assessments contain more detail St Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Germans House DS0000027381.V336491.R01.S.doc Version 5.2 Page 27 - 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. 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