Inspection on 03/07/07 for St John of God Respite Service

This inspection was carried out on 3rd July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

St John of God Respite Service 11/08/09

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Snydale Care Home

Whitwood House

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

CARE HOME ADULTS 18-65 St John of God Respite Service Burnley Road Luddendenfoot Halifax West Yorkshire HX2 6AU Lead Inspector Liz Cuddington Key Unannounced Inspection 3 July 2007 12:30 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 John of God Respite Service DS0000068470.V331495.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 John of God Respite Service DS0000068470.V331495.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St John of God Respite Service Address Burnley Road Luddendenfoot Halifax West Yorkshire HX2 6AU 01325 373700 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) www.sjog.co.uk Saint John of God Care Services Mrs Barbara Ann Hudson Care Home 6 Category(ies) of Physical disability (6) registration, with number of places St John of God Respite Service DS0000068470.V331495.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Newly registered service Brief Description of the Service: This is a respite care centre for people who have a physical disability and some people who may have learning difficulties as well. The centre provides personal and nursing care for up to six people at a time. People are referred to the service through Calderdale Social Services. The house was purpose built and is equipped with the adaptations people need to make their stay as comfortable as possible. The house is situated in Luddendenfoot, on the main Burnley Road between Halifax and Todmorden. There is a car park and a good bus service. The fees are paid by Social Services. St John of God Respite Service DS0000068470.V331495.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Due to a technical change in company arrangements, the service is classed as a ‘new registration’, following a completed application made to the Commission for Social Care Inspection. However, it is an existing service, and this arrangement has made no detrimental changes to the way that the home is run. The purpose of the inspection was to assess the quality of the care and support received by the people who stay at Saint John of God respite centre. The methods I used to gather information included conversations with guests and staff, looking at care plans, examining records and a walk round the house. I spoke to four people who use the service and relatives, to gain their views on the quality of care and support provided. I also received the home’s pre-inspection questionnaire. The questionnaire and the conversations provide a lot of valuable information to help me form a judgement about the quality of service offered, and this is reflected in this report. In the report I have referred to the people who go to stay at the respite centre as ‘guests’, since that is the terminology the service uses. I would like to thank the people who were staying at Saint John of God respite centre when I visited, and the staff, for their welcome and hospitality and everyone who made the time to talk to me. What the service does well: During my visit I observed that everyone receives the level of support and care they need, in accordance with their wishes. Changing needs are acted upon and professional advice is sought, where necessary. Staff receive training to help them meet people’s needs and provide good quality care and support. One person’s relative described the care and support as ‘second to none’. One guest said ‘I look forward to going’ and commented that they wouldn’t want to go anywhere else and would recommend the respite centre to anyone. The interaction between staff and the guests is relaxed, friendly. Staff maintain people’s dignity and privacy. They spend time with people, but respect their right to be left alone if they wish. The relative of one guest told me that the ‘staff are friendly and helpful’. The meals are individually planned to cater for each person’s preferences. Everyone is part of the social aspect of mealtimes, including those whose nutritional needs are more specialised. St John of God Respite Service DS0000068470.V331495.R01.S.doc Version 5.2 Page 6 Care and support is offered in the way each person prefers. The routines are those of each individual, not of the home. Staff understand each person’s needs and give assistance with skill and discretion, maintaining people’s privacy and dignity. Guests’ health is observed and any concerns are followed up with their family and healthcare professionals, if needed. One person’s relative confirmed that ‘if ever there is a problem the communication is good’. People are protected by the organisation’s recruitment procedures, which are safe and thorough. There is suitable training for staff, to give them the skills and knowledge to provide good quality care and support for the guests. Ten of the eleven support staff have a recognised qualification. The guests and staff are involved in making decisions about how the respite centre is run. The complaints and adult protection procedures are effective and understood by guests, their relatives and staff. The house and grounds are well maintained. The house is clean and fresh and good hygiene and infection control measures are in place. The house is suitable to meet the support needs of the guests, and has the adaptations and equipment they need. 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 John of God Respite Service DS0000068470.V331495.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 John of God Respite Service DS0000068470.V331495.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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home carries out a thorough assessment process for prospective guests before their first stay, to make sure the home can meet their needs. EVIDENCE: There is a very comprehensive pre-admission procedure, to make sure the respite centre can meet the person’s needs. An assessment of the person’s care and support needs is carried out by senior members of staff and used as the basis for their care plan. An individual skills assessment is completed before the person’s first visit. Social Services assessments are also used to determine the care needs of the individual. People are welcome to visit the home before reaching a decision. St John of God Respite Service DS0000068470.V331495.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 & 9 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. To maintain their autonomy and independence, staff support people to make choices and decisions about all aspects of their daily lives. People are involved in planning their care and are supported to take risks. EVIDENCE: I looked at four people’s care plans. They are very informative but could be better organised, to make them easier to follow. Each plan shows what the person needs in all aspects of their life, and how staff are to support them during their stay. The home’s senior staff review the plans, to make sure they are up to date and reflect the individual’s current needs and wishes. Some reviews need to be done more regularly, although this can be difficult to fit in and depends upon the length of the person’s stay. Perhaps a system of always evaluating the relevance of the plan during someone’s stay, and updating it where necessary, could be put in place. The individual and/or their family are involved in developing and reviewing the plans, wherever possible. St John of God Respite Service DS0000068470.V331495.R01.S.doc Version 5.2 Page 10 From talking to the guests and the staff, as well as my observations during the visit, it is clear that people are expected to make their own decisions about all aspects of their daily life. If needed, they are supported to make these decisions. The staff respect people’s choices and act upon them. There are detailed risk assessments, skin integrity assessments and moving and handling plans for each person. The daily records reflect any significant events in the person’s day. Everyone has a discharge letter when they go home, which highlights anything they or their family need to be aware of. St John of God Respite Service DS0000068470.V331495.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, 14, 15, 16 & 17 Standard 13 is not applicable People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Guests are supported to keep in contact with family and friends during their visit. A range of leisure activities is provided, to try and make sure each person’s recreational needs and expectations are being met. Guests are given their choice of meals, and other foods, to make sure their dietary needs and preferences are met. EVIDENCE: When people go to the respite centre they choose how they want to spend their time. Some people prefer to continue with their usual daily routine, while others look on the time as a holiday and choose to have a break from their normal activities. The care plans show what each person’s preferences are and St John of God Respite Service DS0000068470.V331495.R01.S.doc Version 5.2 Page 12 how much time they like to spend alone, and how much in company with other guests. The plans show details of people’s choice of leisure activities. Guests are supported to pursue these, either within the centre or through the outreach services. One relative felt that more activities could be provided for guests during their stay, particularly when visiting for more than a couple of days. One guest told me that there is plenty of opportunity to play card games or scrabble, or just sit and read. I saw evidence that people are free to choose who they see during their stay. Some people like to time their stay to coincide with their friends. The staff will accommodate this wherever possible. There are no set routines and each person’s care, support and leisure activities are planned to meet their individual needs and preferences. The meals are shopped for and cooked to suit each individual’s taste. The guests decide what they want to eat and the staff prepare the meals. Mealtimes are sociable occasions and the quality of the food is excellent. Some guests have to take a special diet. My observations confirmed that the staff know exactly what each person’s needs are and are sufficiently skilled and competent to assist people with care and discretion. All the guests are included in the social aspect of mealtimes. St John of God Respite Service DS0000068470.V331495.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. To maintain their health and well-being, people’s personal and healthcare needs are met. People are fully protected by the home’s medication systems. Medications are stored safely and administered accurately. To maintain their dignity, the staff treat people with respect, care and consideration at all times. EVIDENCE: People’s health and well-being is observed and monitored during their stay, and any concerns are followed up with relevant health or social care staff, or the family, and their advice is followed. The plans contain a lot of detail about the guest’s physical and emotional health. The plans that I looked at, and conversations with staff, confirmed that people’s cultural and individual preferences are understood by everyone and form an integral part of the care and support they are offered. St John of God Respite Service DS0000068470.V331495.R01.S.doc Version 5.2 Page 14 The medication is stored securely and safely. The Medicines Administration Record (MAR) charts are accurately completed and quantities of medicines received, in stock and returned to the pharmacy are recorded correctly. The staff that administer medication have all received suitable training. The centre keeps a checklist of the medicines each person brings into the home, and the quantity they take home at the end of their visit. Some of the comments I received from guests and relatives confirmed my own observations that all the staff are respectful and considerate to the people who stay at the Luddendenfoot centre, and make sure people’s dignity is maintained. Staff have a quiet and friendly manner and talking to them confirmed that they are very aware of how each person prefers their support and care to be provided. One relative said that they ‘can’t fault the care and the facilities’ and one guest told me that the staff ‘really are caring’ and that they ‘go beyond what they need to’. St John of God Respite Service DS0000068470.V331495.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The guests and their relatives are aware of how to raise a concern or make a complaint if they are dissatisfied with the service. Staff have received suitable training and understand the adult protection policies and procedures, which makes sure that people staying at the centre are safe. EVIDENCE: The surveys and the people who stay at the respite centre confirmed that people are aware of how to raise a concern or make a complaint, should they need to do so. The complaints procedure is clear and easily available. There is a complaints log to record any complaints or concerns, which are raised. The home deals with any concerns effectively and without delay. One guest told me they have ‘no complaints’ about the service. The staff are aware of the need to report any concerns they have about care practice and there are clear guidelines for reporting such incidents. All of the staff have had Adult Protection training. St John of God Respite Service DS0000068470.V331495.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28, 29 & 30 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The centre offers a safe, comfortable, well-maintained and homely environment planned to suit their needs. EVIDENCE: There is a programme of re-decoration for the bedrooms, as well as for the rest of the house. Several areas, including the kitchen, have recently been redecorated and look fresh and attractive. The bedroom doors all have locks, and there is a lockable storage space in the rooms, which means that people can keep their belongings private and secure. The home is fresh, clean, comfortable and well looked after. Everyone who commented agreed that the house is well kept. The garden is tidy and attractive, providing a safe and sheltered place for people to sit and enjoy the fresh air. One of the guests commented on how nice it is to sit out in the courtyard. St John of God Respite Service DS0000068470.V331495.R01.S.doc Version 5.2 Page 17 The bathrooms and toilets are designed to meet the needs of people who require a lot of assistance. The doorways are wide and have a touch pad opening system. There are adaptations such as track hoists in bedrooms, grab rails and other aids to make moving around the house and using the facilities as easy as possible. There are good infection control systems in place and staff use protective gloves and other measures, where needed. The laundry system is well organised and a relative confirmed that clothes are ‘beautifully laundered’. St John of God Respite Service DS0000068470.V331495.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient staff are employed to meet people’s needs. People are protected by thorough recruitment procedures, which ensure that staff are suitable to work with the guests who stay at the centre. Suitable training is provided, to make sure staff have the skills and knowledge they require to meet people’s needs. EVIDENCE: The staff rotas confirmed my observations that there are plenty of staff on duty to meet the care, social and leisure needs of the people who stay at the centre. The number of staff on duty is adjusted to reflect the needs of the guests. The respite centre is fully staffed and only occasionally needs to employ agency staff. All staff complete an application form and provide two written references. Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) register checks are obtained and no new staff begin work until these checks have been completed satisfactorily. St John of God Respite Service DS0000068470.V331495.R01.S.doc Version 5.2 Page 19 The manager makes sure that staff have the necessary training to help them do their work as well as possible. There is a wide range of courses available and the records confirmed that the staff are allowed the time to attend. The manager has recently attended training in the implications of the Mental Capacity Act and will be passing this training on to the staff team. Ten of the eleven support staff have a relevant National Vocational Qualification (NVQ) at level 2 or above. New support staff all take the Learning Disabilities Award Framework training as part of their induction and foundation training. This makes sure they have a good understanding of their role and responsibilities, and provides a sound basis for NVQ study. One of the guests said that the ‘staff are excellent’. All staff are having one to one supervision sessions with their line manager, as well as their annual appraisals. St John of God Respite Service DS0000068470.V331495.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is safe and well managed and everyone who visits and works at the home can contribute to the decision-making processes. EVIDENCE: The manager has the qualifications and the skills to manage the centre effectively. The manager promotes an open and inclusive management style and everyone is involved in the decision-making processes. My own observation and comments from other people confirm that everyone’s views are valued and taken into account. The policies and procedures are kept up to date; to make sure they provide relevant information to guide staff on how to act in every situation. All the regular health and safety checks for the home are carried out in a timely St John of God Respite Service DS0000068470.V331495.R01.S.doc Version 5.2 Page 21 manner. Staff have basic health and safety training. All these measures make sure that the health, safety and welfare of the people at the centre is promoted and safeguarded. The centre looks after small amounts of people’s money, to pay for their day to day expenses during their visit. The remainder of their money is dealt with by their families, or by other appointees. Confidential information is stored securely. St John of God Respite Service DS0000068470.V331495.R01.S.doc Version 5.2 Page 22 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 4 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 3 28 4 29 4 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 N/A 13 N/A 14 3 15 3 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 N/A 4 X 3 X X 3 X St John of God Respite Service DS0000068470.V331495.R01.S.doc Version 5.2 Page 23 N/A 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St John of God Respite Service DS0000068470.V331495.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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 - 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. 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